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Your first step to recovery

Managing Your Osteoarthritis

Osteoarthritis impacts millions of people worldwide and is typically known as the most common form of arthritis. It is associated with the wear and tear of the protective cartilage which cushions the ends of your bones in your joints over time. Though this condition may cause damage to any joint in the body, osteoarthritis primarily impacts the joints in your spine, hands, hips, and knees.

 

Causes and Risk factors

Over time, the gradual deterioration of the cartilage which cushions the ends of your bones in your joints causes arthritis. Cartilage is a solid slippery tissue which allows almost frictionless joint movement. As the cartilage wears down, bone will eventually rub on bone.

This condition is typically characterized as a wear and tear degenerative disorder. However, in addition to the breakdown of the cartilage, it also impacts the joint as a whole. Osteoarthritis triggers alterations in the bone and damages connective tissue which holds the joint together and attaches your muscles to your bones. Inflammation of the lining of the joint is also triggered.

Factors which may put you at higher risk of developing osteoarthritis include but are not limited to:

  • Your age- the risk increases with getting older
  • Gender- though unclear why, but women are more perceptible to developing osteoarthritis
  • Bony deformities- those with abnormal joints or defective cartilage
  • Sustaining bony or joint injuries like those which take place during sport or from an accident.
  • The risk increases with obesity- the more you weigh, the greater your risk, as it adds more stress to your weight-bearing joints (particularly hips and knees)
  • Your occupation or a sport that you play which puts repetitive and excessive stress/loading on the joints, can eventually lead to the development of osteoarthritis.
  • Certain co-morbidities such as diabetes

 

Common symptoms

Below are some common examples of symptoms you may experience with arthritis. These may develop and worsen gradually over time

  • Pain: Your joints may hurt before and/or after undertaking an activity
  • Loss of joint range of motion– loss of overall joint flexibility and movement
  • Tenderness felt on applying light pressure to the joint
  • Joint stiffness that is most noticeable on waking up first thing in the morning or after a prolonged period of inactivity
  • Noticeable changes in joint pain with changes in the weather- particularly colder weathers
  • Sensations of grating and grinding// sounds of clicking and popping (crepitus) when you use the joint
  • You may notice swelling and redness around the joint, which may be triggered by soft tissue inflammation
  • Bony spurs that feel like hard bumps may develop around the impacted joint

 

How will I be diagnosed?

Osteoarthritis is typically diagnosed based on your medical and occupation history and a physical examination undertaken by your doctor. During the physical examination, your doctor will assess your affected joint(s) for swelling, tenderness, redness, and stiffness. X-rays may be recommended to reveal cartilage loss (the narrowing of the space between the bones of your joints), changes in bone, and bony spurs around the joint. Blood tests may be used to rule out other causes of joint pains like rheumatoid arthritis. Joint fluid analyses may also be used to test for inflammation to ascertain if the pain is triggered by an infection or gout instead of osteoarthritis.

 

Management

Though there isn’t a cure for osteoarthritis, various treatments which can help relieve symptoms of pain and disability are available.

Lifestyle modifications: Changes to your daily life may protect your joints and slow the progression of osteoarthritis.  Minimising activities which exacerbate your symptoms such as climbing stairs, squatting. Swapping high-impact activities like running and jogging to lower-impact activities such as cycling or hydrotherapy will decrease the stress on your joints. Weight-loss reduces the stress and loading on your joints, which then results in less pain with increased function.

Assistive aids: Using assistive aids like a stick/cane, wearing proper shoes w orthotics and supportive braces/sleeves may improve your stability and support your functional capabilities.

Physiotherapy: Targeted exercises may help improve your flexibility as well as build strength in your muscles. Your physiotherapist will develop a personalised active rehabilitation program which is safe and will meet your requirements and lifestyles.

Medications: Various kinds of medication (such as paracetamol and NSAIDs) maybe helpful in treating and controlling the symptoms of osteoarthritis. As everyone responds differently to medications, your doctor will prescribe medicines (type and dosage), which is safe and will work best for you.

Cortisones: Strong anti-inflammatory agents which is injected into the affected joint to give pain relieve and decrease inflammation for a short period of time. Due to potential side-effects, it may be recommended to restrict the number of injections to 2-3 per year.

Other: Heat and ice applications, self-massaging with pain-relieving creams/ointments and/or wearing elastic supports may provide some relief from your pain and give you support.

Surgery: Surgery may be recommended if there is considerable degeneration in your joints and/or if your osteoarthritic pain causes disability that is not relieved with conservative management. Your doctor or specialist will discuss your options with you.

Tennis Elbow Explained

What is Tennis Elbow?

Tennis elbow, or also known as lateral epicondylitis, is a painful disorder of the elbow triggered by overuse. This disorder is characterised by inflammation or, in some cases, micro-tearing of the extensor tendons which link the forearm muscles on the outer part of the elbow. This leads to pain and tenderness on the outside of the elbow, spreading through to the forearm and wrist.

Elbow Pain - Do I have Tennis Elbow? - Oh My Arthritis

Causes

Tennis elbow is characterized as an overuse and muscle strain injury. It is caused by repetitive and/or vigorous contractions of the forearm muscles which is used to straighten, extend, and lift the wrist and hand. The repetitive motions and stress to the tissues can result in a string of tiny, microscopic tears in the tendons which attach your forearm muscles to the bony prominence on the outside of the elbow.

Tennis elbow may result from number of activities including but not limited to:

  • Typing and repetitive computer mouse use
  • Cutting/chopping motions
  • Manual work that involves repetitive turning or lifting of the wrist, such as plumbing, or bricklaying.
  • Gardening
  • Using hand tools such as scissors, clippers, screwdrivers, plumbing and carpentry tools
  • Playing racquet sports, such as tennis, badminton, or squash
  • Throwing sports, such as the javelin or discus
  • Painting
  • Sewing/knitting

Tennis elbow may also occur after a sudden knock or bang to the elbow, if you undertake activities that you are not used to excessively and aggressively, and sometimes there is no apparent cause for it.

Risk Factors

Factors which may increase your risk of tennis elbow include:

Your age: Whilst this disorder impacts people of all ages, it is mostly prevalent in adults in the age group of 30-50 years old.

Your occupation: Those who have jobs which entail repetitive movements of the wrist and arm are more likely to develop this disorder. Examples include but are not limited to painters, computer users, plumbers, butchers, carpenters, and chefs.

Sports: Partaking in racket sports increases the risk of tennis elbow, particularly if you use poor form and technique.

Common Signs and Symptoms

Tennis Elbow - Symptoms, Causes, Treatment & Exercises

Pain noted around the bony knob on the outside of your elbow is the most common characterising symptom of tennis elbow. This knob is where the injured tendons connect to the bone. The pain is often depicted as “burning” in nature. Your elbow may be tender and sore to touch, and the pain can refer down to the forearm. The pain often increases with gripping, grasping, or rotating motions of the wrist and forearm. Bending and straightening your elbow may also be painful.

The severity of your pain may vary from a mild discomfort to severe pain that can interfere with your sleep and day to day activities. The pain typically starts gradually and then worsens over weeks or months.

Diagnosis

During your physical examination your physiotherapist will attempt to produce your pain in your elbow via specific tests and movements. They will assess your range of motion in your elbow, wrist, and shoulder joints. Referrals for X-rays and ultrasound scanning may be indicated to further support your diagnosis and to rule out other potential sources of your pain

Management

A mix of non-surgical treatment options are effective for the majority of tennis elbow cases, and self-resolves over time. You should rest your elbow and painful activities should be avoided. But it is very vital to maintain gentle movements of the forearm, elbow, and wrist through its range of motion.

Potential treatment options include:

  • Ice
  • Rest
  • Physiotherapy and acupuncture
  • Anti-inflammatory medications as recommended by your doctor or pharmacist
  • The use of a wrist and forearm brace or splint to support and rest your forearm

As your initial elbow pain lessens, your muscles around the elbow, forearm and wrist should be safely strengthened and stretched under guidance of a physiotherapist. Your physiotherapist will advise you on particular exercises, give you appropriate symptom management advice and take you through a personalised graduated rehabilitation program. If you continue to experience pain after 6-8 weeks of treatment, your physiotherapist can refer you back to your doctors, to consider administration of a cortisone injection into the elbow to help reduce pain and inflammation, and further referral onto see a specialist to seek guidance on other treatment options.

Helpful Exercises

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.

Meet Your Body Parts!

Here are definitions of common terms for body parts you may hear your doctor or physio use!

 

Ligaments

Ligaments are cordlike extensions that serve to connect ends of two bones to form a joint. They are made up of strong, durable, slightly elastic bandlike structures comprised of collagen fibres. The structural make up of ligaments is advantageous providing joint stability by limiting excessive movement.

What are Ligaments? (with pictures)

Tendons

Similar to ligaments, tendons contain densely packed bundles of tough collagen fibres that hold muscles together to the bone. They are located at the ends of every muscle in the human body. Bound together in tight sheaths they are made to withstand tension and transmit forces exerted by the muscle to the bone to cause movement.

 

10 Facts About Tendons | Physio Direct - Rural Physio at Your Doorstep

Muscles

Human body is made up of over 600 muscles categorised into three different types – cardiac, smooth and skeletal muscle.

  • Cardiac muscle – is only found in the walls of the heart. Its contractions help propel blood through the blood vessels to all part of the body.
  • Smooth muscle – is found mainly in the lining of internal organs (except the heart) including digestive and uninary tract organs, blood vessels. Smooth muscle works to transport substances through the organs by alternately contracting and relaxing.
  • Skeletal muscles – Skeletal muscles are the most abundant type of muscles that form the flesh of the body. They are attached to bones of the skeleton by tendons. They are responsible for voluntary movements of body. Facial expression, mobility, postural control and breathing are some of the movements we observe when skeletal muscles are subjected to voluntary control.

 

Muscle types — Science Learning Hub

Bones

Skeletal system of the human body is made up of 206 bones. Bones are most involved in providing an architectural framework by providing body shape, support and protection of vital organs and for locomotion. Besides these functions, bone is a reservoir for mineral and fats as a source of stored energy and formation of blood cells. Bones are classified by their shape as long, short, flat and irregular. They are connected by ligaments to form joints.

Let's learn about bones | Science News for Students

Cartilage

There are three different types of cartilage found in the human body – hyaline, elastic and fibrocartilage. Hyaline cartilage is the most common cartilage in the human body. It covers the ends of most bones at movable joints, connects ribs to the breastbone, forms the voice-box and nasal passages. It  consists of high water content that provides resilience to withstand great compressive forces found predominantly in joints.

 

What Is Cartilage?

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

Pressure on the Spine in Different Posture

Did You Know?

 

Low back pain is a common health problem which affects up to 80% of the population at some stage in their life.

 

In New Zealand ACC spends in excess of $130 million a year treating back pain related injuries.

Most back pain occurs between the ages of 25 and 60, and most typically in the 40s.

 

 

 

In an era of smart devices, posture has never been more important or harder to achieve. As technology continues to grow, sitting at a desk on a computer or on our phones is becoming more prevalent at work. Having a sedentary desk job can result in sitting for around 8 hours a day. This position actually increases the load on your spine more than standing. Spinal pressure “sits” around 140mm pressure. This pressure usually does not hurt the back right away however, builds up over time and can even change the structure structure of your spine. So, if you slouch then spinal pressure increases to 190mm; add some weight and you’ve put 275 pounds of pressure on your spine.

 

A compromised spine constricts your blood vessels and nerves, causing problems with your muscles, discs, and joints. And all of these problems can lead to headaches, fatigue, and even breathing problems. Your back is a delicate machine. When one part falls out of alignment, it can affect everything setting off a domino effect and wreak havoc throughout your back and body.

 

 


Below is a graph showing different postures and the pressure it exerts on the spine;


But, remember: While you may feel comfortable and supported in your chair and find a perfect sitting posture, staying in the same position for long periods is not healthy for your spine. Varying your postures by occasionally standing and moving around for at least a few minutes each half hour will help keep your spinal joints, muscles, tendons, and ligaments loose and pain free.

 

Stand Up for Your Spine

If you don’t have a sit-stand desk, you can still combat “sitting disease” and protect your spine. Consider these tips:

  • Do some work standing at a high table or counter.

  • Use a lumbar roll behind your back when sitting to improve seated posture

  • Set a timer on your computer for a stand-and-stretch break every 30 minutes.

  • Exercise to assist in improving body weight to lessen additional load on the spine

  • Strengthen the core to provide additional support

The focus is simple: Reduce your sitting throughout the day. But, remember that varying postures is best for your back and neck, so do not go the opposite extreme and never sit. Alternating sitting, standing and movement throughout your day is the best way you can keep your spine safe and body healthy—at work and beyond

 

Still having back pain?

Schedule an initial assessment with one of our Physiotherapists so they can determine the root of the problem.  During this assessment your physiotherapist will be able to decide whether your pain is a source of nerve root irritation, discogenic, postural related, or musculoskeletal.  After arriving with the consensus of the problem, we will be able to use many techniques to relieve the back pain.  These include: manual therapy, therapeutic exercise, and postural recommendations.

 

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

Do you experience Cervicogenic Headaches?

What on Earth is a cervicogenic headache??

Headaches happen for lots of reason and can be cause by several sources- both primary and secondary. Once major “red flags” are ruled out, understanding the type of headache is important in order to have it properly addressed.

A cervicogenic headache is a secondary headache arising from a musculoskeletal dysfunction within the cervical spine, and is a disorder that many physiotherapists treat. The main players that are typically involved in generating the pain are the joints, discs, ligaments, nerves and/or muscles found in the upper portion of the neck.

Characteristics of a Cervicogenic Headache:

:sparkles: Pain usually one sided or one side dominant

:sparkles: Pain originates from the back of the neck and radiates along the forehead, orbits around the eye, temple area and ear.

:sparkles: Steady ache or dull, diffuse pain that travels into shoulder region

:sparkles: Limited neck movement especially when turning head

:sparkles: Tenderness to touch at the muscles at the base of the head.

Here are some exercises that would help alleviate your pain:

  1. Cervical side flexion with chin tuck

  • Sit upright in a chair.
    With your shoulders relaxed, relax one arm to your side.
    Drop your opposite ear to your shoulder until a stretch is felt.
    Using your fingers, tuck your chin in, as to resemble a double chin.
    Gently release pressure with your fingers and hold this position.
    Relax and repeat

2. Levator stretch Neck stretch – levator scapula

  • Start in a seated position.
    Place the hand of the side you want to stretch down by your side.
    Tilt your head forwards and to the opposite side at an angle, as if you are trying to
    look at your armpit.
    Keeping your back straight and upright, continue to tilt your head down until you
    feel a stretch from the base of your skull down into your shoulder blade.

3. Neck stretching (Upper trapezius)

 

  • Stand up straight.
    Take the hand on the symptomatic side and place it behind your back.
    Take your other hand and place it on your head.
    Tilt your ear directly down towards your shoulder and hold this position.
    You should feel a stretch down the side of your neck.

If you believe you experience Cervicogenic Headaches get in touch with us https://physiofusion.co.nz/ for an in-depth assessment and lets knock out those headaches and decrease you dependence on pain meds

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

 

What is your Rotator Cuff and What does it do?

 

You may have seen videos or posts online about people talking about a specific area of your shoulder known commonly as the “Rotator Cuff” and wondered what they were on about. Your shoulders do a lot of important things you might take for granted! They help you get something off a high shelf, comb your hair, or play a game of cricket.

It’s a complicated process that your body makes look easy. And your rotator cuff is a big part of that. It protects and stabilizes your shoulder joint and lets you move your arms over your head. It’s importance is widely used in sports like swimming, tennis and netball.

In New Zealand healthcare, shoulder injuries have one of the highest prevalence when it comes to ACC claims and overall cost. Within this, rotator cuff injuries are among the most common pathologies affecting New Zealanders. Other pathologies include acromioclavicular injuries, dislocations, osteoarthritis and frozen shoulder.

 

So, what exactly is the cuff and how does it influence the shoulder?

  • The rotator cuff (RC) is a combination of four muscles that run through and attach onto specific areas of the humeral head (top of the arm bone).

  • Supraspinatus, Infraspinatus, Teres minor and Subscapularis are the four muscles comprising the RC and each one plays an important role however they all contribute to shoulder stability:

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

A thin triangular muscle that helps perform abduction

A thicker, triangular muscle that performs external rotation.

The smallest muscle of the cuff, helps with rotation as well

The largest muscle of the cuff performs internal rotation (arm behind your back!)

 

 

Many people suffer from shoulder pain, so here are the most common injuries that can happen at the rotator cuff:

Rotator Cuff Tear:

A rotator cuff tear is often the result of high levels of load over a short amount of time or a high impact force stressing one or more of the tendons/muscles. Fortunately, majority of tears are partial. Tears are more common in people with jobs that involve heavy loading or lifting or in high impact sports like rugby. It also can happen suddenly if you fall on your arm or try to lift something heavy. Common and easily treatable with conservative management by a physiotherapist, a rotator cuff tear can come right.

Rotator Cuff Tendinopathy:

A rotator cuff tendinopathy is the most common shoulder pain complaint/injury resulting in inflammation and irritation of one or more of the cuff tendons. This pathology is more common in individuals who have an occupation where repetitive use of the shoulder, particularly in an overhead position such as carpenters or painters, or individuals that play highly repetitive, throwing sports like tennis, baseball or volleyball. Once again, this injury is treatable by a physiotherapist, conservative management can be very effective in treating these injuries with a thorough, well planned exercise program to help get patients back to doing what they love.

Majority of people experience pain around the shoulder joint, with some movements being highly provocative. Tenderness on touch at the affected site is also common – this helps your physiotherapist hone in on potentially which tendon is causing those problems!

 

Medical management vs Physio management

 

Medical management will be advised by your local GP if you decide to see them first. They might prescribe NSAIDs (anti-inflammatory medications such as ibuprofen) to help with the pain you’re experiencing and recommend you see a physiotherapist. Depending on your injury as well as your ability to function, surgery may be an option if conservative medical and physio treatments don’t help. Most people get by without the need of surgery but some tears can be too large to heal without the use of surgical intervention.

Physiotherapy management is designed around reducing pain and disability, restoring range of motion and helping people return to work or sports to perform how they were prior to the injury. In the early stages of these injuries, rest and ice and/or heat are recommended to allow the inflammation to settle – then your physiotherapist will begin to introduce a detailed exercise program, this may include:

  • Isometric (static hold) exercises
  • Resisted movements using bands
  • Range of motion exercises to restore lost movement
  • Functional loading – task specific or sport specific

If this is successful, the last step is to build back up the strength that was lost over time – this is done by concentrically (against gravity) loading the affected tendons/muscles in a way that they adapt and lay down more tissue, grow and becoming stronger in hopes that you get to return to what you enjoy!

 

 

Lifting Mechanics

IS IT DANGEROUS TO LIFT WITH A BENT BACK?

One common belief about lifting is that rounding your back when lifting an object is considered dangerous while lifting with a straight back is considered safe…

 

 

However, there is a lot of misinformation circulating around lifting mechanics and what is deemed “good technique” versus “bad technique.”

Here are some key myths and misinformation that you may have heard:

 

A ROUNDED BACK WHILE LIFTING OVER STRESSES THE BACK MUSCLES AND LIGAMENTS

  • Research has shown that regardless of lifting position, whether you’re stooped, squatting or weightlifting, your back has to produce the same amount of force. Statistically speaking, it’s not significantly different.

 

 

FLEXING THE SPINE WHILE LIFTING INCREASES THE LOAD ON THE LUMBAR DISCS

  • Under heavy loads, discs are unlikely to fail unless >95% flexion is achieved (which is near impossible)

  • With low loads, the disc is unlikely to fail unless you do thousands of repetitions continuously

  • Your body is an amazing adapter, this includes discs! Your discs can adapt and become more and more able to handle loads when stressed appropriately

 

THESE COMPOUND TO CAUSE INJURIES AND PAIN TO THE BACK MUSCLES AND DISCS

  • Resistance training has demonstrated through countless studies the ability to increase bone mineral density (BMD) of the lumbar spine. BMD is actually positively associated with the strength of the spinal discs and ligaments at that level. With appropriate loading and training, disc, ligament, bone and muscles are going to adapt favourably

 

A NEUTRAL SPINE IS SAFER, STRONGER, MORE EFFICIENT AND BETTER TO LIFT WITH

  • There is no significant difference between activities that encourage more spinal flexion and one’s that do not in the long term

  • Lifting with lumbar flexion is not a risk factor for low back pain

  • Research has shown lifting with a bent back is more metabolically and neuromuscularly efficient

  • When the spine is in extension during bent over activities, the hip is actually flexed to a greater degree – decreasing the ability for the glutes and hamstrings to create as much internal torque. Flexing the spine reduces this effect and reduces the moment arm for the hip extensors

 

STOP BACK PAIN & INJURIES BY LIFTING WITH A NEUTRAL SPINE

  • Your lumbar spine flexes every time your hip flexes! It is impossible to isolate one versus the other. It is also impossible to not flex while doing common movements

  • Extreme flexion however (>/=100%), may pose an increased risk under heavy loads, but not at light loads

 

You may still be wondering why you have back pain (stay tuned for our next blog!). Your pain may not be directly related to your lifting strategy.

 

 

Could you have pain with forward bending? Absolutely.

Is bending at the lumbar spine an increased risk for pain or injury? In the vast majority of situations, no.

If I have pain with forward bending, is it bad to temporarily limit doing so? Not at all.

Should I fear bending at the spine with or without pain or injury? No. Being fearful of flexing/moving your spine is actually a stronger predictor of disability and back pain.

 

Work on moving through your spine, after all it’s what it is designed to do! Choose comfortable movements and gain confidence over time, then build up your strength gradually with resistance training – try and not to push too fast, we want nice, healthy adaptation! Give your body time to adapt, back pain is not quick fix sometimes but you are resilient and with healthy, normal movements and some patience, you will be okay.