Physio | LiveWell Health

Ankle Stability Exercises

Posted on June 17, 2024

Ankle Stability Exercises

The ankle joint is a complex hinge joint that connects the lower leg bones (the tibia and fibula) to the foot bone (the talus). It plays a critical role in weight-bearing activities such as walking, running, and jumping. This joint is stabilized by a network of ligaments, tendons, and muscles, which work together to maintain its position and resist movements that could lead to injury.

Anatomy

The ankle joint, or talocrural joint, is a hinge joint connecting the lower leg bones (tibia and fibula) to the foot bone (talus). This joint plays a critical role in weight-bearing and movement, enabling actions like walking, running, and jumping. The tibia and fibula form a stable structure around the talus, providing both flexibility and stability. The joint is lined with a synovial membrane that produces fluid to reduce friction, while articular cartilage cushions the bones during movement.

Stability in the ankle is maintained by ligaments and tendons. Key ligaments include the deltoid ligament on the inner side, which prevents over-eversion, and the lateral ligaments (anterior and posterior talofibular and calcaneofibular ligaments), which prevent excessive inversion. Tendons like the Achilles tendon, connecting the calf muscles to the heel, and the peroneal tendons, which stabilize the outer ankle, ensure controlled motion and protection from injury.

Surrounding muscles, such as the calf muscles (gastrocnemius and soleus), tibialis anterior, and peroneal muscles, work to move and stabilize the ankle. Together with the ligaments and tendons, they allow the ankle to function as a strong, flexible foundation for everyday activities and high-impact movements, while reducing the risk of injury.

Symptoms

Issues with ankle stability often manifest as frequent sprains, a sensation of wobbliness, pain, swelling, and difficulty bearing weight on the affected ankle. Chronic ankle instability can also cause recurring discomfort and impact an individual’s ability to engage in physical activities.

Causes

Ankle instability can result from various factors, including:

Weak muscles supporting the joint.
Poor neuromuscular control.
Previous ankle injuries, such as sprains or fractures.
External factors like inappropriate footwear or uneven surfaces during physical activity.

Recurrent injuries can lead to chronic ankle instability, further increasing the risk of complications.

Diagnosis

Diagnosing ankle instability typically involves a physical examination by a healthcare professional. The process may include:

Assessing the range of motion and strength of the ankle.
Reviewing the patient’s history of injuries.
Imaging studies such as X-rays or MRIs to evaluate the condition of the ligaments, tendons, and bones.

Treatment

Treatment for ankle instability aims to strengthen the joint, improve neuromuscular control, and prevent further injuries. Interventions include:

Deep Tissue Massage and Sports Massage: These therapies help alleviate muscle tension, improve circulation, and promote healing.
Reflexology: Targeted pressure on specific points of the foot to support ankle function.
Heat and Ice Therapy: Heat helps relax muscles, while ice reduces inflammation and pain.
Medical Acupuncture: Stimulates the body’s natural healing processes and reduces pain.
Cupping Therapy: Promotes blood flow and aids in recovery.

Exercises

Strengthening exercises are essential for improving ankle stability. Here are some effective options:

Ankle Dorsiflexion
Use a resistance band to lift your foot toward your shin, strengthening the muscles at the front of the ankle.
Ankle Plantar Flexion
Press your foot away from your body using a resistance band, targeting the calf and ankle.
Eversion and Inversion
With a resistance band, move your foot outward (eversion) and inward (inversion) to strengthen the ankle’s stabilizing muscles.
Calf Raises
Stand on your toes and lift your heels off the ground to build strength in the calf and ankle.
Balance Exercises
Stand on one foot to enhance proprioception and improve stability.

Conclusion

Ankle stability is essential for maintaining proper joint function and preventing injuries. Through targeted exercises and strength and conditioning regime’s designed by our Physiotherapists or Sports Therapists combined with other modalities such as deep tissue massage, reflexology, and medical acupuncture, combined with specific strengthening exercises, individuals can significantly improve their ankle health.

If you experience recurring ankle issues such as sprains or weakness, or if you have sport-specific needs, contact our team of specialists. We can develop a personalized exercise plan and provide professional treatments to support your recovery and performance.

How effective is Kinesio taping?

Posted on June 10, 2024

How effective is kinesio taping ?

Tips for knees, shoulder, ankles, wrists.

Overview

Kinesio taping is a method of taping the skin to provide support and stability to muscles and joints, while also allowing for full range of motion. The tape is made of flexible, breathable material that stretches and moves with the skin. It is applied in specific patterns depending on the area of the body being treated.

Kinesio taping is often used to help alleviate pain, reduce inflammation, improve muscle function, and promote healing. It is also used as a preventative measure to improve muscle activation and stability, as well as to support joints during movements. It’s often used to help with conditions such as back pain, knee pain, sprains, strains and sports injuries.

Kinesio therapy is a non-invasive, drug-free method of treatment, and it is generally considered safe for most people. However, it is best to consult with a physical therapist or doctor before using Kinesio taping, as it may not be appropriate for everyone, especially for those with certain skin conditions or allergies.

How effective is Kinesio taping?

Kinesio taping is relatively new method of treatment and research on its effectiveness is still ongoing. Some studies have shown that Kinesio taping can be effective in reducing pain and inflammation, improving muscle function, and promoting healing.

For example, a study published in The Journal of Athletic Training found that Kinesio taping was effective in reducing pain and improving function and reduced pain in people with the patellofemoral pain syndrome.

However, it is important to note that the effectiveness of Kinesio taping can vary depending on the condition being treated and the individual. Some studies have found that Kinesio taping is no more effective than other treatments such as physical therapy or exercise. It is important to note that more research is needed to fully understand the effectiveness of Kinesio taping and to determine the best ways to use it.

Knee Kinesio taping

Injuries in which the Kinesio taping might be helpful:

Patellofemoral pain syndrome:
This condition is characterized by pain in the front of the knee and around the kneecap, often caused by overuse or improper alignment of the kneecap. Kinesio taping can help to stabilize the kneecap and reduce pain.

Anterior cruciate ligament injuries (ACL):
The ACL is a ligament that helps to stabilize the knee. Injuries to the ACL can cause pain, instability, and difficult walking. Kinesio taping can help to provide support and stability to the knee joint following and ACL injury.

Meniscus injuries:
The meniscus is a piece of cartilage that helps the cushion the knee joint. Injuries to the meniscus can cause pain, swelling, and difficulty walking. Kinesio taping can help to support and stabilize the knee joint following a meniscus injury.

Osteoarthritis:
This degenerative condition that causes pain and stiffness in the knee joint. Kinesio taping can help to reduce pain and improve function in individuals with knee osteoarthritis.

Patellar tendonitis:
This overuse injury that causes pain and inflammation in the tendon that connects the kneecap to the shin bone. Kinesio taping can help to reduce pain and improve function in individuals with patellar tendonitis.

Ankle Kinesio Taping

Sprains:
Kinesio taping can be used to support the ankle during the healing process and reduce swelling and pain.

Tendinitis:
Taping can be used to support the tendons and reduce stress on the area.

Plantar fasciitis:
Taping can be used to provide support for the foot and help reduce pain and inflammation in the heel.

Ankle instability:
Taping can be used to provide support and help stabilize the ankle joint, which can reduce the risk of reinjury.

Overuse injuries:
Taping can be used to support the muscles and tendons of the ankle and reduce the risk of overuse injuries such as stress fractures.

Shoulder Kinesio Taping

Rotator cuff strains and tears:
Kinesio taping can provide support and stability to the rotator cuff muscles, helping to reduce pain and inflammation while promoting healing.

Shoulder Impingement:
Kinesio taping can help to correct muscle imbalances and improve posture, which can help to reduce the risk of shoulder impingements.

Frozen shoulder (Adhesive capsulitis):
Kinesio taping can improve range of motion and reduce pain during the frozen stage of the condition.

Dislocated shoulder:
Kinesio taping can provide support and stability to the shoulder joint, helping to reduce the risk of further dislocations.

Tendinitis:
Kinesio taping can help to reduce pain and inflammation and promote healing of the tendons.

Wrist Kinesio Taping

Carpal Tunnel syndrome:
Taping can be used to provide support for the median nerve and help reduce pain and inflammation in the wrist.

Wrist instability:
Taping can be used to provide support and help stabilize the wrist joint, which can reduce the risk of reinjury.

If you believe that you could benefit from some Kinesio Taping then please contact a member of our team or book an appointment online with one of our kinesio taping experts!

tel: 0330 043 2501 or via email on: info@livewellhealth.co.uk

Adductor Strain

Posted on June 10, 2024

Adductor strain or injury to the adductor muscle group is a common cause of medial leg (inside leg) and groin pain, especially among athletes. A groin strain is an acute injury to the muscles on the inside of the thigh, known as the adductor muscles. These muscles help to stabilize the trunk and move the legs inward. A strain typically occurs because of an athletic injury or awkward movement of the hip joint, which leads to stretching or tearing of the inner thigh muscles.
A strain injury is graded I-III based upon its severity. Mild strains involve overstretching of the muscle, whereas more severe strains can involve complete muscle tears. Most injuries to the adductor muscles are Grades I or II.

Adductor Strain

GRADE 1 GROIN STRAIN

Grade I is a mild strain (tear) with some pain, bruising, and tenderness, but no significant fiber disruption.

GRADE 2 GROIN STRAIN

A Grade II injury involves injury to the muscle-tendon fibers, this is usually a more serious tear which will severely limit movement. However, the overall integrity of the muscle-tendon unit is preserved.

GRADE 3 GROIN STRAIN

A Grade III injury (or complete rupture) is one that results in a loss of overall muscle/tendon integrity. This serious injury will result in severe pain, swelling, joint instability, and pain associated with movement. It may in some cases mean the muscle detatching from it’s attachment point.

Anatomy

The adductor complex includes the three adductor muscles (longus, magnus, and brevis) of which the adductor longus is the most injured. All three muscles primarily provide adduction of the thigh. Adductor longus provides some medial rotation. The adductor magnus also has an attachment on the ischial tuberosity, giving it the ability to extend the hip. In open chain activation, the primary function is hip adduction. In closed chain activation, they help stabilize the pelvis and lower extremity during the stance phase of gait. They also have secondary roles including hip flexion and rotation.

Symptoms

Depending on the underlying cause, pain can be mild or severe, come on gradually or suddenly, and vary in quality (dull, sharp, throbbing, or even burning). Common symptoms include:

Pain and tenderness in the groin and the inside of the thigh
Sudden onset of pain sometimes accompanied by the sensation of a pop in the inner thigh
Failure to continue activity after initial onset of pain
Pain when you bring your legs together or when you raise your knee
Bruising may develop, and limping may also be a symptom

Causes

Most injuries can be managed conservatively by their primary care provider with rest, ice, physical therapy, and a graded return to play.

previous hip or groin injury
age
weak adductors
muscle fatigue
decreased range of motion
inadequate stretching of the adductor muscle complex

Diagnosis

Radiographic evaluation is the initial modality of choice for suspected adductor strain. Anteroposterior views of the pelvis and frog-leg view of the affected hip are recommended as initial imaging studies. In most patients, these images will be normal in appearance; however, occasionally one may observe an avulsion injury. These images can also help evaluate for other causes of groin pain such as osteitis pubis, apophyseal avulsion fractures, and pelvic or hip stress fractures.

If further imaging is needed, magnetic resonance imaging (MRI) is recommended. This is likely to show muscle oedema and haemorrhage at the site of injury. If there is a bony injury, this will be better elucidated on the MRI.

Musculoskeletal ultrasound can further visualize the tendon and bony attachment sites, muscles, ligaments, and nerves. Ultrasound can be used to identify the area and extent of the injury and used to evaluate periodically during the recovery phase.

Treatment

Fortunately, there are several effective treatment options for adductor strains, including rehabilitation and massage. In this article, we will discuss the various treatment options for adductor strains, with a particular focus on the benefits of rehabilitation and massage therapy.

Rest and Ice / Heat Therapy

The first step in treating an adductor strain is to rest the affected muscle. This means avoiding any activities that put stress on the muscle, such as running, jumping, or kicking. In addition, applying ice and heat to the affected area through contrast bathing can help reduce swelling and pain and then through the heat stimulate repair. To contrast bathe we recommend 5 minutes ice, 10 minutes heat, 3 times round 3 times a day. This will equate to 45 minutes at a time.

Compression and Elevation

Compression and elevation are also important in the early stages of adductor strain treatment. Compression can help reduce swelling and provide support to the injured muscle, while elevation can help improve blood flow and reduce inflammation. A compression bandage should be applied snugly but not too tightly, and the affected leg should be elevated above the level of the heart as much as possible.

Physical Therapy / Physiotherapy

Once the initial swelling and pain have subsided, physical therapy can help restore strength and flexibility to the injured muscle. Physical therapy may include exercises to improve range of motion, strengthen the muscles, and improve balance and coordination. Your physical therapist may also use stretching, to help relieve muscle tension and improve circulation to the affected area.

Massage Therapy

Massage therapy is a type of manual therapy that involves manipulating the soft tissues of the body, including muscles, tendons, and ligaments. Massage can help reduce muscle tension and improve circulation, which can help promote healing and reduce pain and stiffness. Massage therapists may use a variety of techniques, including sports massage, deep tissue massage, myofascial release, and trigger point therapy, depending on the specific needs of the patient.

Massage therapy can be especially beneficial for adductor strains because it can help relieve muscle tension and improve circulation to the affected area. Massage can also help reduce pain and stiffness, which can make it easier to perform physical therapy exercises and other activities of daily living.

In conclusion, adductor strains can be a painful and debilitating injury, but there are many effective treatment options available. If you are experiencing symptoms of an adductor strain, it is important to seek advice for a specialist, livewell and our team of highly qualified soft tissue specialists can help. If you want to find out more information or to book an appointment, please contact us.

Exercises

An adductor strain can be a painful and frustrating injury, but with the right exercises and a progressive plan, you can get back to your normal activities in no time. It’s important to start with gentle exercises and progress gradually to more challenging ones as your injury heals. Here are some exercises you can do on a weekly basis to help recover from an adductor strain:

1. Initial Phase: Gentle Stretching

Focus on restoring range of motion without straining the injured muscle.

Butterfly Stretch
- Sit on the floor, bend your knees, and bring the soles of your feet together.
- Gently press your knees toward the floor while keeping your back straight.
- Hold for 15–30 seconds and repeat 2–3 times.
Standing Adductor Stretch
- Stand with feet wider than shoulder-width apart.
- Shift your weight to one side, bending that knee and keeping the other leg straight.
- You should feel a stretch in the inner thigh of the straight leg.
- Hold for 15–30 seconds on each side and repeat 2–3 times.

2. Intermediate Phase: Isometric Strengthening

Begin strengthening the adductor muscles without full range of motion.

Ball Squeeze (Isometric Adduction)
- Sit in a chair with your knees bent at 90 degrees.
- Place a soft ball or pillow between your knees.
- Squeeze the ball gently and hold for 5–10 seconds.
- Repeat 10–12 times.
Side-Lying Hip Adduction
- Lie on your side with the injured leg on the bottom.
- Keep the bottom leg straight and cross the top leg over for support.
- Lift the bottom leg a few inches off the floor and slowly lower it back down.
- Perform 2–3 sets of 10–12 repetitions.

3. Advanced Phase: Dynamic Strengthening

Introduce dynamic and functional movements to restore full strength and prepare for activity.

Side-Lunge with Adductor Focus
- Stand with feet wide apart.
- Shift your weight to one side, bending that knee while keeping the other leg straight.
- Push back to the center and alternate sides.
- Perform 2–3 sets of 8–10 repetitions per side.
Adductor Plank
- Place your top leg on an elevated surface like a bench or step.
- Keep the lower leg straight and lift it off the ground.
- Support your body with your forearm and hold for 10–20 seconds.
- Repeat 2–3 times on each side.
Cable or Resistance Band Adduction
- Attach a resistance band or cable to your ankle.
- Stand sideways to the anchor point and pull your leg inward across your body.
- Slowly return to the starting position.
- Perform 2–3 sets of 10–12 repetitions on each side.

4. Functional Phase: Return to Activity

Incorporate sport-specific drills and movements that mimic real-life activities to ensure the adductor is ready for higher demands. Examples include lateral shuffles, agility drills, and progressive plyometrics. Progress gradually through these exercises and adjust intensity based on pain and recovery. Stop any exercise that causes sharp pain or discomfort.

In conclusion, a progressive exercise plan is essential for recovering from an adductor strain. Starting with gentle isometric exercises and gradually progressing to more challenging resistance and functional exercises can help improve strength, flexibility, and overall function in the injured muscle. Be sure to consult with your healthcare provider before starting any exercise program to ensure it is safe and appropriate for your specific injury.

Prevention

Work on core stability. Having good core and pelvic stability provides a solid base for sport-specific movements and reducing the chance of adductor strains.
Dynamic warm-up! This is easily overlooked, but important. Prior to training and competing, ensure you perform a complete warm-up, including slow to fast movements, dynamic stretches (movement stretches) and sports-specific drills.
Strengthen the lateral hip muscles, mainly the gluteal muscles. This will help with pelvic stability
Stretch the inner thigh and outer thigh muscles on a daily basis.
Regularly get manual therapy and massages from certified physiotherapists, athletic therapists or massage therapists. This will help to get the muscles flexible and break down any trigger points or scar tissue that can lead to injury.
Practice sport-specific drills, change of direction and cutting manoeuvres which commonly cause groin strains. This will help the muscles to adapt and become stronger at performing this kind of movement.
Strengthen the inner thigh muscles using weight machines and resistance bands. It is especially important to strengthen the muscles in the movement which caused the injury, to prevent a reoccurrence.
Improve your proprioception. This is our sense of where each body part is in space and is similar to balance. Proprioception affects the way we move, especially when our balance is compromised and is therefore important in avoiding all injuries.
Get plenty of rest and avoid over-training! If you train too much or for too long fatigue sets in, which increases the risk of injury.

If you feel like you have an adductor strain then please contact a member of our team or make a booking online. For something like this you will need one of our Physiotherapists or Sports Therapists.

AC Joint Inury

Posted on June 10, 2024

The AC (acromioclavicular) joint is where the shoulder blade (scapula) meets the collarbone (clavicle). The highest point of the shoulder blade is called the acromion. Strong tissues called ligaments connect the acromion to the collarbone, forming the AC joint.

Most AC Joint injuries are treated conservatively using various combinations of strengthening exercises, following the immobilisation phase, once pain permits. Surgery is usually reserved for cases where there is a complete dislocation of the AC Joint (Grade 3), or in cases where a less severe injury fails to respond adequately to conservative treatment.

Anatomy

The Acromioclavicular Joint, or AC Joint, is one of four joints that comprises the Shoulder complex. The AC Joint is formed by the junction of the lateral clavicle and the acromion process of the scapula and is a gliding, or plane style synovial joint. The AC Joint attaches the scapula to the clavicle and serves as the main articulation that suspends the upper extremity from the trunk.

The primary function of the AC Joint is:

To allow the scapula additional range of rotation on the thorax.

Allow for adjustments of the scapula (tipping and internal/external rotation) outside the initial plane of the scapula in order to follow the changing shape of the thorax as arm movement occurs.

The joint allows transmission of forces from the upper extremity to the clavicle.

Symptoms

Pain at the end of the collar bone.
Pain may feel widespread throughout the shoulder until the initial pain resolves; following this, it is more likely to be a very specific site of pain over the joint itself.
Swelling often occurs.
Depending on the extent of the injury, a step-deformity may be visible. This is an obvious lump where the joint has been disrupted and is visible on more severe injuries.
Pain on moving the shoulder, especially when trying to raise the arms above shoulder height.

Causes

An AC Joint injury often occurs as a result of a direct blow to the tip of the shoulder from, for example, an awkward fall, or impact with another person. This forces the Acromion Process downward, beneath the clavicle. Alternately, an AC Joint injury may result from an upward force to the long axis of the humerus (upper arm bone) such as a fall which directly impacts on the wrist of a straightened arm. Most typically, the shoulder is in an adducted (close to the body) and flexed (bent) position.

Diagnosis

Firstly, for the diagnosis of scapula winging your doctor will look at the shoulder blades for any clear obvious signs of winging. Some patient’s scapula bone may be more visible than others and have distinct scapula winging. The doctor may also ask you to perform arm/ shoulder movements to examine the range of movement and stability at the joint.

One of the main tests that are used to aid in the diagnosis of scapula winging is the serratus anterior test. This is where the patient is asked to face a wall, standing about two feet from the wall and then push against the wall with flat palms at waist level. This test is carried out to identify if any damage is done to the thoracic nerve causing the scapula to wing.

Treatment

The traditional literature supports non-operative treatment for grade I and II injuries. Patients with grade IV, V and VI injuries benefit from operative treatment, whereas the treatment of grade III injuries remains a controversial issue. 22 Numerous surgical procedures have been described, though there is currently no gold standard for the treatment of AC injuries. The main principle of surgical therapy is accurate reduction of the AC joint in both coronal and sagittal planes. This is achieved either by primary repair or by reconstruction of injured ligaments and maintaining stability to protect this repair or reconstruction. The traditional Weaver-Dunn CA ligament transfer procedure has largely fallen into disfavour today. If the AC joint injury presents within six weeks, it is considered acute. The main goal of treatment is acromioclavicular joint stabilisation. Following techniques are used for stabilisation and reduction of AC joint pain. Whilst you are going through a rehabilitation, strength plan massage can also help with specific soft tissue techniques to eleviate pain and discomfort and inflamation such as lymphatic drainage massage.

Exercises

Initially, complete rest, immobilization and regular application of ice or cold therapy are important to reduce pain and inflammation. Mobility exercises can begin only once shoulder movement is pain-free. This will normally be 7-14 days for grades 1 and 2 sprains. Grade 3 injuries are more frequently treated conservatively, without surgery, but will require an even longer rest/healing period. If the shoulder has been immobilized for a period of time, then it may have lost mobility or range of motion.

Pendulum exercises can begin as soon as the ligament has healed, and pain allows. Gently swing the arm forwards, backward, and sideways whilst lying on your front or bent over as seen opposite.
Gradually increase the range of motion. Repeat this with your arm swinging from side to side as well. Aim to reach 90 degrees of motion in any direction.
Front shoulder stretch
External rotation stretch
Isometric exercises – Strengthening should initially be isometric. This means contracting the muscles without movement.

Resistance band exercises for AC joint sprain:

Internal Rotation
External Rotation
Abduction/lateral raise

Prevention

Wearing protective strapping to support a previously injured AC Joint, particularly in contact sports or sports where full elevation of the arm is not so important. Protective padding is also used in sports such as rugby.
Warming up, stretching and cooling down.
Participating in fitness programs to develop strength, balance, coordination and flexibility.
Undertaking training prior to competition to ensure readiness to play.
Gradually increasing the intensity and duration of training.
Allowing adequate recovery time between workouts or training sessions.

If you feel like you may have an AC Joint injury and would like to know more, please contact our specialist team made up of Physiotherapists and Sports Therapists who deal with these kind of injuries all the time. Alternatively you can make a booking online directly.

Tension Headaches

Posted on June 10, 2024

Tension headaches are the most common type of headache and are caused by muscle tension. Symptoms are often characterised as a dull ache or the feeling of pressure on both sides of the head and are sometimes associated with upper neck pain.

Anatomy

The suboccipital muscles, sternocleidomastoid muscles and trapezius muscles run from the base of the skull, the upper neck and the shoulders. When these muscles become tight and contracted, they may compress the nerves or blood vessels in the head and neck, increasing the pressure. This can result in a dull aching pain in the head and upper neck. This increased pressure may also cause referred pain in which there may be pain around the forehead, temples and eyes.

Symptoms

The symptoms of Tension Headaches can in extreme cases be debilitating. Some of the symptoms can include:

Pain on both sides of the head
Dull aching head pain
Feeling of built up pressure in the head
Tightness across forehead
Neck ache/pain
Tenderness of the scalp, neck and shoulders

Causes

The specific causes of tension headaches are still unclear. Tension headaches are caused by tight, contracted neck muscles and are commonly linked to stress, poor posture, head injury and anxiety. Tension headaches are often linked to running in families and are more common in females.

Diagnosis

Tension headaches are diagnosed by reported symptoms. A full medical exam including other tests may be ran by the GP to rule out any other conditions. Tension headaches can be diagnosed by a discussion with a healthcare professional regarding experienced symptoms.

Treatment

Over the counter painkillers may help relieve pain caused by a tension headache. Heatpacks and gentle stretching may also help relieve symptoms. In some cases stronger medication may be prescribed by the GP for chronic tension headaches.

Sports therapy, physiotherapy and massages can be an excellent treatment for tension headaches. The treatment of the underlying muscle tightness can relieve pressure and consequently reduce symptoms. Treatment sessions may include massage, stretching and mobilisation as well as postural strengthening and advice and education to help reduce symptoms and pain experienced.

Exercises

1. Chin Tucks

Purpose: Strengthen the deep neck flexor muscles and improve posture, which can relieve tension in the neck and reduce headache symptoms.
How to Perform:
- Sit or stand with your back straight.
- Gently tuck your chin toward your chest, as if making a double chin, while keeping your eyes forward.
- Hold the position for 3-5 seconds, then relax.
- Repeat for 20-30 repetitions.

2. Cervical Rotation Stretch

Purpose: Increase flexibility and reduce muscle tension in the neck, which can help alleviate tension headaches.
How to Perform:
- Sit or stand with your back straight.
- Slowly turn your head to one side as far as comfortable, keeping your chin level.
- Hold the stretch for 20 seconds, then return to the centre.
- Repeat on the other side, performing 3 stretches per side.

3. Upper Trapezius Stretch

Purpose: Stretch and relax the upper trapezius muscles, which often become tight and contribute to tension headaches.
How to Perform:
- Sit or stand with your back straight.
- Gently tilt your head to one side, bringing your ear toward your shoulder, while keeping your shoulders relaxed.
- Use your hand to gently increase the stretch by pulling your head closer to your shoulder.
- Hold for 20 seconds, then switch sides. Perform 3 stretches per side.

4. Scapula Pinches

Purpose: Strengthen the muscles between the shoulder blades, improving posture and reducing tension in the upper back and neck.
How to Perform:
- Sit or stand with your arms at your sides.
- Squeeze your shoulder blades together as if trying to pinch something between them.
- Hold the squeeze for a moment, then relax.
- Perform 3 sets of 10-20 repetitions.

Prevention

Due to the nature of our lives and the fact tension headaches can come on through a variety of issues. Some of which are part of our day to day life, such as looking down to your phone, working at a computer/desk, performing certain exercises at gym or just generally feeling stressed from work/life etc.

The good news is with the stretches above, if done regularly, it can prevent the onset of tension headaches. Regular deep tissue massages can also help and trying to take time to de-stress and in some cases meditation/yoga type exercises will also help.

It is important, to slow down and take time for yourself.

If you feel like you are struggling with tension headaches and would like some more advice then please contact us directly, alternatively if you feel a professional massage will help then please make a booking today.

ACL Rupture

Posted on June 10, 2024

Anterior cruciate ligament (ACL) is one of the most injured area of the lower body. The ACL is a strong band of tissue that connects your femur to your tibia. These injuries are mainly common in people who partake in sporting activities such as running, football basketball and netball. This is due to the sports involving a lot of pressure onto the knee, with quick agility movements and changing direction suddenly.

Normally people will know instantly when they have injured the ACL as you will hear a loud popping sound, the knee will suddenly feel weak and painful, unable to put any weight onto the joint. It is important that you seek medical care as soon as possible when this occurs and go and see a doctor for a medical examination.

Anatomy

The ACL ligament is a band of connective tissue which passes from the femur to the tibia bones. The origin of the ACL is the posteromedial corner of the medial aspect of the lateral femoral condyle and inserts into the intercondylar notch of the tibia. The ACL is an important ligament as it provides stability to the knee by preventing the tibia from sliding Infront of the femur.

The main two components of the ACL are the anteromedial and posterolateral bundles, thee insert into the tibial plateau. When the knee is in extension the posterolateral bundle is very tight and the anterolateral bundle is laxed, when the knee is then flexed the ACL changes its positioning causing the AMB to allowing the ligaments to hold more anterior tibial load. When this area is injured, it can be hard for the joint to hold its normal function.

Injury to ligaments is usually graded on a severity scale:

Grade 1: The ligament is mildly damaged and has been slightly stretched but will still be able to keep the knee stable.

Grade 2: The ligament will be stretched to a point where it becomes loose, commonly known as a partial tear.

Grade 3: This is usually known as a full rupture/ tear of the ligament where it has been split, leaving the joint unstable. A grade 3 tear is so common with the anterior cruciate ligament.

Symptoms

Common signs and symptoms of ACL injuries are:

Loud popping of the knee
Pain when walking/ inability to walk
Instability
Difficulty putting weight on the knee joint
Excessive swelling
Constant pain

Causes

There are a number of things that can cause these injuries, usually, but not always, around sports. Such as:

Sudden change in direction.
Planting the foot into the ground whist twisting the leg.
Landing awkwardly from a jump.
Someone else may cause the injury.
Sudden jolt/ stop causing too much pressure onto the knee ligament.

Diagnosis

For the diagnosis of ACL injury your doctor will check your knee for swelling and tenderness, comparing your injured knee to your uninjured knee. The doctor may also move your knee into a variety of positions to assess range of motion and overall function of the joint testing for stability and strength.

Some scans such as an MRI may be used, however a Rupture is easily diagnosed through sight and various movement tests as described above.

Treatment

Once the ACL has encountered a complete rupture, the main treatment to fix this would be surgery. The main focus will be on rebuilding the ACL, this will consist of a complete restructure of the ligament. The doctor will replace the ligament with tissue graft of a tendon, by doing this it allows the graft to act as added support for a new ligament to grow onto.

Other options such as physiotherapy would be recommended to help strengthen and help support the knee joint to get back to its normal function. Exercises and rehabilitation programmes should only be completed once swelling has reduced. Wearing a brace may also be helpful to reduce instability of the knee joint, as well as crutches to take pressure of the knee when walking.

Exercises

Once the rupture has been treated through surgery there is a long road of rehabilitation ahead. Please seek a professional consultation with a registered sports therapist or physiotherapist to get a detailed plan. In the interim, the below exercises can help stregnthen and get you back on the road.

Heel Slides

Purpose: Improve knee range of motion and flexibility after an ACL injury.
How to Perform:
- Lie on your back with your legs straight.
- Slowly slide the heel of the affected leg toward your buttocks by bending your knee as much as possible without pain.
- Hold the position briefly, then slowly slide the heel back to the starting position.

Isometric Quad Contractions

Purpose: Strengthen the quadriceps muscles without moving the knee joint, which is important for stabilizing the knee after an ACL rupture.
How to Perform:
- Sit with your leg straight out in front of you.
- Tighten your quadriceps (the muscles on the front of your thigh) by pressing the back of your knee down into the floor.
- Hold the contraction for 5-10 seconds, then relax and repeat.

Prone Knee Flexion

Purpose: Improve knee flexion and strength in the hamstrings, which are important for knee stability.
How to Perform:
- Lie face down with your legs straight.
- Slowly bend the knee of your affected leg, bringing your heel toward your buttocks.
- Hold briefly at the top, then slowly lower your leg back down.

Heel Raises

Purpose: Strengthen the calf muscles, which support the knee and improve overall leg stability.
How to Perform:
- Stand with your feet shoulder-width apart, using a chair or wall for balance.
- Slowly lift your heels off the ground, rising onto the balls of your feet.
- Hold for a moment at the top, then slowly lower your heels back down.

Half Squats

Purpose: Build strength in the quadriceps, hamstrings, and glutes, which are crucial for knee support without putting excessive strain on the joint.
How to Perform:
- Stand with feet shoulder-width apart.
- Slowly lower your body by bending your knees, keeping your back straight, until your thighs are about halfway to parallel with the floor.
- Push through your heels to stand back up.

One Leg Stands and Hold

Purpose: Improve balance, stability, and strength in the supporting muscles around the knee.
How to Perform:
- Stand on one leg, using a wall or chair for balance if necessary.
- Hold the position for 20-30 seconds, keeping your knee slightly bent, then switch to the other leg.

Isometric Knee Flexion and Extension

Purpose: Strengthen the muscles around the knee without joint movement, which is beneficial for maintaining strength after an ACL rupture.
How to Perform:
- Sit with your knee slightly bent.
- For flexion, press your heel into the floor as if trying to bend your knee further, but without actually moving it.
- For extension, try to straighten your knee by tightening your quadriceps, pressing the back of your knee down into the floor.
- Hold each contraction for 5-10 seconds, then relax and repeat.

Resist Knee Bike Upright

Purpose: Improve range of motion and strength in the knee using a stationary bike, while also providing a low-impact cardiovascular workout.
How to Perform:
- Sit on a stationary bike with the seat adjusted so that your knees are slightly bent at the bottom of the pedal stroke.
- Start with light resistance and pedal smoothly, gradually increasing resistance as tolerated to challenge your knee muscles.
- Aim for 10-20 minutes, depending on your comfort and fitness level.

An ACL rupture can be life changing and as such the rehabilitation back to full fitness can be a long, hard road. If you need help with an ACL issue then please contact a member of our team and make a booking with one of our physiotherapists or sports therapists.

Plantar Fasciitis

Posted on June 3, 2024

In the bottom of the foot there is a thick fibrous tissue known as the plantar fascia. The plantar fascia provides stability for the foot and also works as a shock absorber. Injury to the plantar fascia can lead to an aching sensation on the bottom of the foot when walking, especially after long periods of rest. The term plantar fasciitis refers to inflammation on the sole of the foot.

Plantar fascia injuries are most common in individuals who do lots of exercise such as running, jumping and dancing, involving lots of impact on the bottom of the feet. Treatment methods such as massage and rest can help alleviate the painful symptoms. Painful symptoms may ease on their own but if they still remain after 2 weeks, consult a professional.

Anatomy

The plantar fascia is a long, thick fibrous tissue connecting to the calcaneus (heel bone of the ankle) it runs along the bottom of the foot and divides into five digital bands, along the heads of the metatarsals (toes). It covers the sole of the foot.

The function of plantar fascia is to provide support to the foot when standing and shock absorption when running.

Inflammation or degeneration of the tendon where the fascia originates can cause heel pain.

Symptoms

The symptoms of plantar fasciitis will be aggravated by continuing activity on the sole of the foot such as walking/running and will get worse over time. Some of the symptoms of plantar fasciitis include:

Pain on the bottom of the foot, around the heel and the arch (main symptom)
May be tenderness/pain under sole of foot and under heel when pressing in
Eases pain when exercising, but painful once rest
Difficult to raise toes off floor
Pain occurred gradually
Pain worse first thing in morning/when walking after long periods of rest
Pain eases off only to return later
Pain directly under the heel
Flat or overpronated feet
Tight calves

Causes

Plantar fasciitis is directly caused by damage to the plantar fascia running along the sole of the foot.

Some examples of causes/links consist of:

- Overuse
- Recently started exercising on hard surfaces
- Exercising with a tight calf or heel
- Overstretch the sole of your foot during exercise
- Recently started doing a lot more running, walking or standing up
- More common in sports involving running, dancing or jumping
- Foot biomechanics
- Overpronation (foot rolling in/flattening too much when running or walking which stretches plantar fascia more than normal)
- High arch – unable to absorb as much shock so increased strain on plantar fascia
- Footwear – very flat and unsupportive shoes increase likelihood of developing plantar fasciitis
- Bodyweight – overweight individuals or those that do lots of heavy lifting causes increased load on feet increasing chances of developing heel pain

Flexibility – if have tightness in the calves or plantar fascia this can alter the biomechanics in the foot causing strain on the fascia

Diagnosis

During your visit to your local GP or Sports Therapist / Physiotherapist, they will assess..

- - History- how long the pain has been occurring for and when its most painful
  - Physical examination- check for tenderness in foot, pain during palpation
  - Gait analysis- analysing feet and how they function when walking and running- if overpronate or feet flatten

Treatment

Aims to decrease pain and inflammation, identify and correct possible causes, improve flexibility, gradually increase strength and return to full fitness levels.

Rest- rest from activities causing the pain reduces initial pain and inflammation
Massage – can help stretch and relax the plantar fascia. Massage also helps to stimulate blood flow and loosen tight tissues underneath the foot which cause pain
Stretches – for calf muscles and plantar fascia
Night splint – compliments plantar fasciitis exercises by preventing the tissues from tightening up overnight. Wearing a night splint is more effective than stretching exercises alone.
Taping- supports the arch of the foot and reduces strain on the plantar fascia
Shock Wave Therapy – method of therapeutic treatment for soft tissue injuries- works by passing shock waves into the tissues
Ultrasound – transmits high frequency sound waves into the tissues- has a micro massage effect and can reduce pain and inflammation
Footwear – wear comfortable trainers with good cushioning- avoid hard, flat soles
Cold therapy – ice massage or application of an ice pack for 10 minutes every hour for the first day- reduce to 3-5 times a day as symptoms ease
Medication – doctor may prescribe NSAID’s (Nonsteroidal anti-inflammatory drugs) e.g. ibuprofen in the early stages – always check with a doctor before taking any medication
Orthotics (shoe insoles) – for overpronated feet if feet roll in or overpronate it can cause strain on the foot should be worn at all times, not just when training
Surgery – rarely needed but is used when all other treatments haven’t helped.

Exercises

The best way to treat plantar fasciitis is firstly to rest. If pain allows, some stretching exercises can help improve symptom’s and alleviate some pain.

Foot rolling – rolling the foot over a round object such as a ball, weights bar, rolling pin or can of soup can stretch the plantar fascia. Roll the foot repeatedly over the object, applying increasing downward pressure. You can also apply an object that can be cooled in the freezer (bottle or metal can) to apply cold therapy at the same time – 10 minutes per day until walking in the mornings is pain-free.
Calf stretches – stand facing a wall with one foot in front of the other, the front knee slightly bent, and the back leg straight. Keep both heels on the ground and lean into the wall, feeling a stretch in the calf of the straight leg. Hold for 20-30 seconds, then switch legs and repeat.
Soleus stretch – Stand in the same position as the calf stretch, with one foot in front of the other. This time bend both knees while keeping both heels on the ground. Lean into the wall, feeling a stretch in the lower part of the back calf. Hold for 20-30 seconds, then switch legs and repeat.
Stretching on a step – stand with toes on step and heels off the back, lower heels down below the level of the step until a stretch is felt- hold for 15-20 seconds- further stretches calves and Achilles
Towel Scrunch – While sitting, place a towel on the floor with your foot on top of it. Try scrunching up a towel with your toes like you are trying to pick it up off the floor

No running!

Try to maintain fitness by swimming or cycling & you can begin to start walking again when there has been no pain for at least a week, slowly increase the distance and speed.

Prevention

Stretching – make sure to keep up the stretching of the lower body to prevent strain on the fascia
Footwear and Insoles – try to wear shoes that are supportive for the sole of the foot and absorb shock with cushioning
Ease into more intense exercise gradually – start by walking and gradually increase the amount as time goes on, then eventually ease back into running when pain is eliminated
Keep a healthy lifestyle and your weight under control as excess weight can increase the amount of stress on the foot

Frozen Shoulder

Posted on June 3, 2024

Frozen shoulder (also known as adhesive capsulitis or periarthritis) is used to describe the condition where the glenohumeral joint of the shoulder is stiff and painful. It occurs in about 2-5% of the general population, with a higher prevalence among elderly individuals and those with diabetes. Frozen shoulder is a benign and self limiting condition, usually lasting for 1-3 years, in 20-50% of patients the stiffness and pain only partially resolve, which leads to long lasting effects of shoulder mobility impairment and reduction in sleep quality. Commonly patients who suffer persistent symptoms (over 4-5 years) only suffer mild long term effects.

Anatomy

The hallmark pain and stiffness are caused by the formation of adhesions or scar tissue in the glenohumeral (GH) joint. The GH joint is a ball and socket joint between the scapula and humerus, connecting the upper arm to the trunk. Under normal conditions this joint is one of the most mobile in the human body, allowing for a large range of motion in multiple planes. In the case of frozen shoulder the adhesions limit this range of motion and make movement painful.

Symptoms

There are 4 recognised clinical stages of the condition:

Painful stage- moderate pain and reduction of movement lasting less than 3 months
Freezing stage- severe pain and reduction of movement lasting 3-9 months
Frozen stage- pain may be present but stiffness predominates lasting 10-14 months
Thawing stage- minimal pain and gradual improvement in movement lasting 14-24 months

Causes

The cause of frozen shoulder is still unclear. Historically researchers into the aetiology of the condition have shown that it is characterised by a thickened, tight capsule with chronic inflammatory cells and fibroblasts found in the joint capsule. It can occur as a primary idiopathic condition or secondary to medical conditions or trauma.

Diagnosis

Frozen shoulder is diagnosed by testing positive to three characteristics:

Insidious onset of severe pain over a period of months, night time pain is a common feature
Shoulder stiffness with markedly reduced external rotation
Negative radiographic findings

Some patients describe the pain as a deep ache, poorly localised and non specific without any point of tenderness. In others it presents as a pain which refers to the deltoid origin and radiates down to the bicep area. Manual testing will often return normal rotator cuff strength but a greatly reduced passive and active range of motion.

In some cases laboratory tests may be carried out to identify or rule out underlying conditions. Radiographs of the shoulder will also return normal with a patient suffering from frozen shoulder, but may be carried out to exclude conditions such as shoulder dislocation, GH arthritis or calcific tendinopathy.

Treatment

There is no universally accepted intervention which is viewed as the most effective treatment for restoring motion and reducing pain.

Non-surgical or conservative management is preferred with most patients improving in 6-18 months. This includes analgesics, oral steroids, physical therapies and supra-scapula nerve block. Physical therapy, from a sports massage and remedial therapist or physiotherapist, has traditionally been the first choice of treatment for frozen shoulder. The therapist can work to reduce pain, mobilise the joint and provide the patient with a supervised stretching and strength maintenance programme.

Exercises

Exercises should be carried out under the direction of a qualified therapist and vary according to the stage of the condition.

Early Freezing Stage: Gentle and Short Duration Stretches
1. Pendulum Exercises
  - Purpose: Promote gentle movement in the shoulder joint, reducing stiffness without causing pain.
  - How to Perform:
    - Lean forward with your unaffected arm supported on a table or chair.
    - Let your affected arm hang down loosely.
    - Gently swing your arm in small circles, or forward and back, using your body to initiate the motion.
    - Perform for 1-2 minutes, gradually increasing the range of motion as tolerated.
2. Passive External Rotation
  - Purpose: Maintain range of motion by gently stretching the external rotators of the shoulder.
  - How to Perform:
    - Lie on your back with your arm close to your side and elbow bent at 90 degrees.
    - Use your unaffected hand to gently push your affected arm outward, rotating it externally.
    - Hold for 10-15 seconds, then relax and repeat, avoiding any pain.
3. Supine Passive Forward Elevation
  - Purpose: Improve shoulder mobility by gently stretching the shoulder in a pain-free range.
  - How to Perform:
    - Lie on your back with your affected arm by your side.
    - Use your unaffected hand to slowly lift your affected arm overhead, keeping it straight.
    - Hold at the top for a few seconds, then slowly lower it back down.
    - Repeat, ensuring the movement remains gentle and within a comfortable range.
Later Frozen Stage: Strengthening Exercises
1. Isometric External Shoulder Rotation
  - Purpose: Strengthen the shoulder’s external rotators, stabilising the joint without moving it.
  - How to Perform:
    - Stand with your elbow bent at 90 degrees, and press the back of your hand against a wall or door frame.
    - Push outward against the wall without moving your arm, holding the tension for 10-15 seconds.
    - Relax and repeat, ensuring no pain occurs during the exercise.
2. Posterior Capsular Stretching
  - Purpose: Stretch the tight posterior capsule of the shoulder, improving internal rotation and overall flexibility.
  - How to Perform:
    - Bring your affected arm across your body at shoulder height.
    - Use your other hand to gently pull your arm closer to your chest, stretching the back of your shoulder.
    - Hold the stretch for 20-30 seconds, then release and repeat.
Thawing Stage: Combined Strength and Stretching Exercises
1. Combined Strength and Stretching Exercises
  - Purpose: Enhance overall shoulder function by combining strengthening with stretching, gradually increasing range of motion and strength.
  - How to Perform:
    - Incorporate exercises like active external rotations, shoulder abduction, and flexion against light resistance bands or weights.
    - Alternate between strengthening movements and stretching exercises like doorway stretches or wall slides.
    - Increase the frequency and intensity as tolerated, aiming for 2-3 times daily.

Prevention

As the aetiology of the condition is still unknown advising on how to prevent an incidence of the condition is difficult. Research has suggested that prolonged immobilisation or limited use of the shoulder joint may contribute to the likelihood of developing frozen shoulder. With this in mind regular balanced exercise and stretching can help to maintain the structural support and mobility of the GH joint.

Temporomandibular Disorders (TMD)

Posted on June 3, 2024

Temporomandibular disorders (TMD) are conditions which affect the movement of the jaw. They are sometimes referred to as TMJ disorder or TMJD. It can cause facial pain, tenderness and difficulty moving the joint. TMD is believed to affect up to 15% of adults, with peak incidence at 20 to 40 years of age, more commonly found in women. TMD is treatable, but can have many different causes which can make diagnosis a challenge. Once diagnosed most patients can be successfully treated at home using methods such as reducing stress and changing posture.

Anatomy

TMD refers to a group of disorders affecting the Temporomandibular Joint (TMJ).

This joint connects your lower jaw (mandible) to your skull. It is located bilaterally (on both sides of your head) just in front of your ears. The function of this joint is to open and close your mouth, allowing you to eat and speak.

The TMJ is a hinge joint which allows for precise and complex movements of the jaw.

Symptoms

The symptoms typically present, either on one or both sides of the face:

Pain in the face or neck
Limited jaw range of motion and/or locking of the joint
Stiffness in the jaw muscles
Clicking or popping from the TMJ area
Malocclusion (a shift in jaw position)

Causes

There is no single specific cause for TMD, but some conditions are believed to contribute to developing a disorder. These include arthritis, joint erosion, clenching or grinding of the teeth, congenital structural jaw problems and trauma to the jaw. It is also thought that prolonged stress and poor posture which puts extra strain on the muscles of the face and neck are associated to the development of TMD.

Diagnosis

There is no standard test for TMD, you may be referred to an ENT specialist for a diagnosis. They may physically examine your jaw for swelling or tenderness and possibly carry out and X ray, CT scan or MRI to assess the structure of your jaw.

Treatment

Most TMD patients are treated conservatively, using pain medication, ice to reduce pain and swelling and reducing jaw movements by eating soft foods and avoiding chewing gum.

Many find that physiotherapy or sports massage therapy can support treatment for TMD. Your therapist can manipulate the muscles surrounding your jaw and neck, thereby relieving the tension in your TMJ. They can also provide you with exercises the stretch the muscles around your jaw, optimising joint movement. As stress and upper body posture is believed to be a contributing factor in TMD you may find that regular massage treatments can help you to manage your condition.

In extreme cases your GP or ENT specialist may advise corrective dental treatment if this bite alignment is an issue or arthrocentesis if fluid and debris needs to be cleared from the joint.

Exercises

There are many different exercises which can be used to help TMD. Your Physiotherapist or Sports Massage Therapist will be in a better position to advise which are best for you, but here are a few examples that they may ask you to carry out.

Goldfish Exercise:

Press your tongue to the roof of your mouth. Then place one index finger on your left TMJ and the other index finger on your chin. Apply light pressure on each finger, drop your chin so that your mouth opens, but tongue stays in contact with the roof of your mouth. Repeat with the right TMJ.

Chin Tucks:

Stand or sit tall then bring your head backwards, tucking your chin in towards your chest. Keep your head straight, it might help to focus on a point or object straight in front of you.

Jaw Stabilisation:

Keep your jaw in a neutral position and then partially open it, about the width of the top of your thumb. Apply gentle pressure with your hand, first on the left then right then at the bottom of your jaw. Resist the pressure to keep your jaw stationary.

Prevention

As TMD have no specific cause it can be difficult to prevent their occurrence. You may find it helpful to use a mouth guard at night or use muscle relaxants (under the supervision of your GP) if you are prone to teeth grinding. Physio or sports massage therapy can help to optimise your posture and avoid excess pressure on your TMJ. It is also advisable to reduce, or manage, stress levels and anxiety. This can be achieved through regular exercise, massage treatments, diet and counselling.

Lumbar Disc Herniation

Posted on June 3, 2024

A herniated disc, also known as a slipped or bulging disc, is a relatively common pathology often occurring in people aged 30 to 50. The intervertebral discs play a crucial role in the spine acting as a shock absorber between the vertebrae, as well as allowing for a wide range of movement. Disc herniation refers to a condition in which the spinal discs become damaged & encroach on the nerve roots branching off the spinal cord. This can happen anywhere along the spinal column but often occurs in the cervical or lumbar region, due to the wide range of movement in these areas causing more wear & tear on the discs. For most people a slipped disc is extremely painful due to the nerve compression, however some people don’t even feel that it has happened.

Anatomy

The Spinal column is made up of 24 individual interlocking bones known as vertebrae. These vertebrae are split into 3 different sections consisting of 7 Cervical, 12 Thoracic & 5 Lumbar, followed by the Sacrum & Coccyx. Even though the vertebrae in each section look different they all have the same functional components; the body for load bearing, the vertebral foramen to protect the spinal cord & the transverse processes for ligament attachment. In between these vertebrae the intervertebral discs are found, protecting the bones by absorbing shock from body weight, trauma & daily activities such as walking, lifting or twisting.

Spinal discs are made up of 2 parts, a soft gel-like inner portion called the nucleus pulposus & a tough outer ring known as the annulus fibrosus. The nucleus pulposus, mainly consisting of water plus loose networks of collagen fibers, is where shock absorption primarily takes place. Surrounding this inner core, the annulus fibrosus is composed of tough ligamentous fibers which protect the nucleus pulposus, as well as securely connecting the vertebrae above and below the intervertebral disc.

Causes

A herniated disc occurs when excess pressure is placed on the disc causing the annulus fibrosus to become weak. This weakness can then cause bulging, cracking or ruptures within the annulus fibrosus allowing the nucleus pulposus being able to “leak” through & compress against the nearby nerve roots. The result, intense pain in the lower back followed by shooting pains into the buttock & down the leg.

The main factors that can increase the risk of a herniated disc are:

Age – Over time the intervertebral discs naturally start to lose the fluid which normally allows them to stay pliable and spongy between the vertebrae, this is known as disc degeneration. This dehydration of the discs causes them to become stiff and unable to withstand strenuous compression, leaving the annulus fibrosus more susceptible to bulging or rupturing even from the slightest of movements.

Lifting heavy objects repetitively or incorrectly – Lifting heavy objects can place excessive strain on the lower back which can cause a herniated disc. Especially when they are lifted without correct technique, predominantly using your back muscles instead of your legs to lift combined with a twisting motion overstress the discs increasing risk of herniation. If you have a physically demanding job, the repetitive nature of the role can also increase the risk and your placing this strain on the disc over and over.

Obesity – Excess weight increases the stress on the lumbar spine making individuals who are overweight more likely to herniate a disc.

Smoking – Experts suggest that putting nicotine into your system limits the blood flow to the discs causing them to break down quicker, speeding up degeneration therefore increasing the risk of herniation.

Trauma – The least common cause of disc herniation is trauma, a serious fall or accident can lead to this pathology but is less common than the other factors.

While all these factors can increase the risk of lumbar disc herniation anyone at any time could herniate a disc.

Symptoms

Signs & Symptoms tend to vary depending on where the herniated disc is situated & the level of herniation. Typically only affecting one side of the body, symptoms can range from moderate lower back pain to extreme pain & numbness going all the way down the leg.

Lower back pain
Pain often down one leg from the buttock into the thigh & calf.
Numbness, tingling or burning sensations due to nerve compression
Pain that worsens at night
Pain that worsens with certain movements such bending or sitting
Muscle weakness
Sciatic pain
Difficulty lifting the foot (Foot Drop)
Pain when standing from a seated position

Pain normally eases within six weeks, but during this short duration pain can be severe making daily activities difficult to participate in. However not all herniated discs can cause symptoms, as the herniation may not be compressing on a nerve & therefore not radiating any pain.

Diagnosis

If you believe this is a pathology you may be suffering with you should consult with a healthcare professional so they can conduct a thorough assessment. They will ask about your symptoms, medical history & when/how the pain started. After this a physical exam would be performed to find the source of the pain and discomfort. They will also assess your muscular strength and discover what movements trigger the pain. A herniated disc may be suspected if pain starts in the lower back and is then accompanied by radiating pain down the leg. In order to confirm this more tests can be performed, these include:

Straight Leg Raise Test – While lying on your back & keeping your legs straight, your healthcare professional will slowly raise your affected leg until symptoms occur. If pain is felt during 30 to 70 degrees of hip flexion this indicates lumbar disc herniation. If you have a herniated disc compressing on a nerve, this particular movement recreates symptoms by increasing this compression therefore resulting in a positive test. You will also be asked if any numbness or tingling is felt down the leg while completing this movement.

MRI (Magnetic Resonance Imaging) – This type of scan usually provides the most accurate imaging of a herniated disc, as it shows the disc, surrounding soft tissue & nerve roots. This allows your healthcare professional to actually see where the herniation has occurred & which nerves are being impinged.

X-Ray – These aren’t often used to diagnose herniated discs as the soft tissues structures of the discs & nerves are hard to capture. However, X-Rays are used to rule out any other causes of the pain such as a fracture or bone spur, a tumor or spinal alignment issues.

Your healthcare professional can then put all this information together to diagnose the cause of your pain & discomfort. However, during the initial assessment, if no serious signs of a herniated disc are found then imaging scans may not be provided at this point. As some professionals prefer to wait & see if symptoms ease on their own within the six weeks.

Treatment

Treatment for a herniated disc can range from minimal pain management to surgical treatment. In most cases lumbar disc herniation often resolves from minimal treatment within six weeks. Your GP may prescribe painkillers or muscle relaxants to relieve short term pain and also refer you to a Physiotherapist/Sports Therapist. Your therapist will then provide you with stretches and exercises for the back and surrounding areas.

When slipping a disc, or with any injury in fact, initial response is to decrease the pain that you are in, ways to do this include:

Rest – Bed rest is ok at first when pain is severe, however this should be limited to a couple of days as any longer than this can cause muscles to become stiff and weak. Heavy lifting & intense exercise however should be avoided for the first six weeks.

Ice – Applying ice after initial injury can help to ease pain by reducing inflammation & muscle spasms associated with disc herniation.

Pain Medications – Over the counter painkillers can help to treat pain & inflammation. Also your GP may prescribe muscle relaxants if spasms get particularly bad.

Heat Therapy – Applying heat to the area after the first 48 hours, with a hot water bottle or by having a nice bath, can help to relax the muscles surrounding the injured area & reduce muscle pain & spasms.

Hot & Cold Therapy – Some individuals find maximum relief from using a mixture of hot and cold treatment. For example, applying ice for 10 minutes, immediately followed by a heat pack or hot water bottle for 10 & repeat.

After this you can start to consider more long term solutions for the pathology, this options include:

Strengthening Exercises

Spinal Manipulations

Epidural Injections

Acupuncture

Massage Therapy

If symptoms do not improve after these treatments & persist longer than six weeks, surgery is then sometimes considered.

Exercises

Provided are some exercises that can help lumbar disc herniation:

Back Extension – Lie on your front with your forearms and palms flat on the floor. Slowly lift your upper body up off the floor and hold for up to 30 seconds, aim for 10 reps.
Glute Max Stretch – Lie on your back with your knees bent, life one leg off the ground and place the outside of the ankle joint over the opposite knee. Hold the knee of the lifted leg and pull the leg in towards the body and hopefully you should be able to feel the stretch in the buttock region. Hold stretch for up to 30 seconds and try to treat 3 times on each leg.
Pelvic Tilts – While lying on your back, place your hands on your hips & roll your pelvis back & forth along the ground. Aim for 10 sets of 3 reps
Superman – On your hands and knees slowly lift and straighten your opposite arm and leg. Aim to complete 10 sets of 3 reps.

While completing exercises if any pain or discomfort is felt then stop immediately and rest instead.

Prevention

It isn’t always possible to prevent herniating a disc but here are some steps you can take to reduce your risk.

Strengthening exercises – Increasing your core strength can help to stabilise and support the spine, decreasing the stress placed on your discs.

Maintain good posture – Sitting up straight and keeping your back aligned reduces the pressure placed on the discs.

Lose weight – If you are classed as overweight losing excess weight can help to reduce wear and tear on your discs as the load being placed on them will be less.

Correct lifting techniques – Make sure when you are lifting heavy objects that you are doing it correctly, bend and lift from your legs not your waist.

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