Physio | LiveWell Health

What is Tennis Elbow?

Posted on August 4, 2024

What is Tennis Elbow?

Tennis elbow, officially termed lateral epicondylitis, affects more than just athletes. This prevalent condition involves pain and inflammation in the tendons that link the forearm muscles to the outer part of the elbow.

Repetitive actions such as gripping, twisting, and lifting can often cause this ailment. Activities like going to your local gym, painting, carpentry, and even typing may trigger these motions, leading to small tears in the tendons. Consequently, this results in inflammation and discomfort on the elbow’s exterior, which can intensify with continued use. Symptoms may also include forearm weakness, reduced grip strength, elbow stiffness, and pain extending down the arm.

What is tennis elbow

To diagnose tennis elbow, a physical examination is typically performed alongside a review of your medical history and activities. Imaging tests might be used to exclude other potential conditions but in the main a sports therapist, physiotherapist or doctor can accurately diagnose this condition.

Treatment aims to alleviate pain, reduce inflammation, and facilitate healing. This can involve rest, ice application, specific physical therapy exercises, bracing, over-the-counter pain relievers, or sometimes corticosteroid injections. In general we see huge improvements in the condition through a well strategised and dianamic recoveyr and rehabilitation regime.

Preventing tennis elbow is crucial, particularly if your job or hobbies involves repetitive arm movements. It is important to warm up before engaging in such activities, maintain proper form, take regular breaks, strengthen forearm muscles, and use ergonomic tools when necessary.

If you think you might have tennis elbow, it’s important to consult a healthcare provider for a precise diagnosis and tailored treatment plan. With prompt intervention and appropriate care, you can effectively manage the condition and resume your regular activities. If you would like to read more about the condition, we have written an article that goes into much more detail which can be found here.

Alternatively if you would like to book one of our sports therapists or physiotherapists to conduct a thorough in person review, treatment and then provide you with the exercises to rehabilitate this condition then please either make a booking through our online booking system or contact us directly.

Nerve Impingement

Posted on July 1, 2024

Nerve impingement, also known as nerve compression or pinched nerve, is a condition in which a nerve is compressed or constricted, leading to pain, weakness, numbness, or tingling sensations in the affected area. This can occur in various parts of the body, including the neck, back, arms, and legs.
The pathology of nerve impingement involves pressure or constriction on the nerve, which can be caused by a variety of factors, such as injury, repetitive motions, poor posture, or degenerative conditions like arthritis. This pressure can lead to irritation and inflammation of the nerve, which can cause pain and other symptoms.
The occurrence of nerve impingement is quite common, especially as people age and degenerative changes occur in the spine. It can also be seen in people who perform repetitive motions or maintain poor posture for extended periods of time. Additionally, nerve impingement can result from injuries, such as whiplash or a herniated disc, or from conditions such as carpal tunnel syndrome or sciatica.

Anatomy

The human nervous system is comprised of a complex network of nerves that run throughout the body, transmitting signals between the brain and various tissues and organs. Nerves are made up of axons, which carry electrical signals, and are surrounded by a layer of protective tissue called myelin. Nerves can be affected by a variety of factors, including compression, entrapment, inflammation, and injury.

Symptoms

The symptoms of nerve impingement can vary depending on the location and severity of the impingement. Common symptoms may include pain, numbness, tingling, burning, or a feeling of pins and needles. In severe cases, nerve impingement can lead to muscle weakness, loss of sensation, and difficulty with movement.

Causes

Nerve impingement can be caused by a variety of factors, including physical trauma, repetitive motions, poor posture, and underlying medical conditions such as arthritis, diabetes, and nerve disorders. Other common causes of nerve impingement include spinal stenosis, herniated discs, and degenerative conditions such as spinal cord injuries.

People who are at a higher risk of developing nerve impingement include:

Individuals with certain medical conditions such as diabetes, arthritis, or other conditions that can cause nerve damage or inflammation.
Athletes and physically active individuals who engage in repetitive motions, such as running, cycling, or weightlifting, which can put stress on the nerves.
People who have a sedentary lifestyle and spend long hours sitting or working in positions that can put pressure on the nerves, such as office workers or truck drivers.
Individuals with a family history of nerve impingement, as this may suggest a genetic predisposition to the condition.
People who have suffered a previous injury, such as a fracture or dislocation, that may have damaged the nerves.

Diagnosis

The diagnosis of nerve impingement is typically based on a review of medical history, a physical examination, and diagnostic imaging tests such as MRI or CT scans. Nerve conduction studies and electromyography (EMG) tests can also be used to help diagnose nerve impingement and determine the severity of the injury.

It is important to note that while anyone can develop nerve impingement, early detection and proper treatment can greatly reduce the risk of developing long-term complications and help ensure a full recovery.

Treatment

Here are some of the treatment options for nerve impingement:

Rest: Resting the affected area can help reduce inflammation and give the nerve time to heal. You may need to avoid activities that aggravate your symptoms, such as heavy lifting, repetitive motions, or prolonged sitting or standing.

Physical therapy: Physical therapy can help improve your strength, flexibility, and posture, which can relieve pressure on the affected nerve. Your physical therapist may recommend exercises, stretches, or other techniques to help alleviate your symptoms.

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce inflammation and relieve pain associated with nerve impingement. In some cases, corticosteroids may be prescribed to reduce inflammation and alleviate symptoms.

Injections: In some cases, injections of corticosteroids or other medications may be given directly into the affected area to reduce inflammation and alleviate symptoms.

Surgery: If conservative treatments are not effective, or if nerve impingement is causing significant weakness or loss of function, surgery may be recommended. The type of surgery will depend on the location and severity of the compression and may involve removing bone or tissue to relieve pressure on the affected nerve.

Lifestyle changes: Making lifestyle changes can help prevent or alleviate nerve impingement. This may include maintaining good posture, staying active, avoiding repetitive motions, and avoiding activities that put excessive strain on your nerves.

Exercises

Exercises to help relieve nerve impingement and prevent further damage may include:

Stretching: Gentle stretching exercises can help relieve pressure on the nerves and improve flexibility in the affected area.
Strengthening exercises: Targeting the muscles surrounding the affected nerve can help relieve pressure and prevent further damage.
Posture correction: Paying attention to posture and correcting any imbalances can help reduce stress on the nerves.
Aerobic exercises: Engaging in low-impact aerobic activities, such as swimming or walking, can help improve blood flow to the affected area and promote healing.
Yoga or Pilates: Gentle yoga or Pilates can help improve flexibility and strengthen the muscles surrounding the affected nerve.

It is important to consult with a doctor or physical therapist before beginning any exercise program, as they can help determine which exercises are best for your individual needs and ensure proper form and technique.

Prevention

Maintain Correct Posture:

Be mindful of your posture, especially when sitting or standing for long periods. Maintain a neutral spine position to reduce unnecessary stress on the spine and nerves.

Ergonomics:

Ensure that your workspace, whether at a desk or using electronic devices, is ergonomically designed to support good posture. Use supportive chairs, maintain eye-level screens, and take regular breaks to avoid prolonged periods of the same position.

Regular Exercise:

Engage in regular physical activity to strengthen the muscles that support the spine. Focus on exercises that promote core strength and flexibility, as a strong and flexible spine is less prone to nerve compression.

Correct Lifting Techniques:

When lifting objects, use proper lifting techniques to avoid putting excessive strain on the spine. Bend at the knees, keep the back straight, and lift with the legs rather than the back.

Weight Management:

Maintain a healthy weight to reduce the load on the spine. Excess body weight can contribute to conditions like herniated discs and spinal stenosis, increasing the risk of nerve impingement.

Stay Hydrated:

Hydration is essential for maintaining the elasticity of spinal discs. Dehydration can contribute to disc degeneration, which may increase the risk of nerve compression.

Avoid Repetitive Stress:

Be mindful of repetitive movements or activities that can strain specific nerves. If your work or hobbies involve repetitive motions, take breaks and incorporate stretching exercises to reduce the risk of overuse injuries.

Regular Stretching:

Include regular stretching exercises in your routine to maintain flexibility and prevent muscle imbalances. Focus on stretches that target the muscles around the spine, including the neck, back, and hips.

Quit Smoking:

Smoking has been associated with increased disc degeneration and reduced blood flow to spinal structures. Quitting smoking can contribute to overall spine health.

Proper Nutrition:

Maintain a balanced diet rich in essential nutrients, as proper nutrition supports the health of spinal structures. Calcium and vitamin D are particularly important for bone health.

Regular Check-ups:

Schedule regular check-ups with your healthcare provider to monitor your spine health. Early detection and management of spinal conditions can help prevent the progression to nerve impingement.

Patellofemoral Syndrome (PFS)

Posted on July 1, 2024

Patellofemoral Syndrome (PFS), also known as anterior knee pain, is a condition characterized by irritation or damage to the posterior surface of the patella, the kneecap. This syndrome encompasses a spectrum of severity, ranging from mild dysfunction to more serious and chronic issues. The pain originates from the patellofemoral joint or nearby soft tissues. While previously referred to as anterior knee pain, discomfort associated with PFS can be experienced throughout various regions of the knee.

Anatomically, PFS involves the patellofemoral joint, one of the two major joints in the knee. The patella sits within the femoral groove, and if it is displaced, its sharp undersurface may compress against one side of the femoral groove. The patella is connected to the quadriceps muscle tendon and the patellar ligament, playing a crucial role in knee function.

Anatomy

Patellofemoral Syndrome (PFS) involves the patellofemoral joint, which is a crucial component of the knee anatomy. Here’s a more detailed exploration of the relevant anatomical features associated with PFS:

Patellofemoral Joint: The patellofemoral joint is the articulation between the patella (kneecap) and the femur (thigh bone). This joint allows for smooth movement of the patella as the knee flexes and extends.

Patella (Kneecap): The patella is a sesamoid bone embedded in the tendon of the quadriceps muscle. It plays a vital role in the biomechanics of the knee by providing leverage for the quadriceps and protecting the underlying joint surfaces.

Quadriceps Tendon: The quadriceps tendon attaches the quadriceps muscles (rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius) to the patella. This tendon is essential for the extension of the knee.

Patellar Ligament: The patellar ligament continues from the patella and attaches to the tibial tuberosity on the tibia. This ligament is a continuation of the quadriceps tendon and is involved in knee extension.

Femur: The femur is the long bone of the thigh and forms the upper part of the knee joint. The patella glides in the femoral groove during knee movement.

Femoral Groove: The femoral groove is a groove or channel on the femur where the patella moves as the knee flexes and extends. Any deviation in the alignment of the patella within this groove can contribute to PFS.

Quadriceps Vastus Medialis Obliquus (VMO): The VMO is a specific part of the quadriceps muscle located on the inner side of the thigh. It plays a crucial role in stabilizing the patella and preventing lateral displacement.

Meniscus: The menisci (medial and lateral) are crescent-shaped cartilaginous structures located between the femur and tibia. They contribute to shock absorption and load distribution within the knee joint.

Ligaments:

Ligaments around the knee contribute to stability:

Medial Collateral Ligament (MCL): Stabilizes the inner side of the knee.
Lateral Collateral Ligament (LCL): Stabilizes the outer side of the knee.
Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL):

Cruciate ligaments within the joint that control anterior and posterior movement.

Understanding the specific anatomy involved in PFS is crucial for recognizing factors that may contribute to the development of this syndrome. Issues such as malalignment, muscle imbalances, or abnormal patellar tracking can disrupt the normal function of the patellofemoral joint, leading to pain and dysfunction. Proper diagnosis and treatment often involve addressing these anatomical aspects through targeted interventions such as physical therapy, strengthening exercises, and biomechanical assessments.

Symptoms

Patellofemoral syndrome, also known as patellofemoral pain syndrome (PFPS), is a condition characterized by pain in the front of the knee, around the patella (kneecap) and the surrounding area. It is a common cause of knee pain, especially among athletes and individuals engaged in activities that involve repetitive knee motion. The symptoms may include:

• Pain around the kneecap: The primary symptom is usually a dull, aching pain in the front of the knee, especially around or behind the patella. The pain may be aggravated by activities such as climbing stairs, sitting for long periods with the knee bent, or engaging in activities that stress the knee joint.

• Pain during or after activities: Pain may increase during activities that involve bending the knee, such as running, jumping, squatting, or sitting with the knee bent for an extended period.

• Crepitus or grinding sensation: Some individuals with patellofemoral syndrome may experience a grating or grinding sensation (crepitus) when moving the knee.

• Swelling and inflammation: The knee may exhibit signs of swelling or puffiness around the patella.

• Instability or weakness in the knee: Weakness or a feeling of instability in the knee can be present, making it challenging to perform certain activities.

• Pain when sitting for prolonged periods: Individuals with patellofemoral syndrome may experience discomfort when sitting for extended periods, especially with the knee bent, such as during long car rides or at a desk.

It’s important to note that the symptoms of patellofemoral syndrome can vary from person to person, and the severity of symptoms may fluctuate over time. If you suspect you have patellofemoral syndrome or are experiencing persistent knee pain, it is advisable to consult with a healthcare professional, such as a doctor or physical therapist, for an accurate diagnosis and appropriate management plan. Treatment often involves addressing contributing factors, such as muscle imbalances, and implementing exercises and strategies to improve knee function and reduce pain.

Causes

The exact cause of patellofemoral syndrome (PFPS) can be multifactorial, and it often results from a combination of various factors. Some common causes and contributing factors to the development of PFPS include:

• Overuse or Excessive Training: Activities that involve repetitive knee motion, such as running, jumping, or squatting, can lead to overuse of the patellofemoral joint, contributing to the development of PFPS.

• Muscle Imbalances: Weakness or imbalance in the muscles around the knee, particularly the quadriceps (front thigh muscles) and the muscles that make up the hip, can affect the alignment of the patella within its groove. This imbalance may lead to increased stress on the patellofemoral joint.

• Poor Biomechanics: Abnormalities in the way the lower limb moves, such as issues with foot pronation (rolling inward) or supination (rolling outward), can affect the alignment of the patella and contribute to PFPS.

• Flat Feet or Overpronation: Individuals with flat feet or excessive pronation may have altered biomechanics that can lead to increased stress on the patellofemoral joint.

• Malalignment of the Patella: Anatomical factors, such as a misalignment of the patella within its groove, may contribute to PFPS. This can be influenced by factors like the shape and structure of the knee joint.

• Trauma or Injury: Direct trauma to the kneecap or the surrounding structures can contribute to the development of PFPS.

• Tightness or Weakness in the Hamstrings: Imbalances between the quadriceps and hamstring muscles can affect knee joint mechanics, potentially contributing to PFPS.

• Improper Footwear: Wearing shoes that do not provide proper support or that exacerbate biomechanical issues can contribute to PFPS.

• Joint Laxity: Some individuals may have increased joint laxity, which can affect the stability of the patellofemoral joint.

• Changes in Physical Activity: Sudden increases in intensity, duration, or frequency of physical activity can contribute to the development of PFPS.

It’s important to note that these factors alone are not necessarily the only cause, and often, a combination of them may contribute to the development of patellofemoral syndrome. Additionally, individual variations in anatomy and biomechanics can play a role.

Diagnosis

Diagnosing patellofemoral syndrome (PFPS) typically involves a comprehensive evaluation by a healthcare professional. This may include a thorough medical history, a physical examination, and in some cases, imaging studies. Here is an overview of the diagnostic process for PFPS:

• Your doctor or physical therapist will start by asking about your symptoms, including the nature and location of the knee pain, factors that aggravate or alleviate the pain, and any relevant medical history or previous injuries.

• A physical examination will be conducted to assess various aspects of your knee function. This may involve how you walk, assessing the alignment of your lower limbs, and checking for signs of muscle imbalances or weakness. The healthcare provider may also perform specific manoeuvres to reproduce or exacerbate your symptoms.

• Your healthcare provider may palpate (feel) around various structures around the knee, including the patella, to identify areas of tenderness or swelling.

• The range of motion of the knee joint will be assessed, and strength testing of the muscles around the knee, especially the quadriceps and hamstrings, may be conducted.

• Functional tests, such as evaluating your ability to perform specific movements like squatting or climbing stairs, may be used to assess how your knee functions during activities that can aggravate PFPS.

• While the diagnosis of PFPS is often based on clinical evaluation, imaging such as X-rays or MRIs (Magnetic Resonance Imaging) may be ordered to rule out other structural issues and to assess the alignment of the patella and the condition of the surrounding structures.

It’s important to note that the diagnosis of PFPS is often one of exclusion, meaning other knee pain causing factors will be ruled out first.

Treatment

The treatment of patellofemoral syndrome (PFPS) usually involves a combination of conservative measures aimed at reducing pain, improving knee function, and addressing underlying contributing factors. Here are common treatment approaches:

Rest from activities that exacerbate symptoms can help reduce inflammation and pain.

Modifying or temporarily avoiding activities that involve repetitive knee motion, such as running or jumping, may be beneficial.

A physical therapist can design a specific exercise program to strengthen the muscles around the knee, particularly the quadriceps and hip muscles. These can be physiotherapists, sports therapists or personal trainers.

Stretching exercises to improve flexibility in the muscles and tissues around the knee.

Sports Massage or Deep Tissue Massage performed by a qualified therapist who has level 4 or above.

Patellar taping or bracing may be used to help stabilize the patella.

Orthotics and Footwear:

Custom orthotics or supportive footwear may be recommended to address issues related to foot pronation or other biomechanical factors.

Over-the-counter pain medications, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended for pain relief.

Ice application can help reduce inflammation. Applying an ice pack to the affected area for about 15-20 minutes at a time can be effective.

Guidance on modifying activities or exercises to reduce stress on the patellofemoral joint.

Evaluation of gait and lower limb biomechanics to identify and address any issues contributing to PFPS.

Maintaining a healthy body weight can help reduce stress on the knee joints.

In some cases, a healthcare provider may recommend corticosteroid injections to reduce inflammation and pain. However, these are typically used judiciously due to potential side effects.

Surgery is rarely the first-line treatment for PFPS. However, in cases where conservative measures are not effective, surgical options such as arthroscopy may be considered. This might involve procedures to address structural issues or correct biomechanical problems.

It’s important to note that the effectiveness of treatment can vary from person to person, and a tailored approach is often necessary. It’s recommended to consult with a healthcare professional, such as an orthopaedic specialist or physical therapist, to determine the most appropriate treatment plan based on individual circumstances. Additionally, early intervention and adherence to recommended exercises and modifications are crucial for successful management of PFPS.

Exercises

Exercise is a key component of the treatment plan for patellofemoral syndrome (PFPS). The goal of exercises is to strengthen the muscles around the knee, improve flexibility, and address any muscle imbalances or weaknesses that may be contributing to the pain. Here are some exercises that are commonly recommended for individuals with PFPS. However, it’s crucial to consult with a healthcare professional or a physical therapist before starting any new exercise program, as the specific exercises should be tailored to individual needs and capabilities.

Quad Sets:

Sit or lie down with your leg extended.

Tighten the muscles on the top of your thigh and push the back of your knee into the surface you’re sitting or lying on.

Hold for a few seconds, then relax.

Repeat for several sets.

Straight Leg Raises:

Lie on your back with one leg straight and the other bent.

Lift the straight leg a few inches off the ground and hold for a few seconds.

Slowly lower the leg back down.

Repeat for several sets on each leg.

Wall Sits:

Stand with your back against a wall and slide down into a sitting position, as if you were sitting in an imaginary chair.

Hold the position for 20-30 seconds.

Stand back up and repeat for several sets.

Step-Ups:

Use a sturdy step or platform.

Step up onto the platform with one foot, then bring the other foot up.

Step back down, leading with the same foot.

Repeat for several sets, alternating legs.

Clamshell Exercise:

Lie on your side with your hips and knees bent at a 90-degree angle.

Keeping your feet together, lift the top knee while keeping the feet together.

Lower the knee back down.

Repeat for several sets on each side.

Lateral Leg Raises:

Lie on your side with the bottom leg bent slightly for support.

Lift the top leg to the side, keeping it straight.

Lower the leg back down.

Repeat for several sets on each side.

Hamstring Stretch:

Sit on the floor with one leg extended and the other bent so that the sole of your foot is against the inner thigh of the extended leg.

Reach toward the toes of the extended leg while keeping your back straight.

Hold the stretch for 20-30 seconds and then switch legs.

Calf Stretch:

Stand facing a wall with your hands on the wall at shoulder height.

Step one foot back and press the heel into the floor.

Hold the stretch for 20-30 seconds and then switch legs.

Remember to start slowly and gradually increase the intensity and duration of exercises. If you experience increased pain or discomfort during any exercise, it’s important to stop and consult with your healthcare provider or physical therapist. Additionally, consistency is key, and performing these exercises regularly as part of a comprehensive rehabilitation program can contribute to improved outcomes for individuals with PFPS.

Prevention

While not all cases of patellofemoral syndrome (PFPS) can be entirely prevented, there are several strategies and lifestyle modifications that can help reduce the risk of developing or exacerbating the condition. Here are some preventive measures:

Strengthening:

Regularly incorporate exercises that focus on strengthening the muscles around the knee, especially the quadriceps, hamstrings, and hip muscles. Strong muscles provide better support to the knee joint.

Flexibility:

Include stretching exercises to maintain flexibility in the muscles and tissues around the knee. This can help prevent muscle imbalances and improve joint function.

Warm-up and Cool Down:

Always warm up before engaging in physical activities or sports. A proper warm-up prepares the muscles and joints for the stresses of exercise. Similarly, cool down with stretching exercises to help prevent stiffness.

Gradual Progression:

Avoid sudden increases in the intensity, duration, or frequency of physical activities. Gradual progression allows your body to adapt to new demands, reducing the risk of overuse injuries like PFPS.

Well Fitted Footwear:

Wear supportive footwear that is appropriate for your activity. Shoes with good arch support and shock absorption can help maintain proper biomechanics and reduce stress on the knee joint.

Maintaining a Healthy Weight:

Excess body weight can contribute to increased stress on the knee joints. Maintaining a healthy weight through a balanced diet and regular exercise can reduce the risk of PFPS.

Biomechanical Assessment:

If you have concerns about your gait or lower limb biomechanics, consider consulting with a healthcare professional or a physical therapist for a biomechanical assessment. Addressing any abnormalities early on can help prevent future issues.

Cross-Training:

Engage in a variety of physical activities to avoid overuse of specific muscle groups or joints. Cross-training can help distribute the workload and reduce the risk of repetitive strain injuries.

Good Technique:

Ensure proper technique when participating in sports or exercises. Improper form can contribute to increased stress on the knee joint and may lead to overuse injuries.

Listen to Your Body:

Pay attention to any signs of pain or discomfort during physical activities. If you experience persistent knee pain, consult with a healthcare professional for evaluation and appropriate management.

It’s important to note that individual factors, such as anatomy and genetics, can also influence the risk of developing PFPS. While these preventive measures can help reduce the risk, there is no one-size-fits-all approach. If you have concerns about your knee health or are experiencing persistent pain, it is advisable to consult with a healthcare professional for personalized guidance and recommendations.

Hip Arthritis

Posted on July 1, 2024

Osteoarthritis / Arthritis is a degenerative disease where cartilage in the joints of the body get worn down eventually leaving the bone exposed causing endless amount of pain who anyone who suffers with it. Normal or “healthy” cartilage acts as support in the joint, which allows the bone to run smoothly, when damaged it becomes rough causing discomfort for many people.

Anatomy

The hip is a ball and socket joint and is one of the largest joints in the body. The acetabulum is a part of the pelvis bone which allows the head of the femur to move freely in the socket.

Articular cartilage is a slippery substance which covers the joint, this helps protect and allows free unpainful movement in the ball and socket. Within the hip synovium can be found, this also helps lubricate the joint to allow the hip to function properly.

A person who is suffering with arthritis of the hip will have cartilage that is worn down and will not be producing enough fluid to allow the free movement. This will lead to the bone rubbing against another bone creating discomfort and pain for an individual.

Symptoms

Stiffness around the hip joint
Flare ups when walking, running or performing exercise
Pain when resting
Daily discomfort and ongoing pain in the joint
Stiffness in the groin, thigh and glutes when walking
Swelling around the hip
Grinding sensation in the joint when moving

Causes

Arthritis is more common as you get older
Family history is a common factor of hip arthritis
Individuals who are more overweight often show on going signs of arthritis
An injury to the hip and overuse may lead to the long-term effects of arthritis

Diagnosis

A full physical examination will be carried out by a doctor to determine the severity of your condition.

The doctor will carry out special tests specific for the hip to see what movements create the most pain and discomfort. The professional will need to know information such as when the pain first started to occur, how if effects your sleep and how it affects your day-to-day life and activities.

Special tests that are used for the diagnosis of hip arthritis are Trendelenburg test, supine (leg length test) and gait test.

Treatment

Non- surgical treatment that may be effective to help reduce the pain from arthritis are as follows:

Ensuring you rest enough when the hip joint is in any pain to reduce irritating the arthritis
Preform non-weight baring exercises such as swimming or a gentle cycle to reduce any added pressure onto the hip, this allows the hip to still have good range of motion and keeps the joint functioning
Make sure you are getting enough sleep and resting the hip
Try eating a healthier balanced diet, this will help with weight loss and reduce the amount of stress placed onto the joints
Use over the counter treatment such as deep freeze which may help reduce pain and swelling around the joint

If the pain is ongoing, it is worth speaking to your doctor who may suggest surgery as a last resort. This would mean you would undergo a hip replacement, where you would then follow an 8–12-week rehabilitation programme.

Exercises

These exercises should be performed in sets and reps, it is best to speak to a doctor or physiotherapist to find out the recommended amount suitable for you:

1. Seated Hip Flexion

Purpose: Improve hip flexor strength and maintain mobility in the hip joint, which can help alleviate stiffness and pain from arthritis.
How to Perform:
- Sit on a chair with your feet flat on the floor.
- Lift one knee toward your chest while keeping your back straight.
- Lower your leg back down slowly and repeat with the other leg.

2. Sit to Stand

Purpose: Strengthen the muscles around the hip joint, particularly the quadriceps and glutes, to improve stability and reduce pain from hip arthritis.
How to Perform:
- Sit on a chair with your feet hip-width apart and your hands on your thighs or crossed in front of you.
- Lean slightly forward and push through your heels to stand up, using your leg muscles rather than your arms.
- Slowly lower yourself back down to the chair and repeat.

3. Kneeling Hip Flexor Stretch

Purpose: Stretch the hip flexors, which can become tight and contribute to pain and reduced mobility in people with hip arthritis.
How to Perform:
- Kneel on one knee with the other foot in front of you, forming a 90-degree angle at both knees.
- Gently push your hips forward, stretching the front of your hip on the kneeling side.
- Hold the stretch for 20-30 seconds, then switch legs and repeat.

4. Hip Abduction in Supine Position

Purpose: Strengthen the hip abductors, particularly the gluteus medius, which helps support and stabilise the hip joint.
How to Perform:
- Lie on your back with your legs straight and slightly apart.
- Keeping your leg straight, slowly slide one leg out to the side as far as comfortable, then return it to the starting position.
- Repeat with the other leg.

5. Hip Extension

Purpose: Strengthen the glutes and hamstrings, improving hip stability and reducing pain from arthritis.
How to Perform:
- Stand with your feet hip-width apart and hold onto a sturdy surface for balance.
- Keeping your leg straight, slowly lift one leg backward, squeezing your glutes.
- Lower the leg back down slowly and repeat with the other leg.

6. Glute Bridges

Purpose: Strengthen the glutes and lower back muscles, providing better support for the hip joint and reducing arthritis symptoms.
How to Perform:
- Lie on your back with your knees bent and feet flat on the floor, hip-width apart.
- Lift your hips toward the ceiling, squeezing your glutes and keeping your body in a straight line from shoulders to knees.
- Hold for a few seconds at the top, then slowly lower your hips back down.

7. Body Weight Squat

- Purpose: Strengthen the quadriceps, hamstrings, and glutes, which helps support and stabilise the hip joint.
- How to Perform:
  - Stand with your feet shoulder-width apart.
  - Slowly lower your body by bending your knees and hips, keeping your back straight and your weight on your heels.
  - Lower as far as comfortable, then push through your heels to stand back up

Prevention

Prevention of hip arthritis involves making lifestyle changes and taking steps to reduce your risk of developing the condition. Here are some tips for preventing hip arthritis:

Maintain a healthy weight: Being overweight or obese puts additional stress on your hip joint, increasing your risk of developing arthritis.
Exercise regularly: Regular exercise can help improve your joint health, flexibility, and strength.
Avoid overuse injuries: Repeated stress on the hip joint can lead to arthritis over time.
Use proper technique: When performing physical activities or exercises, use proper technique
Wear appropriate footwear

Avoid sitting for long periods: Sitting for extended periods can increase the pressure on your hips.

Manage other health conditions: Certain health conditions, such as diabetes or rheumatoid arthritis, can increase your risk of developing hip arthritis. Work with your healthcare provider to manage these conditions and reduce your risk.

By making these lifestyle changes and taking steps to reduce your risk of developing hip arthritis, you can help protect your hip joints and maintain good overall health.

Hamstring Tear – Grade 1 and 2

Posted on July 1, 2024

Hamstring tear is an injury to a muscle at the back of the thigh, that is caused by a rapid extensive contraction or a violent stretch of the hamstring muscle group, causing high mechanical stress. They account for up to 29% of lower limb injuries in sport, due to the involvement of high speeds such as sprinting and football, however older age can increase the risk due to a loss of flexibility.

Some experiences of hamstring tears involve pain and tenderness, with limited range of motion, where others experience additional symptoms, such as swelling or a ‘popping’ or tearing sensation.

Grade 1 and 2 hamstring tears can heal within 3 to 8 weeks, however can take months to heal depending on the severity of symptoms.

Anatomy

The hamstrings are a group of three muscles: semitendinosus, semimembranosus, and bicep femoris (long head), that predominantly acts to flex and extend the knee.

Most hamstring tears occur in the central part of the muscle, or where the muscle fibres and tendon fibres intersect (MTJ). Tendons can tear away from a small bone fragment (ischial tuberosity), that typically occur at the proximal origin (top) of the hamstring, however, can occur from the distal origin (bottom), although less common.

Symptoms

Sudden and sharp pain
Tenderness
A “popping sensation” at the time of injury
Swelling and bruising (or discolouration) in the first few hours and days
Weakness and a loss of strength in the leg

Causes

Overload of the hamstrings typically the cause of hamstring tears, that occurs when the muscle is stretches beyond its limit or challenged with sudden load, typically during an eccentric contraction. Previous hamstring injuries can increase the risk of developing a tear, particularly if the body is compensating for another limb injury, or if there is muscle weakness and a lack of flexibility.

Diagnosis

Physical examinations are often performed, such as palpation to pinpoint the area of the hamstring tear, however precise location may be difficult to determine without medical imaging.

Other physical examinations involve performing various movement to evaluate strength and range of motion, to determine the severity or the classification (grade 1 to 3) according to the pain and physical limitations.

Neurological examination may be performed to assess the sciatic nerve, to check any entrapment or irritation in healing scar tissue. Imaging such X-rays and MRI may be advised in severe cases, to detect the location of the tear and the extent of the injury, however for grade 1 and 2 tears, only physical examination if typically required.

Treatment

There are 3 phases of treatment to aid recovery and function of the hamstring injury (grade 1 and 2):

Phase 1 (inflammation phase) -Exercises and excessive stretching should be avoided, to control pain and help scar tissue develop. At the phase, crutches may be required to reduce weight bearing and facilitate recovery.

Phase 2 (reparative phase) – Exercises are introduced to try and regain full range of motion. Progressions of more challenging exercises are included in this stage, however, should be performed tolerably and pain-free. Such exercises could include hamstring curls, hip extension (with added resistance band for progression), hamstring wall stretch, and single leg balance.

Phase 3 (remodelling phase) – specific to patients playing sport to allow return to sport, and their level of function. This phase is specific to the patient, where sport or activity-specific drills such as agility are advised to promote tissue remodelling, or drills involving quick movements such as plyometric exercises.

Exercises

Hamstring stretch: Sit on the floor with your legs straight out in front of you. Lean forward, reaching your hands towards your toes until you feel a stretch in your hamstrings. Hold for 30 seconds and repeat 3 times.
Hamstring curl: Stand facing a wall or chair, with your feet shoulder-width apart. Lift one foot towards your buttocks, keeping your knee bent. Lower your foot and repeat for 10-15 repetitions on each leg.
Deadlift: Stand with your feet shoulder-width apart, holding a barbell or dumbbells in front of your thighs. Hinge forward from your hips, keeping your back straight, and lower the weights towards the floor. Return to the starting position and repeat for 10-15 repetitions.
Romanian deadlift: Stand with your feet shoulder-width apart, holding a barbell or dumbbells in front of your thighs. Hinge forward from your hips, keeping your back straight, and lower the weights towards the floor. Keep your knees slightly bent and your hips back as you lower the weight. Return to the starting position and repeat for 10-15 repetitions.
Glute bridge: Lie on your back with your knees bent and your feet flat on the floor. Lift your hips towards the ceiling, squeezing your glutes at the top. Lower your hips and repeat for 10-15 repetitions. This exercise strengthens the glutes and hamstrings.

Prevention

Warm-up properly: Warming up properly before any physical activity is essential to prevent hamstring tears. It increases blood flow to the muscles, making them more pliable and less prone to injury.
Stretch regularly: Regular stretching, especially before and after exercise, can help prevent hamstring tears. Incorporate stretching exercises such as hamstring stretches, quadriceps stretches, and hip flexor stretches into your routine.
Build strength gradually: Gradually increasing the intensity and duration of your exercise routine can help prevent overloading the hamstrings. Focus on building strength in the hamstrings and surrounding muscles to improve overall stability and reduce your risk of injury.
Use proper technique: Using proper technique when performing exercises that involve the hamstrings, such as running and weightlifting, can help prevent hamstring tears. Avoid over-striding, sudden changes of direction, and landing heavily on your heels.
Wear appropriate footwear: Wearing appropriate footwear that provides adequate support can help prevent hamstring tears. Choose shoes that fit well and have good shock absorption.

Calf Tear

Posted on July 1, 2024

Calf tears are a relatively common injury that occurs in people of all ages and activity levels. It is estimated that up to 18% of all sports injuries involve the calf muscles, making it one of the most injured areas in the lower leg.

Calf tears are more common in people who engage in sports or activities that involve repetitive or explosive movements of the lower legs, such as running, jumping, or dancing. These activities can put a significant amount of stress on the calf muscles, making them more susceptible to injury.

Calf tears are classified into three grades based on the severity of the injury. Grade 1 tears involve minor damage to the muscle fibers, while grade 2 tears involve a partial tear of the muscle. Grade 3 tears are the most severe and involve a complete tear of the muscle.

While calf tears can be painful and limit mobility, they generally heal well with proper treatment and rehabilitation. It is important to seek medical attention if you suspect a calf tear or if you experience persistent pain or swelling in the calf muscle. With proper care, most people are able to return to their normal activities within a few weeks to a few months.

Anatomy

The calf muscle is made up of two muscles: the gastrocnemius and the soleus. The gastrocnemius is the larger of the two muscles and is responsible for flexing the ankle and knee. The soleus is located underneath the gastrocnemius and is responsible for plantar flexion of the ankle.

Symptoms

The symptoms of a calf tear can vary depending on the severity of the injury. The following are some common symptoms of calf tears grade 1 and 2:

Mild to moderate pain in the calf muscle
Swelling and tenderness in the affected area
Difficulty in walking or standing on the affected leg
Stiffness and limited range of motion in the ankle and foot
A popping or snapping sensation at the time of injury

Causes

Calf tears can be caused by a sudden or forceful movement, such as pushing off or jumping, which puts excessive strain on the calf muscle. The following are some common causes of calf tears:

Overuse or repetitive strain on the calf muscle
Sudden movements or changes in direction
Inadequate warm-up before exercise or sports activities
Poor flexibility or strength in the calf muscles
Foot and ankle problems, such as flat feet or ankle instability

Diagnosis

A calf tear can be diagnosed through a physical examination by a healthcare professional. Imaging tests, such as an ultrasound or MRI, may be ordered to confirm the diagnosis and to determine the extent of the injury.

Treatment

The treatment for a calf tear grade 1 or 2 generally includes the following:

Rest: The affected leg should be rested to allow the muscle to heal.
Ice: Applying ice to the affected area can help reduce pain and swelling.
Compression: Compression with a bandage or brace can help reduce swelling and provide support to the affected area.
Elevation: Elevating the affected leg can help reduce swelling and promote healing.
Pain medication: Over-the-counter pain medications may be used to help manage pain.

Exercises

After the initial healing period, the following exercises may be prescribed to help improve range of motion and strength in the calf muscle:

Calf stretches: Stretching the calf muscle can help improve flexibility and reduce the risk of future injury. Stand facing a wall with your hands on the wall and your feet shoulder-width apart. Step back with your affected leg, keeping your heel on the ground. Lean forward into the wall until you feel a stretch in your calf. Hold for 30 seconds and repeat on the other leg.
Calf raises: This exercise helps strengthen the calf muscle. Stand with your feet shoulder-width apart and rise up on your toes, lifting your heels off the ground. Hold for a few seconds and then lower your heels back down. Repeat for 10-15 repetitions.
Single leg balance: This exercise helps improve balance and stability in the affected leg. Stand on your affected leg and lift your other leg off the ground. Hold for 30 seconds and repeat on the other leg.

Prevention

To prevent calf tears, it is important to take the following measures:

Warm-up: Always warm up before engaging in exercise or sports activities. A proper warm-up can help prepare your muscles for activity and reduce the risk of injury.
Stretching: Regular stretching of the calf muscles can help improve flexibility and reduce the risk of tears. Incorporate calf stretches into your warm-up routine and stretch after exercise.
Proper footwear: Choose appropriate footwear that provides adequate support and cushioning for your feet and ankles. Replace worn-out shoes regularly.
Gradual progression: If you are new to a sport or activity, start slowly and gradually increase the intensity and duration of your workouts. This can help prevent overuse injuries.
Strengthening exercises: Regularly performing exercises that strengthen the calf muscles can help prevent tears. Examples include calf raises and resistance band exercises.

By following these preventive measures, you can significantly reduce your risk of calf tears and other lower leg injuries. If you do experience pain or discomfort in your calf muscles, it is important to seek medical attention before continuing with exercise or sports activities.

Sacroiliac Joint Pain

Posted on July 1, 2024

Sacroiliac joint pain refers to discomfort or inflammation in the sacroiliac joint, which is located between the sacrum (the triangular bone at the base of the spine) and the ilium (the pelvic bone). It is a common cause of low back pain and affects both men and women. The exact pathology of the sacroiliac joint pain can vary, but it is often related to issues such as degeneration, inflammation, ligaments sprains, or abnormal joint movement. Certain factors, such as pregnancy, previous lumbar fusion surgery, trauma, or conditions like arthritis, can increase the risk of developing sacroiliac joint pain Although the prevalence of sacroiliac joint pain can vary, studies suggest that it may account for approximately 15-30% of cases of chronic low back pain.

Anatomy

The sacroiliac joints are located on each side of the spine between the two pelvic bones, which attach to the sacrum. The main function within the pelvic girdle is to provide shock absorption for the spine and to transmit forces between the upper body and the lower limbs. The SI joint experiences forces of shearing, torsion, rotation, and tension. Ambulation is heavily impacted by the SI joint, as this is the only orthopaedic joint connecting the upper body to our lower body. The joint is a relatively stiff synovial joint filled with synovial fluid. The bones of the sacrum and ilium are coated in hyaline cartilage at their articular surfaces with dense fibrous tissue connecting the ilium and the sacrum. SI joints typically only have a few degrees of motion.

Symptoms

Some common sacroiliac joint pain symptoms are as follows:

Lower back pain,
Hip pain,
Pain that radiates down the leg
Feeling weakness in the leg

Causes

Predisposing factors for SIJ pain include:

Apparent leg length discrepancy
Older age
Inflammatory arthritis
Previous spine surgery
Pregnancy and trauma

Diagnosis

The diagnostic process collects medical history, including information on current pain and symptoms. Additionally, a medical history includes information on diet, sleep, and activity habits, as well as any recent or past injuries that may contribute to the cause of SI joint pain.

Some of orthopaedic provocation tests can rule out or identify the sacroiliac joint as the pain source, including:

Sacral thrust test
Distraction test
FABER test
Palpation tests

Treatment

Treatment for Sacroiliac Joint Pain typically involves a combination of physical therapy, exercises, and medication. The specific treatment plan will depend on the causes and severity of the pain.

Physical therapy is often recommended as the first line of treatment for SI joint pain. A physical therapist can teach exercises to help strengthen the muscles that support the joint and improve flexibility in the hip and lower back. These may include exercises to strengthen the glutes, hamstrings, and core muscles, as well as stretching exercises for the hip and lower back.
Medications: over the counter pain relievers, such as ibuprofen or naproxen, may be used to manage pain and inflammation. If these are not effective, your doctor may prescribe stronger medications such as muscle relaxants or tricyclic antidepressants.
Injections of corticosteroids or hyaluronic acid into the joint may be used to reduce inflammation and pain.
Surgery is typically only considered for severe cases of SI joint pain that do not respond to other treatments. Surgery to stabilize the joint may be done, but it should be considered as a last resort.
Chiropractic care can also provide manual adjustments to the joint, which can help to reduce inflammation, improve range of motion, and relieve pain

Exercises

Here are some exercises that can help alleviate SI joint pain:

1. Pelvic Tilts

Purpose: Mobilise and strengthen the lower back and pelvic muscles, helping to alleviate stiffness and pain around the SI joint.
How to Perform:
- Lie on your back with your knees bent and feet flat on the floor.
- Gently flatten your lower back against the floor by tilting your pelvis upward, engaging your abdominal muscles.
- Hold the position for a few seconds, then relax and return to the neutral position.
- Repeat for the desired number of repetitions.

2. Clamshells

Purpose: Strengthen the gluteus medius and other hip muscles, which help stabilise the pelvis and SI joint.
How to Perform:
- Lie on your side with your legs stacked and knees bent at 90 degrees.
- Keep your feet together as you lift your top knee, opening your legs like a clam shell while keeping your hips stable.
- Lower your knee back down and repeat before switching to the other side.

3. Bridging

Purpose: Strengthen the glutes and lower back muscles, providing better support and stability to the SI joint.
How to Perform:
- Lie on your back with your knees bent and feet flat on the floor, hip-width apart.
- Lift your hips toward the ceiling, squeezing your glutes and keeping your body in a straight line from shoulders to knees.
- Hold for a few seconds at the top, then slowly lower your hips back down.

4. Lying Leg Abduction

Purpose: Strengthen the hip abductors, particularly the gluteus medius, which helps stabilise the pelvis and reduce SI joint stress.
How to Perform:
- Lie on your side with your legs straight and stacked.
- Lift your top leg upward, keeping it straight and in line with your body.
- Slowly lower the leg back down and repeat before switching sides.

5. Fire Hydrants

- Purpose: Strengthen the gluteus medius and hip muscles, improving pelvic stability and reducing SI joint pain.
- How to Perform:
  - Start on all fours with your hands under your shoulders and knees under your hips.
  - Keeping your knee bent, lift one leg out to the side, like a dog at a fire hydrant, while keeping your hips level.
  - Lower the leg back down and repeat before switching to the other side.

Prevention

Preventing sacroiliac joint pain involves maintaining prohttps://youtu.be/3J1d1jJQ1-Eper alignment and stability of the joint, as well as reducing the stress placed on it.

Maintain good posture
Strengthen your core
Stretch your hip muscles
Avoid high impact activities
Use a proper form when lifting weights
Wear shoes with good arch
Maintain a healthy weight

What Causes Neck Pain And How To Help It?

Posted on June 27, 2024

Neck pain, also known as cervical pain, is a prevalent ailment that affects a significant proportion of the population. The cervical spine, comprising of the uppermost seven vertebrae of the spinal column, is an intricate structure that encompasses bones, muscles, tendons, and ligaments. Irritation or damage to any of these components can result in pain and discomfort in the cervical region.

The cervical spine plays a crucial role in maintaining the stability of the head and providing mobility to the head and neck. Additionally, it serves as a protective structure for the spinal cord and nerve roots. Due to its vital functions, cervical pain can have a significant impact on an individual’s daily activities and quality of life. Thus, it is imperative to have a thorough understanding of the causes, symptoms, assessment, treatment and prevention of cervical pain.

A comprehensive understanding of the cervical spine’s anatomy and the various factors that may contribute to cervical pain can aid in the selection of appropriate treatment and prevention methods. It is always recommended to seek professional medical advice for accurate diagnosis and treatment.

Anatomy

Cervical Spine: The neck is composed of seven cervical vertebrae (C1 to C7) . These vertebrae are responsible for supporting the head and allowing for a wide range of motion. Intervertebrae discs situated between the vertebrae act as cushions and provide flexibility.
Muscles: The neck is supported and moved my a complex system of muscles. Some of the major muscles in the neck inslude: Sternocleidomastoid whihc allow for rotation and tilting of the head. Trapezius: helps rotating and stabilizating the shoulder blades and supports the head and neck. Levaator Scapula:Assists in elevating the shoulder blades and rotationg the neck/ Scale muscles: they asssist in neck flexion and rotation
Nerves: The cervical Spine houses the spinal cord. which is an extension of the central nervous system. From the spinal cord, nerve roots branch out and exit through spaces between the vertebrae. These nerves supply sensation and motor control to various parts of the body, including the neck, shoulders, arms and hands.
Ligaments are strong bands of connecting tissues that provide stability and support to the neck. They connect the vertebrae, helping to maintain proper alignment and limit excessive movement.
Bloos Vessels: Several blood vessels run through the neck, including the carotid arteries and jugular veins, These vessels supply oxygenated blood to the brain and other parts of the head and neck.

Symptoms

Neck pain can present in a variety of ways, including stiffness, soreness, or a sharp or dull ache. Other symptoms may include headaches, muscle spasms, tingling or numbness in the arms or hands, and difficulty moving the neck.

Causes

Neck pain can be caused by a variety of factors, including poor posture, injury, or underlying health conditions. Some common causes include:
Poor posture: Sitting or standing in a slouched position can put a lot of strain on the neck muscles and cause pain
Injury: Whiplash, a common injury from car accidents, can cause damage to the muscles and ligaments in the neck
Degenerative conditions: Arthritis, osteoporosis, and other degenerative conditions can cause the bones in the neck to wear down, leading to pain.
Stress: Stress and tension can cause the muscles in the neck to tighten, leading to pain
Poor sleeping position
Overuse or repetitive movements

Diagnosis

If an individual is experiencing cervical pain, it is imperative to seek professional medical advice for an accurate diagnosis. The diagnostic process typically begins with a thorough physical examination, during which the healthcare professional will assess the individual’s range of motion, muscle strength, and any areas of tenderness or discomfort. This examination may also include a neurological examination to assess the function of the nerves in the neck and upper extremities.

In addition to the physical examination, imaging tests may also be conducted to further evaluate the cervical spine. These may include X-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans, or bone scans. These imaging tests can provide detailed information about the bones, discs, and other structures of the cervical spine and can aid in identifying any abnormalities or injuries.

Treatment

Treatment for neck pain will depend on the underlying cause. Some common treatment options include:

Medications: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help to reduce pain and inflammation.
Physical therapy: Exercises and stretches can help to strengthen and stretch the neck muscles, improving flexibility and reducing pain.
Chiropractic care, Acupuncture
Surgery: In rare cases, surgery may be necessary to address a specific problem in the neck.

Exercises

In addition to physical therapy, there are a number of exercises that can help to relieve neck pain. Some examples include:

Neck stretches: Gently tilt your head to the side, hold for a few seconds, and then release.

Shoulder rolls: Roll your shoulders forward and then backwards, to release tension in the neck.

Upper trapezius stretch: Sit up straight and tilt your right ear to your right shoulder, hold for a few seconds, and then release.

Strengthening exercises: Exercises such as shoulder shrugs, neck extensions, and rotations, can help to strengthen the muscles in the neck.

Prevention

To prevent neck pain, it is important to maintain good posture, take regular breaks when sitting or standing for long periods of time, and to avoid repetitive movements. Additionally, proper sleeping position, stress management techniques and regular exercise can also help to prevent neck pain.

Flat Feet

Posted on June 17, 2024

Flat Foot medically known as Pes planus, is a medical condition in which the medial longitudinal arch (MLA) which runs the length of the foot is flattened out or lowered. Flatfoot may affect one or both feet, and not only increases the load acting on the foot structure, but also interferes with the normal foot function. Therefore, individuals with flat feet experience discomfort while standing for long periods of time and exhibit a distinctive flat-footed gait.

Typical flatfoot symptoms include a tenderness of the plantar fascia, a laxity of the ligaments, a rapid tiring of the foot, pain under stress, and instability of the medial side foot structure. Over time, the mechanical overloading resulting from the flattened MLA is transferred to proximal areas such as the knees, hips and lower back, and thus flatfoot is recognized as a contributory factor in a wide variety of medical conditions, including lower limb musculoskeletal pathologies such as plantar fasciitis Achilles tendonitis, and patello-femoral joint pain.

Flatfoot deformities are commonly treated using some form of orthotic device. Such devices are designed to provide stability and to realign the foot arch, and have a demonstrable success in alleviating patients’ symptoms.

Anatomy

Flatfeet are an anatomical alteration which can occur in one foot or in both feet. The most common structural difference in flatfeet is found to be rear-foot varus which in turn causes excessive pronation of the foot.

In addition, deepened navicular cup, widened talus articular surface, proximally faced talus, and higher positioned navicular articular surface can be seen. These alterations cause the MLA to collapse resulting in a loss of arch height. When this loss of arch height is observable in both non-weight bearing and weight bearing positions, it is termed as rigid flatfeet.

Contrarily, when a normal MLA height is present in non-weight bearing condition and collapses with weight bearing is identified as flexible flatfeet.

Symptoms

The most identifiable symptoms and characteristics of flat feet are the decrease or lack of arches in the feet (especially when weight bearing) and pain / fatigue along the inner side of the feet and arches.

Some issues caused by flat feet include:

Inflammation of soft tissue
Foot, arch, and leg fatigue
Heel, foot, and ankle pain
Knee, hip, and lower back pain
Rolled-in ankles
Abnormal walking patterns
Shin splints
Bunions
Hammertoe
Arthritis
Plantar fasciitis
Posterior tibial tendon dysfunction (PTTD)

Causes

Flatfeet is not unusual in infants and toddlers, because the foot’s arch hasn’t yet developed. Most people’s arches develop throughout childhood, but some people never develop arches. People without arches may or may not have problems.

Some children have flexible flatfeet, often called flexible flatfoot, in which the arch is visible when the child is sitting or standing on tiptoes but disappears when the child stands. Most children outgrow flexible flatfeet without problems.

People without flatfeet can also develop the condition. Arches can collapse abruptly after an injury. Or the collapse can happen over years of wear and tear. Over time, the tendon that runs along the inside of the ankle and helps support the arch can get weakened or tear. As the severity increases, arthritis may develop in the foot.

Diagnosis

The observation of the feet mechanics from the front and back and also toes stand. The strength test in the ankles and locate the main area of pain. The wear pattern on the shoes also may reveal information about the feet.

Imaging tests that can be helpful in diagnosing the cause of foot pain may include:

X-rays. A simple X-ray uses a small amount of radiation to produce images of the bones and joints in the feet. It’s particularly useful in evaluating alignment and detecting arthritis.
CT scan. This test takes X-rays of the foot from different angles and provides much more detail than a standard X-ray.
Ultrasound may be used when a tendon injury is suspected. Ultrasound uses sound waves to produce detailed images of soft tissues within the body.
Using radio waves and a strong magnet, MRIs provide excellent detail of both bone and soft tissues.

Treatment

Many people with flat feet don’t have significant problems or need treatment. However, if foot pain, stiffness or other issues occur health provider might recommend nonsurgical treatments. Rarely, people need surgery to fix rigid flat feet or problems with bones or tendons.

Treatments include:

Nonsteroidal anti-inflammatory drugs (NSAIDs), rest and ice to ease inflammation and pain.
Physical therapies to stretch and strengthen tight tendons and muscles, improving flexibility and mobility.
Supportive devices like foot orthotics, foot or leg braces and custom-made shoes.

Exercises

Toes elevations: Start by standing with your feet shoulder-width apart and flat on the ground. Slowly raise your toes off the ground as high as you can, while keeping your heels on the ground. Hold this position for a few seconds, then lower your toes back down to the ground. Repeat for several repetitions.
Toes scrunches: Begin by sitting in a chair with your feet flat on the ground. Scrunch your toes together as tightly as you can, then relax them. Repeat for several repetitions.
Double/Single leg raises: Start by lying on your back with your legs straight out in front of you. For double leg raises, raise both legs off the ground at the same time, keeping them straight. For single leg raises, raise one leg off the ground while keeping the other leg straight and on the ground. Hold the raised leg in the air for a few seconds, then lower it back down to the ground. Repeat for several repetitions on each leg.
Standing single leg balance: Stand on one foot with your knee slightly bent. Hold this position for as long as you can, up to 30 seconds, then switch to the other foot. For a greater challenge, close your eyes or stand on a pillow or unstable surface.
Toes walks: Start by standing with your feet flat on the ground. Slowly walk forward on your toes, keeping your heels off the ground. Walk for a few steps, then lower your heels back down to the ground. Repeat for several repetitions.
Heel walks: Begin by standing with your feet flat on the ground. Slowly walk forward on your heels, keeping your toes off the ground. Walk for a few steps, then lower your toes back down to the ground. Repeat for several repetitions.
Calf muscle stretch: Start by standing facing a wall with your hands on the wall at shoulder height. Take one step back with one foot, keeping your heel on the ground. Bend your front knee, keeping your back leg straight, until you feel a stretch in your calf muscle. Hold this position for 15-30 seconds, then switch legs and repeat.

Prevention

Flat feet can be hereditary and hereditary causes can’t be prevented. However, to prevent the condition from worsening and causing excessive pain by taking precautions such as wearing shoes that fit well and providing the necessary foot support.

How we can help

Massage therapy and sports therapy can be effective treatment options for individuals with flat feet. These therapies aim to address imbalances in the muscles and connective tissues of the feet and lower legs, which can contribute to the development of flat feet or exacerbate existing flat foot symptoms.

Massage therapy involves the manual manipulation of soft tissues, such as muscles and fascia, to promote relaxation, improve circulation, and reduce tension and pain. A massage therapist can work on the feet and lower legs to release tension in muscles and connective tissues that may be contributing to flat foot symptoms. They may also use techniques such as trigger point therapy or myofascial release to address specific areas of tension or pain.

Sports therapy, on the other hand, focuses on improving strength, flexibility, and function in the muscles and joints of the feet and lower legs. A sports therapist can develop a personalized exercise program to help strengthen weak muscles, improve flexibility, and correct imbalances in the feet and legs that may be contributing to flat feet. They may also use techniques such as kinesiology taping or orthotics to support the arch of the foot and promote proper alignment.

Together, massage therapy and sports therapy can help alleviate pain, improve function, and prevent further complications associated with flat feet. If you are experiencing flat foot symptoms or have been diagnosed with flat feet, consult with a qualified massage therapist or sports therapist to develop a personalized treatment plan that can help you achieve optimal foot health.

Rotator Cuff Injury

Posted on June 17, 2024

In the rotator cuff region there are four muscles, tendons and ligaments, surrounding the shoulder which provide added stability to the shoulder joint. This structure helps to keep the bone securely placed into the socket. Injury to the rotator cuffs can cause an ache like pain in the shoulder. This may lead to a feeling of muscle weakness and inability to lift the shoulder above the head.

Rotator cuff injuries are most commonly presented in people regularly exposed to overhead movements, such as painters, carpenters and builders. Individuals who suffer from this injury can usually manage their symptoms, through sports massage and specific exercises focusing on the rotator cuff muscle region. However, if not treated correctly, further injury to the area may occur such as a complete tear, which may result in surgery.

Anatomy

The rotator cuffs are made up by four muscles, these are the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles aid in keeping the upper arm and shoulder into the socket with stability. They also each allow specific movements at the shoulder joint. The group of four muscles all originate within the shoulder blade, but all insert into different portions of the upper arm bone.

Supraspinatus: This muscle originates at the supraspinous fossa; the muscle belly passes laterally over the acromion process and inserts into the greater tubercle of the humerus bone. This muscle allows the first 15 degree’s movement of abduction, after this the deltoid and trapezius muscles will then allow further motion.

Infraspinatus: The origin of the infraspinatus is the infraspinatus fossa, and the insertion is also the greater tubercle of the humerus. The motion created by this muscle is lateral rotation of the shoulder, moving the arm away from the centreline of the body.

Teres Minor: A small narrow muscle on the back of the shoulder blade which sits underneath the infraspinatus. The origin is the lateral boarder of the scapula. This muscle contributes to external rotation of the arm of the body.

Subscapularis: This rotator cuff is the strongest and largest out of the three listed above. This muscle originates at the subscapularis fossa and inserts into the lesser tubercle of the humerus. The subscapularis allows greater motion at the shoulder and mainly aids in allowing medial rotation of the arm.

Symptoms

Common symptoms of possible rotator cuff injury:

Dull ache
Difficulty lifting arm over head
Weakness around the shoulder
Disturbed sleep
The constant need to use self-myofascial techniques

Causes

There are a few common risk factors of why rotator injury may occur:

Family History: There may be family history of rotator cuff injuries which may make certain family members more prone to having the injury than others.
The type of job you do: Individuals who work in construction or manual labour who have repetitive overhead movement of the shoulder could damage the rotator cuff overtime.
Age: As you get older joints and muscles become weaker, meaning you may be more prone to injury overtime.

Diagnosis

To diagnose a rotator cuff injury a physical examination will be carried out by a doctor or a physiotherapist. Firstly, they may ask about your day-to-day activities which may determine the seriousness of the injury. The doctor will test the range of movement at the shoulder by getting you to perform movements such as flexion, extension, abduction, adduction and medial and lateral rotation. This will allow the doctor to determine if it is actually rotator cuff injury or whether it may be other conditions such as impingement or tendinitis.

Imaging scans such as X-Ray’s may also be used to see if there is any abnormal bone growth within the joint, which may be causing the pain.

Treatment

Treatments for rotator cuff injuries can be non-surgical or surgical. Tendinitis may occur over time from the repetitive strain placed around the joint, so it is important to treat the affected area.

Apply a cold compress/ ice to the effected area to reduce swelling
Heat packs can be used to reduce swelling
Resting the affected area
Inflammatory medication such as ibuprofen and naproxen
Reduce the amount of repetitive movement to the joint
Don’t lift the arm overhead

Exercises

Doorway Stretch: Stand facing an open doorway with your hands placed on the door frame at shoulder height. Step one foot forward and gently lean forward, feeling a stretch in your chest and shoulders. Hold the stretch for 20-30 seconds before releasing. Repeat the stretch with the other foot forward.
External rotation with weight: Hold a dumbbell or weight plate in one hand and stand with your elbow bent at 90 degrees and your upper arm against your side. Rotate your arm outwards, away from your body, while keeping your elbow tucked in. Slowly return to the starting position and repeat for 8-12 repetitions before switching arms.
High to low rows with resistance band: Attach a resistance band to a sturdy anchor point at chest height. Stand facing the anchor point with the band in both hands. Pull the band towards your chest, keeping your elbows tucked in and your shoulders down. Slowly release the band back to the starting position and repeat for 8-12 repetitions.
Reverse fly’s: Hold a dumbbell or weight plate in each hand and bend forward at the waist, keeping your back straight. Extend your arms out to the sides, keeping them parallel to the floor. Squeeze your shoulder blades together as you bring the weights up towards your body, then slowly release back to the starting position. Repeat for 8-12 repetitions.
Lawn mower pull with resistance band: Attach a resistance band to a low anchor point and stand with your side to the anchor point. Hold the band in one hand with your arm extended towards the anchor point. Pull the band towards your chest, keeping your elbow bent and your shoulder blade squeezed down and back. Slowly release back to the starting position and repeat for 8-12 repetitions before switching sides.
Isometric internal rotation: Stand with your elbow bent at 90 degrees and your upper arm against your side. Place a rolled up towel or small ball between your elbow and your side. Squeeze your elbow into your side, holding the contraction for 10-15 seconds before releasing. Repeat for 2-3 sets of 10-15 repetitions.
Isometric external rotation: Stand with your elbow bent at 90 degrees and your upper arm against your side. Hold a resistance band in both hands, with one end of the band anchored to a sturdy object. Rotate your arm outwards, away from your body, while keeping your elbow tucked in. Hold the contraction for 10-15 seconds before releasing. Repeat for 2-3 sets of 10-15 repetitions before switching arms.

Prevention

Strengthen the rotator cuff muscles: Exercises that target the rotator cuff muscles can help to build strength and stability in the shoulder joint. Examples of such exercises include external rotation with a resistance band, internal rotation with a light weight, and scapular stabilization exercises.
Warm up properly: Before engaging in any activities that involve overhead arm movements, it is important to warm up the shoulder joint with dynamic stretches and exercises. This can help to increase blood flow to the muscles and reduce the risk of injury.
Practice good technique: When engaging in activities that involve overhead arm movements, it is important to use proper technique and form. This can help to reduce stress on the rotator cuff muscles and tendons and minimize the risk of injury.
Use proper equipment: Using equipment that is properly fitted and designed for the activity can help to reduce the risk of rotator cuff injuries. For example, using a tennis racket with a larger grip or wearing properly fitting swim goggles can reduce the stress on the shoulder joint.
Rest and recover: Resting and allowing the shoulder joint to recover after activity is important for preventing overuse injuries. Avoiding overuse and engaging in activities that strengthen and stretch the shoulder muscles can help to prevent rotator cuff injuries.

How We Can Help

We understand that dealing with a rotator cuff injury can be a challenging and painful experience. As healthcare professionals, we are dedicated to helping you manage your symptoms and regain full function of your shoulder joint.

We are pleased to offer you our services in massage therapy and sports therapy, both of which can be highly effective in treating rotator cuff injuries. Our trained and experienced therapists can work with you to reduce pain and inflammation, improve range of motion, correct muscle imbalances, and provide advice on injury prevention.

Our services are tailored to meet your individual needs and goals, and we will work with you to develop a treatment plan that is effective and manageable for you. We believe in a collaborative approach to healthcare, and we may work in conjunction with other healthcare professionals, such as physiotherapists or orthopedic specialists, to ensure that you receive the best possible care.

We take pride in providing our patients with high-quality, compassionate care, and we are committed to helping you achieve optimal health and well-being. If you are interested in learning more about our massage therapy and sports therapy services, or if you would like to schedule an appointment, please do not hesitate to contact us.

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