In the foot, pronation should occur naturally when we are fully weightbearing on the front leg. Pronation will appear as the foot rolling inward and the arch flattening.
What are the benefits?
Dissipates the force that the foot receives from the ground.
Allows the foot to become a stable and mobile adaptor to enhance movement opportunity throughout the body.
Loads the muscles of the extensor chain (calf, quads, glutes) to convert ground reaction forces into forward momentum so we can move efficiently and without compensation.
So why have I been told this is bad?
So as you are now aware, pronation is very normal and a critical movement to ensure we move and propel ourselves forward efficiently.
What you may have heard someone say to you is that you ‘overpronate’?
Firstly, overpronation is subjective and not as black and white as it is sometimes made out to be. Overpronation has been defined as: ‘a foot that rolls inward towards the medial (inner) arch excessively’.
What we must understand is that a pronation can only happen when the foot has a stable tripod on the ground. This means that the calcaneus (heel bone), 1st metatarsal (big toe knuckle) and 5th metatarsal (little toe knuckle) must all remain in contact with the ground when the foot rolls inwards and the arch flattens.
So, If you have been told you are ‘overpronated’ , it is most likely that your whole foot is ‘everting’ NOT ‘overpronating’.
What is Eversion?
Eversion can be defined as: ‘the process of turning inside-out’.
In pronation your heel must naturally ‘evert’ (sole of the heel will move away from the midline of the body) NOT your whole foot.
If your ‘whole foot’ everts (turns out) you will no longer have a stable foot tripod as the 5th metatarsal (little toe) will lose contact with the ground.
The key to ensuring this does not happen is to provide an environment for the bones of the midfoot (middle of the foot) and forefoot (toes) to experience the opposite motion to that of the heel. This will mean that the foot has an opportunity to truly pronate with a three points of contact on the ground.
So how can you help me do that?
At Physio fusion we can help guide you to bring your own body into alignment and create an environment in which the healing can begin.
Foot strengthening exercises.
Footwear advice.
Referral to other healthcare specialists for further assistance (e.g. podiatrists).
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
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.
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.
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
Have you been experiencing pain, pins and needles or numbness in your wrist and hands, especially after using the keyboard, chopping up a few veges, reading a book, using your mobile phone or with driving?
If you answered yes – then you are most likely to have Carpal tunnel syndrome.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is the most common condition in the arm. It is caused by compression of one of the three major nerves in the forearm – the median nerve, which travels through the wrist into the hand and fingers. Entrapment of the median nerve usually due to inflammation, occurs in the wrist commonly resulting in tingling of the wrist and hand (in some cases forearm), numbness, pain and weakness of the hand.
Signs and Symptoms
Often unrelated to a specific incident or an injury, symptoms of carpal tunnel syndrome usually develop gradually overtime. Symptoms may be worse in the morning and night. Many people find that the frequency and duration of symptoms increase as the conditions worsen.
Signs and symptoms may include:
Tingling, numbness or burning sensation of the thumb, index, middle and ¾ of ring fingers of the hand
Electric shock like radiating pain through the hand into thumb, index, middle and ¾ of ring finger
Weakened grip, loss of dexterity and fine movements such as picking up a hair pin, buttoning clothes.
Hypersensitivity or in other cases lessened sensation of hand to pressure, heat or cold temperatures
Swollen wrist
Let’s take a closer look at the anatomy!
As its name suggests – a group of small bones aka carpal bones form a tunnel like passageway in the wrist (palmar view). This unique architectural design allows for the tendons of the forearm muscles and the all-important median nerve to pass through the narrow tunnel through the wrist and into the hand and fingers, supplying sensation and motor function.
Causes
Common causes and risk factors that increase the likelihood of carpal tunnel syndrome include:
Repetitive wrist & hands movements – during work related tasks or leisure activities may irritate the tendons in the wrist, resulting in inflammation that irritates the nerve.
Wrist or hand injury – recurring sprains, swelling and reduced wrist movements reduces the space in the carpal tunnel
Pregnancy and menopause – hormonal changes can increase fluid retention in body increasing pressure in the carpal tunnel compressing the median nerve
Genetic history – petite
Medical conditions (rheumatoid arthritis, diabetes, hyperthyroidism)
Interesting facts about carpal tunnel syndrome
Women are 3 times more susceptible to develop carpal tunnel syndrome than men. This can be due to hormonal changes during pregnancy or menopause and also because women tend to have smaller carpal tunnels.
Not all fingers are affected. Median nerve supplies movement and sensation in the thumb, all fingers except the little finger.
Computers/keyboard are not the only reasons to blame – repetitive nature of any work related or leisure word increases risk of developing carpal tunnel syndrome
Diagnosis
Carpal tunnel syndrome is fairly easily diagnosed by your physiotherapy, doctor or a hand therapist.
Your health practitioner will gather information on your general health, history and nature of your symptoms. They will then carefully conduct a thorough clinical assessment to assess the movements of your hand and wrist, strength and use a collection of tests in effort diagnose your symptoms. In some cases, your therapist may examine your neck, shoulders and arms to rule out other potential causes.
You may often hear the physiotherapist or hand therapist mention that they want to conduct a functional assessment – A functional assessment is activity specific, where the therapist will watch you perform the activity that aggravates your symptoms the fastest. For example, if using a keyboard is generally when you feel your symptoms start – the therapist may observe you performing the very task to examine your overall posture.
Referral to scans or nerve conduction tests may be arranged by your doctor or therapist depending on the severity or complexity of your symptoms.
Scans
Referral to scans or nerve conduction tests may be arranged by your doctor or therapist depending on the severity or complexity of your symptoms.
Xray – provides key information on bone health, when dealing with a potential injury, or arthritis
Ultrasound – can examine potential soft tissue injury or inflammation compressing the median nerve
MRI – this advanced imaging provides in depth review of your wrist and hand. Usually arranged by your doctor or a specialist
Nerve conduction study – studies the electrical activity of the median nerve. This test will help you doctor examine the severity of your problem.
Treatment
In most cases, carpal tunnel syndrome will progressively worsen overtime. So, the key is early intervention!
Conservative management
Mild symptoms can be easily managed with a conservative approach.
Wearing splints or braces – keeps your wrist straight to prevent repetitive use of hands, thus reducing pressure or inflammation in the carpal tunnel.
Non-steroidal anti-inflammatory medications – such as celecoxib and ibuprofen as prescribed by your doctor may decompress the median nerve by reducing the inflammation in your body and wrist.
Activity modification: your physiotherapist will play an important role in providing you with advice around to modifying your activities to reduce your symptoms. They will also prescribe you with effective stretches and exercises to help manage your symptoms while safely aiding your recovery.
Steroid injections: your physiotherapist or doctor may recommend a ‘cortisone’, also known as a ‘corticosteroid’ injection to control your symptoms. It contains an anti-inflammatory substance that is injected into your carpal tunnel. The effects of the steroid injection may be temporary and can vary person to person depending on many factors (cause of symptoms, stage of your condition).
In mild to moderate cases, the effects of injection may last between 3-6months.
Surgical intervention
If non-surgical approaches have failed to relieve your symptoms, surgery may be required.
By this stage you would have consulted an orthopaedic surgeon. Your surgeon will thoroughly examine your overall health, symptoms, results from the scans and the nerve conduction study to help you decide on the best treatment approach.
If you decide to undergo surgery – the surgical procedure your surgeon will perform is called ‘carpal tunnel release’.
Recovery and outcomes
After your surgery you may be given a splint or a brace for a period of time specified by your surgeon. While in the splint or brace you will be encouraged to move your fingers to prevent stiffness and swelling.
Expect to experience minor pain, stiffness and swelling for a couple of weeks to months after your surgery. Pain medications provided by your surgeon must be taken as prescribed.
You may be encouraged to see your physiotherapist, who will work closely with your surgeon to help meet post-operative outcomes.
You will have regular 6-8 weekly follow ups with your surgeon as required to assess your healing and discuss gradual return to light activities and return to work.
If you have underlying medical conditions such as arthritis, except that your recovery may be slower than otherwise expected. It is important that you follow post-operative protocols your surgeon, doctor and physiotherapist recommend.
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
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:
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
Lean forward with one arm hanging freely. Use your unaffected arm to brace against a chair for support.
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.
Slowly return to a standing position.
Repeat 4-5 times a day
Shoulder pulley (Flexion)
Put a chair against the door and sit so you are facing away from the door.
Grasp the door pulley handles with both hands.
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.
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)
Put a chair against the door and sit so you are facing away from the door.
Using door pulleys slowly pull down with your unaffected arm so that your affected arm raises up and to the side without effort.
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
Stand upright and hold a stick in both hands
Cup the top end of stick with affected hand
Using your unaffected arm hold the stick midway and drive the affected arm forward and up.
Ensure your elbow is straight throughout
Hold for 5 seconds and return to the starting position.
Repeat 10 times.
Wand Abduction
Stand upright and hold a stick in both hands
Cup the top end of stick with affected hand
Using your unaffected arm hold the stick midway and drive the affected to the side as high as able.
Ensure your elbow is straight throughout.
Hold for 5 seconds and return to the starting position.
Repeat 10 times.
Strengthening exercises with band
Flexion
Stand on one end of the band while holding the other end with your affected side.
Whilst keeping your elbow straight, lift the band up to 90 degrees to shoulder level.
Hold at the top for 1-2 seconds then lower slowly to starting position.
Attach the resistance band to a secure anchor at belly button height.
Stand with unaffected arm perpendicular to the anchor.
Place a towel between your elbow and your torso to stabilize your elbow
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.
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.
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.
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.
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.
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.
In the foot, pronation should occur naturally when the foot comes into contact with the ground. Pronation will appear as the foot rolling inward and the arch flattening.
What are the benefits?
Dissipates the force that the foot receives from the ground
Allows the foot to become a stable and mobile adaptor to enhance movement opportunity
Loads the muscles of the extensor chain (calf, quads, glutes) to convert ground reaction forces into forward momentum so we can propel efficiently.
So why have I been told this is bad?
So as you are now aware, pronation is very normal and a critical movement to ensure we move and propel ourselves forward efficiently.
What you may have heard someone say to you is that you ‘overpronate’?
Firstly, overpronation is subjective and not as black and white as it is sometimes made out to be. Overpronation has be defined as: ‘a foot that rolls inward toward the arch excessively’.
What we must understand is that a pronation can only happen when the foot has a stable tripod on the ground. This means that the calcaneus (heel bone), 1st metatarsal (big toe knuckle), 5th metatarsal (little toe knuckle) must all remain in contact when the foot rolls inwards and the arch flattens.
So, If you have been told you are ‘overpronated’ , it is most likely that your whole foot is ‘everting’ NOT ‘overpronating’.
What is Eversion?
Eversion can be defined as: ‘the process of turning inside-out’.
In pronation your heel must naturally ‘evert’ (sole of the heel will move away from the midline of the body) NOT your whole foot.
If your ‘whole foot’ everts (turns out) you will no longer have a stable foot tripod as the 5th metatarsal (little toe) will lose contact with the ground.
The key to ensuring this does not happen is to provide an environment for the bones of the midfoot (middle of the foot) and forefoot (toes) to experience the opposite motion to that of the heel. This will mean that the foot has an opportunity to truly pronate with a tripod on the ground.
So how can you help me do that?
At Physio fusion we can help you to bring your own body into alignment and create an environment in which the healing can begin
Foot strengthening exercises
Footwear advice
Referral to other healthcare specialists for further assistance (e.g. podiatrists)
To find your nearest Physio Fusion clinic and book an appointment call 09 6266186 or visit our websitehttps://physiofusion.co.nz
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 websitehttps://physiofusion.co.nz
