Get Garden Fit
As the seasons change, so does our garden. Whether we enjoy doing it or not, there comes a time where it must be tackled. Therefore, stresses on the whole body are inevitable.
Rehab After Surgery- Let’s get you moving!
Sometimes surgery may be necessary to enhance your health and it can be stressful, both physically and emotionally. Our highly skilled physiotherapists will endeavor to actively work with your surgeon and yourself to make sure you are getting the best possible treatment towards regaining optimal function, movement, and strength both before and/or after surgery.
Elective Pre-Surgery Physiotherapy
Research has clearly illustrated the advantages of physiotherapy before elective orthopedic surgeries. We recommend pre-surgery physiotherapy to enable an enhanced healing and recovery process. Following a comprehensive assessment, you will be given a pre-surgery exercise program to keep up your strength, movement, and function, in addition to preparing you for your post-surgery programme.
Post-Surgery Physiotherapy
Physiotherapy after orthopedic surgery is essential for optimal recovery. Our skilled physiotherapists are experts at providing rehabilitation for patients after surgery and will undertake a comprehensive assessment after your surgery, which will involve ongoing evaluation of your function, mobility, and strength. As per the different stages of healing, your goals and progress, your physiotherapist will prescribe a personalized rehabilitation program. We will continue to keep close contact with your specialist as needed for the duration of your treatment.
Common surgeries requiring post-operative physio
Many surgeries, particularly those resulting from sporting injury, require physiotherapy treatment during the recovery phase.
These include, but are not limited to:
- Knee reconstructions
- Hip replacements
- Shoulder surgery
- Ankle, wrist, elbow operations
- Spine, neck and back surgery
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
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
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.
Piriformis Syndrome
Piriformis syndrome refers to the dysfunction of the piriformis muscle which irritates the sciatic nerve. It is characterized by deep buttock region pain that radiates down leg and foot often accompanied by pins and needles and numbness traveling along the path of the sciatic nerve.
The simplistic reason for this widely distributed pain comes down to the piriformis muscle itself – Their close proximity means that direct trauma to the buttock region or the supporting structures can result in inflammation and muscle dysfunction which can compress and irritate the sciatic resulting in referred symptoms.
Piriformis syndrome symptoms may include:
- Localised deep buttock region pain
- Pain with continuous sitting or standing for 15 mins or over
- Pins and needles along the leg down to the outer foot
- Numbness in outer leg or foot (often resolves on movements)
- Deep squatting or bending
- Pain on direct palpation
Anatomy
The piriformis muscle originates from the outer surface of a large fused bone of our pelvis called the sacrum. It travels adjacently and inserts into the top of the hip joint. The piriformis muscle is a very active muscle involved in stabilizing the hip and pelvis during majority of our activities (walking, running, standing, sitting or standing, turning in bed). When the piriformis muscle contracts it helps the hip rotate outwards (external rotation) and lift thigh out and up (abduct).
The sciatic nerve originates from where the very base of the spine and the sacrum join known as the lumbosacral region (lower back and saddle region). In this region five separate branches of nerves travel outside of the bony openings of the spine called the nerve roots and connect into a single large nerve – the sciatic nerve. It then travels through the pelvis deep into the buttock region close proximity the piriformis and gluteal muscles. In some individuals the piriformis muscles can travel through the piriformis muscle subjecting them to piriformis syndrome.
Diagnosis
There are no specific tests to diagnose piriformis syndrome. Diagnosis of piriformis syndrome is made by the report of symptoms and by physical exam using a variety of movements to elicit pain to the piriformis muscle. In some cases, a contracted or tender piriformis muscle can be found on physical exam.
In cases where there is underlying pathology (such as disc injury, arthritis, sacroiliac dysfunction or hip injury) resulting in true sciatica – piriformis syndrome may develop to become an additional muscular dysfunction that is required to be addressed. Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.
Consultation with a physiotherapist in this case is highly recommended as they will perform a comprehensive clinical examination to identify the root cause of your symptoms.
Exercises for piriformis syndrome
Corrective exercises with a combination of strength and flexibility regimen is an essential way to treat true piriformis syndrome (without involvement of other underlying pathologies).
The exercises outlined below follow a phase-by-phase progressive regimen to strength key muscles of the hip, buttock and legs.
As you work through these exercises expect to feel some pain during and after your exercise. Pain you may feel during the exercise is an expected sign of muscle activity. Pain you may feel after the exercises is an expected sign of muscle healing and recovery. However, if you are unable to participate in the exercises due to symptom deterioration – it is highly recommended you consult your physiotherapist to rule out other potential causes.
Otherwise, to help you gauge the correct amount of pain you should expect during exercise – use this scale. The ideal range should be 2 to 5. If your baseline pain is over 6 or 7 – it is recommended that you consult your doctor for pain relief appropriate to manage your pain, followed by a consult with a physiotherapist. Your physiotherapist will be able to modify the following exercises or prescribe alternative exercises best suited based on your current level of function and symptoms.
Symptom noting – is a great way to keep track of your progress and symptom behaviour.
- Take a diary
- Note down pain before you begin the exercise.
- Note down the pain rating after each exercise.
- Note down pain at the end of the day
- Repeat the pain recording process for the next 4-5 days
- Examine the trend in your symptoms.
Interference with everyday tasks – Your participation or level of exertion with everyday activities may interfere with your symptoms impacting your exercise tolerance. It is therefore important to note any of these interferences’ contributory to your pain.
Phase 1 – is a beginner stage.
This phase is intended for gently priming muscle activation. It will demand your concentration on technique and compliance to change the possible compensation your body has been used to as a result of pain. This phase can last between 1-2 weeks.
Instructions:
3 sets of 10 repetitions. Hold each repetition for 8-10 seconds. Rest 10-15 seconds between sets, 30 seconds between exercises. Do this exercise 1-2 times per day.
Bridges
Lie on your back.
Bend both knees and place your feet flat on the bed.
Lift your buttocks from the bed.
Place your buttocks back on the bed.
Repeat this exercise and remember to continue to breathe properly.
Clam shells
Lie on your side with your feet, ankles and knees together.
Bend the legs a little and tighten your core stability muscles.
Keeping the feet together, lift the top knee up.
Make sure you don’t roll your body back with the movement.
Control the movement as you bring the knee back down to the starting position.
Phase 2 – intermediate stage
The intermediate phase is similar to the beginner stage with the difference of using changing elements of progression to challenge the muscles capacity further. In this stage you may choose to progress the exercises by choosing to change ONE factor:
- Increase repetitions
- Increase hold time
- Increase sets
- Add appropriate resistance
Instructions:
- 3 sets of 10-15 repetitions. Hold each repetition for 10-15 seconds.
- Rest 10-15 seconds between sets, 30 seconds between exercises.
- Do this exercise 1-2 times per day.
Bridges with resistance
Tie a resistance band around both thighs, just above your knees.
Lie on your back with your knees bent and legs hips width apart.
There should be tension in the band.
Raise your hips up into a bridge, keeping the knees hips width apart.
Control the movement back down to the start position, maintaining constant tension on the band.
Clams with resistance
Lie on your side and place a band above your knees, approximately an inch or two above the knee joint.
Bend your legs a little, keeping the feet in line with your back.
Use your core stability muscles to keep the body stable.
Keeping your feet together, lift the top knee up against the resistance of the band.
Ensure you stay on your side and do not roll your hips and your body back with the movement.
Lower the knee back down, controlling the resistance.
Phase 3 – advance stage
Body weight squats
Start position is standing straight with the arms out in front and bent at the elbows, the fists should be clenched and the palms facing inwards.
Move downwards into a squat position so that the knees are aligned over the toes and the heels are in contact with the floor, make sure the back is straight.
Keep the head and chest upright and the gaze horizontal.
Hold for 2 seconds and return to the start position.
Lunges
Stand straight with your arms to the side or on your hips.
Take a large step forwards on your affected leg, then drop your hips directly down between both feet, bending your hips and knees to a 90 degrees.
Push back up to the starting position, and repeat.
Make sure you take a large enough step that your front knee does not travel over your foot, and ensure your knee travels directly forwards.
Keep your body up straight throughout the movement.
Crab walks
Place a band around your ankles and gather some tension.
Side-step keeping constant tension on the band.
Make sure you do not bring your feet too close together and keep your toes and knees pointing forwards.
Phase 4 – return to activities
Stretching
Do you always need to stretch the muscle? The answer is NO. While stretching is an important tool to improve muscle elasticity. You may not always need to stretch a muscle if it is NOT tight. Thus, stretching is recommended to be limited to areas you feel are TIGHT when you perform a given movement. Check the affected side and unaffected side – don’t need to stretch a muscle that doesn’t need to be stretched.
Seated piriformis stretch
Start in a seated position.
Cross the symptomatic leg your ankle is resting on, to the opposite knee.
Apply gentle pressure to the knee as you lean forward, increasing the depth of the stretch.
Hold this position, you should feel a comfortable tension with no pain.
Pigeon stretch
Start on your hands and knees.
Cross the symptomatic leg underneath you, then lower your hips down to the ground.
Rest your body forwards on your arms.
You should feel a stretch across the buttock.
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.
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.
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
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