Tag: Physiotherapy

Physiotherapy is a process that helps with the rehabilitation or injuries either by sprts people or the general public and is done by a qualified practitioner

Piriformis Syndrome

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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:

  1. 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.
  2. 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.
  3. 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.
  4. 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

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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.

Is It Tendonitis or Tendinopathy…

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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

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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

 

  1. Wrist Flexor Stretch
  1. Start Position: Extend your arm straight in front of you with your palm facing up.
  2. Movement: Use your other hand to gently pull back on the fingers of the extended hand, bending the wrist downward.
  3. Action: Hold the stretch when you feel a gentle pull along the inside of your forearm.
  4. Hold: Maintain this position for 15-30 seconds.
  5. Switch: Repeat on the opposite arm.
  1. Wrist Extensor Stretch
  1. Start Position: Extend your arm straight in front of you with your palm facing down.
  2. Movement: Use your other hand to gently pull the fingers of the extended hand back towards your body.
  3. Action: Hold the stretch when you feel a gentle pull along the top of your forearm.
  4. Hold: Maintain this position for 15-30 seconds.
  5. Switch: Repeat on the opposite arm.
  1. Wrist Flexor Strengthening (with a Dumbbell)
  1. 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.
  2. Movement: Slowly curl the dumbbell upwards by flexing your wrist.
  3. Action: Lower the dumbbell back down in a controlled manner.
  4. Repetitions: Perform 10-15 repetitions for 2-3 sets.
  5. Switch: Repeat with the opposite arm.
  1. Reverse Tyler Twist (Using a Flex Bar)
  1. Start Position: Hold a Flex Bar vertically with your injured arm at the bottom, palm facing inward.
  2. Movement: With your other hand, grasp the top of the Flex Bar and twist it downward.
  3. Action: Slowly extend your injured arm while keeping the twist in the Flex Bar.
  4. Repetitions: Perform 10-15 repetitions for 2-3 sets.
  5. 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.

Why Do We Get Injured?

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Why do we get injured?

Injuries, whether they occur at home, in the workplace, or during physical activities, can result from a variety of factors. Addressing these diverse causes requires a comprehensive understanding of the contributing elements. This article delves into the reasons behind injuries, incorporating statistics and detailed insights into injury prevention strategies.

Common Causes of Injuries:

  • Accidents Everywhere: Accidents have a broad reach, occurring in various settings, including homes, workplaces, and during sports or physical activities. According to the World Health Organization (WHO), unintentional injuries account for over 3.9 million deaths globally each year, making them a significant public health concern.
  • Overuse Injuries and Sporting Activities: Overuse injuries, frequently associated with sports and physical activities, result from repetitive motions causing damage to muscles, tendons, or joints. A study recently published in the Journal of Sports Medicine found that overuse injuries account for approximately 50% of all sports-related injuries. Proper equipment, personalised advice from experts, and robust recovery programs, including massage and physiotherapy, play pivotal roles in preventing such injuries.
  • Posture and Body Mechanics: Poor posture and improper body mechanics contribute to increased stress on muscles and joints, leading to long-term injuries. The American Chiropractic Association reports that poor posture is a significant factor in chronic musculoskeletal conditions, affecting a large portion of the population.
  • Ageing and Micro-Level Changes: Aging brings about changes in bones and muscles, rendering them weaker and more susceptible to injuries. Additionally, micro-level changes such as hormonal fluctuations and vitamin deficiencies become pertinent factors. Livewell Health’s health checks, involving blood testing, allergy testing and food intolreance testing and comprehensive assessments, offer insights into these micro-level changes, facilitating proactive injury prevention.
  • Chronic Conditions: Chronic conditions like arthritis and osteoporosis heighten the risk of injuries. Arthritis alone affects a huge portion of the UK population, making them prone to joint-related injuries.
  • Environmental Factors: Environmental factors, including slippery surfaces, poor lighting, and hazardous working conditions, significantly contribute to injury risks. Workplace slips, trips, and falls account for a substantial number of injuries, with over 30% of reported injuries being fall-related.

The Significance of Injury Prevention:

  • Protective Gear and Physical Fitness: Preventing injuries involves adopting proactive measures, such as wearing appropriate protective gear.
  • Timely Medical Attention and Rehabilitation: In the event of an injury, prompt medical attention and adherence to appropriate treatment and rehabilitation protocols are crucial.
  • Preventative measures: Preventative measures also extend past standard medical and rehabilitation avenues which can be things such as Yoga, Pilates, a robust stretching program, strength and conditioning, dynamic exercise program, massage and other complimentary services to keep your body and mind in tip top form.

Conclusion: Understanding the multifaceted nature of injuries is imperative in developing effective prevention strategies. By acknowledging the diverse causes, ranging from accidents and overuse injuries to ageing and environmental factors, individuals and organisations can take informed steps toward injury prevention. Livewell Health’s commitment to health checks, tailored advice, and holistic wellbeing emphasises the importance of proactive measures, ensuring a healthier and more resilient future for individuals and communities alike.

If you want to know more about correct exercise techniques or would like professional advice from one of our personal trainers then please get in touch then we can help there too with our specialist sports massage service. For more information on how these types of massage could help you, contact us on 07939 212 739 or drop us an email at info@livewellhealth.co.uk

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