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By Physio Team Appointments & Fees, body parts, elbow pain, ergonomics, Exercises, golfers elbow, good posture, hand and wrist pain, Home exercises, Injury, ligaments, Lockdown, medial elbow pain, online consultations, pain management, physical health, Physio, posture, rehabilitation , , , , , , , , , , , , ,

Medial Elbow Pain Explained

Medial elbow pain is also known as medial epicondylitis or golfer’s elbow. It is typically associated with pain on the inside (medial side) of your elbow and can spread into your forearm and wrist. This pain is the result of overloading and damage to the tendons that flex your wrist towards your palm.

 

Causes

This condition is triggered by damage to tendons and muscles which control your fingers and wrist. This damage is associated with excessive or repeated stresses- particularly repetitive and forceful finger and wrist movements, incorrect lifting, hitting and throwing techniques, lack of warmups and/or poor muscle conditioning.

Key risk factors for developing medial elbow pain may include smoking, obesity, being of in age bracket of 40 years old and over and undertaking repetitive activity with your arms for at least two hours daily. High risk occupations may include chefs, office desk workers, plumbers, construction workers, painters, butchers and assembly line workers. Those who partake in sports such as golf, racket sports, rowing, weight lifting and baseball are also at a higher risk.

 

Symptoms

Symptoms may be triggered suddenly due to a traumatic incident or may gradually develop over time and include but are not limited to:

  • Tenderness and pain is typically felt on the inner side of your elbow (particularly on the bony knob), and may refer along the inner side of your forearm and down to your wrist and fingers. It often worsens with certain movements. For example, bending your wrist towards your palm against resistance, or when squeezing a rubber ball.
  • You may feel stiffness in your elbow, and making a fist may hurt
  • You may experience weakness in your forearm, wrist and hand
  • You may experience tingling and numbness that can radiate into one or more fingers — typically to your ring and little fingers.

Diagnosis

This condition is typically diagnosed based on your medical and occupation history and a physical exam by your doctor or physiotherapist. To evaluate stiffness, strength and pain, your clinician may apply pressure to the impacted region and get you to move your elbow, wrist and fingers in various ways. You may also be referred on for imaging such as X-rays and Ultrasounds to aid diagnosis.

Management

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

Potential treatment options include:

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

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

Prevention

Having a good comprehension of risk of injury and being conscious of your everyday activities may aid in the prevention of medial elbow pain. You should:

  • Adopt appropriate technique and form when undertaking repetitive activities or sporting motions
  • Keep up with adequate wrist, forearm, and shoulder muscle strength
  • Undertake gentle wrist and forearm stretches pre and post activities
  • Adopt appropriate posture and body mechanics when lifting heavy objects to reduce joint strain- especially if doing so repetitively
By Physio Team acute pain, Appointments & Fees, body parts, chronic pain, ergonomics, Exercises, good posture, hand and wrist pain, Home exercises, Injury, Lockdown, lockdown wellbeing, muscles, online consultations, pain, pain management, physical health, Physio, posture, rehabilitation, repetitive stress injury, RSI, sitting posture, Sprain, tendon, Therapy, wellbeing, Work Injury , , , , , , , , , , , , , , , , , , , , , , , , , ,

Repetitive Strain Injury (RSI) Explained

 

RSI is typically defined as an overuse disorder- a gradual build-up of overload to nerves, tendons, and muscles arising from repetitive movements or activities. Repetitive use of the same motions leads to inflammation and damage to these soft tissues. This disorder mostly affects the upper limb- particularly the elbows, hands and wrists.

 

Causes

Possible causes of RSI include but are not limited to:

  • Undertaking the same and repetitive movements and stressing the same muscle groups
  • Working in cold environments
  • Assuming a sustained and/or awkward posture for prolonged periods of time
  • Undertaking a particular activity for prolonged periods of time with no rest-breaks
  • Frequent and prolonged use of vibrating equipment
  • Adopting poor postures from working at inappropriately designed workstations
  • Undertaking a motion which involves carrying and/or lifting heavy items

 

 

Symptoms

RSI leads to a gradual development of a broad variety of symptoms, which range from mild to severe in severity. RSI particularly affects the muscles and joints of your wrists, hands, elbows, forearms, shoulders, neck. Having said this, RSI can affect other areas of the body as well.

Common symptoms may include:

  • Pain
  • Tingling
  • Cramping
  • Increased sensitivity to heat and cold
  • Tenderness
  • Fatigue
  • Loss of strength
  • Throbbing
  • Soreness
  • Achiness
  • Stiffness
  • Struggling with typical activities of daily living, such as gripping and twisting motions, carrying light weights, writing, kitchen prepping, dressing, personal cares etc

You may develop these symptoms when you undertake a task repetitively for a period of time, and can settle when you stop. Symptoms may settle over a few hours or over the course of a few days. However, if left untreated or is poorly managed, a minor RSI may gradually progress to a nasty chronic injury.

 

Diagnosis

 

If you experience mild discomfort whilst completing particular activities at home or at your job, it is a good idea to see your GP or physiotherapist to talk about RSI. But an RSI is not always simple to diagnose as there is no particular clinical test for it. Your GP will enquire about your medical history, occupation and work environment, and other activities to attempt to identify any repetitive motions you undertake that may be the cause of your symptoms. A physical examination will be undertaken, where they will assess your movement, check for pain, inflammation, sensation, tenderness, strength and reflexes in the impacted body part. RSI may be triggered by specific health disorders like bursitis, carpal tunnel, tigger finger, ganglion cyst, or tendonitis (inflammation in your tendons). Your GP can refer you on further diagnostic tests such as X-rays, Ultrasounds, blood tests, MRIs, nerve conduction tests etc, to determine if these underlying disorders may be the cause of your symptoms. You may be also be referred onto a physiotherapist and acupuncturist for conservative treatment and management for mild-moderate issues. If symptoms persist, you will then be referred onto a specialist.

 

Management

Initial treatment options for the management of RSI symptoms is conservative. This includes:

  • Rest, Ice, Compression, and Elevation (RICE principles)
  • Taking regular breaks between tasks and looking after your posture
  • Undertaking your activities and movements with appropriate form and posture
  • Intake of Nonsteroidal anti-inflammatory drugs (NSAIDs), both oral and topical as prescribed by the GP
  • Use of cold and heat to the impacted area
  • Administration of steroid injections into inflamed joints and tendons
  • Tailored exercise prescription from physiotherapists to correct posture and strengthen and stretch affected muscles
  • Acupuncture
  • Stress reduction and relaxation training
  • Use of splints and braces to help protect and rest the affected muscles and tendons

Ergonomically appropriate adjustments to your workstation and work environment may be recommended by your physio and GP- for example resetting your desk and chair if you’re working at computer, and alterations to your equipment and activities/motions to lessen the strain and stress on your muscles and joints. Surgery may be necessary in some cases.

 

Prevention

Minimizing repetitive actions particularly if they involve the use of heavy machinery or vibration. Improving your working posture and work-environment as well a taking regular breaks. Employers often undertake risk-assessments when you join a company to determine that the work area is ergonomically fit, comfortable and appropriate for you. You may be able to request for an assessment if you have not had one or are having issues with your work environment

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

Osteoporosis

 

Osteoporosis is a condition which results in weak and brittle bones- to such degree that a fall or even mild stresses like coughing or bending over may result in a fracture. Bones are living tissues which are continually being broken down and replaced. However, your bones become osteoporotic when the formation of new bone does not keep up with the loss of old bone. This condition typically develops over time without any pain or other major symptoms, and is generally not diagnosed until you have sustained a fracture. The hip, pelvis, upper arm, spine and wrists are the most common structures affected by osteoporosis- related fractures.

 

 

How do you know if you have Osteoporosis?

 

Because there are no obvious early warning signs and symptoms, it is difficult to pre-diagnose osteoporosis. You may be unaware that you have this condition perhaps till you have one of the following:

  • Sustained a fracture from an incident more easily than you should have- like a simple fall or a bump
  • A decrease in the height of your spinal vertebrae over time
  • Change in posture – stooping or bending forwards
  • Back pain, due to a fractured or collapsed vertebra

Please see your doctor if you experience the following:

  • If you are over the age of 50 and have sustained a fracture
  • Sustained a spine, wrist, or hip for the first time
  • Sustained a fracture more easily than you should have (a simple fall or after a slight bump)

 

Risk factors

Key factors which may increase your risk of developing osteoporosis include:

  • Females- particularly post-menopausal Caucasian and Asian women
  • Over the age of 50
  • Excessive consumption of caffeine or alcohol
  • Smoking
  • Having a smaller or petite body frame
  • Poor physical activity levels and leading a very sedentary lifestyle
  • Family history of osteoporosis
  • Having low levels of vitamin D and poor dietary calcium intake
  • Decreasing levels of testosterone with ageing in men
  • Estrogen deficiency in women (irregular periods, early (before turning 40) or post-menopausal, surgical removal of the ovaries)
  • Use of long-term medication such as thyroid and epilepsy medications, corticosteroids
  • Having medical conditions such as gastrointestinal diseases; endocrine diseases; rheumatoid arthritis; cancer; and blood disorders

 

 

How will you be diagnosed?

Your doctor will review your signs and symptoms, family and medical history. You may be referred on for a specialized X-ray or CT scan to evaluate the bone density to help diagnose osteoporosis. Your bone density will be classified by comparing it to the typical bone density for a person of equivalent gender, size, and age.

 

 

How is Osteoporosis treated?

The treatment pathway chosen for the management of this condition is dependent on results of your bone density scan, gender, age, medical history and severity of the condition. Potential treatments for osteoporosis may include exercise, making positive lifestyle changes, vitamin and mineral supplements, and medications. Please consult your doctor for appropriate advice and treatment options.

 

 

How can Physiotherapy help?

 

Your physiotherapist will help you strengthen your bones and your muscles through a personalized and graduated rehabilitation program. Components of this rehabilitation program may include weightbearing aerobic exercises, resistance training using free weights/resistance bands/bodyweight resistance, and exercises to enhance posture, balance and body strength. Your physiotherapist will work with you to find activities that suit your needs and as per your physical activity level.

 

 

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

Managing your Medial Knee Pain: MCL injuries

What is it?

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

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

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

 

 

Mechanism of Injury

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

 

 

Grading of MCL Injuries

MCL injuries are often graded using the system below:

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

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

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

 

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

 

 

Signs and Symptoms

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

Common symptoms of an MCL injury may include:

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

 

 

Diagnosis

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

 

Management

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

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

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

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

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

MANAGING FALLS IN OLDER ADULTS

Having a fall is dangerous at any age, however, they become more frequent and may most probably result in injury in adults 55 years and over. It is also estimated that in Aotearoa, approximately a third of older adults over the age of 65 sustain a fall every year. This leads to harmful consequences for them, especially for those who live alone. Alongside, sustaining serious injuries, you may face loss of independence, mobility and confidence. But!!! The good news is that there are a number of ways that you can reduce your risk of falling.

 

So Why Do Older Adults Have Falls?

  • Poor lower limb strength
  • Cognitive and functional impairment
  • Nutritional deficiencies
  • Prior and/or ongoing history of falls
  • Vision deficits
  • Balance or gait disorders
  • Medication related- especially when using anti-depressants, sedatives, anti-arrhythmics, anti-hypertensives, diuretics, and anti-convulsants
  • Hazards around your home environment such as loose carpets, slippery surfaces, poor lighting, lack of safety equipment particularly in the bathroom/toilet
  • Medical conditions such as vertigo, dizziness, diabetes, postural hypotension, drop attacks, and fainting spells

 

The Vicious Falls Cycle

Older adults who have had a fall may limit what they do because of their loss of self-confidence and fear of falling. Whilst this may seem like the most sensible thing for them to do, it increases their risk of falls. This is because, this leads to a further reduction in muscle strength, coordination and balance. Hence, it is healthier for older adults to keep up with their activities they enjoy as safely as they can, work on improving their muscle strength, coordination and balance, and manage their blood sugar levels, blood pressure, and weight under the guidance of their doctor.

 

 

Falls prevention tips

 

Below are some measures you may take to prevent yourself from falling:

Exercise regularly: A number of benefits include better sleep, improved muscle strength, balance and flexibility, increased energy levels, stronger bones, better management of weight, blood sugars and blood pressure. Exercise programs tailored especially for muscle strength and balance have resulted in a reduction in the number of falls and injuries resulting from falls by approximately 30% and 50%. It is advised that you speak to your doctor or physiotherapist before initiating or progressing your exercise levels.

Keeping your vision in check: Vision deficits makes getting around safely a lot harder. Therefore, you should get your eyes checked yearly and wear your contact lenses or glasses with the correct prescription strength.

Being aware of the effects of your medication: As they may have certain side effects that increase your risk of falls. You should review your medications with your doctor for side effects like drowsiness or dizziness.

Reduce hazards at home: Most falls typically take place at home. So be sure to make your home safer by removing tripping hazards, having adequate lighting, and adding in handrails in hallways and bathrooms/toilets.

Other tips:

  • Taking your time to get up and when moving around- no rushing!
  • Having a personal medical alarm (please talk to your doctor about how to get one)
  • Using a night light when you get up at night
  • Wearing appropriate, supportive and well-fitted shoes
  • Not using an easily moveable object to stabilise yourself
  • Using the support of handrails in bathrooms and hallways
  • Avoiding or being very careful on wet or slippery floors
  • Appropriately using your walking aids

 

If You Have Had a Fall

If you sustain a fall, it is vital for you to stay calm.

If you think you are able to get up safely, try to bend your knees, roll to your side, and attempt to get into a 4-point kneeling position. If there is a chair near by or if you are able to crawl towards one, you can use it as support to get yourself up. Please take your time and rest as needed.

If you are unable to get up safely, attempt to crawl or roll towards a phone. You may call out to other members in your household or your neighbour. If you’re at risk of falls, please do consider the use of a personal medical alarm to call out for help when you have a fall.

After a fall, please contact your doctor as soon as you can for an assessment of potential injuries sustained, muscle strength and balance to help prevent future falls. You may be directed to community or in-home sessions to enhance your balance and strength. Please discuss this with your doctors.

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

Dealing with Rheumatoid Arthritis

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

 

 

Signs and Symptoms

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

Other symptoms may include

 

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

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

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

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

 

 

Causes and Risk Factors

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

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

Risk factors for the development of RA include:

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

 

 

 

Diagnosis

 

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

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

 

 

Management

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

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

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

Dealing with De Quervain’s

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

Symptoms

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

Other key symptoms include:

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

Causes

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

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

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

Diagnosis

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

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

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

Management

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

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

Managing Your Osteoarthritis

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

 

Causes and Risk factors

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

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

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

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

 

Common symptoms

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

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

 

How will I be diagnosed?

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

 

Management

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

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

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

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

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

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

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

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

By Physio Team Appointments & Fees, body parts, Exercises, Home exercises, Lockdown, muscles, online consultations, Physio, rehabilitation, Sporting, Working from home , , , , , , , , , , ,

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

 

By Physio Team achilles, acute pain, Appointments & Fees, body parts, chronic pain, Exercises, feet, heel pain, Home exercises, Injury, Lockdown, lockdown wellbeing, muscles, online consultations, orthotics, pain, pain management, physical health, Physio, rehabilitation, Sporting, Sprain, tendon, Therapy , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

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