Rehabilitation | LiveWell Health

Lateral Ankle Sprain

Posted on June 3, 2024

A lateral ligament sprain within the ankle complex is one of the most frequently injured area within the body, being encountered at 83% in sports such as football and many athletic events.

The main mechanism of this occurring is when an individual will be placed in excessive inversion and internal rotation of the foot whilst the leg is forced into external rotation. The anterior talo-fibula ligament is thought to be the most susceptible within this Injury.

As soon as athlete or personnel have sustained a lateral ankle injury, mechanical limitations and neuromuscular control of the joint becomes effected, for example; ligamentous tear, reduced strength and loss of balance. Due to these influences effecting the ankle joint, it leads to a 73% chance of recurrent damage and injury within one year, especially if correct and safe rehabilitation is not carried out.

Anatomy

The ankle complex consists of three key joints; these are the talocrural, subtalar and distal tibiofibular. The talocrural joint is known as a hinge joint, movements such as plantarflexion, dorsiflexion, inversion and eversion can be experienced. However due to the fibula being protracted superiorly towards the lateral malleolus compared to the tibia with medial malleolus, eversion movements become restricted. Therefore, implying why inversion injuries may be more frequent in the lateral ankle complex.

Symptoms

A few symptoms of a lateral ankle sprain are as follows:

Tenderness and swelling
Bruising around the ankle joint
Tenderness on palpation around the joint
Unable to place full body weight onto the joint
Restricted range of movement
General pain and discomfort

Causes

A lateral ankle sprain may occur when the ankle joint is forced out of its natural position, causing an overstretch within the ligaments around the joint, therefore resulting in a possible partial tear or complete tear. Some causes may consist of wrongly falling on the ankle causing it to twist. Awkwardly landing from a jump or pivoting. Walking or running on an uneven surface resulting in loss of balance, or another person unintentionally landing onto the ankle during a sporting event.

Diagnosis

An injury to the ankle complex is classified by grades I to III to distinguish the severity of ligamentous damage and indisposition of the sprain. Lateral ankle injuries consist of two types of dysfunction, one being mechanical instability and the other being functional instability.

Both of these elements influence the acute injury, implying that once an individual has sustained a lateral ankle injury, a development of chronic ankle instability may transpire in the near future. The incidence of CAI may be present due to mechanical instability from where ligaments have not healed properly in the ankle region and joint laxity becomes effected.

Specific Tests can also be used to help with the diagnosis of a lateral ankle sprain:

The Anterior Draw test: Tests the ATFL
Talar tilt test: Tests the CFL
Posterior Draw test: Tests the PTFL

Treatment

Treatment for a lateral ankle sprain can vary as it will be dependant on the severity of the injury.

The first step that should be taken 24-72 hours after the injury is sustained would be to reduce the amount of swelling around the joint. An individual should follow the RICE model. Rest, Ice Compress and Elevate. This would include using a cold compress on the ankle and making sure no weight is placed onto the joint.
Soft tissue massage therapy may also be used to assist with the removal of oedema and aid in mild stretching. However, this technique should only be performed once swelling and bruising has reduced around the joint.
Once the ankle can handle some weight being placed onto it, rehabilitation exercises given by a Physiotherapist or doctor should be performed. This will help decrease stiffness around the joint, increase ankle strength and prevent any further complications such as long-term chronic ankle instability issues. These exercises may consist of proprioceptive, strengthening and early motion specific training exercises.

Exercises

Here is a list of exercises specifically for lateral ankle sprain injuries:

Single Leg Squat (with chair support)

Setup: Stand beside a sturdy chair, using it for support if needed.
Execution: Lift one leg off the ground, slightly in front of you. Squat down on the standing leg, ensuring your knee stays aligned with your toes.
Depth: Lower yourself until your thigh is nearly parallel to the floor or as low as comfortable.
Return: Push through your heel to return to the starting position.
Repeat: Complete the desired number of repetitions, then switch legs.

Single Leg Hip Abduction

Starting Position: Stand upright with feet together and hands on your hips or holding onto a support for balance.
Movement: Lift one leg out to the side, keeping it straight and your toes pointing forward.
Height: Raise your leg as high as comfortable without tilting your torso.
Control: Lower your leg back to the starting position slowly.
Repetitions: Perform the exercise for the specified number of reps, then switch sides.

Wobble Board Balance on One Leg

Preparation: Place a wobble board on the floor and stand next to it for support.
Positioning: Step onto the wobble board with one foot, maintaining a slight bend in your standing knee.
Balance: Lift your other foot off the ground and try to balance on the board.
Stabilisation: Use your core and small movements of your standing leg to maintain balance.
Duration: Hold the position for as long as possible, aiming to increase your balance time progressively. Switch legs and repeat.

Standing Single Leg Balance

Start: Stand with feet hip-width apart and arms at your sides.
Lift: Raise one foot off the ground, bending the knee to a comfortable height.
Hold: Maintain your balance on the standing leg, using your arms to help stabilise if necessary.
Duration: Hold the position for a specified amount of time, then switch legs and repeat.
Progression: Increase the challenge by closing your eyes or standing on an unstable surface.

Star Excursion Balance Test

Setup: Place a series of markers or tape lines on the floor in a star pattern, with the centre being your standing point.
Starting Position: Stand on one leg in the centre of the star.
Reach: Extend the other leg to reach toward each marker, touching it lightly with your toe.
Return: Bring the reaching leg back to the centre after each touch.
Sequence: Move systematically around the star, reaching to each marker without losing balance.
Repetitions: Perform the test on both legs, noting the distance reached and maintaining form throughout the exercise.

Prevention

To assist in the prevention of a lateral ankle sprain from reoccurring you should:

Ensure a full warm up and cool down is performed before and after taking part in Sporting events or exercise activities.
Wear the correct footwear that is made for your activity e.g., suitable running trainers when going for a run.
If suffered with an ankle sprain before then use protective equipment such as a brace or tape to add extra support to the ankle.
Perform some form of stability training and balance exercises regularly.
Use strengthening exercises for the ankle joint.
Make sure any rehabilitation strategies are executed and performed daily.

If you believe you have a lateral ankle sprain or at least want to find out, please contact a member of our physiotherapy or sports therapy team or make a booking online for an appointment.

Piriformis Syndrome

Posted on June 3, 2024

Piriformis Syndrome is a condition where the small Piriformis Muscle, located in the buttock region, can press on or irritate the Sciatic Nerve. Many Doctors and other professionals mistake this condition for “True Sciatica” which is where the Lumbar Spine degenerates and pinches the Sciatic Nerve. Usually Piriformis Syndrome will be incorrectly diagnosed as “Sciatica” just because it affects the Sciatic Nerve. The piriformis muscle, as it irritates the sciatic nerve, will cause pain, numbness and a tingling feeling along the leg and into the foot.

Anatomy

The piriformis muscle is one of 6 muscles known as the “Deep 6” and form the wider gluteal muscles or glutes in the buttock region. The Piriformis muscle alongside the other 5 muscles work together to bring the femur bone into external rotation in the hip socket. The other muscles that form the Deep 6 are the gemellus superior, gemellus inferior, obturator externus, obturator internus, and the quadratus femoris. The piriformis muscle sits over the Sciatic Canal where the sciatic nerve runs through and thus why Piriformis Syndrome gives you sciatic pain.

Symptoms

Piriformis syndrome is quite literally a pain in the ass! The symptoms will typically start with either pain in your bum, lower back, numbness or tingling down from the glutes and down the leg. This usually only presents in one side but in extreme cases can be in both legs depending on various factors. If you do suffer with pain this can range from a minor irritant to extreme pain which can run down the length of the sciatic nerve which runs down into the toes. This pain is known as Sciatica because it affects the nerve but is not as serious as true sciatica which is to do with issues in the lumbar vertebrae. The pain is caused from the piriformis muscle compressing or irritating the sciatic nerve.

Causes

The exact causes of piriformis syndrome are unknown, hence the “syndrome” terminology. However there are suggestions and suspected causes such as:

Tightness in the Piriformis muscle or a spasm. This can be because of over training, incorrect footwear, sitting for long periods of time or even tightness in the quad muscles that can affect the tilt of your pelvic bone.
Injury or Swelling of the piriformis muscle.
Bleeding in the area of the piriformis muscle.

One or a multiple array of the above issues can cause Piriformis Syndrome of the above problems can affect the piriformis muscle.

Diagnosis

There is no definitive test for piriformis syndrome. In most cases just using questioning and getting a history of when the pain started, where the pain / tingling is etc the practitioner can usually have a good idea whether it is Piriformis Syndrome or Sciatica. In some cases, a contracted or tender piriformis muscle can be found on palpation / physical exam.

Treatment

There are a number of ways you can treat Piriformis Syndrome most will involve finding ways to stretch or loosen off the muscle itself. Starting with the least invasive and least painful:

Take a hot bath and use hot water bottles on and around the glute / bum muscles as often as you can, at least twice a day. This will help relax the muscles if there has been a tightening or spasm.
Trigger Pointing the piriformis muscle. If you have an good understanding of the glute anatomy, you can use a foam roller or trigger pointing ball (or a golf ball etc) to apply pressure to the piriformis in order to force it to relax and length.
Stretching the Glute muscles, Hamstring Muscles, Lower Back (Quadratus Lumborum) and Quad (front muscles). Some may argue the anterior leg muscles however if they are tight they could be giving your pelvis an anterior tilt which by lengthening the Piriformis muscle too much can cause it to press against the sciatic nerve.
Massage therapy. A good qualified sports therapist can provide a high level massage therapy / sports massage which can include things such as soft tissue release, neuromuscular therapy and general lengthening and loosing techniques to manipulate the muscle to relax.

Prevention

As this is a syndrome and the direct cause of this condition is unknown we would recommend if you are in a seated job to get up and stretch the hamstrings and glutes from time to time or adjust your sitting position so your legs do not continually get placed under the chair shortening the hamstrings for example.

Walking can also help as this will use antagonist muscles to help relax the posterior chain.

Reducing any sporting activity that you feel is increasing the symptoms.

If you feel like you could be suffering with Piriformis Syndrome our team of physiotherapists and sports therapists can help, contact us today or make a booking!

Morton’s Neuroma

Posted on June 3, 2024

Morton’s Neuroma is a condition in your foot that affects one of the plantar digital nerves that are located between the metatarsals. A neuroma is a non-cancerous tumour that grows from a nerve; however, a Morton’s neuroma is not like this and instead it leads to the thickening of the nerve. This condition usually only affects one foot at a time and is mostly found to affect the nerve in between the third and fourth toes. Morton’s Neuroma usually occurs in women 75% of the time and commonly affects people over the age of 35. The reason for this happening is unknown but Morton’s Neuroma is believed to be a chronic condition that may have occurred as a result of the nerve being compressed or stretched.

Anatomy

Morton’s neuroma usually affects your foot between your 3rd and 4th toes.

It is sometimes referred to as an intermetatarsal neuroma. Intermetatarsal describes its location in the foot between the metatarsal bones. Neuromas can occur in other locations in the foot.

The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Symptoms

The symptoms of Morton’s Neuroma will be aggravated by wearing tight or high heeled shoes and the symptoms will get worse over time. The symptoms will include but may not be limited to:

A shooting or stabbing pain in either the ball of the foot or the toes
Feeling like there is a small stone stuck under your foot
Tingling of the toes
May be difficulty walking

Causes

Morton’s neuroma is the directly caused by an irritated or damaged nerve, which sits between the toe bones.

It’s can often be a cause and linked to:

wearing shoes that are too tight.
Wearing pointy or high-heeled shoes.
Doing a lot of sports such as running, tennis, squash or other sports/activities that place pressure through the feet.
Having other foot related issues. These can be things such as high arches, flat feet, bunions or hammer toes.

Diagnosis

During your visit to your local GP or Sports Therapist / Physiotherapist, they will press on your foot to feel for a mass or tender spot. There may also be a feeling of “clicking” between the bones of your foot.

Imaging tests
You can have various imaging tests which come with varying levels of success.

X-rays – Your doctor is likely to go down the route of X-Ray’s first to look at your foot, this will be to rule out other issues / causes for your pain.
Ultrasound – Ultrasound is beneficial when looking at soft tissue abnormalities
MRI (Magnetic resonance imaging) – This is an expensive but detailed scan of the area and often indicates neuromas in people who have no symptoms.

Treatment

The pain can sometimes be unbearable but whether it is or is not does not affect the fact that the immediate aim is to decrease the pain level.

There are many ways that you can decrease the pain that you are feeling but the most effect way for immediate relief would be to rest the area and then combine this with either heat or cold therapy. This should help to remove the pain or at least reduce the intensity; however, this will only act as a short-term pain relief so if the pain became persistent you would have to do this regularly.

For long term relief and hopefully a complete elimination of the pain there are further ways to treat the area.

By having a deep tissue massage in the area this would help to relieve the pain by focusing the massage on the metatarsal heads whilst being cautious to aggravate the neuroma.

Mobilisation techniques of the metatarsal heads would also be a viable option to try and relieve the pressure in the nerve. In addition to this stretching the toe extensors, calf muscles and the plantar fascia regularly should help to strengthen your feet and improve foot stability.

Exercises

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

You can stretch the calf muscles and Achilles tendon.
Stretch the plantar fascia along the underneath of the foot, this can be done using a hard ball also.

If you are going to exercise, make sure you build these up slowly so that you don’t irritate the nerve and start the inflammation process again.

Firstly, try a gentle walk to start, maybe start with a mile or 2 depending on your level of fitness.

Once you have done this for a week or two and feel comfortable, then try some HIIT walk/running with 4 minutes of walk followed by 2 minutes light jogging, repeating four to six times. The following day complete rest then try again the next day and as time goes on, pain allows and symptoms reduce, increase the length and intensity.

Please see some exercises and stretch examples in our video.

Prevention

There are a number of things you can do to prevent Morton’s neuroma:

Try to limit the time you are wearing tight or high-heeled shoes.
Try to wear shoes or trainers that are wider at the front to stop your toes being pushed together.
If you are training such as Running or Walking, try to wear shoes or trainers that have a good amount of cushioning especially around the balls or your feet.
Keep a Healthy Lifestyle and your Weight under control as excess weight can put undue stress on the foot.
For athletes, discuss alternative training plans with your coaching team.

If you believe you have this condition or would just like to have an assessment to see if you do, our friendly team of sports therapists and physiotherapists can help. Contact us or make a booking today.

Meniscus Tear

Posted on June 3, 2024

This is one of the most common knee injuries, which can be sustained while participating in a number or sports or day to day activities. The severity of the injury can vary greatly from mild, where the injury will resolve on its own given time to heal, to severe, where surgery is often advised.

Anatomy

The meniscus is a ‘C’ shaped piece of cartilage that acts like a cushion between your femur (thigh bone) and tibia (shin bone). It acts to stabilize the joint and prevent wear and tear on the joint surfaces. As the name suggests, a this injury occurs when the meniscus cartilage tears.

Symptoms

The following symptoms could indicate a torn meniscus:

A popping sensation in your knee
Swelling or stiffness
Pain, in particular when twisting or rotating your knee
Difficult to straighten your knee
A feeling of the knee being locked in to place
Feeling like your knee could give way

Causes

A meniscus tear can occur as a result of any activity which requires the forceful twist or rotation of the knee- particularly when that knee is taking full body weight. Aggressive pivoting, sudden stops and turning actions carry a higher risk of injury. It is also possible to tear a meniscus while kneeling, deep squatting or heavy lifting.

Diagnosis

Your doctor my be able to identify a torn meniscus by performing a physical exam, assessing your range of motion, gait and ability to carry out certain movements. They may also use one or more of the following:

X-ray: this will not identify a torn meniscus but may be used to rule out other injuries.

MRI: this will produce and image of the hard and soft tissues in your knee and is considered the best imaging to identify a torn meniscus.

Arthroscopy: this uses a small instrument which is inserted through a tiny incision near your knee. It uses a light and camera to provide an image of your knee, then other surgical tool scan be inserted and used to trim or repair the tear.

Treatment

Treatment generally starts conservatively, depending on the severity of your injury.

Rest – You may be advised to avoid activities which aggravate the pain or involve any twisting, rotating or pivoting. If the pain is severe using crutches can rest your knee and give the injury time to heal.
Ice – This can be used to reduce pain and swelling. Generally it is advisable to apply a cold pack (wrapped in a towel) to your knee for 15 minutes while it is elevated. This can be repeated every 4-6 hours.
Medication – Over the counter pain relievers (often NSAID’s like ibuprofen) can be used to alleviate the pain.
Therapy – Physiotherapy or Sports Massage can help to stabilize and support the knee joint while strengthening the muscles surrounding it.
Surgery – If the injury is still painful after conservative treatment surgery may be advised to repair or trim the meniscus. In the case of severe degenerative arthritis a total knee replacement could be recommended.

Exercises

Once your knee is in recovery there are many exercises that can support your body as it heals. Remember for this type of injury it is not advisable to ‘push through the pain’. Pain is a warning sign from your body that you are asking more than it is capable of at the moment. Under advice from a soft tissue specialist your exercises are likely to proceed through the following stages:

Improve Range of Motion- flexing and extending your knee as far as possible without pain.
Stretches- reducing excess tension in your leg muscles.
Basic Exercises- e.g. straight leg raises and calf raises.
Advanced Exercises- e.g. squats, weighted leg strengthening and advanced stretching.

Prevention

As they are normally caused by an accident, meniscus tears can be difficult to prevent, however the following precautions can lower the risk:

Strengthen your Quadriceps, Hamstring, Adductor and Abductor muscles of the upper leg (thigh muscles) with regular exercise.
Always warm up with light activities and active stretching.
Rest between workouts to allow your body to repair.
Wear shoes that fit well and provide support.
Stretch regularly to maintain flexibility.
Make changed to the intensity of your activity gradually.

If you have any issues around meniscus tears then our team can help diagnose but also and more importantly help you rehabilite the injury. Our specialists physiotherapists and sports therapists deal with issues like this frequency. Contact us today or make a booking.

Carpal Tunnel Syndrome

Posted on June 3, 2024

Carpal Tunnel Syndrome (CTS) is a form of repetitive strain injury (RSI) which occurs as a result of damage to soft tissue structures (such as tendons) and in some cases bones of the wrist. Women are three times more likely to develop CTS than men, with approximately 3 to 6 percent of adults in the general population being affected. The condition is particularly common in people who use their hands repetitively, for example individuals working on computers or assembly lines. It is quite common to develop CTS in both hands, however symptoms tend to be worse in the side of the dominant hand.

Anatomy

The Carpal Tunnel is a narrow passage made up of ligaments and bones at the base of the hand. The Median Nerve and tendons responsible for bending your fingers passes through this passage. The median nerve is the receptor (provides feeling and feedback) for the palm side of your thumb, index, middle and part of your ring fingers.

CTS develops when swelling or damage to the structures of your wrist creates pressure on the median nerve. In addition to swelling due to soft tissue injury inflammation any swelling can develop as a result of medical conditions such as diabetes and arthritis. It can develop during pregnancy, in this case it will probably disappear after delivery.

Symptoms

Symptoms tend to develop gradually over time, beginning with slight discomfort and deteriorating progressively if left untreated. Initially symptoms usually appear in one or both hands during the night. As symptoms get worse, tingling may be felt during the day, especially with repetitive activities such as typing or using a mouse.

Common signs and symptoms of CTS include:

Pain, tingling and numbness in your hand, wrist and also your thumb and fingers.
Fingers may feel and/or appear swollen.
Hand weakness and difficulty gripping.
Partial loss of sensation in the affected thumb and fingers.
In severe cases, where left untreated, muscle wastage of the muscles at the base of the thumb can occur

Causes

CTS is often a combination of many factors which increase pressure on the median nerve rather than a problem with the nerve itself.

Recent studies indicate that CTS can be idiopathic (no identifiable direct cause) and that there may be a genetic component which increases the possibility that an individual develops CTS.

Activities considered high risk for CTS include any which involve repetitive and/or forceful use of one or both hands. In terms of sports this can include gymnastics, weightlifting (Olympic style in particular), racquet sports, cycling, rowing, baseball and golf. CTS also has a high incidence in individuals who regularly use vibrating hand tools (e.g. hammer drill).

Research has shown that certain conditions can increase the risk of developing CTS by causing fluid obstruction in the carpal tunnel. These include:

Pregnancy
Menopause
Obesity
Renal failure/haemodialysis
Hypothyroidism
Use of oral contraceptives
Congestive heart failure
Tumours
Autoimmune disease (eg, rheumatoid arthritis)
Wrist fracture/dislocation/deformity
Age – The majority of those affected are in range 40 to 60 years old, CTS usually only occurs in adults.

Diagnosis

To determine the cause of your CTS your doctor may conduct a physical examination of hands, arms, shoulders and neck. This can help them to decide if the condition is being caused by daily activities, an underlying disorder, or if it is a condition which presents similar symptoms to CTS. They will look for abnormalities in wrist tenderness, swelling, warmth and colour. Your doctor will probably conduct nerve testing to establish sensation in each thumb and finger any check for muscle atrophy (wasting).

You should inform your doctor of any history of fractures, arthritis or diabetes. It will also be helpful if you can provide them with an insight in to your daily activities and hobbies. They will discuss when your symptoms occur, improve or get worse.

They may ask you to have and X-Ray (to check for fractures or arthritis), an ultrasound (which can show if the median nerve is an abnormal size) or an MRI (to check the wrist anatomy).

Treatment

It is important not to ignore the symptoms of CTS. You can often treat it yourself, but it can take months to get better. Leaving the condition untreated can lengthen recovery time considerably.

REST – Where possible stop any activities which make your symptoms worse. Ask an occupational health advisor how you can modify your work station and/ or the activities that cause the pain.

ICE – Applying an ice pack for 5-10 minutes every 1-2 hours in the early stages of the pain/numbness may help reduce swelling and the pressure on the nerve.

SUPPORT – A wrist splint will help limit movement of your wrist which may help reduce the pain and risk of further swelling.

ELEVATION – Try and keep your wrist elevated to reduce the potential for swelling in your wrist. When you lie down this may mean resting your hand on pillows.

MASSAGE – A Sports Massage Therapist can help to relive the pressure in your carpal tunnel by encouraging the proper flow and drainage of fluids to and from your wrist. They may use Soft Tissue Release (STR) to lengthen and normalize the muscles from your wrist in some cases up to your neck. These muscles often become very tight when performing repetitive tasks, this tension can exacerbated the symptoms of CTS. If your therapist is trained in the use of Kinesiology taping they can also use this to create space in the carpal tunnel and support the soft tissue structures of your wrist. Because the problem may be caused, or made worse, by structures as far up as the neck, your therapist will be keen to address these problems as well as the ones at your wrist. Treating the cause of a problem is always more effective than treating the symptoms alone if the condition is to be resolved.

PHYSIOTHERAPY – Consider seeing a Physiotherapist if other treatment have not improved the symptoms.

CTS can be resolved without invasive procedures, following treatments such as those outlined above has been shown to reduce symptoms effectively if properly followed. It is important to be consistent with treatments for CTS as it may take a number of moths for the issue to resolve.

STEROID INJECTION – A medical professional may suggest a treatment involving a steroid injection to reduce inflammation.

SURGERY – In some cases surgery may be necessary but only after all non-surgical methods have been tried.

Exercises:

Wrist Flexor Stretch

Start Position: Extend your arm straight in front of you with your palm facing up.
Movement: Use your other hand to gently pull back on the fingers of the extended hand, bending the wrist downward.
Action: Hold the stretch when you feel a gentle pull along the inside of your forearm.
Hold: Maintain this position for 15-30 seconds.
Switch: Repeat on the opposite arm.

Wrist Extensor Stretch

Start Position: Extend your arm straight in front of you with your palm facing down.
Movement: Use your other hand to gently pull the fingers of the extended hand back towards your body.
Action: Hold the stretch when you feel a gentle pull along the top of your forearm.
Hold: Maintain this position for 15-30 seconds.
Switch: Repeat on the opposite arm.

Tendon Gliding Exercises

Start Position: Hold your hand up with your fingers straight and close together.
Movement:
- Start by bending your fingers at the knuckles to form a hook fist, keeping your thumb straight.
- Next, make a full fist, curling your fingers into your palm.
- Then, return to the hook fist position.
- Finally, straighten your fingers back to the starting position.
Action: Move through each position slowly and smoothly.
Repetitions: Perform 5-10 repetitions, 2-3 times a day.

Median Nerve Glide

Start Position: Extend your arm straight out to the side, parallel to the ground, with your palm facing down.
Movement: Bend your wrist so that your fingers point down towards the ground.
Action:
- Slowly tilt your head away from the outstretched arm.
- You should feel a gentle stretch along your arm and hand.
Hold: Maintain this position for 15-30 seconds.
Switch: Repeat on the opposite arm.

Make sure you are pain-free at all times and take care not to progress too quickly. Where possible stop any activities which make your symptoms worse. We have given suggested sets and repetitions, but everyone is different so your practitioner may give guidance that is more specific to you. It is important to perform the exercises correctly and at the frequency prescribed in order to reach a successful outcome.

Prevention

As CTS can be idiopathic it is not easy to prevent its occurrence. If possible avoid repetitive activities, when unavoidable take time to perform stretches and take regular breaks. Be aware of the first signs of symptoms developing, the earlier you start treatments the quicker it can be resolved.

The video above is not just to help rehabilitate the area it will also help in strengthening the area and again you should seek professional advice for this.

For more infomation or to make a booking with one of our team to help with your Carpal Tunnel Syndrome then please contact us today.

Is It Tendonitis or Tendinopathy…

Posted on June 3, 2024

Tendonitis and Tendinopathy are often used interchangeably as they both present very similar symptoms however the conditions are very different.

Tendonitis: Tendonitis is when a tendon (attachment point of muscles) becomes swollen / inflamed. This can be because of a number of issues such as overuse or a specific injury / movement. The inflamed tendon can become stiff and can cause joint pain as it will be affected in the way it functions. Usually, but not always tendonitis is presented once you finish an exercise or immediately after you have rested it for a period of time and can go away during exercise or use. However it can also present as a dull ache more frequently.

Tendinopathy: Tendinopathy, also referred to as tendinosis, is the breakdown / de-generation of collagen in the tendon. This causes burning pain as well as reduced functionality of the tendon, flexibility and range of movement. While tendinopathy can of course affect any tendon, it’s more common in the Achilles tendon, rotator cuff tendons, patellar tendon and hamstring tendons.

Some suggest that tendinitis precedes tendinopathy (tendinosis) however the fact that a healthy tendon can be up to twice as strong as the muscle is true. This would in turn make the body of the tendon unlikely to tear, unless the tendon is already weakened by degenerative change.

So the very idea that tendinitis is the initial stage of tendinopathy as it will presume micro-tears and inflammation precedes collagen degeneration is wrong. Recent research shows that torn fibres, scar tissue, and calcification are only found in conjunction with tendinosis some of the time, and inflammation are rarely found in tendinosis, which would support the idea that tendinitis occurs secondarily to tendinosis

Symptoms

The symptoms of tendonitis and tendinopathy are very much similar at will present itself at the insertion point where the tendon meets the muscle. The symptoms typically include:

Pain often described as a dull ache, especially when moving the affected limb or joint
Tenderness to touch
Swelling
Pain or Stiffness in the morning
Pain or stiffness after long periods of rest

Causes

Although tendinitis / tendinopathy can happen through a sudden injury or event the condition is much more likely to appear over a long period of time due to overuse or repetitive movements.

Treatment

Tendonitis and Tendinopathy can both be treated in the same way. In more cases Tendonitis will be more effectively treated through conservative methods of rehabilitation as well as rest. The initial advice would be to rest of area that is causing pain, so for example if you are running and that is causing pain to the Achilles tendon then we would advise you to stop that activity an rest usually for around 3-6 weeks depending on the severity. Through this rest period there will be exercises to do in order to strengthen the tendon in question but also by offering stretching techniques and massage to the affected area / muscle attachment.

Tendinopathy can be treated as above however in some more severe cases surgery can be recommended and can also be very effective in providing around 90-95% range of movement and great results.

Golfers Elbow

Posted on June 3, 2024

Golfers elbow, clinically known as medial epicondylitis, is a condition that causes pain around the inside of the elbow joint. Often occurring after repetitive overuse of the forearm muscles and tendons used for moving the wrist and hand. Due to the constant strain of the wrist flexors on the insertion (attachment) point, inflammation or micro tears can occur.

Golfers elbow is a musculoskeletal condition usually seen in people aged 40 – 60, whose daily activities include repetitive wrist flexion. Despite generally being diagnosed in golfer’s, the injury can occur in several other professions or sporting activities.

The level of pain associated with the pathology can vary from a mild niggle to a severe ache. Fortunately there are many different treatments available to help, with more than 80% of people recovering with basic treatment.

Anatomy

Your elbow joint is a joint consisting of 3 bones. The first is in your upper arm and known as the Humerus. The other 2 bones are in your forearm and known as the Radius and Ulna bones. At the bottom of the humerus there are small bony prominences called epicondyles, where muscles within the forearm attach. The bony prominence located on the inside side of the elbow is called the medial epicondyle.

Muscles, ligaments, and tendons play a huge role in holding the elbow joint in position with strength but also flexibility to move.

Medial epicondylitis, or Golfer’s elbow, is a condition that affects the muscles and tendons of your forearm which attach onto the medial epicondyle. Research suggests that the flexor carpi radialis (FCR) and the pronator teres are the muscles most commonly affected.

Symptoms

The symptoms of golfer’s elbow usually develop over a long period of time. In the vast majority of cases the pain can be minor and more of a side note but can worsen over time. In most cases there is no specific mechanism of injury associated with the condition, it is usually due to repetitive overuse.

Common signs and symptoms of tennis elbow include:

Pain or burning on the inner part of your elbow
Weakness or pain when gripping, lifting or twisting objects
Pain when straightening the arm
Sometimes, pain at night

The symptoms are often worse when the forearm is being used in activities that can be as simple as pouring water into a cup, using a screw driver even shaking hands.

Causes

Overuse – As mentioned previously the underlying cause of Golfer’s elbow is overuse, causing the tendons of the muscles to become inflamed. Overtime this inflammation can lead to small tears within the tendon or muscle. Recent studies have shown that particular muscles when damaged can play a large part in the cause of Golfer’s Elbow. These muscles are located in the forearm, known as the flexor carpi radialis (FCR) and the pronator teres. When these muscles become injured or weak from overuse they can get very tight causing the muscles to shorten and pull on the tendons at the insertion point. This constant pull on the tendons is what then causes the inflammation and micro tears, resulting in pain.

Activities – Activities play a large part in the cause of Golfer’s Elbow (Medial epicondylitis). As you would expect Golf and other sports are a factor in the case of Golfer’s Elbow (hence the name) however, anyone can get it and it could even be down to work related overuse. Professionals such as Plumbers, Electricians, Carpenters, Factory Workers and Office Workers can get this condition, any work where grip and wrist strength is important.

Age – Anyone can get Golfer’s Elbow at any stage in their life depending on the activities they are doing and how they are using their arm. That said, the majority of cases we see can range between the ages of 40 and 60.

Diagnosis

When discussing this issue with your doctor, they will take into consideration a number if factors before making a diagnosis. These will include how your symptoms developed, your work and your hobbies etc.

The Doctor will discuss how and when the symptoms occur and are more severe and where on the arm the pain / symptoms are materialising. You will need to make sure you inform your doctor of any underlying health issues such as Arthritis (RA or Osteo), you you have injured your elbow in the past or any other medical issues that has a baring on your elbow.

There are a number of tests the doctors can and should perform during your examination such as asking you to try straighten your wrist and fingers with the doctor providing resistance with your arm straight.

Your doctor may recommend additional tests such as X-rays, Magnetic resonance imaging (MRI) scan or an Electromyography (EMG) – this will be to rule out nerve compression.

Golfers Elbow Treatment

Golfer’s elbow is a condition that will eventually get better over time, the length of time will be determined by how much you are using the arm in the way in which it was damaged in the first place. This may mean you will need to stay off certain activities indefinitely for a period of around 6-8 weeks. This could be shorter or longer depending on what state the injury is in.

However, there are treatments that can be used to speed up your recovery and ultimately help alleviate symptoms while you recover.

The first stage in any recover is

REST. It is important you rest your injured arm and stop doing the activity that’s caused the problem in the first instance.

ICE – Apply a cold compress to the injured arm, such as a bag of frozen peas or a sports ice pack / gel pack for a few minutes several times a day, this will reduce inflammation and ease the pain. Some people have great success with contrast bathing the area so for example, icing the joint itself (the bony / tendonous areas) and using heat on the muscular areas such as Forearm to relax the muscles and speed up recover.

PAINKILLERS – Taking Paracetamol to ease the pain and Non-Steroidal Anti-Inflammatory’s such as Ibuprofen to reduce the inflammation can help greatly whilst in recovery.

MASSAGE – Asking your personal Sports Massage Therapist / Massage Therapist to perform massage on the arm offering STR (Soft Tissue Release) as well as general massage to relax the area and stimulate blood flow can really help to speed up recovery and make you feel better.

PHYSIOTHERAPY – Physiotherapy should be considered with other conservative treatment options especially for more severe and persistent cases.

A good rehabilitation plan with those elements mentioned above has seen great results and improved recovery time as well as reduced inflammation, reduced pain and improvement to the range of movement in your arm.

SURGERY – may be an option if the issue persists and you have gone through a considered and tailored physiotherapy and massage program as a last resort to remove the damaged part of the tendon.

Exercises

Wrist Flexor Stretch

Start Position: Extend your arm straight in front of you with your palm facing up.
Movement: Use your other hand to gently pull back on the fingers of the extended hand, bending the wrist downward.
Action: Hold the stretch when you feel a gentle pull along the inside of your forearm.
Hold: Maintain this position for 15-30 seconds.
Switch: Repeat on the opposite arm.

Wrist Extensor Stretch

Start Position: Extend your arm straight in front of you with your palm facing down.
Movement: Use your other hand to gently pull the fingers of the extended hand back towards your body.
Action: Hold the stretch when you feel a gentle pull along the top of your forearm.
Hold: Maintain this position for 15-30 seconds.
Switch: Repeat on the opposite arm.

Wrist Flexor Strengthening (with a Dumbbell)

Start Position: Sit on a chair and rest your forearm on your thigh, holding a light dumbbell (1-3 lbs) in your hand with your palm facing up.
Movement: Slowly curl the dumbbell upwards by flexing your wrist.
Action: Lower the dumbbell back down in a controlled manner.
Repetitions: Perform 10-15 repetitions for 2-3 sets.
Switch: Repeat with the opposite arm.

Reverse Tyler Twist (Using a Flex Bar)

Start Position: Hold a Flex Bar vertically with your injured arm at the bottom, palm facing inward.
Movement: With your other hand, grasp the top of the Flex Bar and twist it downward.
Action: Slowly extend your injured arm while keeping the twist in the Flex Bar.
Repetitions: Perform 10-15 repetitions for 2-3 sets.
Switch: Repeat on the opposite arm if necessary.

There are a number of exercises you can perform to help in the Recovery of Golfers Elbow but also to help strengthen the area to help in the prevention moving forward. We have put together a video of some of the popular and most effective exercises / rehabilitation programs for this condition.

Prevention

It’s not easy to avoid getting golfers elbow as it can be very minor issues that cause it. However a dynamic and considered training program with a qualified strength and conditioning coach can really help. Further to this if your injury was caused through overuse then looking at reducing that particular activity until you have strengthen the area or looking at other ways to do the task in question will help.

The video above is not just to help rehabilitate the area it will also help in strengthening the area and again you should seek professional advice for this.

If you need any help with your rehabilitation of this particular issue our sports therapy specialits and physiotherapy specialists can help. Please contact us today.

Sciatica

Posted on May 31, 2024

Sciatica is a specific type of pain that radiates down the sciatic nerve. Which extends from your lower back, into the glutes and down the back of the legs, however sciatica generally takes place down one side of your body. The main cause of this happening is when a herniated disk, which is bone spur on the spine, compresses part of the nerve. This can cause numbness and pain in the legs and also inflammation. Generally this is not considered as anything serious and in most cases will goes away after a few weeks. On rare occasions a patient may need surgery but this is only a result if there is a significant weakness in the legs.

Anatomy

The sciatic nerve is the biggest and longest nerve in the human body, starting at the base of the spine, into the gluteal region and running down the back of the leg into the toes. The sciatic nerve is formed in the lower spine by the combination of motor and sensory fibers from spinal nerves L4 to S3. These spinal nerves belong to a larger group of nerves in the lower spine called the lumbosacral plexus.This long, thick, nerve then divides into the Peroneal and Tibial nerves which innervate different parts of the lower leg, foot and toes.

Symptoms

Pain that forms and travels through your legs up via your glute and into your back is the biggest and most common sign that you may have sciatica. Discomfort can be felt almost anywhere but this is more apparent through the nerve pathway through the areas stated above. Feelings such as burning pain can be felt through sciatica and this may be mild or severe. This can sometimes feel worse or be more painful when you sneeze or cough, additionally sitting for a long period of time can also aggravate this more. Another main symptom is numbness or tingling, this is commonly known as the phrase pins and needles. Muscles can also tighten and become weak in the leg and foot.

Causes

Sciatica occurs when an overgrown bone is on your vertebrae/ herniated disk in your spine and results in the sciatic nerve getting pinched.

Some factors such as age can not prolong sciatica. There is sometimes nothing you can do to stop this. Obesity can also be a factor as this puts stress on your spine and the extra weight can cause spinal changes leading to sciatica. Your job can also play part as a factor, for example if you have a heavy lifting job or a job that requires you sitting down for long periods of times like driving long distances. Diabetes can also enhance sciatica because of the way your body uses blood sugar, and increases your risk of nerve damage. Finally not being active can also trigger sciatica.

Diagnosis

Sciatica is commonly diagnosed through the patients history taking and physical screening. By definition patients mentioning the radiating pain in the leg will spark the sciatica diagnosis. They may be asked to report the distribution of the pain and whether it radiates below the knee and drawings may be used to evaluate the distribution. Sciatica is characterised by radiating pain that follows a dermatomal pattern.Physical examination largely depends on neurological testing. The most applied investigation is the straight leg raising test.

Treatment

As stated before sciatica can go on its own so in most cases you won’t have to do an awful lot however some cases are worse than others and there are various things that you can do to help treat this. Easy things like making sure that you stretch regularly can help massively. This allows you to keep your muscles stretched out and start to stimulate the nervous system.

A qualified soft tissue specialist providing Sports Massage can be really beneficial with techniques such as Soft Tissue Release and also Nueromuscular therapy. This also helps stretch the muscles and really stimulate the nervous system by increasing the blood flow especially in the legs.

It is also important if this persists to seek help from a qualified sports therapist or physiotherapist who can work with you on a rehabilitation plan that will involve exercises and stretches.

Exercises

Glute Max Stretch

Start Position: Lie on your back with your knees bent and feet flat on the floor.
Movement: Cross your right ankle over your left knee, forming a “figure 4” shape with your legs.
Action: Reach your hands through your legs and pull your left thigh towards your chest.
Hold: Maintain this position for 20-30 seconds while feeling a stretch in your right gluteus maximus.
Switch: Repeat on the opposite side.

Piriformis Stretch

Start Position: Sit on the floor with your legs extended straight in front of you.
Movement: Cross your right leg over your left leg, placing your right foot flat on the floor next to your left knee.
Action: Twist your torso to the right and use your left elbow to gently press against the outside of your right knee.
Hold: Hold this position for 20-30 seconds, feeling a stretch in the right piriformis muscle.
Switch: Repeat on the opposite side.

Hamstring Stretch

Start Position: Sit on the floor with one leg extended straight in front of you and the other leg bent with the sole of your foot against your inner thigh.
Movement: Reach forward towards your toes of the extended leg while keeping your back straight.
Action: Lean forward from your hips until you feel a gentle stretch along the back of your thigh.
Hold: Hold this stretch for 20-30 seconds.
Switch: Repeat with the opposite leg.

Quadricep Stretch

Start Position: Stand upright, holding onto a wall or chair for balance if needed.
Movement: Bend your right knee and bring your heel towards your buttocks.
Action: Grab your ankle with your right hand and gently pull it closer to your buttocks.
Hold: Hold this position for 20-30 seconds, feeling the stretch in the front of your thigh.
Switch: Repeat on the opposite side.

Trigger Point the Piriformis Muscle

Start Position: Sit on the floor with your knees bent and feet flat on the ground.
Equipment: Use a foam roller or a small, firm ball.
Placement: Position the foam roller or ball under your right buttock, near the area where you feel tension or discomfort.
Action: Slowly roll your body over the roller or ball, applying pressure to the piriformis muscle. You can adjust your body angle to target different areas.
Duration: Spend about 1-2 minutes working on each side, focusing on areas of tightness or tenderness.
Switch: Repeat on the opposite side.

Please see some exercises and stretch examples in our video provided or alternatively contact one of our personal trainers who can talk you through these exercises.

Prevention

As Sciatic can be idiopathic it is not easy to prevent its occurrence. If possible avoid repetitive activities, when unavoidable take time to perform stretches and take regular breaks. Be aware of the first signs of symptoms developing, the earlier you start treatments the quicker it can be resolved.

If you are suffering with Sciatica

Understanding Spinal Manipulation

Posted on May 27, 2024

Spinal manipulation, a therapeutic intervention involving the manual adjustment of the spine, is widely used to address various musculoskeletal issues, particularly back pain. This technique, often associated with chiropractic care or osteopathy, can also be effectively administered by massage therapists, soft tissue specialists, sports therapists, and physiotherapists. These professionals play a crucial role in the holistic management of spine-related conditions, ensuring comprehensive care through their specialised skills and expertise.

What is Spinal Manipulation?

Spinal manipulation, also known as spinal adjustment, involves applying controlled force to a specific joint in the spine. This technique aims to improve spinal motion, alleviate pain, and enhance the body’s overall function. The adjustment often results in a noticeable “cracking” sound, which is the release of gas bubbles from the joint spaces, a phenomenon called cavitation.

The Role of Soft Tissue Specialists

Soft tissue specialists focus on the muscles, tendons, and ligaments surrounding the spine. Their expertise lies in understanding how these tissues interact with the skeletal system. Through techniques such as deep tissue massage, myofascial release, and trigger point therapy, they help relieve muscle tension and improve circulation. By addressing the soft tissues, these specialists can reduce the stress on the spine, enhance the effectiveness of spinal manipulations, and provide lasting pain relief.

For instance, in cases of chronic back pain, a soft tissue specialist might identify and treat muscle imbalances or adhesions that contribute to spinal misalignment. This integrated approach not only supports the spinal manipulation process but also helps prevent the recurrence of issues by ensuring that the surrounding soft tissues are healthy and flexible.

Sports Therapists and Spinal Health

Sports therapists, trained in the prevention, diagnosis, and treatment of sports-related injuries, bring a unique perspective to spinal manipulation. Their focus on functional movement and performance optimization makes them adept at addressing spinal issues that affect athletes and active individuals.

Incorporating spinal manipulation into sports therapy can significantly enhance an athlete’s performance and recovery. For example, a sports therapist might use spinal adjustments to improve an athlete’s range of motion, reduce pain, and prevent injuries. By combining spinal manipulation with other modalities such as corrective exercises, strength training, and biomechanical assessments, sports therapists can create a comprehensive treatment plan that addresses the root cause of spinal issues and promotes overall spinal health.

Physiotherapists: Comprehensive Spinal Care

Physiotherapists, or physical therapists, are healthcare professionals who specialise in restoring and maintaining physical function. They employ a range of techniques, including spinal manipulation, to treat various conditions affecting the spine. Physiotherapists are particularly skilled at integrating spinal manipulation into a broader rehabilitation program.

When dealing with spinal issues, physiotherapists conduct thorough assessments to identify the underlying causes of pain and dysfunction. They may use spinal manipulation to restore proper alignment and mobility, followed by targeted exercises to strengthen the core muscles that support the spine. Additionally, physiotherapists educate patients on posture, ergonomics, and lifestyle modifications to prevent future problems.

Collaborative Care for Optimal Outcomes

The synergy between soft tissue specialists, sports therapists, and physiotherapists ensures a holistic approach to spinal care. By combining their expertise, these professionals can provide comprehensive treatment plans tailored to each patient’s unique needs.

For instance, a patient with chronic lower back pain might start with a soft tissue specialist to address muscle tension, move on to spinal manipulation with a sports therapist to improve spinal alignment and mobility, and finally work with a physiotherapist on strengthening exercises and long-term rehabilitation strategies. This collaborative approach maximises the benefits of spinal manipulation and supports sustained spinal health.

In conclusion, spinal manipulation is a powerful tool in the management of spine-related conditions. When performed by skilled soft tissue specialists, sports therapists, and physiotherapists, it can lead to significant improvements in pain relief, mobility, and overall function. Their integrated approach ensures that patients receive comprehensive care that addresses not only the symptoms but also the underlying causes of spinal issues, promoting long-term wellness and quality of life.

If you feel you are in need of spinal manipulation or articulation then please contact us today or make a booking with one of our professionals.

The healing power of cupping therapy

Posted on May 27, 2024

Cupping therapy, a form of alternative medicine with roots tracing back to ancient Egyptian, Chinese, and Middle Eastern cultures, has gained considerable popularity in contemporary health and wellness circles. This practice involves placing cups on the skin to create suction, which is believed to enhance blood flow, reduce muscle tension, and promote healing and relaxation. Despite its ancient origins, cupping has found a place in modern therapy, offering a holistic approach to health that complements conventional medical treatments.

The History and Techniques of Cupping Therapy

Cupping therapy dates back thousands of years. Historical records suggest that the ancient Egyptians used it as early as 1550 B.C., as documented in the Ebers Papyrus. The technique also features prominently in traditional Chinese medicine (TCM) and has been practised by various cultures worldwide for centuries.

There are two main types of cupping: dry cupping and wet cupping.

Dry cupping involves placing cups on the skin to create a vacuum. This can be achieved either by heating the air inside the cup and then placing it on the skin, causing the air to cool and form a vacuum, or by using a pump to create the suction.
Wet cupping, also known as hijama, involves a similar process, but after the suction, the therapist makes small incisions on the skin to draw out a small quantity of blood. This is believed to help remove toxins from the body.

Cups can be made from various materials, including glass, bamboo, earthenware, and silicone. The type of material and method used can vary depending on the practitioner’s approach and the specific needs of the patient.

The Mechanisms and Benefits of Cupping Therapy

The primary mechanism behind cupping therapy is the creation of a vacuum that draws blood to the surface of the skin. This process is thought to improve blood circulation, relieve muscle tension, and promote cell repair. By enhancing the flow of blood and lymphatic fluid, cupping may help in removing toxins and reducing inflammation.

Key Benefits of Cupping Therapy:

Pain Relief: One of the most significant benefits of cupping therapy is its ability to alleviate pain. The increased blood flow to the affected area can help reduce muscle soreness, stiffness, and overall pain, making it a popular choice for athletes and individuals with chronic pain conditions.
Improved Blood Circulation: Cupping therapy stimulates blood flow, which can enhance the delivery of oxygen and nutrients to tissues and promote healing. This improved circulation can also help reduce the appearance of cellulite and varicose veins.
Muscle Relaxation: The suction and negative pressure created by cupping can loosen muscles, encourage blood flow, and sedate the nervous system, which makes it an effective treatment for high blood pressure.
Detoxification: Wet cupping, in particular, is believed to draw out toxins from the body, helping to cleanse the blood and boost the immune system.
Stress Reduction: By promoting relaxation and reducing muscle tension, cupping therapy can help alleviate stress and anxiety, contributing to overall mental well-being.
Enhanced Skin Health: The increased blood flow and detoxification effects of cupping can improve skin health, reducing conditions like acne, eczema, and inflammation.

Modern Applications and Considerations

Today, cupping therapy is widely used by healthcare professionals, including medical acupuncturists, massage therapists, sports therapists and physiotherapists. Its integration into modern health practices underscores its efficacy and adaptability.

However, it is essential to approach cupping with caution. While generally safe when performed by trained practitioners, cupping can cause side effects such as skin discoloration, bruising, and, in rare cases, burns or infections. Individuals interested in cupping therapy should consult with a healthcare provider to ensure it is appropriate for their specific health needs.

In conclusion, cupping therapy offers a compelling blend of ancient wisdom and modern application. Its ability to provide pain relief, improve circulation, promote detoxification, and reduce stress makes it a valuable addition to contemporary wellness practices. As more people seek holistic and non-invasive treatments, the popularity of cupping therapy is likely to continue its resurgence, bridging the gap between traditional healing and modern health care.

If you are interested in making a booking with one of our cupping practitioners, then please use our booking system or contact us directly.

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