Medial elbow pain is also known as medial epicondylitis or golfer’s elbow. It is typically associated with pain on the inside (medial side) of your elbow and can spread into your forearm and wrist. This pain is the result of overloading and damage to the tendons that flex your wrist towards your palm.
Causes
This condition is triggered by damage to tendons and muscles which control your fingers and wrist. This damage is associated with excessive or repeated stresses- particularly repetitive and forceful finger and wrist movements, incorrect lifting, hitting and throwing techniques, lack of warmups and/or poor muscle conditioning.
Key risk factors for developing medial elbow pain may include smoking, obesity, being of in age bracket of 40 years old and over and undertaking repetitive activity with your arms for at least two hours daily. High risk occupations may include chefs, office desk workers, plumbers, construction workers, painters, butchers and assembly line workers. Those who partake in sports such as golf, racket sports, rowing, weight lifting and baseball are also at a higher risk.
Symptoms
Symptoms may be triggered suddenly due to a traumatic incident or may gradually develop over time and include but are not limited to:
Tenderness and pain is typically felt on the inner side of your elbow (particularly on the bony knob), and may refer along the inner side of your forearm and down to your wrist and fingers. It often worsens with certain movements. For example, bending your wrist towards your palm against resistance, or when squeezing a rubber ball.
You may feel stiffness in your elbow, and making a fist may hurt
You may experience weakness in your forearm, wrist and hand
You may experience tingling and numbness that can radiate into one or more fingers — typically to your ring and little fingers.
Diagnosis
This condition is typically diagnosed based on your medical and occupation history and a physical exam by your doctor or physiotherapist. To evaluate stiffness, strength and pain, your clinician may apply pressure to the impacted region and get you to move your elbow, wrist and fingers in various ways. You may also be referred on for imaging such as X-rays and Ultrasounds to aid diagnosis.
Management
A mix of non-surgical treatment options are effective for the majority of medial elbow pain 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.
Prevention
Having a good comprehension of risk of injury and being conscious of your everyday activities may aid in the prevention of medial elbow pain. You should:
Adopt appropriate technique and form when undertaking repetitive activities or sporting motions
Keep up with adequate wrist, forearm, and shoulder muscle strength
Undertake gentle wrist and forearm stretches pre and post activities
Adopt appropriate posture and body mechanics when lifting heavy objects to reduce joint strain- especially if doing so repetitively
Whether you are squatting racks of weights in the gym or squatting down to the floor to play with your children or simply squatting to sit in a chair – you are still squatting.
Truth of the matter is, squatting is more than just an exercise. If you think about it, it is a functional movement we all do many times in the day.
Knee pain from squatting is a common compliant. Although it is common, it doesn’t mean it is normal.
More often than not, the problem doesn’t only lie at the knee joint. We have to understand the complexity of our body in how our knees are directly linked with how your hips and ankles are moving. So, the purpose of this blog is not only to help you understand the basic mechanics involved in the legs when you squat, but also to help you perfect your lifting craft in the gym.
A bit on what is a squat?
Squatting is characterized as a ‘compound movement’ – fancy fitness lingo that simply means, multiple joints and muscles are moving and working in harmony to contribute to the very movement of squatting.
So here is a checklist to help you find the missing links.
Squatting check list
1. Foot arches
Feet are the foundation to our body. From a balance perspective we can go as far to say that steady the feet, steady the rest of the body. So, what happens at our feet is extremely important to consider when we talking about knee pain in general, let alone, knee pain when squatting.
Foot stability can be best explained using the analogy of a ‘tripod’. As tripod has 3 points of contact with the ground, so should our feet ideally.
The three points of a contact, as in a tripod looks like this in our feet.
Ball of the big toe
Ball of the 5th toe
Heel
Keeping this in mind, lets assess the foundation of your body – Your feet with this small exercise.
Take your shoes and socks off. Stand up tall, plant both your feet flat on the ground. Take a look at both sides individually. What do you see?
Either of your feet collapse in?
Are either of your arches diminished?
Take note of it. Next, remain standing and focus on what you feel at sole of your feet.
Think about the 3 points of contact – the tripod.
Do you feel you have evenly distributed pressure?
Take note.
Now stand on one leg – think about the same TWO things the arch and the pressures.
Which way did your foot go?
Which points of contact in the foot had more pressure?
Did your toes 3-5th lose contact from ground?
If your foot caved in and the last 3-5th toes lost ground contact, then your foot pressure is likely to sit between big toe, the base of 2-3rd toes and heel, suggesting you have a narrowed base of support. This will force the knee, hip and the rest of your body to follow in the direction, creating risk of building up unwanted pressures in others areas of your body. Before you know it, unwanted pressure results in inflammation and pain.
It is important that you consider this of high value and practice on pressure control and arch control before your look at the overall picture of squatting.
2. Ankle mobility
Your foot and ankle are closely linked – between them there are 28 bones, many muscles, ligaments and connective tissue. These anatomical structures work together to provide stability and mobility of the joints – considered KEY essentials to squatting.
Too much or too little flexibility in the ankle can be a problem. In most cases, ankle injuries result in stiffness, a hinderance to simple functional movements.
So, let’s take a closer look at your ankle with a simple mobility test.
Kneel down in front of a wall. Signal a thumbs up and measure the width of it from the wall and mark it. Place your foot on the line and drive your knee forward to the wall. Make sure you drive your knee straight forward without caving in or twisting in with your hips.
What do you see?
Can you touch your knee to the wall?
What about the other side?
Consider what you feel.
One side feels almost effortless, the other side doesn’t?
It is not uncommon to notice that the unaffected side may not be as flexible as you thought.
This is point to note – you have just discovered a link and a potential cause of your knee pain.
You need focus on stretching the muscles of your leg in a way that similar to ‘squatting’ – here is a good one!
Box ankle stretch
Use a box or a chair, plant your foot flat and rock forwards until you feel a stretch in the calf and ankle. Remember to make sure your knee doesn’t cave in or your body doesn’t twist. Do this for 20-25 repetitions, 2-3 sets. Re-test yourself.
3. Hips
Your feet are directly tied to your hips. So, the action of your hip and feet should be working together for good purposeful movement.
Here is a quick way to check this yourself:
Stand tall, with your feet planted shoulder width apart. Drive your knees out to the side. You will notice your foot arch lifts.
It might be a very small amount, but worth taking note. Because, this is no different when you are squatting. If your knees collapse in, it may mean that you are not recruiting the key muscles of your hips that prevent the knees collapsing.
So, driving your knees out to match the alignment of your hip-ankle not only lifts the arches but begins the process of recruitment patterns of hip muscles to engage.
The common deficit contributing to your knee pain may be weak gluteal muscles.
Gluteal muscles are powerful muscles of the lower limb. They are a group of three muscles, each with slight different function
Gluteal maximus – hip external rotation, hip extension
Gluteal medius – hip abduction, internal and external rotation, extension
Gluteal minimus – hip abduction and internal rotation
Banded squat
Banded squats are a great way to activate your gluteus. The band not only provide resistance but provides sensory information to help you learn to push into it, therefore avoid knees from collapsing in.
If you have a lighter level resistance band, place this at knee height.
Descend in to a squat position with emphasis on pushing you knee out into the resistance band, until you reach the hip-knee-ankle alignment.
Do this 15 times, 3 sets.
For starters, work at a level that is easy for you.
Build the reps ups as you gain confidence
Weak or inadequately recruited muscles could be a result of stiffness hips.
To check your flexibility, try this next test:
Sit on tall on a chair. Feet planted flat on ground at shoulder width apart. Test one leg at a time. Keeping your thigh in contact with the chair, drive your knee out to the side (internal rotation). Now try going inwards (external rotation).
What do you see?
Can internally rotate higher? External rotation is difficult? Or vice versa?
What do you feel?
Takes more effort going one way than the other?
Unlock the hips with this beginner hip stretch.
Sit upright on a chair. Cross one leg over on the other. You should feel a stretch in the buttock region. If not, progress by leaning forward with an upright posture. Hold for 15-20 seconds. Repeat 3-5 times.
Perfecting your squat
Perfect practice makes perfect. Now bearing the rules of movement in mind, practice your squats.
Some tips to help you better practice:
Do not worry about the depth of your squat
It’s the quality not the quantity. So as you begin to learn and adapt these principles, only squat down to a level where you feel in control of your foot, ankle, knee and hip.
Use a mirror
Visual learning is a great tool! It provides for a greater ability to correct your mistakes and perfect that ‘quality over quantity’ rule.
Start with barefoot
This allows you to connect the sensory receptors in the soles of your feet to the ground, making it much easier to learn the tripod grip.
Still having pain?
Remember, the complexity of our body and the complexity in how we move as whole can be the result of your knee pain. So, if you are still having pain – its time you get it checked.
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
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
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.
Low back pain is a common health problem which affects up to 80% of the population at some stage in their life.
In New Zealand ACC spends in excess of $130 million a year treating back pain related injuries.
Most back pain occurs between the ages of 25 and 60, and most typically in the 40s.
In an era of smart devices, posture has never been more important or harder to achieve. As technology continues to grow, sitting at a desk on a computer or on our phones is becoming more prevalent at work. Having a sedentary desk job can result in sitting for around 8 hours a day. This position actually increases the load on your spine more than standing. Spinal pressure “sits” around 140mm pressure. This pressure usually does not hurt the back right away however, builds up over time and can even change the structure structure of your spine. So, if you slouch then spinal pressure increases to 190mm; add some weight and you’ve put 275 pounds of pressure on your spine.
A compromised spine constricts your blood vessels and nerves, causing problems with your muscles, discs, and joints. And all of these problems can lead to headaches, fatigue, and even breathing problems. Your back is a delicate machine. When one part falls out of alignment, it can affect everything setting off a domino effect and wreak havoc throughout your back and body.
Below is a graph showing different postures and the pressure it exerts on the spine;
But, remember: While you may feel comfortable and supported in your chair and find a perfect sitting posture, staying in the same position for long periods is not healthy for your spine. Varying your postures by occasionally standing and moving around for at least a few minutes each half hour will help keep your spinal joints, muscles, tendons, and ligaments loose and pain free.
Stand Up for Your Spine
If you don’t have a sit-stand desk, you can still combat “sitting disease” and protect your spine. Consider these tips:
Do some work standing at a high table or counter.
Use a lumbar roll behind your back when sitting to improve seated posture
Set a timer on your computer for a stand-and-stretch break every 30 minutes.
Exercise to assist in improving body weight to lessen additional load on the spine
Strengthen the core to provide additional support
The focus is simple: Reduce your sitting throughout the day. But, remember that varying postures is best for your back and neck, so do not go the opposite extreme and never sit. Alternating sitting, standing and movement throughout your day is the best way you can keep your spine safe and body healthy—at work and beyond
Still having back pain?
Schedule an initial assessment with one of our Physiotherapists so they can determine the root of the problem. During this assessment your physiotherapist will be able to decide whether your pain is a source of nerve root irritation, discogenic, postural related, or musculoskeletal. After arriving with the consensus of the problem, we will be able to use many techniques to relieve the back pain. These include: manual therapy, therapeutic exercise, and postural recommendations.
To find your nearest Physio Fusion clinic and book an appointment call 09 6266186 or visit our websitehttps://physiofusion.co.nz
An ergonomically correct workstation has all the best practices to help maintain a healthy posture and improve your health and productivity.
Here are a few helpful tips;
1. Set up your screen
Adjust the monitor height so that the top of the screen is at—or slightly below—eye level. Your eyes should look slightly downward when viewing the middle of the screen. Position the monitor at least 20 inches (51 cm) from your eyes—about an arm’s length distance. If you have a larger screen, add more viewing distance.
2. Set up your chair
Height – You should be able to sit with your feet flat on the floor and your thighs roughly parallel to the floor. If you require a taller chair in order to reach the floor you can use a foot rest to ensure you achieve the right angle.
Backrest Recline and Tilt – Research has shown that a reclined seat (at least 135 degrees back) significantly reduces the pressure on your back, and is particularity beneficial for people with back
Lumbar support – the shape of the backrest should have a natural curve to support your lower back.
Arm rests – Look for armrests that are not just height adjustable and support the entire length of the forearms.
3. Adjust your Desk Height
Your legs should fit comfortably under the desk if you are sitting with your feet flat on the floor: you should have enough space to cross your legs.
The angle between your forearm and upper arm should be between 90 degrees and 110 degrees while your arms are at rest on the desk.
Make your desk organized using storage accessories i.e. Document holders
Use an ergonomic mouse pad; to keep your wrists supported.
4. Organizing your Desk space
Organize all the items on the workstation according to their priorities and assign them to the proper ergonomic reach zones.
Primary Zone: High use items, easiest access
Secondary Zone :Medium use items, comfortable reach
Third Zone: Low use items, reduction in efficiency
MOVEMENT IS KEY
Its a simple action step, but mighty! Get up out of your chair and take frequent posture breaks!
When we sit in one position for hours without moving, our performance slowly starts to deteriorate, our body slows down, static loading takes over our muscles and we actually get fatigued even when we aren’t putting in any physical effort. However, when you consciously integrate these microbreaks into your day, you’re giving your body a much-needed refresher and an opportunity to wake up your muscles and replenish blood flow. Research has shown that movement can also help with creativity, or get you ‘unstuck’ so you can approach your work with a different or fresh perspective and energy.
If you think your desk set up could be better, or want us to have a quick look we can do this via a video call. Book in for an appointment www.physiofusion.co.nz or give us a call on (09) 626 6186
Headaches happen for lots of reason and can be cause by several sources- both primary and secondary. Once major “red flags” are ruled out, understanding the type of headache is important in order to have it properly addressed.
A cervicogenic headache is a secondary headache arising from a musculoskeletal dysfunction within the cervical spine, and is a disorder that many physiotherapists treat. The main players that are typically involved in generating the pain are the joints, discs, ligaments, nerves and/or muscles found in the upper portion of the neck.
Characteristics of a Cervicogenic Headache:
Pain usually one sided or one side dominant
Pain originates from the back of the neck and radiates along the forehead, orbits around the eye, temple area and ear.
Steady ache or dull, diffuse pain that travels into shoulder region
Limited neck movement especially when turning head
Tenderness to touch at the muscles at the base of the head.
Here are some exercises that would help alleviate your pain:
Cervical side flexion with chin tuck
Sit upright in a chair.
With your shoulders relaxed, relax one arm to your side.
Drop your opposite ear to your shoulder until a stretch is felt.
Using your fingers, tuck your chin in, as to resemble a double chin.
Gently release pressure with your fingers and hold this position.
Relax and repeat
2. Levator stretch Neck stretch – levator scapula
Start in a seated position.
Place the hand of the side you want to stretch down by your side.
Tilt your head forwards and to the opposite side at an angle, as if you are trying to
look at your armpit.
Keeping your back straight and upright, continue to tilt your head down until you
feel a stretch from the base of your skull down into your shoulder blade.
3. Neck stretching (Upper trapezius)
Stand up straight.
Take the hand on the symptomatic side and place it behind your back.
Take your other hand and place it on your head.
Tilt your ear directly down towards your shoulder and hold this position.
You should feel a stretch down the side of your neck.
If you believe you experience Cervicogenic Headaches get in touch with us https://physiofusion.co.nz/ for an in-depth assessment and lets knock out those headaches and decrease you dependence on pain meds
The restrictions and change brought by the outbreak of COVID-19 has resulted in a great deal of control being taken from our hands; this has been anxiety provoking for many of us. Nevertheless, it’s important to re-evaluate, acknowledge and place focus upon the matters that we DO have control over so that we can gain our personal power back!
Lockdown Productivity Tips
Check in with yourself: how is your body and mind feeling. Embrace your emotions and give yourself permission to feel the way toy do.
Stay connected: Social connection is inevitably limited at the moment but catching up with people via text or facetime will help prevent feelings of isolation.
Maintain some form of routine: Maintaining a routine helps provide some structure do days which often all seem to merge into one.
Get fresh air where possible: Daily fresh air can provide an easy change of scenery when we are stuck at home most of the day.
Gentle exercise is a MUST!
Stay Hydrated: Drinking enough water is important to keep your body hydrated and makes sure your body functions properly.
Eat well- You’d be surprised how your diet can affect how you feel. Gut health in particular is linked to mental health.
Get to that “thing” you’ve been delaying for months
Pick up a good book
Learn new habits or rediscover old ones
These may seem like simple strategies but sometimes it’s the simple things that are most effective
“One day this will all be over and we will be grateful for life in ways we never felt possible”
The gratitude we will have for the things we once took for granted will be unmeasurable- getting on a plane, an impromptu visit to the cinema, a shopping spree, going to the gym, even meeting a friend for lunch at a café. Keep going, nothing lasts forever and we have so much to look forward to. In the mean time take each day as it comes, be kind, support those who are struggling and keep going! You are stronger and more resilient than you know!
