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Your first step to recovery

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.

Meet Your Body Parts!

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

 

Ligaments

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

What are Ligaments? (with pictures)

Tendons

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

 

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

Muscles

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

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

 

Muscle types — Science Learning Hub

Bones

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

Let's learn about bones | Science News for Students

Cartilage

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

 

What Is Cartilage?

Ankle injuries – Your first step to recovery

Common? Oh Yes!

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

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

 

The road to recovery

Planning for Resiliency and the Road to Recovery

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

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

 

Investigations

Ankle x-rays

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

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

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

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

 

What to look out for

Ankle sprains:

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

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

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

Ankle - Wikipedia

 

Ankle Fractures:

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

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

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

Fractures generally take longer to recover compared to sprains.

 

What treatment to expect

Foot and Ankle Doctor | EmergeOrtho—Triangle Region

Acute phase:

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

Analgesia and anti – inflammatory medication may also be used.

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

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

 

Rehabilitation phase:

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

Strengthening will continue and running will start soon.

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

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

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

 

What can you do on the day of the injury?

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

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

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

Elevate the leg.

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

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

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

 

Remember, your injury will heal and you will recover!

 

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

We Want You To Understand Your Pain

What is pain?

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

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

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

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

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

This is our bodies way of protecting us

So what is happening in our brain?

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

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

Long term pain or Chronic pain

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

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

 

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

 

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

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

Management of chronic pain:

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

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

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

Medication:

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

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

Occupational Therapy:

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

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

Physiotherapy:

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

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

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

  • Movement gradually suppresses the pain system.

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

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

Self Help:

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

  • The Pain ToolKit

The myth about foot pronation (flat foot)

Myth: Foot pronation(flat foot) is the enemy.

Quest - Article - Surgery Sometimes, Bracing Often, Caution Always |  Muscular Dystrophy Association

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’.

Foot Pronation: Underpronation & overpronation explained- The Foot Clinic

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.

The Foot Tripod - Fix Flat Feet

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 website https://physiofusion.co.nz

Pressure on the Spine in Different Posture

Did You Know?

 

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

 

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

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

 

 

 

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

 

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

 

 


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


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

 

Stand Up for Your Spine

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

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

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

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

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

  • Strengthen the core to provide additional support

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

 

Still having back pain?

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

 

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

Exercises you can do during lockdown

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

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

 

How much exercise is enough?

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

This is a quick full body routine:

Bodyweight Squats

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

Arm dips

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

 

Lunges

Stand straight with your arms to the side or on your hips. Take a large step forwards on your affected leg, then drop your hips directly down between both feet, bending your hips and knees to a 90 degrees. Push back up to the starting position, and repeat. Make sure you take a large enough step that your front knee does not travel over your foot, and ensure your knee travels directly forwards. Keep your body up straight throughout the movement.

 

Mountain Climbers

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

 

What is your Rotator Cuff and What does it do?

 

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

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

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

 

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

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

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

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

A thin triangular muscle that helps perform abduction

A thicker, triangular muscle that performs external rotation.

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

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

 

 

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

Rotator Cuff Tear:

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

Rotator Cuff Tendinopathy:

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

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

 

Medical management vs Physio management

 

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

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

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

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

 

 

Lifting Mechanics

IS IT DANGEROUS TO LIFT WITH A BENT BACK?

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

 

 

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

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

 

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

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

 

 

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

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

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

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

 

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

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

 

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

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

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

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

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

 

STOP BACK PAIN & INJURIES BY LIFTING WITH A NEUTRAL SPINE

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

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

 

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

 

 

Could you have pain with forward bending? Absolutely.

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

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

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

 

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