The Physiotherapy Blog

Discussion in 'Injuries and Prevention' started by Late for dinner, Apr 13, 2012.

  1. Late for dinner

    Late for dinner Valued Member

    As some as you may know I run a physiotherapy/sports injury clinic and have been doing so for 20+ years. I started a blog to give some information to my patients and I thought perhaps some of you might find my meanderings on health and fitness issues interesting. I would love any feedback anyone might like to give me about either form or content but please be gentle. :' ) I recently transferred the blog over to a wordpress set up and the older posts look a bit tatty. Apologies.. I will try to clean it up as I get more time and knowledge in doing this. Any advice/suggestiong you might like to give would be appreciated.

    Thanks in advance for your thoughts and critiques.



    LFD
     
    Last edited by a moderator: Jan 16, 2015
  2. Late for dinner

    Late for dinner Valued Member

    My recent blog is on how age affects athletes as far as strength/endurance goes.. interesting to see the differences in the legs of people in their 40's and their 70's...

    There is no sales pitch here.. People can ask for topics that I can post on and leave comments or questions on the original blog.


    Everything you wanted to know about Sciatica.

    Sciatica!!!This common problem gets a lot of peoples’ attention! The difficulty is that there isn’t just one problem, and often people (clinician’s and patients) use the term to mean differing things.
    You will get different advice from medical doctors, physiotherapists, acupuncturists, sports therapists, chiropractors, osteopaths and massage therapists. Each one has their own perspective but it’s not always clear what’s the best option to take. It can be really confusing!

    The trouble is that sciatica is a symptom and not really a ”diagnosis” at all. Most of the time people refer to pain down the back of the thigh as ”sciatica” as though there was something in the leg that had actually had been damaged. This isn’t always the case.

    There are 4 main things that can produce pain down the back of the leg –

    First there is the ”classic sciatica” which is thought to be a compression injury to the sciatic nerve in the buttock by the piriformis muscle.

    Secondly pain down the thigh can be produced by tissues in the back which may or may not involve nerve entrapment.

    Nerve entrapment can be produced by a disc compression type injury, stenosis (narrowing of the holes in the back centrally or on one side due to joint degeneration, disc herniation or wear) or by a combination of these factors.

    Thirdly, you can also have pain down the leg simply by having a disc being irritated, so that it causes pain to be referred along the course of the nerve sheath, without actually having any damage to the nerve at all.

    Finally, you could also have pain referred, or occurring locally, in the back of the leg due to injuries to the hip joint, sacro-illiac joint or hamstring muscles.

    Really it can seem like a maze trying to figure out what is wrong or what to do about the symptoms that you have.

    Diagnostic imaging can show damage that may never cause symptoms. The use of MRI and x-ray can confuse the issue, because of the inconsistency of the relationship between how much damage people have and what complaints they have. Sometimes there is nothing to be seen on a scan or x-ray, yet people suffer greatly.

    There are many opinions as to what the best tests are, but a thorough history and examination performed by an experienced clinician can go a long way towards clarifying

    what a person is suffering from
    what to expect
    what sort of treatment, if any, is necessary.
    There are no magical new examination methods that have been shown to work any better than this.
     
    Last edited by a moderator: Jan 16, 2015
  3. Late for dinner

    Late for dinner Valued Member

    Newest blog piece on the dangers of sitting..

    Get up off of that thing! :' D


    Sitting can undo the benefits of a healthy lifestyle!

    I have been warning people for years about the dangers of too much sitting. Now a number of sources have come up reasons not to sit too long that further convinced me!

    Firstly, sitting is known to be one of the most compressive position on the spine and has been thought to lead to potential disc injury over time.

    [​IMG]

    Our discs are tough but they are not meant to be constantly loaded without a break. Some people are lucky and have a greater degree of protection due to their genetics. Not everyone is this lucky. Typically I tell people, especially those with a history of acute low back pain attacks, not to sit for more than 30 minutes without either getting up or changing the position they are working in. This is all common sense and is easy to understand (although I do understand that some people might have different opinions).

    Secondly, the new information (not that new really) shows that there is a high correlation between the amount of time you sit and the development of certain illnesses such as diabetes, heart disease and high blood pressure . This can certainly affect the average person but some groups are more prone to these diseases and sitting less might be one thing a person could do that would help to lower their risks. There has even been talk that people working hard to maintain their fitness, such as runners, can loose up to 8% of the benefit of their run from every hour that they are sitting. One author came up with the term ”active couch potatoes” to describe athletes who sit too much. Alex Hutchinson , on the Runner’s World web site commented

    ” sitting appears to have some significant bad effects that can’t be “cancelled out” by exercising. Too much sitting and not enough exercise are two different things, and they’re both worth paying attention to. ”

    Finland have worked out ways to minimize the effects of sitting on children by including a 15 minute break in every hour in the class room. I believe that this was put in place to help stop children from being restless. it has the potential to help in so many areas that it is something schools might want to consider bringing in anywhere. Businesses could learn from this example and help to reduce occupational health risks, as well as cardiovascular diseases, by encouraging regular breaks at work. Too often you hear that people work through their lunches and breaks, come to work early and stay well beyond what one might consider a reasonable working day.

    Although the focus is often to try and help physical health getting up and being active has been recognised as a valuable tool in combating some mental health issues. Centres like the Mayo Clinic have strongly encouraged exercising, such as walking, as one tool to help combat complaints such as depression,

    It may sound like a rant but the benefits of getting up and moving about, both physical and mental, are too important to be ignored. Some are calling sitting ”the new smoking” because of all the associated problems that can be linked to inactivity. Perhaps instead of just saying prevention is better than cure we should be looking at ways to put good ideas into practice. As ”James Brown” once so aptly put it ”get up off of that thing”!
     
    Last edited by a moderator: Jan 16, 2015
  4. Late for dinner

    Late for dinner Valued Member

    New blog piece on scars.

    Scars? Physiotherapy can help you!

    Scars. You have them from injuries or surgery but often no one tells you what to do about them if they bother you. Some women find scar pain is present in scars following a c-section. Other people find scars post mastectomy can be painful for quite a long period of time. Most people don’t know that there are a few things that can be done to help with scar pain or that a scar can benefit from remodelling of a sort.

    Why should a scar be remodeled?

    1. It can help decrease pain
    2. It can improve range of motion in the surrounding joint and muscle
    3. It restores normal mobility and function

    A scar needs to be assessed and treated as it can affect your performance in a variety of areas including work, sport or even the bedroom. Episiotomy scars, perineal tears, overly tight stitching and c-section scars can all leave a woman uncomfortable and not comfortable being intimate. Typically these sort of scars (vaginal/perineal) are treated in a specialised hospital pelvic floor treatment unit as opposed to an outpatient/sports clinic. C-section or other abdominal scars are routinely treated in an outpatient clinic. Sportsmen may find that a scar hampers their mobility, strength and co-ordination. It is difficult to perform to your true potential when you feel restricted or if you are waiting for a stab of pain to kick in.

    Treatments can be active or passive. These include a number of the procedures commonly used in physio/physical therapy practice such as soft tissue mobilizations(manual or instrument assisted), ultrasound, acupuncture and exercises. Additionally silicone gel sheets/silicone ointments and mildly stretchy K-tape may be used to add additional heat/stretch or humidity to the scar for longer periods of time.

    [​IMG]

    [​IMG]

    [​IMG]

    A great amount of treatment can be carried out by patients on their own but often it takes an independent person to see all the problems that aren’t immediately evident. Unsurprisingly people often avoid putting pressure on a scar and don’t notice just how sensitive the tissues in the area are.

    If you have concerns about a scar then consider speaking to your family medical doctor or your physical therapist regarding having the scar assessed. There is no reason why you should have to suffer without some help/advice considering the amount of knowledge that is available these days.
     
    Last edited by a moderator: Jan 16, 2015
  5. Alansmurf

    Alansmurf Aspire to Inspire before you Expire Supporter

    As usual buddy a great source of pertinent and useful information .

    Thanks
     
  6. Late for dinner

    Late for dinner Valued Member

    Cheers Alan...

    Didn't think anyone actually read my stuff so +1 for giving me a midweek surprise! ;' )

    LFD
     
  7. belltoller

    belltoller OffTopic MonstreOrdinaire Supporter

    We'd read a lot more if we knew when and where to look. Its a scavenger hunt here, you know ;)
     
  8. Mangosteen

    Mangosteen Hold strong not

    You're blog annoys me...
    Because their isn't enough content!

    Everyone on MAP should read your blog. You're a physio, a rugby player, a ex greco-roman wrestler, a kung fu man, had a massive squat (170kg IIRC) at a super low body weight - all as an old man!
     
  9. Late for dinner

    Late for dinner Valued Member

    Here is an article from my newsletter discussing different types of arthritis (broad categories) and (on the original article) a couple of links to orgs that have arthritis self help info. There are also a couple of links (on the newsletter) to youtube for animations on how to sit and work to minimiise injury to yourself.


    Arthritis!!!


    This common problem gets a lot of peoples' attention! The difficulty is that there isn't just one problem, and often people (clinicians and patients) use the term to mean differing things.

    It can be really confusing!

    [​IMG]

    You might have an image of your older relative bent over and hobbling with this disorder. You might remember someone you know laid up in bed with hot swollen joints unable to do anything. Then you get examined and you get told you have it! What to expect? What to do?

    Arthritis isn't one thing but a name given to a group of disorders that affect the joints. The aren't all the same and in fact they may not even affect the same tissues. The one common component is that the whole joint is affected to some degree.

    Broadly speaking there are 3 sorts of categories of arthritises: degenerative, inflammatory and traumatic. They aren't automatically mutually exclusive, you could get/have more than one at a time.

    Degenerative arthritis is the famous ''wear and tear'' that eventually occurs if you live long enough. There are some that think there are other factors at play that may speed up or slow down degeneration but wear is the defining problem and it primarily affects the cartilage/bone and related tissues.

    In contrast inflammatory arthritis occurs when something causes the joint to become inflamed. This could be infection or something could cause your body to attack itself. Auto-immune conditons such as rheumatoid arthritis are typical with the synovial lining of the joint becoming swollen and inflamed leading to problems for the whole joint as it becomes filled up.

    Lastly traumatic arthritis is what you see when you have a joint sprain. The body will limit the effects of injury by making the joint swell and thickening the surrounding tissues to immobilize the joint as it heals.

    Each of these different classes of arthrits are managed differently. Inflammatory conditions quite often need to be evaluated by a rheumatologist and the patient could be taking strong anti-inflammatory medications to control the inflammation. Degenerative arthritis might improve with adequete support (knee sleeve), strengthening and modifying habits to reduce the load on the joint. A joint affected by traumatic arthritis , once the inflammation has started to subside, will need to be stretched out so that the joint can go back to working normally. With exercise and training the patient may regain full normal function again.
     
    Last edited by a moderator: Jan 16, 2015
  10. Late for dinner

    Late for dinner Valued Member

    No Pain, No Gain?

    Changes in the seasons often bring on changes in people's sporting activities...these can all bring on some new aches and pains that aren't expected.

    If you pace yourself, warm up a bit first and prepare before setting out on new activities you shouldn't have too many problems. If you aren't sure about what you should expect, should pain occur, then the following information on how to interpret pain might be useful for you.

    Good Pain?

    Very often muscle soreness from a great workout can be confused with pain, when in fact, it is actually a sign that your body is getting stronger and healthier. Muscle soreness is a dull and uncomfortable ache deep in the muscle, whereas pain is very uncomfortable, and a sometimes-sharp sensation in the muscle, joint or bone.

    No Pain No Gain

    The phrase “no pain no gain” is one that we’re all familiar with. It was invented from the feeling of delayed onset muscle soreness, or DOMS. If you’re experiencing DOMS, congratulations! You are becoming stronger and healthier. DOMS is the good pain you feel from working out and improving performance. It’s a result of micro tears in the muscle, which means your body is adapting to the new exercise load.

    How To Decipher DOMS:

    Pain is felt the day after exercise, not during or immediately after.
    Peak intensity is usually felt 2 days post workout and may last anywhere from 1-5 days after exercise.
    Soreness will be in the muscles that were targeted and felt in the muscle belly.
    Pain can occur bilaterally if you were working your body symmetrically
    Normally there shouldn't be pain when you are training but if the pain is felt during exercise it occurs with intensity increase or frequency, or starting exercise after a break. This is more likely to be felt if you have already started a programme that is taxing the muscles leaving them more sensitive.

    Activities Known to Cause DOMS:

    Strength training
    Walking down hills
    Jogging
    Step aerobics
    Jumping
    Treatment for DOMS

    The good news is, when it comes to muscle soreness, there is usually no medical intervention needed. The bad news is, that the only way to make it through is to experience it. You can prevent it by slowly progressing to a new exercise program that allows for adaptation. While your muscles are recovering, it’s recommended to only engage in light activity or refraining from activity altogether. An ice pack, foam rolling or a massage can be helpful in reducing painful symptoms. Some people feel better using a liniment or something similar that produces pleasant sensations to distract you while your body heals.

    What is Bad Pain?

    Deciphering bad pain isn’t as cut and dry as you may think. While good pain may be uncomfortable, it’s relatively easy to live through. Bad pain is the type that wakes you up in the middle of the night like an unwanted noisy neighbour. If you experience pain due to an injury rather than DOMS, it is more likely to be felt inside the joint rather than the muscle. If there is swelling around the joint, it indicates an injury and not a muscle issue and needs to be addressed. It can be acute or chronic, with generalized discomfort and a sudden onset.

    Symptoms of Bad Pain

    Pins, needles, numbness, weakness
    Sharp, sudden onset, or stabbing sensation of pain
    Limited mobility
    Radicular pain – pain that shoots from one area to another, usually progressing down the limb away from the spine
    Pain resulting from a ‘popping’, ‘clicking’, ‘snapping’ or ‘giving way’
    Swelling, heat and redness
    Referred pain - pain that moves and is felt down the limb when a higher area is irritated, usually a dull ache, not as sharp as radicular pain
    Pain that wakes you up in the night
    Constant or unremitting pain
    Any pain that gets worse

    Treatment for Injury

    Obviously, prevention is the best treatment for painful injury, but if it is too late, treating as early as possible will prove to be the most effective. Don’t try to work through bad pain, it will only prolong recovery and may lead to more serious injury.

    Pain is your body’s way of telling you there is a problem that needs to be addressed. You wouldn’t ignore a friend, coworker, spouse, parent, or child’s request for help, so make sure to treat your own body’s request with as much loving care as you do anything else.

    When bad pain occurs then it's best to consult with a professional, such as your family doctor or your physiotherapist, to find out what's wrong and what steps you should take to get better.

    (Happy to hear any suggestions/differences of opinion that might help to make my information more inclusive/complete/accurate :' )

    LFD
     
  11. Late for dinner

    Late for dinner Valued Member

    Basics on progressing your stretches

    Basics on progressing your stretches

    People have an injury, it stops hurting and then they return to their normal activities. Ideally it would be this simple but often you are left with tightness/discomfort. This happens partly due to the fact that tissues tighten and shorten as they heal. There may also be sensitivity issues which affect how tight things feel when trying to get back to your’normal’ activity. In the following section I am going to look at a basic simple progression on how to get back your knee flexion mobility following a resolved injury.

    To start with the simplest thing to do is just repeat the movement that is tight. For example one could just repeat the tight movement and the anterior thigh muscles should loosen to a degree just from doing that same movement. This is a basic stretch that you can see footballers doing on the side of the pitch before and after a soccer match-

    http://t.co/K4dItN6EPM

    If this basic stretch isn’t enough then you can progress the stretch as tolerated depending on how sensitive the knee is. If the restriction appears to just be soft tissue tightness and not a problem within the joint, then this second stretch might allow you to progress to a pain free state. To do this stretch you use a pillow to gap the knee joint so avoid joint compression while stretching the thigh muscles. The joint might be painful simply because the soft tissues crossing the joint are tight. By using the pillow ,and external support, you may avoid joint pain and see whether the knee/thigh can be more comfortable once the soft tissue tightness is relieved-

    http://t.co/OdV9LDju8Q

    Whatever you are stretching, you need to consider what factors might be in play that could be producing discomfort or restrictions. I mentioned that sometimes as area can be tight because of external factors making the area sensitive. Another factor that can affect tightness is whether there are any muscles involved that cross more than one joint. When a muscle crosses more than one joint then you need to adjust your stretches to make sure that both ends of the muscle are being stretched to get the soft tissues to fully relax and allow good extensibility.

    In this last stretch there is an emphasis to get the rectus femoris muscle stretched. It is important to tighten the abdominal muscles to make sure the stretch isn’t being overly focused in the lumbar spine. Be careful when doing this stretch that you don’t fall over. You may need to do the stretch near a wall. You might also find that you can’t reach back fully so a towel or belt might be needed to allow you go get to the stretch you are capable of even if your arms won’t reach.

    http://t.co/dR6tq9nXij

    So a recap. In this instance I have gone from an easy stretch, to a more difficult stretch to finally a specialised stretch to get full comfortable flexion of my thigh muscles. As mentioned other procedures might be needed if the knee joint is affected. Sometimes you might need to use a foam roller or cross tissue massage to loosen any tightness that is in a direction unusual for the muscle being stretched. If the joint is affected then you may need to apply pressures across the joint to allow better mobility. Joint work is something you need to discuss with a professional before trying on your own. Finally remember that once you regain your mobility you should be performing strength and co-ordination training to enable the limb to work normally. You might find that these last two procedures can be added into the mix earlier as tolerated and in fact may be necessary in order to regain full flexibility.

    Lots to consider. I hope that this information at least gets you started in your quest to regain your function. It is a bit artificial to separate things out but by doing so it might help to localise and identify where problems are occurring. Please let me know if you have any suggestions or comments that might be useful in these endeavours.

    LFD
     
  12. Bozza Bostik

    Bozza Bostik Antichrist on Button Moon

    Pins, needles, numbness, weakness - check
    Sharp, sudden onset, or stabbing sensation of pain
    Limited mobility - check
    Radicular pain – pain that shoots from one area to another, usually progressing down the limb away from the spine
    Pain resulting from a ‘popping’, ‘clicking’, ‘snapping’ or ‘giving way’
    Swelling, heat and redness
    Referred pain - pain that moves and is felt down the limb when a higher area is irritated, usually a dull ache, not as sharp as radicular pain - check
    Pain that wakes you up in the night - check
    Constant or unremitting pain - check
    Any pain that gets worse

    Should I be worried! Is my arm about to drop off?
     
  13. Late for dinner

    Late for dinner Valued Member

    Hmm worried? Well if you don't have a good reason for theses sort of complaints then sure I would be worried. A lot depends on the circumstances involved and that might be what determines whether you should be worried or not. Had all of the same after a shoulder injury in judo that took 9 months to sort itself out. Did my arm fall off? No, I started playing rugby and it never limited me in any way.

    If you have concerns then see your family physician and make sure there isn 't something dangerous going on. If you get the all clear then there a re a few routes of rehabilitation that may be of some use to you.

    Realistically, asking for anything more than general information on the internet is not going to be too satisfying. It's hard to give advice when you can't see/examine someone and you don't have access to any sorts of diagnostic tests. :dunno:

    Don't know if that is much help but it's the truth. :thinking:

    LFD
     
    Last edited: Apr 28, 2015
  14. Bozza Bostik

    Bozza Bostik Antichrist on Button Moon

    Oh, I totally understand, I am not looking for advice. :) You just made some interesting points that got me a bit concerned!

    I hurt my shoulder climbing and it hasn't been right since. It messes up my whole arm and into my hand. A physio said it was nerve damage and I had to let it just heal itself and claimed there was nothing to be done about it...I don't really buy that (the health care here is appalling). Unfortunately neither my girlfriend or I are working really at the moment so can't afford to go to a decent physio.

    What worries me the most is that, as you said, the longer you leave the problem the harder it is to fix. And it's been a good few years already.
     
    Last edited: Apr 28, 2015
  15. belltoller

    belltoller OffTopic MonstreOrdinaire Supporter

    Hey Ross - great blog!

    I was formally diagnosed yesterday with what I already suspected to be severe lateral epicondylitis, which has all but incapacitated the use of my right arm. It began during a two-hour bowling session. I'd started to feel a lot of discomfort and eventually pain about halfway through the session and continued playing anyway.

    Despite ice, NSAIDs and rest, the bony prominence on the outside of the elbow has swollen to the size of a golf ball and even a light tap against a wall will send me through the roof.

    I was given a Px for anti inflamatories, a referal to a physio whom I'll meet with Friday and a forearm brace (sleeve, really) - whose function and efficacy I'm uncertain and rather dubious of.

    Even though the tendonitis manifested itself while bowling two weeks ago, I'm concerned that there may have been underlying problems - my son and I often bowl 4 - 5 hour sessions during the 'all-you-can-bowl-for-' on Friday and I've not had problems with it before.

    My question is twofold: I've recently increased my right cross punching power by several factors and regularly train the punch - is it possible that hyperextending my right arm set up the conditions that have led to the tendonitis?

    In your experience, do people who've developed this ever return to the point where it is no longer a plague that doggs them from that point on? I.e., is this going to be an issue that keeps coming back?

    Cheers,

    belltoller
     
  16. Late for dinner

    Late for dinner Valued Member

    Don't give up tooo quickly. Even if physio isn't the answer person's may be able to direct you to something more appropriate. I was at a meeting a few weeks ago with a doctor who does high volume injections, that is lots of water injected between two structures - say 100 ml, to open up scarring between a tendon and it's sheath. The patient in question had suffered for >20 years and was completely dubious as to anything would help but attended on the recommendation of a friend. Not for everyone but for some conditions it can be helpful.

    Nerve damage? Well I would have to know more to make that sort of diagnosis. It may or may not be true.. physios are human , have opinions and can be wrong just like everyone else.

    Keep an open mind. I have had lots go wrong over the decades and recovered enough to still be training. I will say that some thing do better as you get older specifically because how your body changes, surprisingly. Lots of possibilities even if you are short of dosh!

    LFD
     
  17. Late for dinner

    Late for dinner Valued Member

    You have some possibilities. As you said you have been doing this stuff for years so it would be odd for something to all of a sudden go wrong with bowling. The punches could be at fault but it might be more of a joint problem rather than strictly an epicondylitis. If the joint is sprained then the muscles and tendons that cross it can carry referred pain/tenderness which can confuse the issue. One thing is that when a joint is affected then it will affect both directions of movement where as if a muscle is affected it may hurt with stretch and should hurt with resisted/loaded contratction.

    Not necessarily an issue but I can't tell you what is wrong yet. The thing is perhaps you need to try and sort out not hyper-extending your elbow when you throw your punch so that if this is the cause you stop hurting things.

    Chat more later

    LFD
     
  18. belltoller

    belltoller OffTopic MonstreOrdinaire Supporter

    They did do xrays and said that he saw no problem with the elbow itself, said I war free of arthritis, etc. I'm assuming if were the joint, it would show up on xray - though I don't know if this is true or not.

    Bending he arm in (as in a curl) produces no problem. Its extending the arm - in fact, I can no longer fully extend it - to the point that I just keep the hand rested across my chest for want of a better place to put it. I'm beginning to resemble Van (Redcoat Ninja) on one of his Napoleon fits (;))

    I canna say if I'd been hyper-extending or not - if so, it an accidental habit I've picked up - I'm speculating out loud if I might have been unintentionally doing it.
     
  19. Late for dinner

    Late for dinner Valued Member

    It's interesting regarding your inability to straighten the elbow since typically a tennis elbow/lateral epicondylitis does not affect the ability to extend the elbow. It is the forearm muscles that are producing the pain and they originate distal to the elbow so elbow motion should not be problematic. When you grip/lower something while holding onto it then the wrist extensors are being stretched while working and this produces symptoms. This happens with a backhand in tennis and why the term ''tennis elbow'' was chosen initially for this complaint.

    LFD
     
  20. belltoller

    belltoller OffTopic MonstreOrdinaire Supporter

    Yep - canna extend the arm - they couldna even straighten it out all the way for the xray and curling/bending it produces no pain at all - though gripping anything or even closing my hand in this position - palm facing up - is very bad. Its not the elbow joint itself that has the problem, its the area just to the outside left (right) of it.

    He didn't mention anything about the inability to straighten it out being odd - just that with it being so sensitive, he'd hesitate to give me a shot of cortisone.

    Ja, I wondered why he put the band/gelpad thing down on the forearm about three fingerspan down from the bony prominence.

    Cheers,
     

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