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Category: physical health

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By Physio Team acute pain, Appointments & Fees, ergonomics, Exercises, feet, flat feet, foot, foot pain, heel pain, Home exercises, Lockdown, lockdown wellbeing, online consultations, orthotics, pain, pain management, physical health, Physio, plantar fasciitis, Therapy , , , , , , , , , , , , ,

Managing Your Heel Pain

 

Plantar fasciitis is a very common cause of heel pain. It is associated with inflammation of the thick web-like ligament (plantar fascia) which runs across the base of your heel to the front of your foot. The plantar fascia provides support to the arch of your foot and is a shock-absorber, helping you walk. Hence it is obvious that this ligament experiences a considerable amount of wear and tear in your day to life.

 

 

Symptoms

 

 

Plantar fasciitis is associated with inflammation of plantar fascia triggered by the development of small tears in the plantar fascia which leads to heel pain and other symptoms. This condition mostly develops gradually and worsens over time. You may notice some swelling, redness, and warmth in the affected region. You may experience more pain in the centre of your heel, which may radiate along the sole of your foot. The pain may be achy, sharp, dull, stabbing.  It is mostly experienced when initiating movement first thing in the morning or after a period of inactivity, and may ease after a period of mobility. You may have no resting as the plantar fascia is offloaded and relaxed. It generally impacts just one foot, but it may impact both feet.

 

Causes

The plantar fascia is a thick web-like ligament which supports the arch of your foot and absorbs shock when you walk. Excessive stress and tension on the plantar fascia may cause smalls tears. Repeated stretching and tearing may inflame and irritate the fascia, though the cause remains unclear in many cases of plantar fasciitis.

 

Key factors which may increase your risk of developing this condition include:

  • Foot mechanics: Having flat feet or very high arches or adopting abnormal gait patterns may have an impact of the way your weight is dispersed when you are standing/running/walking and lead to excessive stress on the plantar fascia
  • Obesity: Extra weight increases the tension on the plantar fascia
  • Exercises: Certain exercises such as long-distance running/walking and dancing may put more stress on your heel and plantar fascia
  • Age and Gender: Plantar fasciitis is more often noted in women than men, and is most common in the 40-to-60-year age group.
  • Occupation: which require prolonged periods of walking and standing especially on hard surfaces
  • Sudden and rapid change in activity levels
  • Footwear: Wearing high heels and/or poor fitting shoes that do not provide sufficient arch support cushioning
  • Muscle tightness: particularly of your lower limbs

 

 

Diagnosis

The diagnosis of this condition may be determined by your medical and occupational history, the nature, length and severity of your signs and symptoms, and the existence of localized tenderness in your heel. You may be referred on for imaging such as X-rays, ultrasounds or MRIs to aid the diagnosis and to possibly rule out other causes for your symptoms (fractures, arthritis, heel spurs etc).

 

Management

Initial management of this condition is focused on the reduction of pain and inflammation:

  • Resting is vital
  • Ice application
  • Taking anti-inflammatory medications
  • Wearing appropriate and supportive footwear with arch supports and shock absorbing orthotics
  • Getting your foot and ankle taped for sufficient support and alignment
  • Physiotherapy (involving a graduated rehabilitation program of stretching/strengthening exercises)

If you still do not notice any improvement in your symptoms, your doctor may recommend corticosteroid therapy. Corticosteroid medication is injected into the impacted region with the purpose of treating the inflammation directly hence, relieving your pain. Using a splint at night to avoid the Achilles tendon and plantar fascia from tightening while you sleep may also be recommended at this time. A surgical intervention is seldom recommended and is only usually opted for where the pain is severe and all other treatment has failed. Please discuss your management options with your doctors.

 

Prevention

Here are some helpful tips to prevent the development of plantar fasciitis and decrease the risk of reaggravating your symptoms:

  • Ensure you make warm ups and cool downs as part of your exercise regimes
  • Undertake exercises to strengthen your lower limb muscles
  • Regularly stretch your Achilles, calf and intrinsic foot muscles to increase their flexibility
  • Gradually increase your activity and exercise levels
  • Maintain a healthy body-weight
  • Wear appropriate and supportive footwear (use orthotics for support if needed)
  • Take regular rest breaks if standing and or walking for prolonged periods of time at work
By Physio Team Appointments & Fees, body parts, elbow pain, ergonomics, Exercises, golfers elbow, good posture, hand and wrist pain, Home exercises, Injury, ligaments, Lockdown, medial elbow pain, online consultations, pain management, physical health, Physio, posture, rehabilitation , , , , , , , , , , , , ,

Medial Elbow Pain Explained

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
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 back pain, chronic pain, Exercises, Home exercises, Injury, pain management, physical health, Physio, tendon , , , , , , , , , , , , , , ,

Piriformis Syndrome

Piriformis syndrome refers to the dysfunction of the piriformis muscle which irritates the sciatic nerve. It is characterized by deep buttock region pain that radiates down leg and foot often accompanied by pins and needles and numbness traveling along the path of the sciatic nerve.

The simplistic reason for this widely distributed pain comes down to the piriformis muscle itself – Their close proximity means that direct trauma to the buttock region or the supporting structures can result in inflammation and muscle dysfunction which can compress and irritate the sciatic resulting in referred symptoms.

Piriformis syndrome symptoms may include:

  • Localised deep buttock region pain
  • Pain with continuous sitting or standing for 15 mins or over
  • Pins and needles along the leg down to the outer foot
  • Numbness in outer leg or foot (often resolves on movements)
  • Deep squatting or bending
  • Pain on direct palpation

Anatomy

 

The piriformis muscle originates from the outer surface of a large fused bone of our pelvis called the sacrum. It travels adjacently and inserts into the top of the hip joint. The piriformis muscle is a very active muscle involved in stabilizing the hip and pelvis during majority of our activities (walking, running, standing, sitting or standing, turning in bed). When the piriformis muscle contracts it helps the hip rotate outwards (external rotation) and lift thigh out and up (abduct).

The sciatic nerve originates from where the very base of the spine and the sacrum join known as the lumbosacral region (lower back and saddle region). In this region five separate branches of nerves travel outside of the bony openings of the spine called the nerve roots and connect into a single large nerve – the sciatic nerve. It then travels through the pelvis deep into the buttock region close proximity the piriformis and gluteal muscles. In some individuals the piriformis muscles can travel through the piriformis muscle subjecting them to piriformis syndrome.

Diagnosis

There are no specific tests to diagnose piriformis syndrome. Diagnosis of piriformis syndrome is made by the report of symptoms and by physical exam using a variety of movements to elicit pain to the piriformis muscle. In some cases, a contracted or tender piriformis muscle can be found on physical exam.

In cases where there is underlying pathology (such as disc injury, arthritis, sacroiliac dysfunction or hip injury) resulting in true sciatica – piriformis syndrome may develop to become an additional muscular dysfunction that is required to be addressed. Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.

Consultation with a physiotherapist in this case is highly recommended as they will perform a comprehensive clinical examination to identify the root cause of your symptoms.

Exercises for piriformis syndrome

Corrective exercises with a combination of strength and flexibility regimen is an essential way to treat true piriformis syndrome (without involvement of other underlying pathologies).

The exercises outlined below follow a phase-by-phase progressive regimen to strength key muscles of the hip, buttock and legs.

As you work through these exercises expect to feel some pain during and after your exercise. Pain you may feel during the exercise is an expected sign of muscle activity. Pain you may feel after the exercises is an expected sign of muscle healing and recovery. However, if you are unable to participate in the exercises due to symptom deterioration – it is highly recommended you consult your physiotherapist to rule out other potential causes.

Otherwise, to help you gauge the correct amount of pain you should expect during exercise – use this scale. The ideal range should be 2 to 5. If your baseline pain is over 6 or 7 – it is recommended that you consult your doctor for pain relief appropriate to manage your pain, followed by a consult with a physiotherapist. Your physiotherapist will be able to modify the following exercises or prescribe alternative exercises best suited based on your current level of function and symptoms.

Symptom noting – is a great way to keep track of your progress and symptom behaviour.

  • Take a diary
  • Note down pain before you begin the exercise.
  • Note down the pain rating after each exercise.
  • Note down pain at the end of the day
  • Repeat the pain recording process for the next 4-5 days
  • Examine the trend in your symptoms.

Interference with everyday tasks – Your participation or level of exertion with everyday activities may interfere with your symptoms impacting your exercise tolerance. It is therefore important to note any of these interferences’ contributory to your pain.

Phase 1 – is a beginner stage.

This phase is intended for gently priming muscle activation. It will demand your concentration on technique and compliance to change the possible compensation your body has been used to as a result of pain. This phase can last between 1-2 weeks.

Instructions:

3 sets of 10 repetitions. Hold each repetition for 8-10 seconds. Rest 10-15 seconds between sets, 30 seconds between exercises. Do this exercise 1-2 times per day.

Bridges

 

Lie on your back.
Bend both knees and place your feet flat on the bed.
Lift your buttocks from the bed.
Place your buttocks back on the bed.
Repeat this exercise and remember to continue to breathe properly.

Clam shells

 

 

 

 

 

 

Lie on your side with your feet, ankles and knees together.
Bend the legs a little and tighten your core stability muscles.
Keeping the feet together, lift the top knee up.
Make sure you don’t roll your body back with the movement.
Control the movement as you bring the knee back down to the starting position.

Phase 2 – intermediate stage

The intermediate phase is similar to the beginner stage with the difference of using changing elements of progression to challenge the muscles capacity further. In this stage you may choose to progress the exercises by choosing to change ONE factor:

  • Increase repetitions
  • Increase hold time
  • Increase sets
  • Add appropriate resistance

Instructions:

  • 3 sets of 10-15 repetitions. Hold each repetition for 10-15 seconds.
  • Rest 10-15 seconds between sets, 30 seconds between exercises.
  • Do this exercise 1-2 times per day.

Bridges with resistance

 

 

 

 

 

 

 

Tie a resistance band around both thighs, just above your knees.
Lie on your back with your knees bent and legs hips width apart.
There should be tension in the band.
Raise your hips up into a bridge, keeping the knees hips width apart.
Control the movement back down to the start position, maintaining constant tension on the band.

Clams with resistance

Lie on your side and place a band above your knees, approximately an inch or two above the knee joint.
Bend your legs a little, keeping the feet in line with your back.
Use your core stability muscles to keep the body stable.
Keeping your feet together, lift the top knee up against the resistance of the band.
Ensure you stay on your side and do not roll your hips and your body back with the movement.
Lower the knee back down, controlling the resistance.

Phase 3 – advance stage

Body weight squats

Start position is standing straight with the arms out in front and bent at the elbows, the fists should be clenched and the palms facing inwards.
Move downwards into a squat position so that the knees are aligned over the toes and the heels are in contact with the floor, make sure the back is straight.
Keep the head and chest upright and the gaze horizontal.
Hold for 2 seconds and return to the start position.

Lunges

Stand straight with your arms to the side or on your hips.
Take a large step forwards on your affected leg, then drop your hips directly down between both feet, bending your hips and knees to a 90 degrees.
Push back up to the starting position, and repeat.
Make sure you take a large enough step that your front knee does not travel over your foot, and ensure your knee travels directly forwards.
Keep your body up straight throughout the movement.

Crab walks

Place a band around your ankles and gather some tension.
Side-step keeping constant tension on the band.
Make sure you do not bring your feet too close together and keep your toes and knees pointing forwards.

Phase 4 – return to activities

Planning on running a marathon? A sports dietitian on what to eat for long-distance running

Stretching

Do you always need to stretch the muscle? The answer is NO. While stretching is an important tool to improve muscle elasticity. You may not always need to stretch a muscle if it is NOT tight. Thus, stretching is recommended to be limited to areas you feel are TIGHT when you perform a given movement. Check the affected side and unaffected side – don’t need to stretch a muscle that doesn’t need to be stretched.

Seated piriformis stretch 

Start in a seated position.
Cross the symptomatic leg your ankle is resting on, to the opposite knee.
Apply gentle pressure to the knee as you lean forward, increasing the depth of the stretch.
Hold this position, you should feel a comfortable tension with no pain.

Pigeon stretch

 

Start on your hands and knees.
Cross the symptomatic leg underneath you, then lower your hips down to the ground.
Rest your body forwards on your arms.
You should feel a stretch across the buttock.

 

 

 

 

 

 

By Physio Team Appointments & Fees, Exercises, knee pain, ligament damage, ligaments, Lockdown, lockdown wellbeing, MCL knee pain, MCL ligament, medial knee pain, muscles, online consultations, pain management, physical health, Physio, Sprain, surgery, Therapy , , , , , , , , , , , , , , , , , , , , , ,

Managing your Medial Knee Pain: MCL injuries

What is it?

Although your knee has free movement going forwards and backwards, its’ sideward movements are restricted by the robust collateral ligaments on either sides of your knee. The medial collateral ligament (MCL) is situated on the inner part of your knee, but on the outside of your joint. The MCL connects the top of your shinbone (tibia) to the bottom of your femur (thighbone). It helps hold your bones together, provides stability and prevents your knee from bending sideways away from your body.

Injuries to the MCL are from the result of a direct blow to the outer part of your knee- and is most commonly seen in contact sports such as football and soccer. These injures may either over-stretch or cause a tear in the ligament. Whilst surgery may be needed in some severe cases, it is not always the go-to form of management.

Read on to know how physiotherapy can help manage your MCL related-knee pain.

 

 

Mechanism of Injury

Injury to the MCL typically occurs when a force drives the lower leg in a sideward direction away from your upper leg and body. Awkwardly landing from a height, twisting of your knee with your foot fixated to the ground, or from a direct blow to the outer part of your knee- most commonly seen in contact sports, are frequent causes of injury to the MCL.

 

 

Grading of MCL Injuries

MCL injuries are often graded using the system below:

Grade 1: Regarded as a minor injury- means that the MCL has been overstretched but not torn

Grade 2: Regarded as a moderate injury- means that there is a partial tear in MCL, and presents with some degree of instability in the knee

Grade 3: Regarded as a severe injury- means that the MCL has completely ruptured/torn, and presents with noticeable joint instability

 

Often 3 MCL injuries are associated with concurrent medial meniscus and ACL ligament damage, which may need surgical intervention. But, the good news is that most MCL injuries may be treated well with conservative physiotherapy management. It usually takes between 2-8 weeks for Grade 1 and 2 MCL injuries to heal, and a graduated rehabilitation programme is highly commended for prevention of future injury.

 

 

Signs and Symptoms

Because injury to the MCL may present with similar symptoms as with other knee injuries such as ACL damage, it is vital to have a medical professional such as your physiotherapist evaluate your injury.

Common symptoms of an MCL injury may include:

  • Tenderness and pain along in the inner part of your knee
  • Swelling in the knee
  • Experience catching and locking sensations in the knee joint
  • A ‘pop’ sound at the time of injury
  • Actual or feeling of giving way of the knee (often indicate grade 2 or 3 injury)

 

 

Diagnosis

Your physiotherapist will discuss your injury and its presenting symptoms, past medical history (including a history of any prior knee injuries) and will also undertake a thorough physical examination. During the physical examination, your physiotherapist will assess the structures of your injured knee and compare them to the non-injured side. The range of motion, strength and stability of your knee will be assessed. You may be referred on for imaging such as X-rays and Ultrasounds to help aid the diagnosis. For more severe MCL injuries, and if your symptoms do not resolve with conservative physiotherapy management, you may be referred onto a specialist who may consider referring you for an MRI to get a deeper look at your knee.

 

Management

The management options for MCL injuries will be dependent on the severity of the injury. In the initial stages of injury, management is focused on controlling swelling and pain, whilst allowing your body to initiate healing processes via inflammation. This is typically achieved through the P.O.L.I.C.E. principles (Protect, Optimal Loading, Ice, Compression and Elevation).

Over the counter medication such as ibuprofen and paracetamol may be taken to reduce pain. Other stronger painkillers and NSAIDs may be prescribed by your doctor to help reduce swelling and inflammation as well.

After assessing your knee, your physiotherapist will frame a rehabilitation programme with exercises tailored to your needs. The purpose of physiotherapy is to help restore your knee’s range of motion, stability and strength, which in turn will then allow you to safely return to your usual day-to-day and sporting activities as soon as possible.

Management of most MCL injuries usually only involves knee bracing and physiotherapy treatment. However, in some cases, surgery may be recommended. Particularly if there is damage to more than one ligament or structure in your knee or if you continue to experience instability in spite of physiotherapy.

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 acute pain, Appointments & Fees, chronic pain, Home exercises, Injury, Lockdown, lockdown wellbeing, online consultations, osteoarthritis, pain management, physical health, Physio, RA, rehabilitation, Rheumatoid arthritis, Rheumatoid arthritis (RA), Therapy , , , , , , , , , , , , , , , , , ,

Dealing with Rheumatoid Arthritis

Rheumatoid arthritis (RA), a chronic inflammatory condition associated with swelling, pain, fatigue, and joint deformity. Although there are no known cures for this condition at present, a combination of treatments are available to help manage your symptoms. RA is the 2nd most common form of arthritis after osteoarthritis and is known to affect 1–2% of New Zealand’s population.

 

 

Signs and Symptoms

RA may develop very quickly or gradually over time, with its signs and symptoms, as well as the severity varying from one person to another. This condition is associated with episodes of remission and flare ups, with or without apparent triggers.

Other symptoms may include

 

  • Swollen, tender joints- (often accompanied by warmth and redness)
  • Joint pain
  • Joint stiffness which worsens in the mornings and after a period of inactivity
  • Fever, loss of appetite weakness, and fatigue
  • Muscle pain
  • Changes to the skin and nails

In the early stages of RA, you may notice its impact on your smaller joints- especially in your toes and fingers. And as this condition develops, your symptoms typically branch out to the bigger joints- your shoulders, ankles, knees, wrists, hips and elbows. Symptoms are likely to affect your joints bilaterally. Over time, RA also causes joints to deform and shift out of place.

Because RA is a systemic condition, it is estimated that approximately 40% of the RA population may experience symptoms and signs other body systems than the joints. These may include:

  • Kidneys, lungs, heart
  • Skin, eyes, mouth
  • Bone marrow
  • Nerves and blood vessels

 

 

Causes and Risk Factors

Your immune system is designed to help protect your body from infection and disease. However, in RA, changes occur in your immune system that (for poorly understood reasons), causes it to mistakenly attack the healthy soft-tissues of joints resulting in pain, swelling and inflammation. Because of this ongoing process, over time damages to the lining of your joints and other soft-tissues may lead to bone erosion and joint deformity. It can also have an impact on your heart, lungs, nerves, eyes and skin.

One can get RA at any age, although it is more probable to develop in those in the age bracket of 25-50 years old. Though rare, under 16s may also develop Juvenile RA or Still’s disease.

Risk factors for the development of RA include:

  • Family history of RA
  • Age bracket of 25-50 years old
  • Smoking
  • Women are more likely to develop RA than men
  • Obesity

 

 

 

Diagnosis

 

At present there is no single test to confirm a clinical RA diagnosis. It is often difficult to differentiate this condition in its initial stages from other forms of connective tissue inflammation (fibromyalgia, lupus, gout etc.).

Your doctor will get your full medical history (as well as any familial history of RA), discuss your signs and symptoms, undertake a physical assessment- particularly of your joints, and refer you on for imaging and blood tests. X-rays may help evaluate RA progression in your joints over time, whilst MRI and ultrasound imaging may help evaluate the severity of RA in your body. The blood test will evaluate your level of anti-bodies and proteins (including the rheumatoid factor protein that is present in approximately eighty percent of the RA population), and markers of inflammation.

 

 

Management

At present, though there is no cure for RA, a range of treatments are available which may help slow its’ progression and reduce pain and inflammation, minimise and/or prevent joint damage and maximise joint movement.

A combination of prescribed medication as advised by your doctor and other treatment options as noted below are recommended:

  • Cease smoking if you are smoker
  • Physiotherapy will help improve and maintain your joint range of motion, increase your muscle strength, and decrease your pain. Additionally, your physiotherapist or occupational therapist will be able to teach you ways of using your body efficiently to reduce stress on your joints
  • Finding a balance between rest and activity
  • Use of heat and cold packs to help ease pain and inflammation
  • The use of splints or braces for joint support as needed
  • Hydrotherapy- exercising in water reduces the pressure on your joints, whilst the warmth of the water will relax your muscles and help lessen your pain.
  • Seeking regular medical advice and check-ups to monitor your RA symptoms and the progression of the condition
  • Adopting a healthy and active lifestyle