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
Osteoarthritis impacts millions of people worldwide and is typically known as the most common form of arthritis. It is associated with the wear and tear of the protective cartilage which cushions the ends of your bones in your joints over time. Though this condition may cause damage to any joint in the body, osteoarthritis primarily impacts the joints in your spine, hands, hips, and knees.
Causes and Risk factors
Over time, the gradual deterioration of the cartilage which cushions the ends of your bones in your joints causes arthritis. Cartilage is a solid slippery tissue which allows almost frictionless joint movement. As the cartilage wears down, bone will eventually rub on bone.
This condition is typically characterized as a wear and tear degenerative disorder. However, in addition to the breakdown of the cartilage, it also impacts the joint as a whole. Osteoarthritis triggers alterations in the bone and damages connective tissue which holds the joint together and attaches your muscles to your bones. Inflammation of the lining of the joint is also triggered.
Factors which may put you at higher risk of developing osteoarthritis include but are not limited to:
Your age- the risk increases with getting older
Gender- though unclear why, but women are more perceptible to developing osteoarthritis
Bony deformities- those with abnormal joints or defective cartilage
Sustaining bony or joint injuries like those which take place during sport or from an accident.
The risk increases with obesity- the more you weigh, the greater your risk, as it adds more stress to your weight-bearing joints (particularly hips and knees)
Your occupation or a sport that you play which puts repetitive and excessive stress/loading on the joints, can eventually lead to the development of osteoarthritis.
Certain co-morbidities such as diabetes
Common symptoms
Below are some common examples of symptoms you may experience with arthritis. These may develop and worsen gradually over time
Pain: Your joints may hurt before and/or after undertaking an activity
Loss of joint range of motion– loss of overall joint flexibility and movement
Tenderness felt on applying light pressure to the joint
Joint stiffness that is most noticeable on waking up first thing in the morning or after a prolonged period of inactivity
Noticeable changes in joint pain with changes in the weather- particularly colder weathers
Sensations of grating and grinding// sounds of clicking and popping (crepitus) when you use the joint
You may notice swelling and redness around the joint, which may be triggered by soft tissue inflammation
Bony spurs that feel like hard bumps may develop around the impacted joint
How will I be diagnosed?
Osteoarthritis is typically diagnosed based on your medical and occupation history and a physical examination undertaken by your doctor. During the physical examination, your doctor will assess your affected joint(s) for swelling, tenderness, redness, and stiffness. X-rays may be recommended to reveal cartilage loss (the narrowing of the space between the bones of your joints), changes in bone, and bony spurs around the joint. Blood tests may be used to rule out other causes of joint pains like rheumatoid arthritis. Joint fluid analyses may also be used to test for inflammation to ascertain if the pain is triggered by an infection or gout instead of osteoarthritis.
Management
Though there isn’t a cure for osteoarthritis, various treatments which can help relieve symptoms of pain and disability are available.
Lifestyle modifications: Changes to your daily life may protect your joints and slow the progression of osteoarthritis. Minimising activities which exacerbate your symptoms such as climbing stairs, squatting. Swapping high-impact activities like running and jogging to lower-impact activities such as cycling or hydrotherapy will decrease the stress on your joints. Weight-loss reduces the stress and loading on your joints, which then results in less pain with increased function.
Assistive aids: Using assistive aids like a stick/cane, wearing proper shoes w orthotics and supportive braces/sleeves may improve your stability and support your functional capabilities.
Physiotherapy: Targeted exercises may help improve your flexibility as well as build strength in your muscles. Your physiotherapist will develop a personalised active rehabilitation program which is safe and will meet your requirements and lifestyles.
Medications: Various kinds of medication (such as paracetamol and NSAIDs) maybe helpful in treating and controlling the symptoms of osteoarthritis. As everyone responds differently to medications, your doctor will prescribe medicines (type and dosage), which is safe and will work best for you.
Cortisones: Strong anti-inflammatory agents which is injected into the affected joint to give pain relieve and decrease inflammation for a short period of time. Due to potential side-effects, it may be recommended to restrict the number of injections to 2-3 per year.
Other: Heat and ice applications, self-massaging with pain-relieving creams/ointments and/or wearing elastic supports may provide some relief from your pain and give you support.
Surgery: Surgery may be recommended if there is considerable degeneration in your joints and/or if your osteoarthritic pain causes disability that is not relieved with conservative management. Your doctor or specialist will discuss your options with you.
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.
Tennis elbow, or also known as lateral epicondylitis, is a painful disorder of the elbow triggered by overuse. This disorder is characterised by inflammation or, in some cases, micro-tearing of the extensor tendons which link the forearm muscles on the outer part of the elbow. This leads to pain and tenderness on the outside of the elbow, spreading through to the forearm and wrist.
Causes
Tennis elbow is characterized as an overuse and muscle strain injury. It is caused by repetitive and/or vigorous contractions of the forearm muscles which is used to straighten, extend, and lift the wrist and hand. The repetitive motions and stress to the tissues can result in a string of tiny, microscopic tears in the tendons which attach your forearm muscles to the bony prominence on the outside of the elbow.
Tennis elbow may result from number of activities including but not limited to:
Typing and repetitive computer mouse use
Cutting/chopping motions
Manual work that involves repetitive turning or lifting of the wrist, such as plumbing, or bricklaying.
Gardening
Using hand tools such as scissors, clippers, screwdrivers, plumbing and carpentry tools
Playing racquet sports, such as tennis, badminton, or squash
Throwing sports, such as the javelin or discus
Painting
Sewing/knitting
Tennis elbow may also occur after a sudden knock or bang to the elbow, if you undertake activities that you are not used to excessively and aggressively, and sometimes there is no apparent cause for it.
Risk Factors
Factors which may increase your risk of tennis elbow include:
Your age: Whilst this disorder impacts people of all ages, it is mostly prevalent in adults in the age group of 30-50 years old.
Your occupation: Those who have jobs which entail repetitive movements of the wrist and arm are more likely to develop this disorder. Examples include but are not limited to painters, computer users, plumbers, butchers, carpenters, and chefs.
Sports: Partaking in racket sports increases the risk of tennis elbow, particularly if you use poor form and technique.
Common Signs and Symptoms
Pain noted around the bony knob on the outside of your elbow is the most common characterising symptom of tennis elbow. This knob is where the injured tendons connect to the bone. The pain is often depicted as “burning” in nature. Your elbow may be tender and sore to touch, and the pain can refer down to the forearm. The pain often increases with gripping, grasping, or rotating motions of the wrist and forearm. Bending and straightening your elbow may also be painful.
The severity of your pain may vary from a mild discomfort to severe pain that can interfere with your sleep and day to day activities. The pain typically starts gradually and then worsens over weeks or months.
Diagnosis
During your physical examination your physiotherapist will attempt to produce your pain in your elbow via specific tests and movements. They will assess your range of motion in your elbow, wrist, and shoulder joints. Referrals for X-rays and ultrasound scanning may be indicated to further support your diagnosis and to rule out other potential sources of your pain
Management
A mix of non-surgical treatment options are effective for the majority of tennis elbow cases, and self-resolves over time. You should rest your elbow and painful activities should be avoided. But it is very vital to maintain gentle movements of the forearm, elbow, and wrist through its range of motion.
Potential treatment options include:
Ice
Rest
Physiotherapy and acupuncture
Anti-inflammatory medications as recommended by your doctor or pharmacist
The use of a wrist and forearm brace or splint to support and rest your forearm
As your initial elbow pain lessens, your muscles around the elbow, forearm and wrist should be safely strengthened and stretched under guidance of a physiotherapist. Your physiotherapist will advise you on particular exercises, give you appropriate symptom management advice and take you through a personalised graduated rehabilitation program. If you continue to experience pain after 6-8 weeks of treatment, your physiotherapist can refer you back to your doctors, to consider administration of a cortisone injection into the elbow to help reduce pain and inflammation, and further referral onto see a specialist to seek guidance on other treatment options.
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.
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
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
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 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
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 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
An ergonomically correct workstation has all the best practices to help maintain a healthy posture and improve your health and productivity.
Here are a few helpful tips;
1. Set up your screen
Adjust the monitor height so that the top of the screen is at—or slightly below—eye level. Your eyes should look slightly downward when viewing the middle of the screen. Position the monitor at least 20 inches (51 cm) from your eyes—about an arm’s length distance. If you have a larger screen, add more viewing distance.
2. Set up your chair
Height – You should be able to sit with your feet flat on the floor and your thighs roughly parallel to the floor. If you require a taller chair in order to reach the floor you can use a foot rest to ensure you achieve the right angle.
Backrest Recline and Tilt – Research has shown that a reclined seat (at least 135 degrees back) significantly reduces the pressure on your back, and is particularity beneficial for people with back
Lumbar support – the shape of the backrest should have a natural curve to support your lower back.
Arm rests – Look for armrests that are not just height adjustable and support the entire length of the forearms.
3. Adjust your Desk Height
Your legs should fit comfortably under the desk if you are sitting with your feet flat on the floor: you should have enough space to cross your legs.
The angle between your forearm and upper arm should be between 90 degrees and 110 degrees while your arms are at rest on the desk.
Make your desk organized using storage accessories i.e. Document holders
Use an ergonomic mouse pad; to keep your wrists supported.
4. Organizing your Desk space
Organize all the items on the workstation according to their priorities and assign them to the proper ergonomic reach zones.
Primary Zone: High use items, easiest access
Secondary Zone :Medium use items, comfortable reach
Third Zone: Low use items, reduction in efficiency
MOVEMENT IS KEY
Its a simple action step, but mighty! Get up out of your chair and take frequent posture breaks!
When we sit in one position for hours without moving, our performance slowly starts to deteriorate, our body slows down, static loading takes over our muscles and we actually get fatigued even when we aren’t putting in any physical effort. However, when you consciously integrate these microbreaks into your day, you’re giving your body a much-needed refresher and an opportunity to wake up your muscles and replenish blood flow. Research has shown that movement can also help with creativity, or get you ‘unstuck’ so you can approach your work with a different or fresh perspective and energy.
If you think your desk set up could be better, or want us to have a quick look we can do this via a video call. Book in for an appointment www.physiofusion.co.nz or give us a call on (09) 626 6186
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.
