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Category: pain

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By Physio Team acute pain, bones, chronic pain, Exercises, feet, flat feet, foot, good posture, Home exercises, Injury, lifting, muscles, pain, pain management, physical health, Physio, posture, rehabilitation, Sporting, Sprain

Knee pain from squats explained

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.

Book yourself in for an appointment today.

By Physio Team acute pain, Appointments & Fees, body parts, bones, chronic pain, Home exercises, Injury, ligaments, muscles, pain, pain management, physical health, Physio, rehabilitation, Sporting, Sprain , , , , , , , , , , , ,

Fix the grinding in your knees when you squat

There can be multiple reasons why your knees sound like popping popcorns or grating stones when you squat.

Generally popping in the knees is attributed to stiffness of the quadriceps muscle and the fascia that surrounds the knee joint. Overtime, stiffness causes pressure to build up under knee cap, which on movement can cause a sudden release causing a ‘popping’ sound. As worrying as it may be, most of the time popping noises in the knee without pain is NORMAL. However, for others the noise can be accompanied with a grinding sensation under the knee cap which is painful. This suggests there is an underlying pathology that needs to be addressed.

This is something we would clinically consider to be Patella Femoral Pain Syndrome aka Runner’s knee – an umbrella term that encompasses the idea of dysfunctional knee cap tracking.

When you straighten and bend your knee, naturally your knee cap tracks up and down between its groove (trochlea groove) – like a train moving up and down a train track.

When the quadricep muscles on the outside (vastus lateralis) and inside (vastus medialis oblique) part of the leg are working in synchronization as they should, your knee cap is able to track up and down properly. However, if the quadriceps muscle (Vastus lateralis) is overly activated and the fascia (Iliotibial band & lateral retinaculum) on the outer part of you knee cap is excessively stiff, the knee cap gets pulled to the outside.

Essentially the train is being pulled and tilted more to the outside. Eventually overtime, repetitive or violent lateral pull of the knee cap increases friction in the knee grating the smooth underside of the knee cap called, chondromalacia. Additionally, the constant pulling and stiffness of the lateral side will cause stretching on the inside of muscles. On top of that, pain and swelling will cause the muscles in the inside of the leg to shut down.

Here are two steps to managing your symptoms.

STEP ONE

  1. Foam roller or tennis ball

Instructions:

  • Lie on your front and place the foam roller underneath your leg.
  • Bend the opposite leg and bring it out to the side to help you move back and forth.
  • Roll the entire length of the thigh muscle, staying off the knee joint.

Make sure you move through the length of the muscle close to the knee cap as you can. You should be looking for stiff spots in the muscles and any sore spots you feel concentrate on it for couple of seconds and work deeper in to the tissue. You should also move in the inside and outside of the quadriceps muscles. Do this with you knee straight and then move into knee flexed position to optimize the release.

For a more concentrated release, use a tennis ball or a lacrosse ball especially at the quadriceps tendon where much of the stiffness is likely present. The reduced surface area of the ball allows you to work on specific spots a lot better to break down deeper areas of stiffness and create more mobility.

Do this mobility routine for 1-2 minutes

  1. Quadricep stretches

  • Start in a standing position. Use support if required for balance.
  • Raise one leg behind you grabbing hold of your ankle, or your lower leg.
  • Lift and hold for 20-30 second, and then repeat for the other leg.
  • Get into a lunge position with back leg flat on floor
  • Bend your knee and slowly pull your leg into a stretch
  • Hold this stretch for 20-30 seconds
  • For comfort place a rolled face towel under the knee cap

Modified quadricep stretch

For some people if kneeling down is irritating for the knee you can modify the stretch.

  • Rest your leg on the chair with your foot against the back rest
  • Make sure your stance leg is far enough in front of the chair
  • Lunge forward until stretch is felt
  • Do this for 20-30 seconds.

NOTE: Long duration stretches of over a minute and more can decrease the potential for you to create strength and power in those muscles during your workout. So, prior to your workout focus on short duration stretches.

  1. Functional mobility stretch

Deep squat sits are great to expand the stretch. If your symptoms are not aggravated, try deep squat sits for 30 seconds up to a minute.

  • Stand with feet shoulder width apart
  • Point your feet out to about 45 degrees
  • Sit in to a deep squat keeping the pressure evenly distributed across feet

STEP TWO

Now that you’ve resolved the stiffness in the lateral portion of your knee, next step is to address the muscles imbalances caused by pain and swelling. That is, turning back the firing of the quadriceps muscles.

An effective way to address this, is by doing what we call close chain exercises – these are exercises done where your feet are on the ground, such as squats. Initially you want start slow and high. Mini squats are great because they allow you to strengthen your quadriceps without putting too much compressive forces into your knee. As you get comfortable, advance to a deeper squat and slowly begin to work towards building you strength by adding on weight.

Mini bodyweight squats

  • Stand behind a chair or table and place your hands onto the back rest.
  • Keeping your back straight, bend both knees into a semi-squatting position, allowing your hands to slide forwards.
  • Your hips should travel backwards as you counterbalance by leaning your chest forwards.
  • Push through your buttock and thigh muscles as you return to standing, and repeat.

Deep bodyweight squats

  1. Hold on to the dumbbell, keeping it close to your chest.
  2. Step your feet wide apart and turn the toes out slightly.
  3. Drop down into a deep squat position, keeping your feet on the floor.
  4. Control the movement back to the start position.

Caution: Avoid deep squats especially if you have ongoing grinding pain. Do not push in to pain, as this will only increase the forces and worsen your symptoms. At this point, it is highly recommended that you come in to see a physiotherapist to examine a potential underlying pathology.

By Physio Team Appointments & Fees, body parts, chronic pain, ergonomics, Exercises, hand and wrist pain, Home exercises, Injury, muscles, OA, osteoarthritis, pain, pain management, physical health, Physio, post-op, pre-op, rehabilitation, Sprain, tendon, Therapy, Work Injury

Wrist pain: De Quervains tenosynovitis

De Quervains tenosynovitis is a painful condition caused by inflammation of two prominent tendons that are located at the wrist and thumb.

The two tendons called the Extensor pollicus brevis  and Abductor pollicus longus originate from the middle of the forearm travel down towards and over the wrist to insert into the thumb. Collectively they function to extend the thumb, whilst abductor pollicus longus extends and also abducts the thumb (lifting thumb up to the ceiling).

What causes it?

The most common cause of De Quervains tenosynovitis is the repetitive overuse of thumb and wrist whether it is occupational or hobby related. For example, the repetitive thumb movement whilst using scissors by hair dressers, landscapers using shears or whilst gardening). Trauma to the tendons from injuries to the wrist or the thumb can cause inflammation of the tendons.

In some cases, age related degeneration of the tendon sheath or underlying conditions such as rheumatoid arthritis increases the risk of the developing De Quervains tenosynovitis. Hormonal changes resulting in fluid build up in young mothers can commonly result in De Quervains tenosynovitis.

Symptoms

Commonly your symptoms may include:

  • Pain located at base of your thumb
  • Pain elicited by movement of thumb (gripping or making a fist)
  • Grating or snapping feeling
  • Tightness in the wrist
  • Swelling surrounding the base of thumb and wrist

How is De Quervains tenosynovitis diagnosed?

Your doctor or physiotherapist will be able to diagnose the condition based on your symptoms and after doing a thorough movement assessment to rule out any other potential diagnosis.

  • Finkelstein test is used to elicit symptoms to confirm De Quervains tenosynovitis.

How to test:

  1. Wrap your thumb with your fingers.
  2. Slowly bend your wrist down

A positive test would elicit pain at the site of the two tendons.

Radiological investigations in lights of ultrasound and an x-ray might be recommended for further investigations, particularly to confirm clinical diagnosis or to rule out any other possible causes of De Quervains such as osteoarthritis.

What treatment options are available?

Conservative (non-surgical) management

Conservative management measures are generally recommended as the first line of management for mild to moderate symptoms. This is because up to 60-70% of symptoms are likely to improve over a period of 6-8 weeks of regular physiotherapy intervention. In this period, the following strategies are recommended by your therapist to fast-track your recovery

  • Rest and application of heat or cold packs
  • Avoid repetitive use of thumb
  • Pain medications (anti-inflammatory medications) such as diclofenac or ibuprofen
  • Splints or braces
  • Steroid injection

Surgical management

In more severe cases when conservative management has failed, surgery may be recommended by an orthopaedic specialist or surgeon.

Prior to your surgery you will have the opportunity to thoroughly discuss with your surgeon the details of the surgical procedure and about the post operative rehabilitation process.

  • Surgical procedure

Surgery may be performed under general or local anaesthesia. A small incision is made at the wrist and thumb region. The covering of the tendons (sheath) is then separated and expanded to provide the tendon space to allow the tendon to move smoothly within the sheath. After this the, the incision in then sutured with a firm dressing applied over the suture site.

  • While you recover from the surgery, an information sheet with post operative guidelines will be provided to you by your surgical team. It is important that you must follow the guidelines recommended by your surgeon for optimal recovery.
  • In most cases your will have a follow up with your surgeon few weeks after your surgery to check your wound healing and your progress. You are often times referred to physiotherapy for strength and conditioning of your wrist and hand movements to facilitate your recovery.
By Physio Team acute pain, Appointments & Fees, body parts, chronic pain, ergonomics, Exercises, good posture, hand and wrist pain, Home exercises, Injury, Lockdown, lockdown wellbeing, muscles, online consultations, pain, pain management, physical health, Physio, posture, rehabilitation, repetitive stress injury, RSI, sitting posture, Sprain, tendon, Therapy, wellbeing, Work Injury , , , , , , , , , , , , , , , , , , , , , , , , , ,

Repetitive Strain Injury (RSI) Explained

 

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

By Physio Team Appointments & Fees, body parts, bone weaking, bones, Exercises, falls, Home exercises, Injury, Lockdown, lockdown wellbeing, muscles, older adult, online consultations, osteoporosis, pain, pain management, Physio, posture, rehabilitation, Therapy, weak bones, wellbeing , , , , , , , , , , , , , , , , , , , , , , ,

Osteoporosis

 

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.

 

 

By Physio Team acute pain, back pain, body parts, bones, chronic pain, ergonomics, Exercises, good posture, hand and wrist pain, Home exercises, Injury, muscles, neck pain, pain, pain management, physical health, Physio, rehabilitation, repetitive stress injury, shoulder pain, sitting posture, Sprain, Uncategorized, WFH, Working from home , , , , ,

EASY STRETCHES DESK STRETCHES

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
By Physio Team Appointments & Fees, back pain, body parts, chronic pain, Injury, Leg, OA, pain, pain management

Sciatica Pain

Sciatica is not a diagnosis, it is a term that describes symptoms of pain, pins and needles, numbness and in some cases weakness that radiates along path of the sciatic nerve from the lower back to buttocks and leg.

Causes of Sciatica?

  • Disc derangement / herniation
    Disc injuries are most common cause of sciatica. Discs are cushion like pads located between each spinal segments that act as shock absorbers. The core interior of the discs is made up a gel like substance called the nucleus pulposus surrounded by thick fibrous outer ring called the annulus. Sudden forces applied to the disc can result in the the core interior to push through the outer ring resulting in a disc bulge or in severe cases can rupture the outer ring resulting in disc herniation which can compress the nerve root.
  • Disc degeneration / Arthritis / stenosis
    Age related degenerative changes in the spine can result thinning of the disc and narrowing of the spinal joints. Overtime the narrowing results in bony growths that can compress the nerve roots resulting in sciatica.
  • Soft tissue injury resulting in inflammation
    Thick ligaments and connective tissue envelope the spinal segments to optimize stability. Injury to any of the structures will result in inflammation and swelling which can affect the sciatic nerve directly resulting in sciatic symptoms.
  • Piriformis syndrome
    Piriformis muscle is a located deep in the buttock region. It originates from the sacrum and inserts into the upper part of the hip. The sciatic nerve travels adjacent to the piriformis muscles. Injury to the muscle resulting in tightness or spasm directly affects the sciatic nerve resulting in symptoms.
  • Other possible causes:
    • Sacroiliac Joint Dysfunction
    • Hip joint injury or arthritis
    • Spinal fractures
    • Tumors

Anatomy of the Sciatic nerve

Sciatic nerve is the largest nerve in the human body. It originates in the lower back from five branches of nerves that extend from the spinal cord. The branches exit the spine at nerve roots L4, L5, S1, S2, S3 connect together to form the sciatic nerve.

The large sciatic nerve then travels deep in gluteal region and descends vertically down to the back of the thigh. It supplies motor function and sensation to the skin and all muscles in the posterior compartment of thigh.

At the knee joint the sciatic nerve then divides into two branches the tibial nerve and common fibular nerve.

What exactly does it feel like?

Symptoms of Sciatica are often characterized by one or more of the following features:

  • Unilateral. Sciatica is typically affects one leg.
  • Pain. Nature of pain is often constant with heaviness or dull ache. You may experience sharp, shooting, electric shocks intermittently with postural movements.
  • Neural irritation. pins and needles with occasional postural numbness is common. Postural numbness can occur when you sit or stand for a period of time, but should resolve with movement.  However, if numbness is constant you must be reviewed by your general practitioner or your physiotherapist. 
  • Location of pain: symptoms of sciatica are felt along the path of the large sciatic nerve. The following picture shows the potential pathways you may feel your symptoms radiate to depending on the origin of nerve irritation or entrapment. Most commonly the areas affected included the lower back, lateral thigh extending to the calf and foot.

If symptoms are presented on both sides with additional symptoms outlined below – this could warrant an urgent medical review.

Red flags

Signs and symptoms that require prompt medical assessment include:

  • Age >50 years
  • History of trauma
  • Severe unrelenting pain that does not resolve with rest or pain control
  • Partial or complete loss of bowel and bladder function or control
  • Numbness in private regions and the affected side of leg or both
  • Discoloration of skin in comparison to unaffected side
  • Recent or current infection with fever chills and night sweats
  • Sudden unplanned weight-loss
  • History of cancer, kidney dysfunction

Diagnosis

It is important to correctly identify the cause your sciatica is essential in order to formulate an effective treatment plan to manage your symptoms and improve function.

Your GP or a physiotherapist will conduct a thorough diagnostic assessment. Your consultation with your clinician will begin with a comprehensive conversion that allows your clinician to formulate an understanding around potential causes of your symptoms. This includes questions specific to your presenting concerns, general health, history of injuries contributing and medication history and your symptoms management strategies. A physical examination is then followed where by your clinician will assess the range of movement of your lower back and lower extremities, reflexes, strength and sensation assessment to test the integrity of the nerve.

Radiographic examination

Further diagnostic examination in forms of radiographic imaging may be recommended by your clinician to assess the quality of your joints, alignment and check for the presence of any potential lesions contributing to your symptoms.

  • XRAY – commonly used in initial stages to review underlying joint pathology such as wear and tear of joints, fractures or in some cases to view lesions or tumors
  • MRI – high standard imaging that is able to examine in very refined detail possible soft tissues such as muscles, ligaments and internal organs as well as the bony architecture and possible disc injuries.
  • Discogram – A discogram test may be helpful in determining abnormalities in an intervertebral disc. A contrast dye injected into the tissues may allow abnormalities in the disc, such as bulging or herniation to be seen on a medical imaging scan (such as computed tomography scan).

Treatment 

It is advisable to treat sciatica as early as possible in order to avoid the progression of symptoms. Treatments for sciatica may include both non-surgical and surgical approaches.
Typically, non-surgical management is recommended first. Surgery may be required if non-surgical methods have failed to manage your symptoms or the underlying cause is causing deterioration of symptoms. However, in a few severe cases where red flags are presented, surgery may be considered as the first option

Non-surgical approach is the first step to management. This includes intake of pain medications as prescribed by your doctors and referral to physiotherapy.

Pain medications 

Your doctor will prescribe pain medications best suited for your symptoms. These may include

Non-steroidal anti-inflammatory medications such as ibuprofen, celecoxib
Neuropathic medications such as gabapentin, amitriptyline
Analgesics such as codeine, tramadol or oxycodone.
Muscle relaxants such as norflex

Physiotherapy

Physiotherapy will incorporate a combination of gentle strengthening, stretching, and the use of manual therapy to facilitate therapeutic gains.

The goals of physiotherapy for sciatic symptom management includes:

  • Strengthen muscles of the spine, core and lower extremities.
  • Improve flexibility of any tight muscles
  • Improve mobilization of the sciatic nerve
  • Facilitate optimal circulation through slight conditioning exercise (walking, swimming)
  • Education around activity modifications (especially for work-related participation)

Alternative therapies such as acupuncture may be recommended in combination to physiotherapy to facilitate management of your symptoms.

Acute mild sciatica usually improves with 4 to 6 weeks with regular conservative treatment. However, for moderate to severe cases of sciatica especially with a chronic underlying pathology pain may last over 8 weeks and, treatment time may take longer.

Steroid Injections 

Steroid injections are slightly an invasive method used for pain management. Your specialist or an orthopedic surgeon may recommend and administer the injection. In addition to this, injections are also used as a diagnostic method to identify the target nerves or nerve roots affected. The common types of injections for sciatic pain relief include epidural injections.

Surgical approach

In cases where pain and or weakness persists for more than 6-8 weeks or if your symptoms are affecting everyday activities – Surgery may be considered. Your physiotherapist or doctor will arrange the referral for you to meet with an orthopedic back surgeon. Depending on the cause of your sciatica, your surgeon will discuss with you in detail the intended surgical approach, risks involved, post operative management and possible adverse reactions you may have after surgery.

By Physio Team Appointments & Fees, Exercises, falls, Home exercises, Lockdown, lockdown wellbeing, older adult, pain, pain management, rehabilitation , , , , , , , , , , , ,

MANAGING FALLS IN OLDER ADULTS

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.

By Physio Team hand and wrist pain, Home exercises, Injury, online consultations, pain, pain management, physical health, Physio, rehabilitation, Sprain, tendon, Therapy , , , , , , , , , , , ,

Dealing with De Quervain’s

De Quervain’s tenosynovitis is categorised as an overuse disorder which affects the tendons in your wrist that you use to straighten your thumb. It is associated with swelling in the two tendons around the base of your thumb, which then causes the sheaths encompassing these tendons to become inflamed. This results in increased pressure on surrounding nerves as well, resulting in symptoms such as numbness, tenderness and pain. You are likely to have these symptoms when making a fist, gripping or grasping something, pinching, twisting your wrist, and/or laterally bending your thumb.

Symptoms

The key distinguishing symptom of De Quervain’s tenosynovitis is tenderness and/or pain at the base of your thumb. You can experience pain referring up or down your forearm. You may notice the pain gradually develop or appear suddenly, and worsen when using your wrist, thumb and hand. Painful movements include making a fist, gripping or grasping something, twisting your wrist, pinching, and/or laterally bending your thumb.

Other key symptoms include:

  • Swelling at the base of your thumb
  • Experience numbness along the back of your index finger and thumb
  • ‘Snapping’ or ‘catching’ sensation experienced when you move your thumb

Causes

De Quervain’s tenosynovitis is typically associated with the chronic overuse of your thumb, hand and wrist. When undertaking movements like gripping, grasping, clenching, pinching, or wringing items in your hand, the two tendons in your lower thumb and wrist usually glide in a smooth manner via the small tunnel which attaches them to the base of your thumb. However, when you repeat a certain movement day in day out, it irritates the sheath around these two tendons, resulting in swelling and thickening which restrict their movements.

Factors which may increase your risk of developing this condition are:

  • Being in the age bracket of 30 to 50 years old
  • Pregnancy
  • Found more commonly in women.
  • Baby care: Lifting, carrying and/or holding your child repetitively with using your thumbs as leverage.
  • Hobbies or occupations which involve repetitive wrist and hand movements

Diagnosis

Your doctor or physiotherapist will discuss your medical and occupational history, and carry out a physical assessment of your wrist and hand.

The physical examination will include palpation for pain when pressure is applied to the thumb side of the wrist, as well as clinical test called the Finkelstein test. This test requires you to bend your thumb across the palm of your hand and bend your fingers down over your thumb. You will then bend your wrist towards your little finger. If this causes pain on the thumb side of your wrist, you are likely to have this condition.

Whilst X-rays are usually not needed for the diagnosis, however, you may be referred on for ultrasound imaging.

Management

The aim of the management for this condition is to reduce pain caused by the irritation and inflammation of the tendons, preserve movement in the wrist and thumb, and prevent its reoccurrence. If treatment is commenced early, the symptoms should subside in 4-6 weeks. If your symptoms arise during pregnancy, they may settle around the end of the pregnancy or post the breast-feeding stage.

  • Splints may be utilised to immobilise and rest your wrist and thumb
  • Ice application to the affected area
  • Your doctor may recommend the use of anti-inflammatory medication to ease swelling and decrease pain
  • Avoiding pinching with your thumb when moving your wrist from side to side
  • Avoidance of aggravating repetitive movements and activities
  • Administration of corticosteroid injection into the tendon sheath can ease pain and decrease swelling if recommended by your GP
  • Physiotherapy: Your physiotherapist will examine how you use your wrist and provide suggestions on how to make technique modifications to relieve stress on your wrists. They will teach you strengthening exercises for your wrist, hand and arm to help decrease pain and limit tendon irritation
  • Surgery may be recommended by your specialist in more severe cases and if conservative management fails
By Physio Team Appointments & Fees, body parts, chronic pain, Exercises, good posture, Home exercises, Injury, Lockdown, muscles, OA, online consultations, osteoarthritis, pain, pain management, physical health, Physio, rehabilitation , , , , , , , , , , ,

Managing Your Osteoarthritis

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.