RSI is typically defined as an overuse disorder- a gradual build-up of overload to nerves, tendons, and muscles arising from repetitive movements or activities. Repetitive use of the same motions leads to inflammation and damage to these soft tissues. This disorder mostly affects the upper limb- particularly the elbows, hands and wrists.
Causes
Possible causes of RSI include but are not limited to:
Undertaking the same and repetitive movements and stressing the same muscle groups
Working in cold environments
Assuming a sustained and/or awkward posture for prolonged periods of time
Undertaking a particular activity for prolonged periods of time with no rest-breaks
Frequent and prolonged use of vibrating equipment
Adopting poor postures from working at inappropriately designed workstations
Undertaking a motion which involves carrying and/or lifting heavy items
Symptoms
RSI leads to a gradual development of a broad variety of symptoms, which range from mild to severe in severity. RSI particularly affects the muscles and joints of your wrists, hands, elbows, forearms, shoulders, neck. Having said this, RSI can affect other areas of the body as well.
Common symptoms may include:
Pain
Tingling
Cramping
Increased sensitivity to heat and cold
Tenderness
Fatigue
Loss of strength
Throbbing
Soreness
Achiness
Stiffness
Struggling with typical activities of daily living, such as gripping and twisting motions, carrying light weights, writing, kitchen prepping, dressing, personal cares etc
You may develop these symptoms when you undertake a task repetitively for a period of time, and can settle when you stop. Symptoms may settle over a few hours or over the course of a few days. However, if left untreated or is poorly managed, a minor RSI may gradually progress to a nasty chronic injury.
Diagnosis
If you experience mild discomfort whilst completing particular activities at home or at your job, it is a good idea to see your GP or physiotherapist to talk about RSI. But an RSI is not always simple to diagnose as there is no particular clinical test for it. Your GP will enquire about your medical history, occupation and work environment, and other activities to attempt to identify any repetitive motions you undertake that may be the cause of your symptoms. A physical examination will be undertaken, where they will assess your movement, check for pain, inflammation, sensation, tenderness, strength and reflexes in the impacted body part. RSI may be triggered by specific health disorders like bursitis, carpal tunnel, tigger finger, ganglion cyst, or tendonitis (inflammation in your tendons). Your GP can refer you on further diagnostic tests such as X-rays, Ultrasounds, blood tests, MRIs, nerve conduction tests etc, to determine if these underlying disorders may be the cause of your symptoms. You may be also be referred onto a physiotherapist and acupuncturist for conservative treatment and management for mild-moderate issues. If symptoms persist, you will then be referred onto a specialist.
Management
Initial treatment options for the management of RSI symptoms is conservative. This includes:
Rest, Ice, Compression, and Elevation (RICE principles)
Taking regular breaks between tasks and looking after your posture
Undertaking your activities and movements with appropriate form and posture
Intake of Nonsteroidal anti-inflammatory drugs (NSAIDs), both oral and topical as prescribed by the GP
Use of cold and heat to the impacted area
Administration of steroid injections into inflamed joints and tendons
Tailored exercise prescription from physiotherapists to correct posture and strengthen and stretch affected muscles
Acupuncture
Stress reduction and relaxation training
Use of splints and braces to help protect and rest the affected muscles and tendons
Ergonomically appropriate adjustments to your workstation and work environment may be recommended by your physio and GP- for example resetting your desk and chair if you’re working at computer, and alterations to your equipment and activities/motions to lessen the strain and stress on your muscles and joints. Surgery may be necessary in some cases.
Prevention
Minimizing repetitive actions particularly if they involve the use of heavy machinery or vibration. Improving your working posture and work-environment as well a taking regular breaks. Employers often undertake risk-assessments when you join a company to determine that the work area is ergonomically fit, comfortable and appropriate for you. You may be able to request for an assessment if you have not had one or are having issues with your work environment
Osteoporosis is a condition which results in weak and brittle bones- to such degree that a fall or even mild stresses like coughing or bending over may result in a fracture. Bones are living tissues which are continually being broken down and replaced. However, your bones become osteoporotic when the formation of new bone does not keep up with the loss of old bone. This condition typically develops over time without any pain or other major symptoms, and is generally not diagnosed until you have sustained a fracture. The hip, pelvis, upper arm, spine and wrists are the most common structures affected by osteoporosis- related fractures.
How do you know if you have Osteoporosis?
Because there are no obvious early warning signs and symptoms, it is difficult to pre-diagnose osteoporosis. You may be unaware that you have this condition perhaps till you have one of the following:
Sustained a fracture from an incident more easily than you should have- like a simple fall or a bump
A decrease in the height of your spinal vertebrae over time
Change in posture – stooping or bending forwards
Back pain, due to a fractured or collapsed vertebra
Please see your doctor if you experience the following:
If you are over the age of 50 and have sustained a fracture
Sustained a spine, wrist, or hip for the first time
Sustained a fracture more easily than you should have (a simple fall or after a slight bump)
Risk factors
Key factors which may increase your risk of developing osteoporosis include:
Females- particularly post-menopausal Caucasian and Asian women
Over the age of 50
Excessive consumption of caffeine or alcohol
Smoking
Having a smaller or petite body frame
Poor physical activity levels and leading a very sedentary lifestyle
Family history of osteoporosis
Having low levels of vitamin D and poor dietary calcium intake
Decreasing levels of testosterone with ageing in men
Estrogen deficiency in women (irregular periods, early (before turning 40) or post-menopausal, surgical removal of the ovaries)
Use of long-term medication such as thyroid and epilepsy medications, corticosteroids
Having medical conditions such as gastrointestinal diseases; endocrine diseases; rheumatoid arthritis; cancer; and blood disorders
How will you be diagnosed?
Your doctor will review your signs and symptoms, family and medical history. You may be referred on for a specialized X-ray or CT scan to evaluate the bone density to help diagnose osteoporosis. Your bone density will be classified by comparing it to the typical bone density for a person of equivalent gender, size, and age.
How is Osteoporosis treated?
The treatment pathway chosen for the management of this condition is dependent on results of your bone density scan, gender, age, medical history and severity of the condition. Potential treatments for osteoporosis may include exercise, making positive lifestyle changes, vitamin and mineral supplements, and medications. Please consult your doctor for appropriate advice and treatment options.
How can Physiotherapy help?
Your physiotherapist will help you strengthen your bones and your muscles through a personalized and graduated rehabilitation program. Components of this rehabilitation program may include weightbearing aerobic exercises, resistance training using free weights/resistance bands/bodyweight resistance, and exercises to enhance posture, balance and body strength. Your physiotherapist will work with you to find activities that suit your needs and as per your physical activity level.
Piriformis syndrome refers to the dysfunction of the piriformis muscle which irritates the sciatic nerve. It is characterized by deep buttock region pain that radiates down leg and foot often accompanied by pins and needles and numbness traveling along the path of the sciatic nerve.
The simplistic reason for this widely distributed pain comes down to the piriformis muscle itself – Their close proximity means that direct trauma to the buttock region or the supporting structures can result in inflammation and muscle dysfunction which can compress and irritate the sciatic resulting in referred symptoms.
Piriformis syndrome symptoms may include:
Localised deep buttock region pain
Pain with continuous sitting or standing for 15 mins or over
Pins and needles along the leg down to the outer foot
Numbness in outer leg or foot (often resolves on movements)
Deep squatting or bending
Pain on direct palpation
Anatomy
The piriformis muscle originates from the outer surface of a large fused bone of our pelvis called the sacrum. It travels adjacently and inserts into the top of the hip joint. The piriformis muscle is a very active muscle involved in stabilizing the hip and pelvis during majority of our activities (walking, running, standing, sitting or standing, turning in bed). When the piriformis muscle contracts it helps the hip rotate outwards (external rotation) and lift thigh out and up (abduct).
The sciatic nerve originates from where the very base of the spine and the sacrum join known as the lumbosacral region (lower back and saddle region). In this region five separate branches of nerves travel outside of the bony openings of the spine called the nerve roots and connect into a single large nerve – the sciatic nerve. It then travels through the pelvis deep into the buttock region close proximity the piriformis and gluteal muscles. In some individuals the piriformis muscles can travel through the piriformis muscle subjecting them to piriformis syndrome.
Diagnosis
There are no specific tests to diagnose piriformis syndrome. Diagnosis of piriformis syndrome is made by the report of symptoms and by physical exam using a variety of movements to elicit pain to the piriformis muscle. In some cases, a contracted or tender piriformis muscle can be found on physical exam.
In cases where there is underlying pathology (such as disc injury, arthritis, sacroiliac dysfunction or hip injury) resulting in true sciatica – piriformis syndrome may develop to become an additional muscular dysfunction that is required to be addressed. Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.
Consultation with a physiotherapist in this case is highly recommended as they will perform a comprehensive clinical examination to identify the root cause of your symptoms.
Exercises for piriformis syndrome
Corrective exercises with a combination of strength and flexibility regimen is an essential way to treat true piriformis syndrome (without involvement of other underlying pathologies).
The exercises outlined below follow a phase-by-phase progressive regimen to strength key muscles of the hip, buttock and legs.
As you work through these exercises expect to feel some pain during and after your exercise. Pain you may feel during the exercise is an expected sign of muscle activity. Pain you may feel after the exercises is an expected sign of muscle healing and recovery. However, if you are unable to participate in the exercises due to symptom deterioration – it is highly recommended you consult your physiotherapist to rule out other potential causes.
Otherwise, to help you gauge the correct amount of pain you should expect during exercise – use this scale. The ideal range should be 2 to 5. If your baseline pain is over 6 or 7 – it is recommended that you consult your doctor for pain relief appropriate to manage your pain, followed by a consult with a physiotherapist. Your physiotherapist will be able to modify the following exercises or prescribe alternative exercises best suited based on your current level of function and symptoms.
Symptom noting – is a great way to keep track of your progress and symptom behaviour.
Take a diary
Note down pain before you begin the exercise.
Note down the pain rating after each exercise.
Note down pain at the end of the day
Repeat the pain recording process for the next 4-5 days
Examine the trend in your symptoms.
Interference with everyday tasks – Your participation or level of exertion with everyday activities may interfere with your symptoms impacting your exercise tolerance. It is therefore important to note any of these interferences’ contributory to your pain.
Phase 1 – is a beginner stage.
This phase is intended for gently priming muscle activation. It will demand your concentration on technique and compliance to change the possible compensation your body has been used to as a result of pain. This phase can last between 1-2 weeks.
Instructions:
3 sets of 10 repetitions. Hold each repetition for 8-10 seconds. Rest 10-15 seconds between sets, 30 seconds between exercises. Do this exercise 1-2 times per day.
Bridges
Lie on your back.
Bend both knees and place your feet flat on the bed.
Lift your buttocks from the bed.
Place your buttocks back on the bed.
Repeat this exercise and remember to continue to breathe properly.
Clam shells
Lie on your side with your feet, ankles and knees together.
Bend the legs a little and tighten your core stability muscles.
Keeping the feet together, lift the top knee up.
Make sure you don’t roll your body back with the movement.
Control the movement as you bring the knee back down to the starting position.
Phase 2 – intermediate stage
The intermediate phase is similar to the beginner stage with the difference of using changing elements of progression to challenge the muscles capacity further. In this stage you may choose to progress the exercises by choosing to change ONE factor:
Increase repetitions
Increase hold time
Increase sets
Add appropriate resistance
Instructions:
3 sets of 10-15 repetitions. Hold each repetition for 10-15 seconds.
Rest 10-15 seconds between sets, 30 seconds between exercises.
Do this exercise 1-2 times per day.
Bridges with resistance
Tie a resistance band around both thighs, just above your knees.
Lie on your back with your knees bent and legs hips width apart.
There should be tension in the band.
Raise your hips up into a bridge, keeping the knees hips width apart.
Control the movement back down to the start position, maintaining constant tension on the band.
Clams with resistance
Lie on your side and place a band above your knees, approximately an inch or two above the knee joint.
Bend your legs a little, keeping the feet in line with your back.
Use your core stability muscles to keep the body stable.
Keeping your feet together, lift the top knee up against the resistance of the band.
Ensure you stay on your side and do not roll your hips and your body back with the movement.
Lower the knee back down, controlling the resistance.
Phase 3 – advance stage
Body weight squats
Start position is standing straight with the arms out in front and bent at the elbows, the fists should be clenched and the palms facing inwards.
Move downwards into a squat position so that the knees are aligned over the toes and the heels are in contact with the floor, make sure the back is straight.
Keep the head and chest upright and the gaze horizontal.
Hold for 2 seconds and return to the start position.
Lunges
Stand straight with your arms to the side or on your hips.
Take a large step forwards on your affected leg, then drop your hips directly down between both feet, bending your hips and knees to a 90 degrees.
Push back up to the starting position, and repeat.
Make sure you take a large enough step that your front knee does not travel over your foot, and ensure your knee travels directly forwards.
Keep your body up straight throughout the movement.
Crab walks
Place a band around your ankles and gather some tension.
Side-step keeping constant tension on the band.
Make sure you do not bring your feet too close together and keep your toes and knees pointing forwards.
Phase 4 – return to activities
Stretching
Do you always need to stretch the muscle? The answer is NO. While stretching is an important tool to improve muscle elasticity. You may not always need to stretch a muscle if it is NOT tight. Thus, stretching is recommended to be limited to areas you feel are TIGHT when you perform a given movement. Check the affected side and unaffected side – don’t need to stretch a muscle that doesn’t need to be stretched.
Seated piriformis stretch
Start in a seated position.
Cross the symptomatic leg your ankle is resting on, to the opposite knee.
Apply gentle pressure to the knee as you lean forward, increasing the depth of the stretch.
Hold this position, you should feel a comfortable tension with no pain.
Pigeon stretch
Start on your hands and knees.
Cross the symptomatic leg underneath you, then lower your hips down to the ground.
Rest your body forwards on your arms.
You should feel a stretch across the buttock.
Although your knee has free movement going forwards and backwards, its’ sideward movements are restricted by the robust collateral ligaments on either sides of your knee. The medial collateral ligament (MCL) is situated on the inner part of your knee, but on the outside of your joint. The MCL connects the top of your shinbone (tibia) to the bottom of your femur (thighbone). It helps hold your bones together, provides stability and prevents your knee from bending sideways away from your body.
Injuries to the MCL are from the result of a direct blow to the outer part of your knee- and is most commonly seen in contact sports such as football and soccer. These injures may either over-stretch or cause a tear in the ligament. Whilst surgery may be needed in some severe cases, it is not always the go-to form of management.
Read on to know how physiotherapy can help manage your MCL related-knee pain.
Mechanism of Injury
Injury to the MCL typically occurs when a force drives the lower leg in a sideward direction away from your upper leg and body. Awkwardly landing from a height, twisting of your knee with your foot fixated to the ground, or from a direct blow to the outer part of your knee- most commonly seen in contact sports, are frequent causes of injury to the MCL.
Grading of MCL Injuries
MCL injuries are often graded using the system below:
Grade 1: Regarded as a minor injury- means that the MCL has been overstretched but not torn
Grade 2: Regarded as a moderate injury- means that there is a partial tear in MCL, and presents with some degree of instability in the knee
Grade 3: Regarded as a severe injury- means that the MCL has completely ruptured/torn, and presents with noticeable joint instability
Often 3 MCL injuries are associated with concurrent medial meniscus and ACL ligament damage, which may need surgical intervention. But, the good news is that most MCL injuries may be treated well with conservative physiotherapy management. It usually takes between 2-8 weeks for Grade 1 and 2 MCL injuries to heal, and a graduated rehabilitation programme is highly commended for prevention of future injury.
Signs and Symptoms
Because injury to the MCL may present with similar symptoms as with other knee injuries such as ACL damage, it is vital to have a medical professional such as your physiotherapist evaluate your injury.
Common symptoms of an MCL injury may include:
Tenderness and pain along in the inner part of your knee
Swelling in the knee
Experience catching and locking sensations in the knee joint
A ‘pop’ sound at the time of injury
Actual or feeling of giving way of the knee (often indicate grade 2 or 3 injury)
Diagnosis
Your physiotherapist will discuss your injury and its presenting symptoms, past medical history (including a history of any prior knee injuries) and will also undertake a thorough physical examination. During the physical examination, your physiotherapist will assess the structures of your injured knee and compare them to the non-injured side. The range of motion, strength and stability of your knee will be assessed. You may be referred on for imaging such as X-rays and Ultrasounds to help aid the diagnosis. For more severe MCL injuries, and if your symptoms do not resolve with conservative physiotherapy management, you may be referred onto a specialist who may consider referring you for an MRI to get a deeper look at your knee.
Management
The management options for MCL injuries will be dependent on the severity of the injury. In the initial stages of injury, management is focused on controlling swelling and pain, whilst allowing your body to initiate healing processes via inflammation. This is typically achieved through the P.O.L.I.C.E. principles (Protect, Optimal Loading, Ice, Compression and Elevation).
Over the counter medication such as ibuprofen and paracetamol may be taken to reduce pain. Other stronger painkillers and NSAIDs may be prescribed by your doctor to help reduce swelling and inflammation as well.
After assessing your knee, your physiotherapist will frame a rehabilitation programme with exercises tailored to your needs. The purpose of physiotherapy is to help restore your knee’s range of motion, stability and strength, which in turn will then allow you to safely return to your usual day-to-day and sporting activities as soon as possible.
Management of most MCL injuries usually only involves knee bracing and physiotherapy treatment. However, in some cases, surgery may be recommended. Particularly if there is damage to more than one ligament or structure in your knee or if you continue to experience instability in spite of physiotherapy.
Sitting at a desk working, studying or surfing the net for long hours at a time makes it extremely difficult to maintain proper posture. That’s because our bodies are not designed for hours of idle sitting. So as the clock gets ticking many of us have the tendency lean forward, slouch our shoulders and hunch our backs.
Unfortunately, this increases pressure on multiple areas in your body. This explains why most of us experience pain and stiffness in our neck, shoulders, back and in some cases your tailbone!
So what do I need to do you ask?
The answer is simple, STAND, MOVE AND STRETCH!
It sure does sound easier said than done, especially if you are pressed with time to complete set work tasks. BUT the good news is that stretching or moving is a buildable habit that can be easily implement as you work. It doesn’t take long!
For starters set an alarm to take micro 2–3-minute break for every 20-30 minutes. Use this time to stand up, walk over to a colleague, go for a toilet break, drink water or make yourself tea or a coffee.
Or try out these simple easy stretches while you sit or stand at your desk
So let’s get started!
SPINAL TWIST:
Sit up tall, relax your shoulders
Cross one leg over the other, then place your opposite elbow on your top thigh.
Take a deep breath and as you exhale slowly twist your body (not your neck) and look over your shoulder.
Hold for 10 seconds.
Slowly return to resting position and repeat on the other side.
BACK ARCHES
Sit tall, set your feet flat on the ground hip-width apart.
Rest your hands behind your hips, then slowly arch your back as you gently tilt your head back.
If you experience pain or discomfort in your neck or tingling in your arms – do this stretch without head tilt.
Hold for 10 seconds, return to start and repeat
ARM REACHES
Sit up tall with your feet flat on the ground.
Interlace your fingers and stretch your arms straight as you turn your palms up to the ceiling.
Hold this position for 10 seconds and repeat
SHOULDER CIRCLES
Sit or stand up tall, feet hip width apart
Relax your arms and shoulder, begin by rolling your shoulder backward in a circular motion.
Do this 5 times, repeat forward circles
NECK CIRCLES
Sit or stand up tall, with feet planted flat on floor
Slowly begin to roll your head in a clockwise position
Do this 20 seconds, then repeat in a counterclockwise direction
CHEST STRETCH
Stand close to wall or a door frame
Place your forearm in a 90-degree angle at shoulder height.
Take one step forward on the leg closest to the wall and slowly rotate your chest away until you feel a stretch across your chest.
Do not hunch or round your shoulders.
Hold the stretch for 20 seconds, repeat
Do this both for both sides
BACK EXTENSIONS
Stand with your legs at hip width apart and straight.
Place your hands on your hips.
Lean your body backwards, trying to arch in the lower back as much as you can, lifting your chest up towards the ceiling.
Try to avoid allowing your hips to swing forwards too far.
Hold this position for 10 seconds, return to start position & repeat 5 times.
FLOOR REACHES
Sit on a chair with upright posture
Slowly bend forward to plant your hands on the floor.
Hold for 10 seconds, return to start
SHOULDER BLADE SQUEEZE
Start in an upright position.
Practice bringing your shoulder blades back and down.
Picture gently drawing your shoulder blades towards the centre of your lower back.
This is a subtle movement, ensure you do not over strain your shoulder blades when performing this action.
Hold for 10 seconds, repeat 3-5 times
SHOULDER BLADE STRETCH
Clasp your hands together and hold them in front of your body.
Push your arms as far forward as you can whilst rounding your shoulder blades.
Gently drop your chin down to your chest.
Hold this position while you feel a stretch between your shoulder blades.
WRIST STRETCHES
Stretch out your arm straight in front of you with your palm facing away
Use your opposite hand to gently pull your palm back
Hold for 5 seconds, repeat with your palm facing your body
Having a fall is dangerous at any age, however, they become more frequent and may most probably result in injury in adults 55 years and over. It is also estimated that in Aotearoa, approximately a third of older adults over the age of 65 sustain a fall every year. This leads to harmful consequences for them, especially for those who live alone. Alongside, sustaining serious injuries, you may face loss of independence, mobility and confidence. But!!! The good news is that there are a number of ways that you can reduce your risk of falling.
So Why Do Older Adults Have Falls?
Poor lower limb strength
Cognitive and functional impairment
Nutritional deficiencies
Prior and/or ongoing history of falls
Vision deficits
Balance or gait disorders
Medication related- especially when using anti-depressants, sedatives, anti-arrhythmics, anti-hypertensives, diuretics, and anti-convulsants
Hazards around your home environment such as loose carpets, slippery surfaces, poor lighting, lack of safety equipment particularly in the bathroom/toilet
Medical conditions such as vertigo, dizziness, diabetes, postural hypotension, drop attacks, and fainting spells
The Vicious Falls Cycle
Older adults who have had a fall may limit what they do because of their loss of self-confidence and fear of falling. Whilst this may seem like the most sensible thing for them to do, it increases their risk of falls. This is because, this leads to a further reduction in muscle strength, coordination and balance. Hence, it is healthier for older adults to keep up with their activities they enjoy as safely as they can, work on improving their muscle strength, coordination and balance, and manage their blood sugar levels, blood pressure, and weight under the guidance of their doctor.
Falls prevention tips
Below are some measures you may take to prevent yourself from falling:
Exercise regularly: A number of benefits include better sleep, improved muscle strength, balance and flexibility, increased energy levels, stronger bones, better management of weight, blood sugars and blood pressure. Exercise programs tailored especially for muscle strength and balance have resulted in a reduction in the number of falls and injuries resulting from falls by approximately 30% and 50%. It is advised that you speak to your doctor or physiotherapist before initiating or progressing your exercise levels.
Keeping your vision in check: Vision deficits makes getting around safely a lot harder. Therefore, you should get your eyes checked yearly and wear your contact lenses or glasses with the correct prescription strength.
Being aware of the effects of your medication: As they may have certain side effects that increase your risk of falls. You should review your medications with your doctor for side effects like drowsiness or dizziness.
Reduce hazards at home: Most falls typically take place at home. So be sure to make your home safer by removing tripping hazards, having adequate lighting, and adding in handrails in hallways and bathrooms/toilets.
Other tips:
Taking your time to get up and when moving around- no rushing!
Having a personal medical alarm (please talk to your doctor about how to get one)
Using a night light when you get up at night
Wearing appropriate, supportive and well-fitted shoes
Not using an easily moveable object to stabilise yourself
Using the support of handrails in bathrooms and hallways
Avoiding or being very careful on wet or slippery floors
Appropriately using your walking aids
If You Have Had a Fall
If you sustain a fall, it is vital for you to stay calm.
If you think you are able to get up safely, try to bend your knees, roll to your side, and attempt to get into a 4-point kneeling position. If there is a chair near by or if you are able to crawl towards one, you can use it as support to get yourself up. Please take your time and rest as needed.
If you are unable to get up safely, attempt to crawl or roll towards a phone. You may call out to other members in your household or your neighbour. If you’re at risk of falls, please do consider the use of a personal medical alarm to call out for help when you have a fall.
After a fall, please contact your doctor as soon as you can for an assessment of potential injuries sustained, muscle strength and balance to help prevent future falls. You may be directed to community or in-home sessions to enhance your balance and strength. Please discuss this with your doctors.
Osteoarthritis impacts millions of people worldwide and is typically known as the most common form of arthritis. It is associated with the wear and tear of the protective cartilage which cushions the ends of your bones in your joints over time. Though this condition may cause damage to any joint in the body, osteoarthritis primarily impacts the joints in your spine, hands, hips, and knees.
Causes and Risk factors
Over time, the gradual deterioration of the cartilage which cushions the ends of your bones in your joints causes arthritis. Cartilage is a solid slippery tissue which allows almost frictionless joint movement. As the cartilage wears down, bone will eventually rub on bone.
This condition is typically characterized as a wear and tear degenerative disorder. However, in addition to the breakdown of the cartilage, it also impacts the joint as a whole. Osteoarthritis triggers alterations in the bone and damages connective tissue which holds the joint together and attaches your muscles to your bones. Inflammation of the lining of the joint is also triggered.
Factors which may put you at higher risk of developing osteoarthritis include but are not limited to:
Your age- the risk increases with getting older
Gender- though unclear why, but women are more perceptible to developing osteoarthritis
Bony deformities- those with abnormal joints or defective cartilage
Sustaining bony or joint injuries like those which take place during sport or from an accident.
The risk increases with obesity- the more you weigh, the greater your risk, as it adds more stress to your weight-bearing joints (particularly hips and knees)
Your occupation or a sport that you play which puts repetitive and excessive stress/loading on the joints, can eventually lead to the development of osteoarthritis.
Certain co-morbidities such as diabetes
Common symptoms
Below are some common examples of symptoms you may experience with arthritis. These may develop and worsen gradually over time
Pain: Your joints may hurt before and/or after undertaking an activity
Loss of joint range of motion– loss of overall joint flexibility and movement
Tenderness felt on applying light pressure to the joint
Joint stiffness that is most noticeable on waking up first thing in the morning or after a prolonged period of inactivity
Noticeable changes in joint pain with changes in the weather- particularly colder weathers
Sensations of grating and grinding// sounds of clicking and popping (crepitus) when you use the joint
You may notice swelling and redness around the joint, which may be triggered by soft tissue inflammation
Bony spurs that feel like hard bumps may develop around the impacted joint
How will I be diagnosed?
Osteoarthritis is typically diagnosed based on your medical and occupation history and a physical examination undertaken by your doctor. During the physical examination, your doctor will assess your affected joint(s) for swelling, tenderness, redness, and stiffness. X-rays may be recommended to reveal cartilage loss (the narrowing of the space between the bones of your joints), changes in bone, and bony spurs around the joint. Blood tests may be used to rule out other causes of joint pains like rheumatoid arthritis. Joint fluid analyses may also be used to test for inflammation to ascertain if the pain is triggered by an infection or gout instead of osteoarthritis.
Management
Though there isn’t a cure for osteoarthritis, various treatments which can help relieve symptoms of pain and disability are available.
Lifestyle modifications: Changes to your daily life may protect your joints and slow the progression of osteoarthritis. Minimising activities which exacerbate your symptoms such as climbing stairs, squatting. Swapping high-impact activities like running and jogging to lower-impact activities such as cycling or hydrotherapy will decrease the stress on your joints. Weight-loss reduces the stress and loading on your joints, which then results in less pain with increased function.
Assistive aids: Using assistive aids like a stick/cane, wearing proper shoes w orthotics and supportive braces/sleeves may improve your stability and support your functional capabilities.
Physiotherapy: Targeted exercises may help improve your flexibility as well as build strength in your muscles. Your physiotherapist will develop a personalised active rehabilitation program which is safe and will meet your requirements and lifestyles.
Medications: Various kinds of medication (such as paracetamol and NSAIDs) maybe helpful in treating and controlling the symptoms of osteoarthritis. As everyone responds differently to medications, your doctor will prescribe medicines (type and dosage), which is safe and will work best for you.
Cortisones: Strong anti-inflammatory agents which is injected into the affected joint to give pain relieve and decrease inflammation for a short period of time. Due to potential side-effects, it may be recommended to restrict the number of injections to 2-3 per year.
Other: Heat and ice applications, self-massaging with pain-relieving creams/ointments and/or wearing elastic supports may provide some relief from your pain and give you support.
Surgery: Surgery may be recommended if there is considerable degeneration in your joints and/or if your osteoarthritic pain causes disability that is not relieved with conservative management. Your doctor or specialist will discuss your options with you.
Have you been experiencing pain, pins and needles or numbness in your wrist and hands, especially after using the keyboard, chopping up a few veges, reading a book, using your mobile phone or with driving?
If you answered yes – then you are most likely to have Carpal tunnel syndrome.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is the most common condition in the arm. It is caused by compression of one of the three major nerves in the forearm – the median nerve, which travels through the wrist into the hand and fingers. Entrapment of the median nerve usually due to inflammation, occurs in the wrist commonly resulting in tingling of the wrist and hand (in some cases forearm), numbness, pain and weakness of the hand.
Signs and Symptoms
Often unrelated to a specific incident or an injury, symptoms of carpal tunnel syndrome usually develop gradually overtime. Symptoms may be worse in the morning and night. Many people find that the frequency and duration of symptoms increase as the conditions worsen.
Signs and symptoms may include:
Tingling, numbness or burning sensation of the thumb, index, middle and ¾ of ring fingers of the hand
Electric shock like radiating pain through the hand into thumb, index, middle and ¾ of ring finger
Weakened grip, loss of dexterity and fine movements such as picking up a hair pin, buttoning clothes.
Hypersensitivity or in other cases lessened sensation of hand to pressure, heat or cold temperatures
Swollen wrist
Let’s take a closer look at the anatomy!
As its name suggests – a group of small bones aka carpal bones form a tunnel like passageway in the wrist (palmar view). This unique architectural design allows for the tendons of the forearm muscles and the all-important median nerve to pass through the narrow tunnel through the wrist and into the hand and fingers, supplying sensation and motor function.
Causes
Common causes and risk factors that increase the likelihood of carpal tunnel syndrome include:
Repetitive wrist & hands movements – during work related tasks or leisure activities may irritate the tendons in the wrist, resulting in inflammation that irritates the nerve.
Wrist or hand injury – recurring sprains, swelling and reduced wrist movements reduces the space in the carpal tunnel
Pregnancy and menopause – hormonal changes can increase fluid retention in body increasing pressure in the carpal tunnel compressing the median nerve
Genetic history – petite
Medical conditions (rheumatoid arthritis, diabetes, hyperthyroidism)
Interesting facts about carpal tunnel syndrome
Women are 3 times more susceptible to develop carpal tunnel syndrome than men. This can be due to hormonal changes during pregnancy or menopause and also because women tend to have smaller carpal tunnels.
Not all fingers are affected. Median nerve supplies movement and sensation in the thumb, all fingers except the little finger.
Computers/keyboard are not the only reasons to blame – repetitive nature of any work related or leisure word increases risk of developing carpal tunnel syndrome
Diagnosis
Carpal tunnel syndrome is fairly easily diagnosed by your physiotherapy, doctor or a hand therapist.
Your health practitioner will gather information on your general health, history and nature of your symptoms. They will then carefully conduct a thorough clinical assessment to assess the movements of your hand and wrist, strength and use a collection of tests in effort diagnose your symptoms. In some cases, your therapist may examine your neck, shoulders and arms to rule out other potential causes.
You may often hear the physiotherapist or hand therapist mention that they want to conduct a functional assessment – A functional assessment is activity specific, where the therapist will watch you perform the activity that aggravates your symptoms the fastest. For example, if using a keyboard is generally when you feel your symptoms start – the therapist may observe you performing the very task to examine your overall posture.
Referral to scans or nerve conduction tests may be arranged by your doctor or therapist depending on the severity or complexity of your symptoms.
Scans
Referral to scans or nerve conduction tests may be arranged by your doctor or therapist depending on the severity or complexity of your symptoms.
Xray – provides key information on bone health, when dealing with a potential injury, or arthritis
Ultrasound – can examine potential soft tissue injury or inflammation compressing the median nerve
MRI – this advanced imaging provides in depth review of your wrist and hand. Usually arranged by your doctor or a specialist
Nerve conduction study – studies the electrical activity of the median nerve. This test will help you doctor examine the severity of your problem.
Treatment
In most cases, carpal tunnel syndrome will progressively worsen overtime. So, the key is early intervention!
Conservative management
Mild symptoms can be easily managed with a conservative approach.
Wearing splints or braces – keeps your wrist straight to prevent repetitive use of hands, thus reducing pressure or inflammation in the carpal tunnel.
Non-steroidal anti-inflammatory medications – such as celecoxib and ibuprofen as prescribed by your doctor may decompress the median nerve by reducing the inflammation in your body and wrist.
Activity modification: your physiotherapist will play an important role in providing you with advice around to modifying your activities to reduce your symptoms. They will also prescribe you with effective stretches and exercises to help manage your symptoms while safely aiding your recovery.
Steroid injections: your physiotherapist or doctor may recommend a ‘cortisone’, also known as a ‘corticosteroid’ injection to control your symptoms. It contains an anti-inflammatory substance that is injected into your carpal tunnel. The effects of the steroid injection may be temporary and can vary person to person depending on many factors (cause of symptoms, stage of your condition).
In mild to moderate cases, the effects of injection may last between 3-6months.
Surgical intervention
If non-surgical approaches have failed to relieve your symptoms, surgery may be required.
By this stage you would have consulted an orthopaedic surgeon. Your surgeon will thoroughly examine your overall health, symptoms, results from the scans and the nerve conduction study to help you decide on the best treatment approach.
If you decide to undergo surgery – the surgical procedure your surgeon will perform is called ‘carpal tunnel release’.
Recovery and outcomes
After your surgery you may be given a splint or a brace for a period of time specified by your surgeon. While in the splint or brace you will be encouraged to move your fingers to prevent stiffness and swelling.
Expect to experience minor pain, stiffness and swelling for a couple of weeks to months after your surgery. Pain medications provided by your surgeon must be taken as prescribed.
You may be encouraged to see your physiotherapist, who will work closely with your surgeon to help meet post-operative outcomes.
You will have regular 6-8 weekly follow ups with your surgeon as required to assess your healing and discuss gradual return to light activities and return to work.
If you have underlying medical conditions such as arthritis, except that your recovery may be slower than otherwise expected. It is important that you follow post-operative protocols your surgeon, doctor and physiotherapist recommend.
Tennis elbow, or also known as lateral epicondylitis, is a painful disorder of the elbow triggered by overuse. This disorder is characterised by inflammation or, in some cases, micro-tearing of the extensor tendons which link the forearm muscles on the outer part of the elbow. This leads to pain and tenderness on the outside of the elbow, spreading through to the forearm and wrist.
Causes
Tennis elbow is characterized as an overuse and muscle strain injury. It is caused by repetitive and/or vigorous contractions of the forearm muscles which is used to straighten, extend, and lift the wrist and hand. The repetitive motions and stress to the tissues can result in a string of tiny, microscopic tears in the tendons which attach your forearm muscles to the bony prominence on the outside of the elbow.
Tennis elbow may result from number of activities including but not limited to:
Typing and repetitive computer mouse use
Cutting/chopping motions
Manual work that involves repetitive turning or lifting of the wrist, such as plumbing, or bricklaying.
Gardening
Using hand tools such as scissors, clippers, screwdrivers, plumbing and carpentry tools
Playing racquet sports, such as tennis, badminton, or squash
Throwing sports, such as the javelin or discus
Painting
Sewing/knitting
Tennis elbow may also occur after a sudden knock or bang to the elbow, if you undertake activities that you are not used to excessively and aggressively, and sometimes there is no apparent cause for it.
Risk Factors
Factors which may increase your risk of tennis elbow include:
Your age: Whilst this disorder impacts people of all ages, it is mostly prevalent in adults in the age group of 30-50 years old.
Your occupation: Those who have jobs which entail repetitive movements of the wrist and arm are more likely to develop this disorder. Examples include but are not limited to painters, computer users, plumbers, butchers, carpenters, and chefs.
Sports: Partaking in racket sports increases the risk of tennis elbow, particularly if you use poor form and technique.
Common Signs and Symptoms
Pain noted around the bony knob on the outside of your elbow is the most common characterising symptom of tennis elbow. This knob is where the injured tendons connect to the bone. The pain is often depicted as “burning” in nature. Your elbow may be tender and sore to touch, and the pain can refer down to the forearm. The pain often increases with gripping, grasping, or rotating motions of the wrist and forearm. Bending and straightening your elbow may also be painful.
The severity of your pain may vary from a mild discomfort to severe pain that can interfere with your sleep and day to day activities. The pain typically starts gradually and then worsens over weeks or months.
Diagnosis
During your physical examination your physiotherapist will attempt to produce your pain in your elbow via specific tests and movements. They will assess your range of motion in your elbow, wrist, and shoulder joints. Referrals for X-rays and ultrasound scanning may be indicated to further support your diagnosis and to rule out other potential sources of your pain
Management
A mix of non-surgical treatment options are effective for the majority of tennis elbow cases, and self-resolves over time. You should rest your elbow and painful activities should be avoided. But it is very vital to maintain gentle movements of the forearm, elbow, and wrist through its range of motion.
Potential treatment options include:
Ice
Rest
Physiotherapy and acupuncture
Anti-inflammatory medications as recommended by your doctor or pharmacist
The use of a wrist and forearm brace or splint to support and rest your forearm
As your initial elbow pain lessens, your muscles around the elbow, forearm and wrist should be safely strengthened and stretched under guidance of a physiotherapist. Your physiotherapist will advise you on particular exercises, give you appropriate symptom management advice and take you through a personalised graduated rehabilitation program. If you continue to experience pain after 6-8 weeks of treatment, your physiotherapist can refer you back to your doctors, to consider administration of a cortisone injection into the elbow to help reduce pain and inflammation, and further referral onto see a specialist to seek guidance on other treatment options.
Rotator cuff injuries are the most common source of shoulder problems. They can range from minor sprains causing impingement type symptoms, to massive tears resulting in severe loss of function and pain. They commonly occur as a result of acute injuries (sports, falls), chronic overuse (repetitive loading) or due to gradual aging.
Anatomy of shoulder
The shoulder joint (glenohumeral joint) is the most mobile joint in the human body. It comprises of the humeral head (top portion of upper arm bone) which fits in the glenoid cavity of the scapula (shoulder blade) to create a ball and socket configuration. This anatomical configuration results in limited bony contact between the humeral head and the glenoid fossa, which reduces the stability of the joint.
Several passive and active structures stabilize and maintain proper biomechanics of the shoulder joint.
Passive stabilizers include the ligaments, joint capsule, cartilage and the bony concavity of glenoid fossa. Thick cartilage known as labrum lines the glenoid fossa to further deepen the groove by about 50% which is advantageous in stabilizing the shoulder joint during the articulation.
Dynamic stabilizers of the glenohumeral joint is gained from the coordination of rotator cuff muscles that compress the passive structures providing stability and mobility as whole.
The rotator cuff muscles include:
supraspinatus
infraspinatus
subscapularis
teres minor
Injury to any or all these four muscles, including the tendons that attach the muscles to bone can result movement dysfunction and severe pain.
Other important joints of the shoulder complex include:
sternoclavicular joint
arcomioclavicular joint
scapulothoracic joints
Types of rotator cuff pathology
Tendinitis and Tendinosis
More often than not the term tendinitis and tendinosis are interchangeably used to describe a similar tendon pathology. However, the factor that differentiates the two is the time of injury (acute or chronic).
Tendinitis results from acute injury to the tendon which sets off an inflammatory process characterized by pain, swelling, and redness. On the other hand, tendinosis is a chronic pathology that does not involve an inflammatory process. It is characterized by degeneration of collagen fibers in response to persistent micro-trauma, vascular compromise and aging.
Acute rotator cuff tear
Acute tears result from sudden forceful lifting of the arm against resistance or in an attempt to cushion a fall (for example, heavy lifting or a fall on the shoulder).
Chronic injuries
Most commonly resulting from occupational or sports requiring excessive repetitive overhead activity.
Signs and symptoms
Symptoms of a rotator cuff injury are due to the inflammation that accompanies the strain. Swelling that forms within the small space of the joint prevents the normal mechanics of the shoulder, resulting in the clinical picture of pain and decreased range of motion.
Acute rotator cuff tears
Tearing sensation
Immediate severe localised pain
Reduced strength
Symptomatic clicking
Reduced and worsening pain with movements
Affects daily activities (personal care, lifting, reaching etc)
Chronic rotator cuff tears
Generalized deep dull ache, sharp onset of pain with movements
Global shoulder weakness
Reduced movements and daily activities (especially moving to the side, reaching behind back)
When to seek medical treatment
See your doctor or a physiotherapist if you experience any of the following symptoms in the shoulder:
Pain, especially pain that does not improve with rest
Swelling, redness or tenderness around the joint
Shoulder weakness
Reduced shoulder movement
For more severe rotator cuff injuries, you may require immediate medical attention.
Seek immediate medical attention if you experience the following symptoms:
Sudden, severe pain
Visible joint deformity
Inability to move or use your shoulder joint
Sudden swelling, discoloration
Diagnosis
To diagnoses an injured rotator cuff, your physiotherapist will begin with a thorough subjective and physical examination of your shoulder.
Subjective assessment
Your physiotherapist will begin with a thorough subjective assessment inquiring about your signs and symptoms of an acute injury as well as any symptoms that may suggest a more long-term problem.
Physical assessment
The physical examination often involves observation to look for muscle wasting, deformities, and/or changes in appearance of the injured shoulder to the unaffected side. Your physiotherapist will also palpate different areas of the shoulder complex to find the area of pain or tenderness. Further examination will involve assessment of movement and strength to establish injury to muscles or tendons.
Radiology
In addition, your physiotherapist may refer you for imaging tests to diagnosis the cause of your symptoms:
MRI: provides detailed imaging of areas injured (referred by doctors, specialists or surgeons)
Treatment
Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in.
Initial treatment of rotator cuff tendinitis involves managing pain and swelling to promote healing. This can be done by:
avoiding activities that cause pain
applying cold packs to your shoulder three to four times per day
taking anti-inflammatory medications like ibuprofen and naproxen
Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear.
When a tear occurs, there is frequently atrophy of the muscles around the arm and loss of motion of the shoulder. An individualized physiotherapy program is necessary to regain strength and improve function in the shoulder.
Physical therapy
Physiotherapy will initially consist of passive exercises to help restore range of motion and ease pain.
Once the pain is under control, your physiotherapist will prescribe exercises to help regain strength in your arm and shoulder.
Steroid injection
If you have persisting symptoms, your physiotherapist may recommend a steroid injection. This is injected into the tendon to reduce inflammation, which reduces pain.
Surgery
Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. In which case, your physiotherapist will refer you to surgeon for an opinion of surgical intervention.
Exercises
Range of movement exercise
Pendulums
Lean forward with one arm hanging freely. Use your unaffected arm to brace against a chair for support.
With your affected side, gently swing the hanging arm from side to side, forward and back, and in a circular motion for 15-20 seconds each direction.
Slowly return to a standing position.
Repeat 4-5 times a day
Shoulder pulley (Flexion)
Put a chair against the door and sit so you are facing away from the door.
Grasp the door pulley handles with both hands.
Pull down on the pulley with your unaffected arm. This will lift your injured arm up over your head. Pull it as high as you can.
DO NOT FORCE THE MOVEMENT. Your affected arm should be relaxed. The unaffected arm does the work.
Hold for 5 seconds. Relax and repeat 10-15 times, 3 sets.
Three times a day.
Shoulder pulley (Abduction)
Put a chair against the door and sit so you are facing away from the door.
Using door pulleys slowly pull down with your unaffected arm so that your affected arm raises up and to the side without effort.
Your affected arm should be relaxed. The unaffected arm does the work.
Hold for 5 seconds. Relax and repeat 10-15 times, 3 sets.
Three times a day.
Wand flexion
Stand upright and hold a stick in both hands
Cup the top end of stick with affected hand
Using your unaffected arm hold the stick midway and drive the affected arm forward and up.
Ensure your elbow is straight throughout
Hold for 5 seconds and return to the starting position.
Repeat 10 times.
Wand Abduction
Stand upright and hold a stick in both hands
Cup the top end of stick with affected hand
Using your unaffected arm hold the stick midway and drive the affected to the side as high as able.
Ensure your elbow is straight throughout.
Hold for 5 seconds and return to the starting position.
Repeat 10 times.
Strengthening exercises with band
Flexion
Stand on one end of the band while holding the other end with your affected side.
Whilst keeping your elbow straight, lift the band up to 90 degrees to shoulder level.
Hold at the top for 1-2 seconds then lower slowly to starting position.
Attach the resistance band to a secure anchor at belly button height.
Stand with unaffected arm perpendicular to the anchor.
Place a towel between your elbow and your torso to stabilize your elbow
Grab the band using your affected side and then slow pull the band away from your body by squeezing your shoulder blade in towards the middle of your back.
