fbpx
Your first step to recovery

Rotator cuff injury

Rotator cuff injuries are the most common source of shoulder problems. They can range from minor sprains causing impingement type symptoms, to massive tears resulting in severe loss of function and pain. They commonly occur as a result of acute injuries (sports, falls), chronic overuse (repetitive loading) or due to gradual aging.

Anatomy of shoulder

The shoulder joint (glenohumeral joint) is the most mobile joint in the human body. It comprises of the humeral head (top portion of upper arm bone) which fits in the glenoid cavity of the scapula (shoulder blade) to create a ball and socket configuration. This anatomical configuration results in limited bony contact between the humeral head and the glenoid fossa, which reduces the stability of the joint.

Several passive and active structures stabilize and maintain proper biomechanics of the shoulder joint.

  • Passive stabilizers include the ligaments, joint capsule, cartilage and the bony concavity of glenoid fossa. Thick cartilage known as labrum lines the glenoid fossa to further deepen the groove by about 50% which is advantageous in stabilizing the shoulder joint during the articulation.

  • Dynamic stabilizers of the glenohumeral joint is gained from the coordination of rotator cuff muscles that compress the passive structures providing stability and mobility as whole.

The rotator cuff muscles include:

  • supraspinatus

  • infraspinatus

  • subscapularis

  • teres minor

Rotator Cuff Disorders: The Facts | OrthoBethesda

 

 

Injury to any or all these four muscles, including the tendons that attach the muscles to bone can result movement dysfunction and severe pain.

Other important joints of the shoulder complex include:

  • sternoclavicular joint

  • arcomioclavicular joint

  • scapulothoracic joints

Types of rotator cuff pathology

Tendinitis and Tendinosis

More often than not the term tendinitis and tendinosis are interchangeably used to describe a similar tendon pathology. However, the factor that differentiates the two is the time of injury (acute or chronic).

Tendinitis results from acute injury to the tendon which sets off an inflammatory process characterized by pain, swelling, and redness. On the other hand, tendinosis is a chronic pathology that does not involve an inflammatory process. It is characterized by degeneration of collagen fibers in response to persistent micro-trauma, vascular compromise and aging.

Acute rotator cuff tear

  • Acute tears result from sudden forceful lifting of the arm against resistance or in an attempt to cushion a fall (for example, heavy lifting or a fall on the shoulder).

Chronic injuries

  • Most commonly resulting from occupational or sports requiring excessive repetitive overhead activity.

Signs and symptoms

Symptoms of a rotator cuff injury are due to the inflammation that accompanies the strain. Swelling that forms within the small space of the joint prevents the normal mechanics of the shoulder, resulting in the clinical picture of pain and decreased range of motion.

  • Acute rotator cuff tears
    Tearing sensation
    Immediate severe localised pain
    Reduced strength
    Symptomatic clicking
    Reduced and worsening pain with movements
    Affects daily activities (personal care, lifting, reaching etc)

  • Chronic rotator cuff tears
    Generalized deep dull ache, sharp onset of pain with movements
    Global shoulder weakness
    Reduced movements and daily activities (especially moving to the side, reaching behind back)

When to seek medical treatment

See your doctor or a physiotherapist if you experience any of the following symptoms in the shoulder:

  • Pain, especially pain that does not improve with rest

  • Swelling, redness or tenderness around the joint

  • Shoulder weakness

  • Reduced shoulder movement

For more severe rotator cuff injuries, you may require immediate medical attention.

Seek immediate medical attention if you experience the following symptoms:

  • Sudden, severe pain

  • Visible joint deformity

  • Inability to move or use your shoulder joint

  • Sudden swelling, discoloration

Diagnosis

To diagnoses an injured rotator cuff, your physiotherapist will begin with a thorough subjective and physical examination of your shoulder.

  • Subjective assessment

Your physiotherapist will begin with a thorough subjective assessment inquiring about your signs and symptoms of an acute injury as well as any symptoms that may suggest a more long-term problem.

  • Physical assessment

The physical examination often involves observation to look for muscle wasting, deformities, and/or changes in appearance of the injured shoulder to the unaffected side. Your physiotherapist will also palpate different areas of the shoulder complex to find the area of pain or tenderness. Further examination will involve assessment of movement and strength to establish injury to muscles or tendons.

  • Radiology

In addition, your physiotherapist may refer you for imaging tests to diagnosis the cause of your symptoms:

  • Ultrasound: examines soft-tissue structures (muscles, tendons, bursa)

  • X-rays: examines bone health, calcification

  • MRI: provides detailed imaging of areas injured (referred by doctors, specialists or surgeons)

Treatment

Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in.

Initial treatment of rotator cuff tendinitis involves managing pain and swelling to promote healing. This can be done by:

  • avoiding activities that cause pain

  • applying cold packs to your shoulder three to four times per day

  • taking anti-inflammatory medications like ibuprofen and naproxen

Rehabilitation plays a critical role in both the nonsurgical and surgical treatment of a rotator cuff tear.

When a tear occurs, there is frequently atrophy of the muscles around the arm and loss of motion of the shoulder. An individualized physiotherapy program is necessary to regain strength and improve function in the shoulder.

Physical therapy

Physiotherapy will initially consist of passive exercises to help restore range of motion and ease pain.

Once the pain is under control, your physiotherapist will prescribe exercises to help regain strength in your arm and shoulder.

Steroid injection

If you have persisting symptoms, your physiotherapist may recommend a steroid injection. This is injected into the tendon to reduce inflammation, which reduces pain.

Surgery

Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. In which case, your physiotherapist will refer you to surgeon for an opinion of surgical intervention.

Exercises

Range of movement exercise

Pendulums

  1. Lean forward with one arm hanging freely. Use your unaffected arm to brace against a chair for support.

  2. With your affected side, gently swing the hanging arm from side to side, forward and back, and in a circular motion for 15-20 seconds each direction.

  3. Slowly return to a standing position.

  4. Repeat 4-5 times a day

 

Shoulder pulley (Flexion)

  1. Put a chair against the door and sit so you are facing away from the door.

  2. Grasp the door pulley handles with both hands.

  3. Pull down on the pulley with your unaffected arm. This will lift your injured arm up over your head. Pull it as high as you can.

  4. DO NOT FORCE THE MOVEMENT. Your affected arm should be relaxed. The unaffected arm does the work.

Hold for 5 seconds. Relax and repeat 10-15 times, 3 sets.
Three times a day.

Shoulder pulley (Abduction)

  1. Put a chair against the door and sit so you are facing away from the door.

  2. Using door pulleys slowly pull down with your unaffected arm so that your affected arm raises up and to the side without effort.

  3. Your affected arm should be relaxed. The unaffected arm does the work.

Hold for 5 seconds. Relax and repeat 10-15 times, 3 sets.
Three times a day.

Wand flexion

  1. Stand upright and hold a stick in both hands

  2. Cup the top end of stick with affected hand

  3. Using your unaffected arm hold the stick midway and drive the affected arm forward and up.

  4. Ensure your elbow is straight throughout

  5. Hold for 5 seconds and return to the starting position.

  6. Repeat 10 times.

Wand Abduction

  1. Stand upright and hold a stick in both hands

  2. Cup the top end of stick with affected hand

  3. Using your unaffected arm hold the stick midway and drive the affected to the side as high as able.

  4. Ensure your elbow is straight throughout.

  5. Hold for 5 seconds and return to the starting position.

  6. Repeat 10 times.

Strengthening exercises with band

Flexion

  1. Stand on one end of the band while holding the other end with your affected side.

  2. Whilst keeping your elbow straight, lift the band up to 90 degrees to shoulder level.

  3. Hold at the top for 1-2 seconds then lower slowly to starting position.

  4. Repeat 10-15 repetitions, rest 20-25 seconds, complete 3 sets.

Abduction

  1. Stand on the band while holding the band with affected hand.

  2. Keep your elbow straight, lift the band up to 90 degrees to shoulder level.

  3. Hold at the top for 1-2 seconds then lower slowly to starting position.

  4. Repeat 10-15 repetitions, rest 20-25 seconds, complete 3 sets.

External Rotation

  1. Attach the resistance band to a secure anchor at belly button height.

  2. Stand with unaffected arm perpendicular to the anchor.

  3. Place a towel between your elbow and your torso to stabilize your elbow

  4. Grab the band using your affected side and then slow pull the band away from your body by squeezing your shoulder blade in towards the middle of your back.

  5. Slowly return to starting position.

  6. Repeat 10-15 repetitions, rest 20-25 seconds, complete 3 sets.

Internal Rotation

  1. Attach the resistance band to a secure anchor at belly button height.

  2. Stand with affected arm perpendicular to the anchor.

  3. Place a towel between your elbow and your torso to stabilize your elbow

  4. Grab the band using your affected side and then slow pull in to your body

  5. Slowly return to starting position.

  6. Repeat 10-15 repetitions, rest 20-25 seconds, complete 3 sets.

Ankle injuries – Your first step to recovery

Common? Oh Yes!

The ankle is the most commonly injured joint in sport. This does not exclude other people such as active hikers, beach goers and even your average Sunday stroller. Good news though – your ankle injury is highly likely to be uncomplicated.

It is still vital that your ankle is examined, evaluated and treated early. This will ensure a swift return to activity and prevent further complications.

 

The road to recovery

Planning for Resiliency and the Road to Recovery

Your clinician will ask you some questions related to how you injured your ankle, pain, instability and any past episodes of injury. The earlier you get your ankle checked, the sooner your recovery will begin.

Keeping a mental note of things like initial pain, swelling, ability to walk and balance will go a long way in assisting your clinician to making an accurate diagnosis.

 

Investigations

Ankle x-rays

In most cases, initial X – rays are done to rule out broken bones.

Ultrasounds can be used to diagnose some ligament and tendon damage.

MRI is the best form of imaging but this does come at a higher cost and higher exposure to radiation. These are usually done after failed conservative treatment or in instances where pain remains high for longer periods.

A CT scan is helpful with complicated foot and ankle fractures. It will normally be ordered by a specialist surgeon who is planning for an operation.

 

What to look out for

Ankle sprains:

This is normally a twisting injury that causes a stretch or tear of ligaments surrounding the ankle. Your health care professional will provide you with all the information and tools you need for recovery.

These heal relatively quickly when the outside border of the foot is affected and a little slower when the inside border of the ankle is affected.

You will normally feel pain on certain ankle movements, stiffness in the ankle and experience some swelling and bruising.

Ankle - Wikipedia

 

Ankle Fractures:

These normally present with swelling, bruising and pain initially – although not always. In some cases, it is too painful to put weight on the ankle.

They are usually best confirmed with X – ray and specialist referral.

Management may be surgical or non-surgical depending on the severity and site of the fracture.

Fractures generally take longer to recover compared to sprains.

 

What treatment to expect

Foot and Ankle Doctor | EmergeOrtho—Triangle Region

Acute phase:

Your healthcare professional will normally initiate techniques to minimise your pain and swelling with rest, ice, compression and elevation.

Analgesia and anti – inflammatory medication may also be used.

Strapping may be used for stability at this stage and can be done by your physiotherapist.

You will also be encouraged to increase movement and begin strengthening.

 

Rehabilitation phase:

Balance and proprioceptive exercises will be given to you by your physiotherapist.

Strengthening will continue and running will start soon.

Once running in a linear motion pain free, you will progress to sport specific exercises.

Finally, you will return to sport or previous function such as trekking with a graded program.

Strapping may continue for up to 12 months after your injury in order to prevent re–injury.

 

What can you do on the day of the injury?

Rest by reducing time spent walking or standing. This will help the ankle to heal.

Ice the ankle for up to 20 minutes every couple of hours.

Compress the ankle with a firm bandage during the day and remove the bandage at night.

Elevate the leg.

Attempt circulatory exercises such as ankle circles and foot pumps (About 10 – 30 repetitions every couple of hours).

Contact your health professional or physiotherapist in order to make appointment for assessment.

If you are unable to stand on your leg or have excruciating pain in the ankle, head on to the local emergency department for immediate investigation.

 

Remember, your injury will heal and you will recover!

 

To find your nearest Physio Fusion clinic and book an appointment call 09 6266186 or visit our website https://physiofusion.co.nz

We Want You To Understand Your Pain

What is pain?

Pain is the brain giving out a message to protect you . It is part of our bodies natural defense system.

When an event occurs that we need protecting from, our brains response is to increase our pain. Living things detect and respond to stimulus. | Characteristics of living  things, Natural hairstyles for kids, Characteristics

Example: Putting a hand on a hot pan. You feel pain, which is the brain giving you a warning signal to move your hand away.

Pain is all about protection, never about measuring the condition of the tissues in the body.

In this instance we experience a high level of pain to prevent a bigger injury eg. causing a burn.

This is our bodies way of protecting us

So what is happening in our brain?

  • We as human beings are amazingly adaptable. The longer we have pain, the longer our brains learn to produce pain.

  • It hurts in the tissues (back, knee, hand), but the problem is in the nervous system. There is an adaptation within our nervous system.

Long term pain or Chronic pain

Chronic pain is defined as persistent or recurrent pain lasting longer than 3 months

If you have had pain for more than 3 months, your system is now overprotective. Your nervous system and immune systems have learnt.

 

Movement is medicine: why exercise therapy reduces chronic pain - Hinge  Health

 

  • With chronic pain the buffer size is increased- therefore pain comes on quicker than before.

  • You get pain when you are not anywhere near being in danger.

Management of chronic pain:

  • Identify why your brain is protecting you – fear, anxiety, quality of movement, posture, injury

  • Reduce the size of your buffer – desensitization, reassurance, progressive load management

  • Understand your pain- know that it may not go completely, but can become more manageable

Medication:

  • Depending on the type of pain you are experiencing, painkillers/NSAID’s may be beneficial in the short term – speak to your GP/pharmacist

  • Note: the research does not show good outcomes for the long-term use of medication to treat chronic pain.

Occupational Therapy:

  • If you have been off work because of your pain – try to return to work asap. An OT can discuss and plan a gradual return to work plan for you

  • They can also assist by providing aids to helps with daily tasks such as getting out of bed, or putting on shoes.

Physiotherapy:

  • There is no quick fix for persistent pain. We can help guide you along your journey to recovery

  • With persistence and hard work you can learn to adapt and cope with your pain

  • Movement is king – it is critical for retraining the system

  • Movement gradually suppresses the pain system.

  • Finding any form of exercise or movement that you enjoy and gradually increasing the volume over time

  • Moving regularly- on your good days and your bad days

Self Help:

  • Meditation or mindfulness – Apps such as Headspace or Calm are easy to use and will guide you through the process

  • The Pain ToolKit

Exercises you can do during lockdown

I know how hard it can be when it comes to working out and its really easy to find an excuse to avoid lockdown workouts but it’s not just about staying in shape its also about keeping active to feel mentally strong. We know that exercise does wonders for mental health and at a time where its all uncertainty, anxiety, and a daily dose of doom and gloom, we all need to work out that frustration somewhere!

If you’re struggling with a lack of motivation or negative mindsets there’s only one way to turn it all around: Take :boom: ACTION :boom:

 

How much exercise is enough?

You’ve heard the saying something is always better than nothing and that’s the case when it comes to exercise. The current recommendation for adults according to Best Exercises for Health and Weight Loss.org is to aim for 150 minutes of moderate intensity activity every week (or 75 minutes of vigorous intensity) with two sessions of strength building activities per week. That’s about 30 minutes of movement, five times per week.

This is a quick full body routine:

Bodyweight Squats

Stand with your feet shoulder-width apart. Engage your core muscles and gently squat down. As you squat, bend from your hips. Keep your back straight as you push your hips back and counterbalance by leaning your torso forwards. Keep your knees aligned with your toes. Your weight should be evenly on your heels and the balls of your feet, not your toes. It might help to image your are trying to sit down in a chair that is too far away from you. Tense your bottom muscles at the bottom of the squat and keep them tense as you straighten back up to the start position.

Arm dips

Start in a seated position. Place your hands on the seat of the chair and use your arms to move yourself forwards towards the front of the chair. You will need to move your feet further forwards to help your stability. From this position, use the strength of your arms to slowly lower your body directly down towards the floor and then raise yourself back up. Do not actually sit on the floor and keep your hands close in beside you. Relax and repeat.

 

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.

 

Mountain Climbers

Adopt a plank position insuring your hands are directly beneath your shoulders.
Fully flex one hip and hold.
Extend the bent leg to the rear and repeat the movement pattern on the opposite side

 

Disorders of the Achilles Tendon

Basic Anatomy

The Achilles tendon is the largest tendon in the human-body. It is a band of tissue that connects your calf muscles to your heel bone (calcaneus). This tendon primarily facilitates general mobility such as walking, running, climbing stairs, jumping, and standing on your tip toes, by helping to raise the heel off the ground.

 

 

Common Achilles Pathology

Achilles tendinitis and tendinosis are two common disorders and are typically classified as overuse injuries.

Achilles tendonitis involves inflammation of the Achilles tendon. Inflammation is the body’s natural response to injury or disease, and often causes swelling, pain, or irritation. This inflammation is typically short-lived. Over time, if this is left resolved, the condition may progress to degeneration of the tendon- Achilles tendinosis, in which case, the tendon loses its organized structure and is likely to develop microscopic tears.

There are two types of Achilles tendonitis and it is based on which part of the tendon is inflamed:

  • Insertional Achilles tendonitis affects the lower portion of your tendon where it attaches to your heel bone.
  • Non-insertional Achilles tendonitis involves fibres in the middle portion of the tendon and tends to affect younger people who are active.

In both non-insertional and insertional Achilles tendinitis, damaged tendon fibres may also calcify (harden) and often bone spurs (extra bone growth) develop with insertional Achilles tendinitis. Achilles tendonitis may also increase your risk of sustaining an Achilles tendon rupture (tear).

Causes

Typically referred to as “overuse” conditions, Achilles tendonitis and tendinosis are often caused by the sudden increase in repetitive activity involving the Achilles tendon. This can put too much stress on the tendon too quickly, that can then lead to micro-injury of the tendon fibres. Because of this ongoing stress on the Achilles, the body is not able to repair the injured tissue. The structure of this tendon is then modified, resulting in continued pain and other symptoms. The Achilles tendon also has poor blood supply that makes it more susceptible to injury and may make recovery from injury slow.

Common factors that may lead to the development of disorders of the Achilles tendon include:

  • Weak and/or tight calf muscles
  • Rapidly increasing the amount or intensity of exercise within a short span of time
  • Hill climbing or stair climbing exercises
  • Presence of bony spurs in the back of your heel
  • Changes in footwear – especially changing from wearing high-heeled shoes to flat shoes
  • Wearing poor fitting, inappropriate, or worn out shoes during sporting activities
  • Exercising without adequate warm-ups and stretching
  • A sudden sharp movement which causes the calf muscles to contract and the stress on the Achilles tendon to be increased. This can cause the tendon fibres to tear.
  • Excessive mobility
  • Poor feet positioning and biomechanics (excessive pronation and flattening of the arches of the foot)

 

Symptoms

Achilles tendon pain: Causes. when to see a doctor, and treatment

 

Common symptoms include:

  • Pain and stiffness along the Achilles tendon especially first thing in the morning
  • Pain along the tendon or back of the heel that worsens with activity
  • Severe pain the day after exercising
  • Visible thickening of the tendon
  • Tenderness to touch
  • Bone spur
  • Swelling that is present all the time and gets worse throughout the day with activity

If you have experienced a sudden “pop” in the back of your calf or heel, you may have torn your Achilles tendon. Please seek urgent medical attention if you think you may have torn your tendon.

Diagnosis

If Achilles tendonitis or tendinosis is suspected, please deter from any activity or exercise which causes the pain. It is advisable to see your doctor or physiotherapist as soon as possible so that an accurate diagnosis may be made and appropriate treatment recommended.

You will be asked about the nature and duration of your symptoms and the medical professional assessing you will have a look at your foot and ankle. Ultrasound scanning may be used to evaluate the damage to the tendon and/or surrounding structures.

An MRI may be recommended if symptoms persist. X-rays may also be taken to rule out other disorders which may cause symptoms like Achilles tendonitis and tendinosis.

Achilles Tendonitis - Ankle - Conditions - Musculoskeletal - What We Treat  - Physio.co.ukHow to Treat Achilles Tendinopathy with Physical Therapy -  prohealthcareproducts.com

Treatment

Treatment will depend on the nature, severity, and length of the injury. Generally speaking, the longer the symptoms are present before treatment commences, the longer the timeframe until full recovery is attained.  Full recovery may take between three and nine months.

Initial treatment options in the early stages may include:

  • Rest – to avoid further injury to the area
  • Ice – to reduce inflammation
  • Elevation – to reduce swelling
  • Non-steroidal anti-inflammatory drugs to reduce pain and inflammation.

 How physiotherapy can help:

Physiotherapy typically focuses on two main areas: treatment and rehabilitation. Treatment may entail massage, shockwave therapy, acupuncture, gait re-education, and gentle stretching, whereas, rehabilitation predominantly entails strengthening of the Achilles and surrounding musculature.

Strengthening of the muscles surrounding the Achilles tendon facilitates healing in the tendon itself. Strengthening is attained through the utilization of specific exercises, that will be taught by your physiotherapist. It is common for the rehabilitation programme to take up to three months.

 

Exercises

 

 

Stay safe, Stay fit

Our daily routine has been forced to change during the lockdown and it has never been more important to focus on your physical and mental health. The current situation we’re facing is strange, stressful, emotionally exhausting and there is no surprise that the motivation to keep fit has been a bit of a struggle. It is in these disquieting times that exercise can provide much-needed solace.

Research shows that being physically active helps lower cholesterol and blood pressure and can significantly reduce the risk of heart disease, stroke, and diabetes. Physical activity also maintains mass and bone density, reducing the risk of developing osteoporosis (loss of bone density), Sarcopenia (loss of muscle mass), and helps boost one’s immune system, as it flushes bacteria from the lungs and airways, increases white blood cell circulation and raises body temperature, all of which help the body fight infection.

How much Activity is Recommended?

Be active every day, in as many ways as possible. Aim for at least 2 ½ hours of moderate (or 1 ¼ hours of vigorous physical activity) spread throughout the week. The Ministry of Health outlines how much physical activity New Zealanders need to stay healthy https://www.health.govt.nz/your-health/healthy-living/food-activity-and-sleep/physical-activity/how-much-activity-recommended.

Create a Routine

Whether you are looking to maintain an exercise regime or just stay motivated from one day to the next, as your own four walls start to make you feel a bit stir crazy, many people find that it helps to have a set routine. It portions the day into bite-size chunks and allows you to feel a sense of accomplishment as you tick off the day’s tasks.

Few of us are lucky enough to have an exercise bike/treadmill at home. Fortunately, there are plenty of simple exercises that you can do around the house or with household objects that will work instead. If you do not have your own weights at home there are some surprising substitutes you can utilize instead i.e bags of rice or flour, a tin of beans and bottled water can be used, if you need something heavier you can always fill a carrier bag with a few items inside.

1. Squats

Directions:

Lie on the floor and rest on your back. Ensure that your knees are bent, and your feet are touching the floor.

Put your hands behind your head and then lift both your chest and your legs slightly but leave a gap between them.

Go back to the starting position and repeat.

2. Crunches

Crunches are another important exercise for your abs to strengthen your body core.

Directions:

Widen your feet parallel to your shoulder and extend your arms in front of you.

Bend your knees and your hips slightly and then do the traditional squat position.

Push up using your heels and repeat.

3. Stationary Lunge

Directions:

Stand up straight and put your right leg forwards and your left leg backward. It should look like you’re preparing to run.

Place your hands on your hips. Bend your right leg, leaving a little gap between the floor and the knee.

Then, switch your legs and do the same.

These bodyweight exercises are a great way to start your day and get the blood pumping in your body.

 

Safety during exercise outside

If you’re working from home, getting outside for physical activity will do wonders for your physical and mental health. Regular walking, running or cycling is a great way to stay active and healthy during lockdown, but it is important to keep your distance and stay more than two metres away from others. Plan your route when you’re thinking of heading out for a cycle/jog. If possible try to think of roads, neighborhoods, and parks that will be quieter and less congested. Follow the latest advice about whether you will also need to wear a mask.

Take a Bit of You Time

Fill your own cup first…Being healthy is not just about maintaining an exercise regime and eating right, it is also about staying mentally healthy too. If you are in isolation with your family, it is easy to spend the day making sure they are happy and entertained, but don’t forget to take a bit of time for you. Do a quick meditation or yoga routine while the kids are watching TV or maybe just go into the garden and take a few deep breaths to relieve some stress!

During this time of uncertainty, something we can take control of is our health and well-being. So, whatever your situation, try to keep active, eat healthily, and stay hydrated.

Ngā mihi and stay safe

KNEE PAIN

Knee pain is one of the most common musculoskeletal complaints that affects peoples of all ages.
Knee pain can result from injuries of traumatic nature or due to complications from medical conditions.

Depending on the structures involved, pain can be localized to a specific area or be felt all
around the knee.

 

ANATOMY OF KNEE

The knee joint is a hinge joint. Other than bearing the weight of the body, it’s primary function is to bend, straighten and rotate to a small degree. To achieve this function, the knee joint relies on a number of structures.

 

Image result for knee anatomyImage result for knee anatomy

 

Bones

Knee joint consists of four bones to provide structure and weight-bearing ability.

  •  Lower end of thigh bone (femur)
  •  Upper part of shin bone (tibia)
  • Knee cap (patella)
  • Fibula (not involved in weight-bearing, but provides attachments for ligaments and tendons)

 

Ligaments

Four important ligaments connect the two big bones, providing multi-directional stability.

  • Cruciate ligaments

Anterior cruciate ligament (ACL)

Posterior cruciate ligament (PCL)

  • Collateral ligaments

Medial collateral ligament (MCL)

Lateral collateral ligament (LCL)

 

Cartilage

  • Glossy cartilage lines the end of each bone to protect and allow smooth movements against each other with almost no friction.
  • Meniscus is another type of strong cartilage that lines the upper surface of the tibia bone to cushion and stabilize the knee.

 

Tendons

There are two important tendons located on the front of the knee joint.

  • Quadriceps tendon is a strong durable tissue that extends from the quadriceps muscle and connects it to the knee cap.
  • Patella tendon connects the knee cap to the tibia bone.

 

Bursa

Bursa are fluid filled sacs that are found in areas that require the most protection. They occur where ligaments, muscles, skins, tendons or bones rub together.

 

Muscles

Many muscles cross the knee joint, some of which cross from the hip or ankle joints. Due to this, some people may experience knee pain as a result of muscle imbalances such as weakness, poor flexibility and or dynamic control.

 

CAUSE OF PAIN

Some of the common causes of knee pain include:

  • Ligamentous sprain
  • Meniscus injuries (bulge or tears)
  • Fracture or dislocation
  • Tendinitis, Sprains
  • Bursitis
  • Calcification
  • Baker’s cyst
  • Arthritis (osteoarthritis)
  • Overuse syndromes (patella-femoral syndrome, chondromalacia)
  • Autoimmune conditions (Infection, Gout, Lupus, rheumatoid arthritis)

 

WHEN TO SEEK HELP

Consult your doctor or physiotherapist if your symptoms have not subsided after one-week of consistent self-management (RICE, pain medications or alternative pain-relieving modalities), or if your knee pain is stopping you from managing your hobbies or day to day activities.

 

Immediate medical attention: 

Knee pain from with the following signs and symptoms may require immediate attention:

  • Severe pain
  • Pain that does not resolve with rest
  • Sudden swelling or bruising
  • Clicking or locking of the knee
  • Inability to bend or straighten the knee
  • Inability to weight bear

 

SIGNS AND SYMPTOMS

  • Pain
  • Swelling
  • Bruising
  • Stiffness
  • Clicking, locking
  • Redness

 

DIAGNOSIS:

Treatment of your knee pain will depend on its underlying cause. So, it is all about the diagnosis.

A focused subjective and physical examination of your knee will be performed by your physiotherapist.

 

Subjective

Your physiotherapist will ask a range of questions

  • Location of pain – front or behind the knee
  • Description of pain – dull ache or sharp
  • The behavior of pain – constant or intermittent
  • Aggravating and easing factors
  • General health
  • Goals of treatment

 

Physical assessment

Your physiotherapist will inspect your knee joint to diagnose the source and the potential underlying cause(s) of pain.

You may be referred to have radiological Imaging to make or confirm the diagnosis.

 

Radiology

Image result for xray knee

 

TREATMENT

In most cases, individuals suffering from knee pain respond well to conservative modes of treatment (pain relief, physiotherapy, acupuncture, etc). Surgical intervention may be required where conservative management has failed to optimize function and reduce pain.

 

CONSERVATIVE MANAGEMENT

A self-management remedy to control inflammation (pain and swelling) in acute or chronic knee pain is using the ‘RICE’ principle (rest, ice, compress, elevate)

  • Rest – refrain from activities that impose repetitive strain or aggravation of knee pain
  • Ice – use an ice pack for 10-15 minutes, 2 to 3 times per day (with care)
  • Compress – use a compression bandage to reduce swelling (not to be worn when sleeping)
  • Elevate – using pillows elevate injured leg. This works best when the leg is higher than the level of heart, to use gravity to help facilitate the circulation of fluid.

 

Pain medications

Over the counter pain relievers such as non-steroidal anti-inflammatory medications (ibuprofen, celecoxib) play an important role in reducing inflammation and pain.

(Note: If you have problems with bleeding, stomach ulcers or other liver, kidney conditions, anti-inflammatory medications MUST NOT be consumed without consulting your doctor. 

Visit your general practitioner for more information on what medications are right for you.

 

Physiotherapy

After establishing your diagnostic findings, your physiotherapist will devise a tailored recovery programme to help you manage your pain, improve strength and flexibility.

Your physiotherapist will work with you to advance your understanding of your symptoms and provide a range of exercises, stretches and self-managing strategies that will help you be in control of your recovery.

As required, your therapist may liaise with your doctor or other health professionals (acupuncturist, podiatrist, knee specialists) to facilitate your progress.

 

Acupuncture/Acupressure

Acupuncture and acupressure are two different options available for individuals suffering from pain and swelling. While both aim to help control inflammation and fasten healing and recovery, acupuncture involves inserting thin needles into the body, whereas acupressure relies on hand pressure and some forms of massage.

 

Steroid Injection

In some instances, knee injections are recommended by your physiotherapist or doctor to reduce inflammation and relieve pain.

 

SURGERY

Surgical intervention may be required where conservative management has failed to optimize function and reduce pain. In this case your physiotherapist will refer you to a surgeon for the opinion of care.

 

EXERCISES FOR KNEE PAIN

The thought of exercise when you have knee pain can be daunting. However, your trusted physiotherapist will work with you to provide specific ‘pain-free’ exercises to get you started on effective strengthening.

Image result for knee exercise cycling

Alternatively, low-impact activities such as cycling or elliptical machines are great. Notice what feels right for you. Swimming, jogging in water, or water aerobics may be appropriate if skin integrity is maintained.

Note: muscle soreness after a hard workout is normal. 

If you experience sharp, shooting, or sudden knee pain you must consult your physiotherapist or doctor.

SHIN SPLINTS NO MORE

Shin splints, medically known as medial tibial stress syndrome, is a collective term used to describe multiple conditions that cause shin pain. Therefore, it is important to establish that there is not one singular cause.

Image result for shin splints

More specifically there are two distinct types of shin splint:

Type 1:

A stress reaction occurs on the inside border of the tibia bone. A stress reaction is the stage preceding a stress fracture.

Type 2:

The inner shin bones outer surface known as the periosteum becomes irritated at the attachment sites of the Tibialis Posterior and Soleus muscles.

Symptoms: 

Shin splints is characterized by pain in the lower leg, on the front, outside or most commonly on the inside of the leg.

Image result for shin splint

The cause of this injury is thought to be due to repetitive overuse, being more common in long distance runners, dancers, and gym goers.

Did you know? 

Shin splints account for an estimated 10.7 percent of injuries in male runners and 16.8 percent of injuries in female runners. Aerobic dancers are among the worst affected and have shin splint rates of up to 22 percent (medicalnewstoday,2021)

What other factors may predispose me to shin splints?

  • A sudden increase in running distance, intensity or frequency.
  • Running on uneven terrain such as hills, concrete or uneven road.
  • Poor foot mechanics (an inability to pronate and supinate).
  • Poor footwear.
  • Weak hip muscles.
  • Poor ankle strength.
  • Short muscle length in calf or hamstrings (or too long).

Image result for running on uneven terrain 

Diagnosis

Your Physiotherapist can usually diagnose you based on a full history of your present condition, current symptoms, athletic activity and a physical examination. In some instances, further investigation may be required in the form of an x-ray or ultrasound.

Image result for physio diagnosis

Early stage rehab

If you have been diagnosed with shin splints and it is stopping you from doing what you love there is good news! Shin splints can be cured IF managed well. In the acute stages, the PRICE (Protection, Rest, Ice, Compression, Elevation) method is a good place to start. From there, one of our trusted Physiotherapists can help you on your way to full recovery.

Image result for rice method for shin splints

What may Physiotherapy look like for me?

You can be sure that with us, you are in good hands. Here are some ways our physiotherapist may choose to help you get back on track.

  • Gait & run analysis: To examine your running technique to see if there are any biomechanical causes.
  • Addressing lower limb muscle imbalances with muscle strengthening, coordination, stretching and mobility exercises.
  • Soft tissue massage to reduce pain, tension and improve blood circulation.
  • Application of tape to improve muscle function, reduce pain, swelling and fatigue.
  • Provision of an appropriate return to run program with incremental increase in frequency, intensity, and time.
  • Activity modification: balance of maintaining cardiovascular fitness without aggravating the shins.
  • A referral to our acupuncturist for treatments such as Periosteal acupuncturepecking: Tapping on the surface of the shin bone with acupuncture to stimulate healing.
  • A referral out to an podiatrist if the condition is foot related.

Image result for rehab for shin splints

References:

  1. medicalnewstoday.(2021)allyouneedtoknowaboutshinsplints. Available: https://www.medicalnewstoday.com/articles/best-running-shoes#product-list. Last accessed 16/02/2021.

5 COMMON MISCONCEPTIONS ABOUT PHYSIOTHERAPISTS – PART 2

Myth 1: When you see a physiotherapist you just lie on the bed and get given an ice or heat pack.

At Physio Fusion we use an active approach to treatments. Physiotherapy will include manual hands-on therapy to facilitate tissue healing and tissue load tolerance alongside an exercise program individualized to your needs.

Myth 2: If I have elbow pain then the injury must be in my elbow.

The area of pain is not always the area that is the issue! It may be a result of a previous injury that was never fully rehabilitated. This is where we can help you out. Our assessment will consist of gathering information on your presenting complaint, any previous injuries or traumas (physical and emotional) and a medical history followed by an objective evaluation of your body. This allows us to get to the root cause of the pain and manage your symptoms most effectively.

Myth 3: I can’t do any of my normal activities while I attend physiotherapy.

Not true! Our Physiotherapists want to keep you as functional as possible whilst allowing your injury to heal. During the initial assessment your physiotherapist will determine what activities you can do and advise you on those that must be avoided. You will then be given clear and timely objectives to ensure you reach your goals to get you back doing what you love!

Myth 4: A scan will show me exactly what is wrong.

Sometimes it will, but sometimes it won’t. It’s no secret that our bodies change as we age, so even people without pain are likely to have an imperfect scan. Medical imaging can sometimes play an important role in the assessment and management of your musculoskeletal issue. When necessary, your physiotherapist will know what type of imaging to refer you for.

Myth 5: Is cracking my back/neck/knuckles bad for me?

There is no strong evidence to suggest that ‘cracking’ your joints causes degeneration, laxity or instability. The ‘cracking’ occurs when we move a joint to its end range. The audible sound happens because of ‘cavitation’ in the joint; this involves gas bubbles popping within the fluid surrounding the joint as pressures change.

But is it good to crack?

Self manipulation can be a helpful way to reduce the feeling of stiffness or tightness. If you are finding that you need to ‘crack your joints’ often it is good to know that there are many other more beneficial ways to provide greater long term relief.

Top tips:

  1. Ask your physiotherapist to provide you with some specific exercises to help you overcome the feeling of stiffness or tightness.
  2. Move regularly and avoid movements or positions that exacerbate your symptoms until you have been seen by your physiotherapist.

5 COMMON MISCONCEPTIONS ABOUT PHYSIOTHERAPISTS- PART 1

Myth 1: ‘’Physiotherapy is just massage’’

This is a common phrase people use to describe a physiotherapists role. It is true that as a profession we like to work ‘hands on’. This is because our profession is directly affiliated with the anatomy of our clients and by using touch we can more accurately assess, locate and treat any dysfunctional motions within your body. Our physiotherapists like to use massage as it is a great way reduce pain and improve bodily function but their skill set is much more extensive than this.

Did you know?

There are well over 20 different treatment approaches commonly used by physiotherapists.  These may include, but are not limited to:

  • Exercise prescription.
  • Joint mobilization.
  • Joint manipulation.
  • Instrument mobilization.
  • Muscle energy techniques (improves muscle and joint function).
  • Neurodynamics (mobilization of the nervous system).
  • Taping.
  • Dry needling.
  • Acupuncture.

Myth 2: Always sit up straight! Slouching is bad.

In fact, forcing yourself to adhere to the traditional ‘good posture’ (back straight and shoulders back) may be putting unnecessary tension on your body. That isn’t to say being upright is bad either, but in life we must always find a balance. To reduce stress on your body whilst seated, ensure your back is supported and your feet firmly on the ground. To prevent and reduce the likelihood of back pain we must look to vary our posture frequently throughout the day and ensure we take short breaks to stretch, stand and walk.


Myth 3: Physiotherapy sessions are painful

Physiotherapists aim to help you reduce pain and get you back to doing what you love! Whether your injury is acute or chronic our physios always ensure they work within your pain threshold to help you regain lost movement and function.

Myth 4: I need a referral to see a Physiotherapist’

We have got you covered!

Remember, physios are registered health care professionals. Physio Fusion is a registered ACC provider. This means that if you have had a recent injury (within one year), you can see us directly and we can help you lodge an injury claim directly with ACC. You do not need a referral for your doctor.


Myth 5: Lower back pain …. surgery is my only option

Around 70-90% of the total world population will experience lower back pain during the course of a life time. Symptoms can range from mild to severe and can either last for short or long periods or remain constant. Back pain can be very debilitating and when the pain does not resolve as soon as anticipated many fear that surgery may be the only option. In few cases surgery may be necessary, but for the majority there’s often nothing to fear, and with time and a gradual loading or exercise program, you can make a full recovery.

Did you know ?

Back pain is not always a sign of injury or damage. Each individuals back pain story will be different, and for many non-physical factors play a huge part in their story. These factors can be:

Psychological –

  • Stress.
  • Fear of movement.
  • Depression.

Health related –

  • Sleep deprivation.
  • Physical inactivity.
  • Smoking (nicotine decreases blood flow to your back).
  • Overweight.

Physio Fusions top recommendations for keeping back pain away:

  • Keep active – regular exercise nourishes joints, strengthens muscles, increases blood flow and improves your mood.
  • Sleep well.
  • Maintain a healthy weight by ensuring you maintain proper nutrition and diet.
  • Sit in a chair with good lower back support.
  • Quit smoking.
  • Ensure that when you lift or pick up objects you do so in a safe manner. This is something one of our physiotherapists can guide you with.

See a doctor urgently if you have the following symptoms:

  • Numbness in the groin or buttocks.
  • Loss of bladder or bowel control.
  • Redness or swelling on your back.
  • Difficulty walking.
  • Constant pain, especially at night.
  • Pain that is getting much worse, or spreading up your spine.
  • Numbness or pins and needles in both legs.
  • Feeling unwell with your back pain, such as a fever or significant sweating that wakes you from sleep.