Common Injuries
Disclaimer:
The information contained within these articles is purely informational in nature. In no event shall Bridge Physiotherapy or any individual or company involved with Bridge Physiotherapy be liable for special, indirect, incidental, or consequential damages of any nature, including, but not limited to personal injury, loss of anticipated profits, or claims from third parties.
Always consult your doctor before making any changes in your diet and before performing any of the exercises presented in these articles.
For further information on your readiness to participate in an activity program go to:
CSEP Get Active Questionnaire – Canadian Society for Exercise Physiology (CSEP)
Neck Injuries:
ANATOMY
The Goal of this series of articles is to:
- Help you understand how your spine works and what can go wrong with it.
- Help you understand and gain access to the most effective treatment or treatments for your back problem.
This information is meant to compliment care you are currently receiving from your physiotherapist or other health care practitioner, and should not be taken as a replacement for seeking appropriate advice and care from a health care professional.
Note: For convenience the term back will be used to refer to any/all parts of the spine.
You are not alone. Back problems are very common. Up to 80% of the population will, at some point in their life, experience significant back and/or neck pain. At any given time between 20% and 50% of the population will be experiencing some type of back pain. Most do not find that the pain, while troublesome, does not significantly interfere with their normal activities of daily living (ADL’s).
However, approximately 10-12% will experience back problems that are disabling in nature. Their spine pain is severe enough that it interferes with their normal ADL’s.
To put this in perspective, Bridge Physiotherapy is located in the city of Nanaimo, British Columbia, which has a population of approximately 90,000 people. In Nanaimo, we can reasonably assume disabling back problems are affecting approximately 9,000 people at any given time.
What Can You Do About Your Back Problem?
The fact that these problems affect so many people is somewhat of a mixed blessing. On the positive side, there has been a significant amount of attention from the health care and scientific community focused on this problem over the past several years. This has given us a significant amount of information towards understanding and managing back problems. Unfortunately, there is so much information out there it is difficult to know what to believe.
Educating Yourself about Your Back
We feel that your best bet to coping with your back or neck problem is to become your own Back Mechanic. With the advent of the Internet, people can easily access information on back problems, but is there too much information? The answer is “yes”, and not all of it is good. We have tried to summarize below is the basic information you need to be an informed spine patient!
The vertebral column, commonly called the back bone has three basic functions. It supports the head and extremities while permitting freedom of movement. It provides areas of attachment for muscles and ligaments. It also protects the spinal cord and nerves.
In a healthy spine there are 3 systems that work together to allow these functions to occur.
- Skeletal: The bones and joints make up the basic support unit.
- Soft tissues: The muscles, ligaments, discs, and tendons are the connective tissues that stabilize and allow movement of the bones and joints.
- Nervous system: The brain and spinal cord. Messages travel along the nerves in split seconds. Pain and discomfort are messages that something is wrong and corrective action is needed.Although we have only one spine, we tend to refer to the spine in five different segments:
- Cervical Spine: This is the Neck and is located between the skull and the rib cage. It is composed of 7 vertebrae. They are numbered from top to bottom i.e. the first cervical vertebra is labelled C1 and the last is C7 (C1 to C7). It is the most flexible part of spine. It supports skull. The slight forward curve is called a lordosis.
- Thoracic Spine: This is the part of the spine that the rib cage connects on to. It is composed of 12 vertebrae (T1 to T12). The backwards curve is called a kyphosis.
- Lumbar Spine: This is the low back and is located between the rib cage and the pelvis. It is composed of 5 vertebrae (L1 to L5).
- Sacrum: This is the part of the spine that joins onto the pelvis. It is composed of 5 vertebrae (S1 to S5). These 5 vertebrae typically fuse together as we grow to form one, triangular-shaped bone at the base of our spine called the sacrum.
- Coccyx: This is a rudimentary, triangular-shaped bone joined onto the bottom of the sacrum, commonly referred to as the “tailbone”.
The primary building block of the skeleton is the vertebral body. It is the largest portion of the vertebra and is responsible for weight bearing. Projecting behind the vertebra is a series of bony projection called pedicles, lamina, transverse, and spinous processes. The spinous process is the hard bony point you can feel below the skin when you run you hand across your back. These processes serve as points of attachment for muscles. Between the transverse processes are the facet joints. They are found on either side of the vertebra and interlock with the facet joints above and below. These joints determine the direction of movement between two vertebras.Their structure is similar to other joints in the body. They are covered in cartilage and are encased in an elastic capsule that contains fluid. They are about the size of finger joint. In the neutral position the joints support bout 25 % of the load on the spine. When we bend forward there is less loading. When we bend backwards the opposite occurs.
Lying between the vertebras are the discs. They act as spacers between the vertebras and are firmly attached from above and below holding the vertebra strongly together. They also act as shock absorbers. They permit movement, vertebra are just big blocks of bone and on there own would have no movement. The basic functional unit of the spine is called a motion segment. This is comprised of two vertebras with the disc between them.
The disc is composed of two parts; 1) the annulus, which is the outer shell and surrounds the nucleus with strong crisscrossing fibers, 2) the nucleus, which is the centre of the disc and is composed of a jelly like substance. It is about 85% water in a young healthy disc. With age it water content decreases and it loses some of its ability to function as a shock absorber.
Note: the term slipped disc is incorrect. Discs cannot slip; instead the jelly-like material can bulge or protrude from between the vertebra creating the impression the disc has moved.
Protruding discs can place pressure on the nerves.
The following diagram shows three vertebrae stacked on top of one another. The top vertebrae has had the front of it removed (the “vertebral body”) to show you the spinal canal, which is the bony tunnel that all the nerves travel through.
Ligaments are designed to prevent excessive or abnormal movement from occurring between vertebras. They connect and stabilize vertebra as one continuous structure. They are tough elastic fibers that are found in front, behind, at the side, and between vertebras.
The muscles provide movement and stabilization with voluntary control. Without their support the spine is unstable. Muscles are attached to bone by tendons. The main function of the back muscles is in keeping the vertebra aligned and balanced. They are not designed for heavy lifting. They are sometimes referred to as prime movers and core stabilizers. The prime movers are the muscles that are responsible for the forward and backward movements in the spine (as well as rotation and side bending at some levels). The stabilizers are the muscles that maintain your spine in the neutral position. We will review these muscles in more detail in the core stability session.
The spinal cord is the connection between the central processor (brain) and the sensors (nerves). The spinal cord ends at the level of the first lumbar vertebra.
The spinal cord and nerves send sensory information to the brain from the extremities. The brain reacts by sending messages down the spinal cord and nerves to tell the muscles what to do. There are approximately 31 nerves branch from the spinal cord and travel throughout the body. In the neck a group of nerves combine to form the brachial plexus. These nerves control your arm function. In the low back, the sciatic and femoral nerves control leg function.
The spinal cord along with the brain forms the CNS. The nerves form the peripheral nervous system.
The following diagram is a view from above as we look down on the spine. This shows how the spinal cord travels through the spinal canal as well as the relationship of the disc to the spinal cord.
RISK FACTORS FOR SPINAL PAIN
Poor Body Mechanics: Incorrect body mechanics when performing repetitive lifting or positioning increases the stress on one or more structures in the spine, eventually causing irritation in these structures. Flexing the spine, holding the weight away from the body, or twisting the spine all increase intra-discal pressure causing it to bulge backward. Eventually this causes irritation and pain.
Sustained or Poor Posture: prolonged postures (>15 minutes) without changing position can cause pain and inflammation due to the constant loading.
Stressful Working and Living Habits: Forceful exertions may result when a load shifts suddenly while lifting, or is heavier than anticipated. As the weight increases so too do the forces involved. Baby boomers are sometimes referred to as the “sandwich generation. The population is aging resulting in an increased number of people requiring physical assistance. They are increasingly being required to look after aging parents living at home. This reduces the time available for stress reducing hobbies and exercise.
At the same time cutbacks in the health care sector results in fewer caregivers to provide for an increasing number of clients.
Changes in business practices, such as downsizing places additional stresses on the worker.
Technology has resulted in increased convenience and efficiency. The cost associated with this is work that is increasingly repetitive in nature. Examples of this can be found in office workers who until a few years ago would share an office printer. This required them to get up from their desk to retrieve the printed material. Technology has reduced the cost of printers such that it is not unusual for each person to have their own printer within easy reach. They are now able to sit uninterrupted for hours at a time.
Loss of Flexibility: Individuals with poor flexibility are more likely to be injured when an external load is applied to the spine. Without full movement the spine is unable to accommodate the strain effectively.
Loss of Physical Fitness: Poorly conditioned individuals fatigue more quickly making them less able to accommodate stress. In addition they do not recover as quickly from the injury.
TREATING PRACTITIONERS
Physiotherapist
Physiotherapy is a science based healthcare profession which views movement as central to health and well-being. Physiotherapists aim to identify and make the most of movement ability by health promotion, preventative advice, treatment and rehabilitation.
They work in a great variety of settings such as orthopaedics, occupational health, ergonomics, and sports medicine. The core skills used by a physiotherapist include manual therapy, therapeutic exercise, and the application of electrophysical modalities.
Physiotherapists believe it is vital to take note of psychological, cultural, and social factors which influence their clients. They believe in encouraging their patients to take an active role to help themselves to make the best of their independence and function.
Physiotherapists assist you in achieving your highest level of physical functioning by providing you with a personalized treatment plan based on your specific needs. They will assess your posture, range of motion (ROM), strength and other physical abilities. Then they will design a personalized treatment and exercise program to assist in alleviating pain, restore joint ROM, increasing muscle strength and co-ordination and maximizing independence. Physiotherapists will also assist in designing an ergonomically correct work and home environment. They will educate you in the use of assistive devices such as cane and crutches if necessary. They will help you return to work and leisure activities through physical conditioning programs.
When looking for a physiotherapist, a good place to start is to ask your primary care physician or specialist for the names of physiotherapists who they trust. It also helps to ask friends, co-workers and neighbors for recommendations.
Exercise caution however, because one person’s definition of a good physiotherapist may be quite different from another person’s definition. In general, if multiple resources recommend the same person, chances are good that the physiotherapist is reliable.
Chiropractor
Chiropractors practice a drug-free, manual approach to health care that includes patient assessment, diagnosis and treatment. In particular, chiropractors assess patients for disorders related to the spine, pelvis, extremity joints, and their effect on the nervous system. As a result of taking a physical assessment and patient history, chiropractors are able to provide a differential diagnosis for the patient’s presenting condition(s) and develop a comprehensive treatment/management plan. Chiropractors are also trained to recommend therapeutic exercise, to utilize other non-invasive therapies, and provide nutritional, dietary and lifestyle counselling.
Chiropractic adjustment is the most common form of treatment utilized by chiropractors in clinical practice. Also known as spinal manipulative therapy, adjustment is a non-invasive, manual procedure that is a carefully controlled by a skilled practitioner to dysfunctional spinal or extremity joints. The primary goal is to decrease pain, improve areas of reduced movement in the joints and supporting tissues, particularly of the spine, and decrease muscle tightness or spasm. This is done through the restoration of normal mechanics and improved functioning of the spine, extremities and supporting soft tissue structures.
Adjustment rarely causes discomfort. However, as it is a manually applied therapy, patients may sometimes experience mild soreness or aching following treatment which usually resolves within 12 to 48 hours.
When looking for a chiropractor, a good place to start is to ask your primary care physician or specialist for the names of chiropractors who appear competent and trustworthy. It also helps to ask friends, co-workers and neighbors for recommendations.
Exercise caution however, because one person’s definition of a good chiropractor may be quite different from another person’s definition. In general, if multiple resources recommend the same chiropractor, chances are good that the chiropractor is reliable.
Kinesiologist
Kinesiology is the study of human movement, the goal of which is to discover strategies for human health and performance. A Kinesiologist has trained in a four year University program, graduating with a bachelor’s degree in Kinesiology. This training gives them expertise in physical fitness and exercise therapy. Their role is to perform various physical fitness testing which help to guide in establishing what exercises will benefit you the most. They also monitor and help you learn your personalized exercise program to ensure you perform the activity properly and safely.
Acupuncturist
Acupuncture literally means “needle piercing”, the practice of inserting very fine needles into the skin to stimulate specific anatomic points in the body (called acupoints or acupuncture points) for therapeutic purposes. Along with the usual method of puncturing the skin with the fine needles, the practitioners of acupuncture also use heat, pressure, friction, suction, or impulses of electromagnetic energy to stimulate the points. The acupoints (acupuncture points) are stimulated to balance the movement of energy (qi) in the body to restore health.
Massage Therapists
Registered Massage Therapists are health care professionals committed to restoring and maintaining optimal health and pain-free function of the body. They are educated and trained to accurately assess and treat with techniques that include massage and manual therapy, joint mobilization, hydrotherapy, and patient education.
Massage Therapy is an effective approach to pain management and rehabilitation. They treat and providing relief for a wide range of conditions such as migraine headaches, tendonitis, arthritis, osteoporosis, fibromyalgia, sports injuries, as well as many other common conditions related to soft tissue and joint dysfunction. Research shows that massage therapy provides several important health benefits, including improving blood circulation, relaxing muscles for an improved range of motion, and increasing endorphin levels (which helps improve mood and decrease the effect of chronic pain).
Nutritionists
Nutritionists require a master’s or bachelor’s degree in dietetics, nutrition or a related field such as food and nutritional science or biochemistry and one to two years of supervised practical training.
Nutritionists plan food and nutrition programs and supervise the preparation and serving of meals. They help to prevent and treat illnesses by promoting healthy eating habits and recommending dietary modifications, such as the use of less salt for those with high blood pressure or the reduction of fat and sugar intake for those who are overweight.
Spinal Neurosurgeons and Orthopaedic Surgeons
Neurosurgeons and Orthopaedic surgeons gain experience in the diagnosis and nonsurgical and surgical treatment of spinal disorders during a six or seven year residency training program (after medical school). When physicians graduate from an accredited training program, they usually have assisted in many hundreds of spinal procedures. If they wish to gain even more advanced training, they may elect to do a post-graduate fellowship in spine surgery. This intensive, focused training is typically one or two years after residency training. Though most patients think of neurosurgeons as “brain surgeons”, it may be interesting to know that the majority of operations performed by neurosurgeons across the country are spine surgeries.
Is surgery for neck or back pain necessary? The answer is: sometimes. It is reasonable to consider spine surgery if the pain has not diminished after several months of non-surgical treatment, if your pain does not respond to narcotic medications, or if you are unable to complete basic daily activities. But fear not – there’s a wide array of surgery options. Some are minimally invasive procedures (e.g. micro discectomy for a herniated disc) allow for a quick recovery, while other types of surgery (e.g. a posterolateral fusion for degenerative disc disease) are more extensive and have a much longer recovery time. Understanding your surgery options will help you better decide on a course of action.
Alternative Health Care Options
Other options exist beyond surgery and medication to help you deal with your pain, but it can be difficult to know whether an alternative treatment will actually help reduce your pain and suffering. Whether you’re consideringnutrition changes,yoga,Pilates, or tai chi,to help provide pain relief, deeper knowledge and insight into each of these alternatives is vital to successful pain recovery.
TREATMENT OF SPINE PROBLEMS – ACTIVE VS. PASSIVE
Generally, non-surgical management of back problems can be divided into two types of care: Passive and Active.
Passive treatments are things that are done to you in an effort to alleviate your pain and improve your mobility. This means that you, as the patient, do not typically do much, other than present yourself to the clinic and allow health care professional to administer the therapy.
Examples of Passive treatments are:
- Spinal manipulation: Typically performed by chiropractors, although lately there has been more interest by the physiotherapy community in learning this type of treatment.
- Physiotherapy modalities: These are things such as ice, heat, cold Laser, ultrasound, interferential current, TENS, traction.
- Acupuncture
- Massage Therapy
- Medication (anti-inflammatory, pain-killers)
Active treatments are things that you actively participate in to try and alleviate your pain and improve your mobility, strength and fitness. It is important to realize that greater than 95% of your day is spent outside of your therapists’ office. What you do, for yourself, is actually more important than what your therapist does to you. As you transition into stages 2 and 3 your therapists’ primary role is in educating you as to what you can and should do for yourself.
Examples of Active treatments are:
- Education: Actively engaging in educating yourself as to the nature of your problem so that as treatment proceeds you are more capable of taking responsibility for long term management of your back.
- Active rest: Remaining active in a fashion that does not create more injury. This typically involves activity modifications such as choosing different activities or modifying the amount of time spent doing a certain activity. This is imperative to do when you have back pain instead of complete rest, which we now know is harmful over the long term.
- Exercise: There is no “one size fits all” exercise program for people with back pain. You will need to work with a heath care professional to develop an exercise regime that is right for you.
Treatment typically follows a three staged approach:
- Pain control; most people limit the treatment they receive to ones that focus on immediate pain control. Long-term resolution is only achieved by progressing through all three stages of recovery (see stage 1)
- An early, safe return to normal activity (see stages 2 and 3). In the acute stages after an injury, the average person will lose between 1-3% of their muscle strength per day. This effect does not automatically reverse itself when your pain has resolved. It is not necessary to have achieved complete pain relief before starting your active rehab program. Remember that hurt does not always equal harm, so it is entirely possible for you to progress into functional restoration even if you continue to experience discomfort. We have known for some time now that lack of physical activity is directly linked to ill health. We have also known for a long time that ongoing stiffness and weakness (deconditioning) in the injured part of the body is the number one cause of ongoing disability.
One of the additional difficulties that people encounter today is that technology has allowed us to be more sedentary in our activities of daily living (see Risk Factors for Spinal Pain). Instead of walking, we drive; rather than climb stairs, we use elevators etc. While once we were regularly active, we now spend much of our lives sitting at desks and in front of computers. The result of this sedentary lifestyle is that of we have already become progressively less fit and less flexible than our parents’ generation – even before we got hurt.
The only way to prevent or reverse this deconditioning effect as well as the diseases and disabilities associated with inactivity is to remain active (see video 23 ½ hours). When resuming a more active lifestyle it is important to realize, however, that exercise is another stress on the body. If we stress our bodies in a correct manner, and then allow it sufficient time to recover the body will respond by making itself stronger. This phenomenon is referred to as a Training Effect. Naturally, you should consult with a health care professional to help guide you through this process to insure you are not overdoing it as you begin to get active. Inappropriate introduction of activity may temporarily re-aggravate you, forcing you to cycle back into Phase I. You will likely need to undergo treatment and active rest again as you deal with achieving Pain Control again. This can be very frustrating, and lead to abandonment of treatment. We will review how to do this properly during the course of your treatment. - Encouragement to pro-actively manage your health through a wellness model. Once your level of fitness is sufficient to return to normal function it is your responsibility to maintain it. This is sometimes difficult to do when you are no longer in pain. It may help to think of your body as a finely tuned piece of machinery such as your car. It is a lot cheaper to keep your car in good working order than to fix it once it has broken down. The same is true of your body. (AND IT HURTS A LOT LESS TOO!!)
Shoulder Injuries
ROTATOR CUFF TENDONITIS
Description:
Rotator cuff tendonitis is a condition characterised by damage, inflammation and/or degeneration of one or more of the rotator cuff tendons. Four muscles, the supraspinatus, infraspinatus, subscapularis, and teres minor muscles form the rotator cuff. These muscles attach the shoulder blade (scapula) to the arm bone (humerus). As the arm is raised, the rotator cuff keeps the head of the humerus and the socket of the scapula moving properly together.
This wear and tear usually occurs over a period of time i.e. from overuse; however, it may also occur traumatically due to a specific incident. The rotator cuff muscle that is most commonly affected in this condition is the supraspinatus. Although this condition can occur at any age, it is commonly seen in patients between the ages of 40 and 60. It may also be seen with shoulder instability, especially in the younger athlete and may be associated with clunking, numbness, or a feeling that the shoulder is out of place.
Causes:
Degeneration of the rotator cuff is a common occurrence as we age. Repetitive or prolonged use of the arm, especially in an overhead position such as throwing, can cause increased wear and tear on the tendons. The irritation causes the tendons to swell, which may then rub on the undersurface of the acromion, further aggravating the problem. Trauma such as falling on an outstretched hand or the point of the shoulder, bone spurs on the scapula or humerus also increases the risk of developing the problem.
Other factors which may influence the development of Rotator cuff tendonitis are:
- Shoulder instability
- Muscle imbalances
- Muscle tightness
- Participation in certain sports: throwing (baseball), swimming, and paddle sports
- Poor posture
- Poor mechanics i.e. (e.g. poor throwing or stroke technique)
- Past history of shoulder injury
- Certain bone anatomy, or degenerative bony spurring, on the acromion
Prevention:
- Maintain good posture.
- Avoid keeping the arms out to the side or overhead for prolonged periods of time.
- When participating in sports where falls are more likely, make sure to wear proper protective gear.
- Perform the three stretches and five strengthening exercise listed in the weak links section below on a regular basis.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy: Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist. During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the rotator cuff this is with the arm about 4 inches out to the side with the hand over the belly button (preferably resting on a pillow) when you are sitting. When you are out and about try placing your hand in the pocket.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress: Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate: Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self-treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches:
- Stretch #1: Repeated retraction
- Stretch #2: Pectorals stretch
- Stretch #3: Sleeper stretch
Stage 3: Weak Link Strengthening:
- Strength exercise #1: NODS
- Strength exercise #2: Scapular stabilization (I drill)
- Strength exercise #3: Shoulder internal and external rotation
- Strength exercise #4: Lawnmower drill
- Strength exercise #5: Push up with a plus
DISLOCATED SHOULDER
Description:
A dislocation occurs when the normal position of a joint is disturbed i.e. the bones are forced out of their normal position. The shoulder joint is the most mobile joint in the body, and as such is inherently unstable. In fact it is the most commonly dislocated joint in the body.
The shoulder joint is consists of the head of the humerus (arm bone) and the glenoid fossa (a shallow depression in the shoulder blade. The labrum is a fibrous cartilage ring that makes the fossa a little deeper. Further stability is provided by the shoulder capsule and ligaments. Together these comprise the static stabilizers of the joint. The rotator cuff muscles provide the dynamic stability for the joint.
A dislocation occurs when the head of the humerus is forced out of the glenoid fossa. It causes an immediate onset of quite severe pain. The arm is usually held in a guarded position, slightly away from the body. There is usually significant muscle spasming, and there may be bruising, swelling, or a bump in the front or back of the shoulder depending on how it has been dislocated. Approximately 25% of dislocations also have an accompanying fracture.
Causes:
In younger individuals dislocations are usually caused by trauma such as in sports or falls. Most dislocations are anterior, and occur when the arm is forced backwards while it is in an overhead position injury such as seizures. As we age we become more prone to dislocations because of gradual weakening of the ligaments and muscles that support the shoulder. However, there still needs to be some force applied to the shoulder joint to make it dislocate.
Posterior dislocations are far less common (2-4%) and are usually associated with epileptic seizures, electrocution, and high energy trauma.
Prevention:
Wear appropriate protective gear for your sport. Try to avoid falling. Exercise on a regular basis to maintain strength in your dynamic shoulder stabilizer (see weak link exercises in stage 3).
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy: Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are – for a dislocated shoulder it is the 90-90 position. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist. During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the shoulder this is with the arm about 4 inches out to the side with the hand over the belly button (preferably resting on a pillow) when you are sitting. When you are out and about try placing your hand in the pocket. Note: this is after the shoulder stabilization splint has been removed – often up to six weeks after the dislocation.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress: Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate: Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self-treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Stretching
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches:
- Stretch #1: Repeated retraction
- Stretch #2: Pectoral stretch
- Stretch #3: Upper Trapezius stretch
Stage 3: Weak Link Strengthening:
- Strength exercise #1: NODS
- Strength exercise #2: Scapular stabilization (I – T – Y – W drills)
- Strength exercise #3: Shoulder internal and external rotation
- Strength exercise #4: Push ups with a plus
- Strength exercise #5: Proprioception program
Elbow Pathologies
TENNIS ELBOW
Description:
Tennis elbow is the common term used to describe pain occurring at the outside bump (lateral epicondyle) of the elbow. The muscles of the forearm that bend the wrist backwards have a common tendon attaching them to the lateral epicondyle. During contraction of the forearm extensors, tension is placed through the extensor tendon at its attachment to the lateral epicondyle. When this tension is excessive straining of the tendon occurs.
The symptoms associated with this condition usually develop gradually over a period of time. The pain is usually described as aching and is made worse by gripping objects such as a screwdriver or jug of milk, or when extending the wrist. It is often be felt first thing in the morning, and may also be accompanied by stiffness at this time. The pain is located on the outside of the elbow, about 1-2cm down from that outside bony.
Causes:
Tennis elbow is associated with repetitive forceful twisting or gripping, especially if the elbow is extended. The majority of people who develop it do not actually play tennis. It does occur in sports such as tennis, squash, as well as in manual task such as hammering, painting, or using a computer. It is thought by some to be due to a small tear occurring in the tendon. The body begins to repair the injury but due to repetitive use is unable to, and eventually seems to give up on trying to do so. Others feel the tendon changes are primarily a result of decreased blood flow to the area. For this reason it is often grouped with a number of other problems under the name Cumulative Trauma Disorder (CTD). CTD is not really a disease, but the result of repetitive activity without allowing enough time to recover before resuming the activity. For the body to work properly, it requires a steady supply of blood, rich in oxygen and nutrients. Chronically tensed muscles reduce their own blood flow. Without adequate oxygen muscles produce lactate, a pain-causing chemical. As pain develops, muscles tighten further to “guard” the surrounding area- and blood flow is slowed even more.
Other factors which may influence the development of Tennis elbow are:
- excessive or inappropriate activity
- poor sporting technique or equipment i.e. incorrect racquet size, grip size, or string tension
- muscle imbalances
- inadequate rehabilitation following a previous elbow injury
- a history of injury to the nerves that supply the elbow
Prevention:
Good posture: slouching with the spine or leaning the head forward puts the body out of balance causing the limbs to be stretched or bent awkwardly. Staying in one position for too long can lead to muscle fatigue. Be relaxed and pace yourself, take frequent breaks, rotate job duties: Repeated motions with tense or fatigued muscles that are not allowed to rest properly prevents the body’s tissues from recovering fully, perform stretching exercises, modify the work site when possible. Do the weak link workout.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy: Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist. During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the elbow is with the arm slightly flexed with the forearm half way between palm up and palm down. Often a forearm or tennis elbow splint can provide relief especially when performing essential daily activities that aggravate the situation such as using a computer.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress: Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate: Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches:
- Stretch #1: Forearm stretch with palm down
- Stretch #2: Forearm stretch with palm up
Stage 3: Weak Link Strengthening:
- Strength exercise #1: Wrist curls palm down
- Strength exercise #2: Wrist curls palm down
- Strength exercise #3: Wrist deviations
- Strength exercise #4: Flexbar (Bob’s favorite)
GOLFERS ELBOW
Description:
Golfers elbow is the common term used to describe pain occurring at the inside bump (medial epicondyle) of the elbow. The muscles of the forearm that bend the wrist forewords have a common tendon attaching them to the medial epicondyle. During contraction of the forearm flexors, tension is placed through the tendon at its attachment to the epicondyle. When this tension is excessive straining of the tendon occurs.
The symptoms associated with this condition usually develop gradually over a period of time. The pain is usually described as aching and is made worse by gripping objects such as a screwdriver or shaking hands, or when flexing the wrist. It is often be felt first thing in the morning, and may also be accompanied by stiffness at this time. The pain is located on the inside of the elbow, about 1-2cm down from that bony bump. It may occasionally radiate down the forearm.
Causes:
Golfers elbow is associated with repetitive forceful twisting or gripping, especially if the elbow is extended. The majority of people who develop it do not actually play golf. It does occur in sports such as tennis, squash, as well as in manual task such as hammering, painting, or using a computer. It is thought by some to be due to a small tear occurring in the tendon. The body begins to repair the injury but due to repetitive use is unable to, and eventually seems to give up on trying doing so. Others feel the tendon changes are primarily a result of decreased blood flow to the area. For this reason it is often grouped with a number of other problems under the name Cumulative Trauma Disorder (CTD). CTD is not really a disease, but the result of repetitive activity without allowing enough time to recover before resuming the activity. For the body to work properly, it requires a steady supply of blood, rich in oxygen and nutrients. Chronically tensed muscles reduce their own blood flow. Without adequate oxygen muscles produce lactate, a pain-causing chemical. As pain develops, muscles tighten further to “guard” the surrounding area- and blood flow is slowed even more.
Other factors which may influence the development of Tennis elbow are:
- excessive or inappropriate activity
- poor sporting technique or equipment i.e. incorrect racquet or grip size, golfers who regularly take divots
- muscle imbalances
- inadequate rehabilitation following a previous elbow injury
- a history of injury to the nerves that supply the elbow
Prevention:
Good posture: slouching with the spine or leaning the head forward puts the body out of balance causing the limbs to be stretched or bent awkwardly. Staying in one position for too long can lead to muscle fatigue. Be relaxed and pace yourself, take frequent breaks, rotate job duties: Repeated motions with tense or fatigued muscles that are not allowed to rest properly prevents the body’s tissues from recovering fully, perform stretching exercises, modify the work site when possible.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy: Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist. During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the elbow is with the arm slightly flexed with the forearm half way between palm up and palm down. Often a forearm or elbow splint can provide relief especially when performing essential daily activities that aggravate the situation such as using a computer.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress: Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate: Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches:
- Stretch #1: Forearm stretch with palm down
- Stretch #2: Forearm stretch with palm up
Stage 3: Weak Link Strengthening:
- Strength exercise #1: Wrist curls palm down
- Strength exercise #2: Wrist curls palm down
- Strength exercise #3: Wrist deviations
- Strength exercise #4: Flexbar (Bob’s favorite)
Wrist and Hand Injuries
CARPAL TUNNEL SYNDROME
Description:
The wrist is composed of eight (8) bones surrounded by a strong fibrous band that normally functions as a support for the joint. The space between the fibrous band and the wrist bones is called the carpal tunnel. The median nerve passes through this tunnel to supply the thumb, index and middle fingers. Carpal tunnel syndrome can be caused by anything that creates swelling (e.g. pregnancy) or a change in the positions of the wrist structures (e.g. fracture or dislocation). This causes squeezing on or irritation of the median nerve. This irritation of the nerve may cause tingling and numbness into the thumb and two fingers, as well as weakness in some of the muscles of the hand.
These symptoms generally come on over a period of time. They are often more of a problem at night. This is probably due to a bent-wrist position while sleeping and/or fluid accumulation while lying flat. As the condition progresses some individuals develop burning sensations, cramping and weakness of the hand. Chronic carpal tunnel syndrome can also lead to wasting of the hand muscles.
Causes:
There are many common conditions that lead to carpal tunnel syndrome, such as, obesity, pregnancy, arthritis, diabetes, and trauma. Tendon inflammation from repetitive or prolonged activities such as typing,sports such as gymnastics and cycling as well as manual work such as carpentry, painting, or use of vibrating machinery. For this reason it is often grouped with a number of other problems under the name Cumulative Trauma Disorder (CTD). CTD is not really a disease, but the result of repetitive activity without allowing enough time to recover before resuming the activity. For the body to work properly, it requires a steady supply of blood, rich in oxygen and nutrients. Chronically tensed muscles reduce their own blood flow. Without adequate oxygen muscles produce lactic acid, a pain-causing chemical. As pain develops, muscles tighten further to “guard” the surrounding area- and blood flow is slowed even more. Nerves deprived of blood and squeezed by muscles begin to tingle or go numb.
As noted above it may also occur after a fracture of the wrist. Although carpal tunnel syndrome can occur at any age, it is commonly seen in patients greater than 50. It is more common in women and usually affects the dominant hand.
For most individuals however, the cause of their symptoms is unknown.
Prevention:
Good posture: slouching with the spine or leaning the head forward puts the body out of balance causing the limbs to be stretched or bent awkwardly. Staying in one position for too long can lead to muscle fatigue. Be relaxed and pace yourself, take frequent breaks, rotate job duties: Repeated motions with tense or fatigued muscles that are not allowed to rest properly prevents the bodies tissues from recovering fully, perform stretching exercises, modify the work site when possible, shake your hands every hour to relieve the muscle tension.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy: Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist. During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the wrist it is with the wrist bent back slightly (extended) – often a night splint can provide relief especially if the symptoms are worse through the night or when waking in the am. A variation on this theme – a dorsal wrist splint may be helpful if you must perform the “CTD” activities listed above on a regular basis.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress: Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate: Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches:
- Stretch #1: Forearm stretch with palm down
- Stretch #2: Forearm stretch with palm up
- Stretch #3: Spider pushups: with your hands in a prayer position, spread your fingers wide, and then make a steeple by separating your wrists while keeping your fingers together.
Stage 3: Weak Link Strengthening:
- Strength exercise #1: Wrist curls palm down
- Strength exercise #2: Wrist curls palm down
- Strength exercise #3: Wrist deviations
DE QUERVAIN’S
Description:
There are two tendons (the extensor pollicis brevis and abductor pollicis longus) that pull the thumb out and back from the hand. They run in a tunnel on the side of the wrist above the thumb. The tunnel lining is like a sheath with a slippery coating called a synovium. Irritation of the tendon or synovium may lead to pain on the side of the wrist just above the thumb. It may also be accompanied by a squeaking sound, called crepitus, as the tendons attempt to move through the swollen and inflamed synovium.
The pain over the back of the thumb and forearm usually comes on slowly; it may be noticed as a stiffness at the beginning or end of the day, but as it progresses pain may be felt with every day activities such as carrying groceries, opening a jar, or using the computer. There may also be swelling, crepitus or pain with palpating the tendons.
Causes:
Overuse of the wrist, especially with wrist extension and extreme ulnar deviation may eventually cause irritation. For this reason it is often grouped with a number of other problems under the name Cumulative Trauma Disorder (CTD). CTD is not really a disease, but the result of repetitive activity without allowing enough time to recover before resuming the activity. For the body to work properly, it requires a steady supply of blood, rich in oxygen and nutrients. Chronically tensed muscles reduce their own blood flow. Without adequate oxygen muscles produce lactate, a pain-causing chemical. As pain develops, muscles tighten further to “guard” the surrounding area- and blood flow is slowed even more. Nerves deprived of blood and squeezed by muscles begin to tingle or go numb.
It also is associated with pregnancy, injury, such as a fracture of the wrist and rheumatoid disease. It is most common in middle-aged women.
Prevention:
Good posture: slouching with the spine or leaning the head forward puts the body out of balance causing the limbs to be stretched or bent awkwardly. Staying in one position for too long can lead to muscle fatigue. Be relaxed and pace yourself, take frequent breaks, rotate job duties: Repeated motions with tense or fatigued muscles that are not allowed to rest properly prevents the body’s tissues from recovering fully, perform stretching exercises, modify the work site when possible.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy: Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist. During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the thumb it is with the wrist and thumb in a neutral position (halfway between the hand fully open and making a fist). Often a splint specifically made for the thumb can provide relief especially when performing essential daily activities that aggravate the situation such as using a computer.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress: Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate: Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self-treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches:
- Stretch #1: Thumb deviation stretch – Begin with your elbow straight and your fingers curled up around your thumb. Gently bend your wrist towards the little finger side until you feel a mild to moderate stretch.
- Stretch #2: Forearm stretch with palm up
- Stretch #3: Forearm stretch with palm down
Stage 3: Weak Link Strengthening:
- Strength exercise #1: Wrist curls palm down
- Strength exercise #2: Wrist curls palm down
- Strength exercise #3: Wrist deviations
- Strength exercise #4: Thumb rubber band routine
Back Injuries
ANATOMY
The Goal of this series of articles is to:
- Help you understand how your spine works and what can go wrong with it.
- Help you understand and gain access to the most effective treatment or treatments for your back problem.
This information is meant to compliment care you are currently receiving from your physiotherapist or other health care practitioner, and should not be taken as a replacement for seeking appropriate advice and care from a health care professional.
Note: For convenience the term back will be used to refer to any/all parts of the spine.
You are not alone. Back problems are very common. Up to 80% of the population will, at some point in their life, experience significant back and/or neck pain. At any given time between 20% and 50% of the population will be experiencing some type of back pain. Most do not find that the pain, while troublesome, does not significantly interfere with their normal activities of daily living (ADL’s).
However, approximately 10-12% will experience back problems that are disabling in nature. Their spine pain is severe enough that it interferes with their normal ADL’s.
To put this in perspective, Bridge Physiotherapy is located in the city of Nanaimo, British Columbia, which has a population of approximately 90,000 people. In Nanaimo, we can reasonably assume disabling back problems are affecting approximately 9,000 people at any given time.
What Can You Do About Your Back Problem?
The fact that these problems affect so many people is somewhat of a mixed blessing. On the positive side, there has been a significant amount of attention from the health care and scientific community focused on this problem over the past several years. This has given us a significant amount of information towards understanding and managing back problems. Unfortunately, there is so much information out there it is difficult to know what to believe.
Educating Yourself about Your Back
We feel that your best bet to coping with your back or neck problem is to become your own Back Mechanic. With the advent of the Internet, people can easily access information on back problems, but is there too much information? The answer is “yes”, and not all of it is good. We have tried to summarize below is the basic information you need to be an informed spine patient!
The vertebral column, commonly called the back bone has three basic functions. It supports the head and extremities while permitting freedom of movement. It provides areas of attachment for muscles and ligaments. It also protects the spinal cord and nerves.
In a healthy spine there are 3 systems that work together to allow these functions to occur.
- Skeletal: The bones and joints make up the basic support unit.
- Soft tissues: The muscles, ligaments, discs, and tendons are the connective tissues that stabilize and allow movement of the bones and joints.
- Nervous system: The brain and spinal cord. Messages travel along the nerves in split seconds. Pain and discomfort are messages that something is wrong and corrective action is needed.Although we have only one spine, we tend to refer to the spine in five different segments:
- Cervical Spine: This is the Neck and is located between the skull and the rib cage. It is composed of 7 vertebrae. They are numbered from top to bottom i.e. the first cervical vertebra is labelled C1 and the last is C7 (C1 to C7). It is the most flexible part of spine. It supports skull. The slight forward curve is called a lordosis.
- Thoracic Spine: This is the part of the spine that the rib cage connects on to. It is composed of 12 vertebrae (T1 to T12). The backwards curve is called a kyphosis.
- Lumbar Spine: This is the low back and is located between the rib cage and the pelvis. It is composed of 5 vertebrae (L1 to L5).
- Sacrum: This is the part of the spine that joins onto the pelvis. It is composed of 5 vertebrae (S1 to S5). These 5 vertebrae typically fuse together as we grow to form one, triangular-shaped bone at the base of our spine called the sacrum.
- Coccyx: This is a rudimentary, triangular-shaped bone joined onto the bottom of the sacrum, commonly referred to as the “tailbone”.
The primary building block of the skeleton is the vertebral body. It is the largest portion of the vertebra and is responsible for weight bearing. Projecting behind the vertebra is a series of bony projection called pedicles, lamina, transverse, and spinous processes. The spinous process is the hard bony point you can feel below the skin when you run you hand across your back. These processes serve as points of attachment for muscles. Between the transverse processes are the facet joints. They are found on either side of the vertebra and interlock with the facet joints above and below. These joints determine the direction of movement between two vertebras.Their structure is similar to other joints in the body. They are covered in cartilage and are encased in an elastic capsule that contains fluid. They are about the size of finger joint. In the neutral position the joints support bout 25 % of the load on the spine. When we bend forward there is less loading. When we bend backwards the opposite occurs.
Lying between the vertebras are the discs. They act as spacers between the vertebras and are firmly attached from above and below holding the vertebra strongly together. They also act as shock absorbers. They permit movement, vertebra are just big blocks of bone and on there own would have no movement. The basic functional unit of the spine is called a motion segment. This is comprised of two vertebras with the disc between them.
The disc is composed of two parts; 1) the annulus, which is the outer shell and surrounds the nucleus with strong crisscrossing fibers, 2) the nucleus, which is the centre of the disc and is composed of a jelly like substance. It is about 85% water in a young healthy disc. With age it water content decreases and it loses some of its ability to function as a shock absorber.
Note: the term slipped disc is incorrect. Discs cannot slip; instead the jelly-like material can bulge or protrude from between the vertebra creating the impression the disc has moved.
Protruding discs can place pressure on the nerves.
The following diagram shows three vertebrae stacked on top of one another. The top vertebrae has had the front of it removed (the “vertebral body”) to show you the spinal canal, which is the bony tunnel that all the nerves travel through.
Ligaments are designed to prevent excessive or abnormal movement from occurring between vertebras. They connect and stabilize vertebra as one continuous structure. They are tough elastic fibers that are found in front, behind, at the side, and between vertebras.
The muscles provide movement and stabilization with voluntary control. Without their support the spine is unstable. Muscles are attached to bone by tendons. The main function of the back muscles is in keeping the vertebra aligned and balanced. They are not designed for heavy lifting. They are sometimes referred to as prime movers and core stabilizers. The prime movers are the muscles that are responsible for the forward and backward movements in the spine (as well as rotation and side bending at some levels). The stabilizers are the muscles that maintain your spine in the neutral position. We will review these muscles in more detail in the core stability session.
The spinal cord is the connection between the central processor (brain) and the sensors (nerves). The spinal cord ends at the level of the first lumbar vertebra.
The spinal cord and nerves send sensory information to the brain from the extremities. The brain reacts by sending messages down the spinal cord and nerves to tell the muscles what to do. There are approximately 31 nerves branch from the spinal cord and travel throughout the body. In the neck a group of nerves combine to form the brachial plexus. These nerves control your arm function. In the low back, the sciatic and femoral nerves control leg function.
The spinal cord along with the brain forms the CNS. The nerves form the peripheral nervous system.
The following diagram is a view from above as we look down on the spine. This shows how the spinal cord travels through the spinal canal as well as the relationship of the disc to the spinal cord.
RISK FACTORS FOR SPINAL PAIN
Poor Body Mechanics: Incorrect body mechanics when performing repetitive lifting or positioning increases the stress on one or more structures in the spine, eventually causing irritation in these structures. Flexing the spine, holding the weight away from the body, or twisting the spine all increase intra-discal pressure causing it to bulge backward. Eventually this causes irritation and pain.
Sustained or Poor Posture: prolonged postures (>15 minutes) without changing position can cause pain and inflammation due to the constant loading.
Stressful Working and Living Habits: Forceful exertions may result when a load shifts suddenly while lifting, or is heavier than anticipated. As the weight increases so too do the forces involved. Baby boomers are sometimes referred to as the “sandwich generation. The population is aging resulting in an increased number of people requiring physical assistance. They are increasingly being required to look after aging parents living at home. This reduces the time available for stress reducing hobbies and exercise.
At the same time cutbacks in the health care sector results in fewer caregivers to provide for an increasing number of clients.
Changes in business practices, such as downsizing places additional stresses on the worker.
Technology has resulted in increased convenience and efficiency. The cost associated with this is work that is increasingly repetitive in nature. Examples of this can be found in office workers who until a few years ago would share an office printer. This required them to get up from their desk to retrieve the printed material. Technology has reduced the cost of printers such that it is not unusual for each person to have their own printer within easy reach. They are now able to sit uninterrupted for hours at a time.
Loss of Flexibility: Individuals with poor flexibility are more likely to be injured when an external load is applied to the spine. Without full movement the spine is unable to accommodate the strain effectively.
Loss of Physical Fitness: Poorly conditioned individuals fatigue more quickly making them less able to accommodate stress. In addition they do not recover as quickly from the injury.
TREATING PRACTITIONERS
Physiotherapist
Physiotherapy is a science based healthcare profession which views movement as central to health and well-being. Physiotherapists aim to identify and make the most of movement ability by health promotion, preventative advice, treatment and rehabilitation.
They work in a great variety of settings such as orthopaedics, occupational health, ergonomics, and sports medicine. The core skills used by a physiotherapist include manual therapy, therapeutic exercise, and the application of electrophysical modalities.
Physiotherapists believe it is vital to take note of psychological, cultural, and social factors which influence their clients. They believe in encouraging their patients to take an active role to help themselves to make the best of their independence and function.
Physiotherapists assist you in achieving your highest level of physical functioning by providing you with a personalized treatment plan based on your specific needs. They will assess your posture, range of motion (ROM), strength and other physical abilities. Then they will design a personalized treatment and exercise program to assist in alleviating pain, restore joint ROM, increasing muscle strength and co-ordination and maximizing independence. Physiotherapists will also assist in designing an ergonomically correct work and home environment. They will educate you in the use of assistive devices such as cane and crutches if necessary. They will help you return to work and leisure activities through physical conditioning programs.
When looking for a physiotherapist, a good place to start is to ask your primary care physician or specialist for the names of physiotherapists who they trust. It also helps to ask friends, co-workers and neighbors for recommendations.
Exercise caution however, because one person’s definition of a good physiotherapist may be quite different from another person’s definition. In general, if multiple resources recommend the same person, chances are good that the physiotherapist is reliable.
Chiropractor
Chiropractors practice a drug-free, manual approach to health care that includes patient assessment, diagnosis and treatment. In particular, chiropractors assess patients for disorders related to the spine, pelvis, extremity joints, and their effect on the nervous system. As a result of taking a physical assessment and patient history, chiropractors are able to provide a differential diagnosis for the patient’s presenting condition(s) and develop a comprehensive treatment/management plan. Chiropractors are also trained to recommend therapeutic exercise, to utilize other non-invasive therapies, and provide nutritional, dietary and lifestyle counselling.
Chiropractic adjustment is the most common form of treatment utilized by chiropractors in clinical practice. Also known as spinal manipulative therapy, adjustment is a non-invasive, manual procedure that is a carefully controlled by a skilled practitioner to dysfunctional spinal or extremity joints. The primary goal is to decrease pain, improve areas of reduced movement in the joints and supporting tissues, particularly of the spine, and decrease muscle tightness or spasm. This is done through the restoration of normal mechanics and improved functioning of the spine, extremities and supporting soft tissue structures.
Adjustment rarely causes discomfort. However, as it is a manually applied therapy, patients may sometimes experience mild soreness or aching following treatment which usually resolves within 12 to 48 hours.
When looking for a chiropractor, a good place to start is to ask your primary care physician or specialist for the names of chiropractors who appear competent and trustworthy. It also helps to ask friends, co-workers and neighbors for recommendations.
Exercise caution however, because one person’s definition of a good chiropractor may be quite different from another person’s definition. In general, if multiple resources recommend the same chiropractor, chances are good that the chiropractor is reliable.
Kinesiologist
Kinesiology is the study of human movement, the goal of which is to discover strategies for human health and performance. A Kinesiologist has trained in a four year University program, graduating with a bachelor’s degree in Kinesiology. This training gives them expertise in physical fitness and exercise therapy. Their role is to perform various physical fitness testing which help to guide in establishing what exercises will benefit you the most. They also monitor and help you learn your personalized exercise program to ensure you perform the activity properly and safely.
Acupuncturist
Acupuncture literally means “needle piercing”, the practice of inserting very fine needles into the skin to stimulate specific anatomic points in the body (called acupoints or acupuncture points) for therapeutic purposes. Along with the usual method of puncturing the skin with the fine needles, the practitioners of acupuncture also use heat, pressure, friction, suction, or impulses of electromagnetic energy to stimulate the points. The acupoints (acupuncture points) are stimulated to balance the movement of energy (qi) in the body to restore health.
Massage Therapists
Registered Massage Therapists are health care professionals committed to restoring and maintaining optimal health and pain-free function of the body. They are educated and trained to accurately assess and treat with techniques that include massage and manual therapy, joint mobilization, hydrotherapy, and patient education.
Massage Therapy is an effective approach to pain management and rehabilitation. They treat and providing relief for a wide range of conditions such as migraine headaches, tendonitis, arthritis, osteoporosis, fibromyalgia, sports injuries, as well as many other common conditions related to soft tissue and joint dysfunction. Research shows that massage therapy provides several important health benefits, including improving blood circulation, relaxing muscles for an improved range of motion, and increasing endorphin levels (which helps improve mood and decrease the effect of chronic pain).
Nutritionists
Nutritionists require a master’s or bachelor’s degree in dietetics, nutrition or a related field such as food and nutritional science or biochemistry and one to two years of supervised practical training.
Nutritionists plan food and nutrition programs and supervise the preparation and serving of meals. They help to prevent and treat illnesses by promoting healthy eating habits and recommending dietary modifications, such as the use of less salt for those with high blood pressure or the reduction of fat and sugar intake for those who are overweight.
Spinal Neurosurgeons and Orthopaedic Surgeons
Neurosurgeons and Orthopaedic surgeons gain experience in the diagnosis and nonsurgical and surgical treatment of spinal disorders during a six or seven year residency training program (after medical school). When physicians graduate from an accredited training program, they usually have assisted in many hundreds of spinal procedures. If they wish to gain even more advanced training, they may elect to do a post-graduate fellowship in spine surgery. This intensive, focused training is typically one or two years after residency training. Though most patients think of neurosurgeons as “brain surgeons”, it may be interesting to know that the majority of operations performed by neurosurgeons across the country are spine surgeries.
Is surgery for neck or back pain necessary? The answer is: sometimes. It is reasonable to consider spine surgery if the pain has not diminished after several months of non-surgical treatment, if your pain does not respond to narcotic medications, or if you are unable to complete basic daily activities. But fear not – there’s a wide array of surgery options. Some are minimally invasive procedures (e.g. micro discectomy for a herniated disc) allow for a quick recovery, while other types of surgery (e.g. a posterolateral fusion for degenerative disc disease) are more extensive and have a much longer recovery time. Understanding your surgery options will help you better decide on a course of action.
Alternative Health Care Options
Other options exist beyond surgery and medication to help you deal with your pain, but it can be difficult to know whether an alternative treatment will actually help reduce your pain and suffering. Whether you’re consideringnutrition changes,yoga,Pilates, or tai chi,to help provide pain relief, deeper knowledge and insight into each of these alternatives is vital to successful pain recovery.
TREATMENT OF SPINE PROBLEMS – ACTIVE VS. PASSIVE
Generally, non-surgical management of back problems can be divided into two types of care: Passive and Active.
Passive treatments are things that are done to you in an effort to alleviate your pain and improve your mobility. This means that you, as the patient, do not typically do much, other than present yourself to the clinic and allow health care professional to administer the therapy.
Examples of Passive treatments are:
- Spinal manipulation: Typically performed by chiropractors, although lately there has been more interest by the physiotherapy community in learning this type of treatment.
- Physiotherapy modalities: These are things such as ice, heat, cold Laser, ultrasound, interferential current, TENS, traction.
- Acupuncture
- Massage Therapy
- Medication (anti-inflammatory, pain-killers)
Active treatments are things that you actively participate in to try and alleviate your pain and improve your mobility, strength and fitness. It is important to realize that greater than 95% of your day is spent outside of your therapists’ office. What you do, for yourself, is actually more important than what your therapist does to you. As you transition into stages 2 and 3 your therapists’ primary role is in educating you as to what you can and should do for yourself.
Examples of Active treatments are:
- Education: Actively engaging in educating yourself as to the nature of your problem so that as treatment proceeds you are more capable of taking responsibility for long term management of your back.
- Active rest: Remaining active in a fashion that does not create more injury. This typically involves activity modifications such as choosing different activities or modifying the amount of time spent doing a certain activity. This is imperative to do when you have back pain instead of complete rest, which we now know is harmful over the long term.
- Exercise: There is no “one size fits all” exercise program for people with back pain. You will need to work with a heath care professional to develop an exercise regime that is right for you.
Treatment typically follows a three staged approach:
- Pain control; most people limit the treatment they receive to ones that focus on immediate pain control. Long-term resolution is only achieved by progressing through all three stages of recovery (see stage 1)
- An early, safe return to normal activity (see stages 2 and 3). In the acute stages after an injury, the average person will lose between 1-3% of their muscle strength per day. This effect does not automatically reverse itself when your pain has resolved. It is not necessary to have achieved complete pain relief before starting your active rehab program. Remember that hurt does not always equal harm, so it is entirely possible for you to progress into functional restoration even if you continue to experience discomfort. We have known for some time now that lack of physical activity is directly linked to ill health. We have also known for a long time that ongoing stiffness and weakness (deconditioning) in the injured part of the body is the number one cause of ongoing disability.
One of the additional difficulties that people encounter today is that technology has allowed us to be more sedentary in our activities of daily living (see Risk Factors for Spinal Pain). Instead of walking, we drive; rather than climb stairs, we use elevators etc. While once we were regularly active, we now spend much of our lives sitting at desks and in front of computers. The result of this sedentary lifestyle is that of we have already become progressively less fit and less flexible than our parents’ generation – even before we got hurt.
The only way to prevent or reverse this deconditioning effect as well as the diseases and disabilities associated with inactivity is to remain active (see video 23 ½ hours). When resuming a more active lifestyle it is important to realize, however, that exercise is another stress on the body. If we stress our bodies in a correct manner, and then allow it sufficient time to recover the body will respond by making itself stronger. This phenomenon is referred to as a Training Effect. Naturally, you should consult with a health care professional to help guide you through this process to insure you are not overdoing it as you begin to get active. Inappropriate introduction of activity may temporarily re-aggravate you, forcing you to cycle back into Phase I. You will likely need to undergo treatment and active rest again as you deal with achieving Pain Control again. This can be very frustrating, and lead to abandonment of treatment. We will review how to do this properly during the course of your treatment. - Encouragement to pro-actively manage your health through a wellness model. Once your level of fitness is sufficient to return to normal function it is your responsibility to maintain it. This is sometimes difficult to do when you are no longer in pain. It may help to think of your body as a finely tuned piece of machinery such as your car. It is a lot cheaper to keep your car in good working order than to fix it once it has broken down. The same is true of your body. (AND IT HURTS A LOT LESS TOO!!)
Hip Injuries
Groin Strain
Description:
The muscles at the inner aspect of your thigh are known as the adductor or groin muscles. These muscles originate from the pelvis and insert into the inner aspect of the thigh and lower leg bones. The groin muscles are responsible for stabilising the pelvis and moving the leg towards the midline of the body (adduction). They are particularly active during running (especially when changing direction) and kicking.
A groin strain is a relatively common condition characterized by tearing of the adductor muscle group. Groin strains range from a grade 1 to a grade 3 strain and are classified as follows:
- Grade 1: a small number of muscle fibres are torn resulting in some pain but allowing near normal function.
- Grade 2: a significant number of muscle fibres are torn with moderate loss of function.
- Grade 3: all muscle fibres are ruptured resulting in major loss of function.
It is usually associated with a sudden pain or pulling sensation in the inner thigh or groin during activity. Depending on the severity of the strain you may or may not be able to continue with the activity. It is also common to experience pain on rising in the morning or when performing a groin stretch. With grade 2 and 3 trains you may experience bruising or welling on the inside of the leg
Causes:
Groin pulls are common in people who play sports that require a lot of running and jumping. In particular, suddenly jumping or changing direction is a likely cause. Groin pulls often appear in people who play soccer and football, and they make up about 10% of all injuries in professional hockey players.Groin strains tend to occur more commonly in the older athlete and particularly following an inadequate warm-up.
Other factors which may influence the development of IT Band syndrome are:
- muscle imbalances
- excessive or inappropriate training or activity
- inadequate rehabilitation following a previous lower limb injury
- a sudden change in training volume
- tightness in specific joints (hip, knee or ankle)
Prevention:
Exactly what exercises and stretches are most important in still unclear, but some suggestions for groin injury prevention include stretching the inner thigh, and strengthening the adductors, gluts, and core stabilizers – see Weak Link Workout.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy:Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist.During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the adductor this is with the leg in a few degrees of flexion at the hip and knee. If you are a runner but still need to get a cardio workout in, try swimming or riding a bike.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress: Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate: Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches:
- Stretch #1: Groin stretch – quadruped
- Stretch #2: Low lateral squat
- Stretch #3: 90-90 stretch or Brettzel
Stage 3: Weak Link Strengthening:
- Strength exercise #1: Glut medius isolation – Clamshell or side lying SLR
- Strength exercise #2: Isometric adduction – legs bent and legs straight
- Strength exercise #3: Glut max isolation – bridging
ILIO-TIBIAL BAND SYNDROME
Description:
The ilio-tibial (IT) band is a thick fibrous band that runs along the outer edge of the leg. The gluteus maximus and tensor fascia lata muscles attach to it near the pelvis, and it inserts on the outside edge of the tibia (lower leg bone). As the IT Band crosses the knee, it runs over a bony prominence known as the femoral epicondyle. As the knee flexes and extends the ITB moves back and forth over this epicondyle. If this friction becomes excessive the IT Band will become inflamed.
Symptoms include pain or aching on the outer aspect of the knee, which may radiate part way up the thigh. The pain does not usually start immediately, usually coming on in the middle or end of an activity such as running.Pain may be also be worse first thing in the morning following activity. Some individuals may experience joint stiffness, pain on touching the outside of the knee, or crepitus (grinding) which may cause them to limp or even make the knee give way due to pain.
Causes:
During flexion and extension of the knee the IT Band rubs over the femoral condyle. Anything which increases this rubbing may contribute to the syndrome; this may include bow legs, leg length discrepancy, and over- pronation of the foot causing increased internal rotation of the lower leg, and running on a crowned surface or on a circular track. It may also be caused by to rapid an increase in activity level (more than 10% per week).
Other factors which may influence the development of IT Band syndrome are:
- muscle imbalances
- excessive or inappropriate training or activity
- inadequate rehabilitation following a previous lower limb injury
- a sudden change in training volume
- tightness in specific joints (hip, knee or ankle)
- inappropriate footwear or surfaces
Prevention:
Perform regular side stretching for the IT Band to prevent loss of flexibility. Avoid running on crowned surfaces or circular tracks. Otherwise, be sure to change the direction in which you run on a regular basis to balance out the stresses on the body. If you are a runner, examine your training regimen, shorten your stride and wear motion control shoes or orthotics to prevent over-pronation.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy: Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist.During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the IT Band this is with the knee in a few degrees of flexion. If you are a runner but still need to get a cardio workout in, try swimming or riding a bike.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress: Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate: Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures.
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches:
- Stretch #1: Glut Maximus
- Stretch #2: Tensor Fascia Lata
- Stretch #3: Deep lateral rotators of the hip
Stage 3: Weak Link Strengthening:
- Strength exercise #1: Clamshell
- Strength exercise #2: or side lying SLR
- Strength exercise #3: Monster walk or kicks
Knee Injuries
ANTERIOR CRUCIATE LIGAMENT STRAIN
Description:
A ligament is a strong fibrous band that attaches bone to bone. The Anterior Cruciate Ligament (ACL) is one of four ligaments that stabilizes the knee. It runs from the back of the femur (thigh bone) to the front of the tibia (shin bone). The ACL plays a role in preventing excessive twisting, hyperextension, or forward movement of the tibia on the femur.
An ACL strain/tear is a relatively common sporting injury characterized by tearing of the fibrous bands that make up the ligament. Ligament strains range from a grade 1 to a grade 3 strain and are classified as follows:
- Grade 1: a small number of ligament fibres are torn resulting in some pain but allowing near normal function.
- Grade 2: a significant number of ligament fibres are torn with moderate loss of function.
- Grade 3: all ligament fibres are ruptured resulting in major loss of function. At this level of injury other structures in and around the knee such as menisci may also be injured.
It is usually associated with a sudden pain or pulling sensation in the knee. Depending on the severity of the strain you may or may not be able to continue with the activity. In cases of a complete rupture of the ACL, pain is usually severe at the time of injury, and is associated with a rapid onset of swelling in the knee joint. It is also common to feel as if the knee is going in and out of place.
Causes:
There are three main causes of ACL injuries; 1) twisting of the knee with the foot planted on the ground when changing directions, 2) hyperextension of the knee, 3) landing awkwardly from a jump (basketball or volleyball) or a fall (skiing). These movements may also occur in combination, but the most common cause is twisting.
ACL tears occur frequently in contact sports such as football, those that require sudden changes in direction such as soccer or skiing, or when landing from a jump such as in basketball or volleyball.
Other factors that may influence the development of an ACL injury are:
- Gender ACL injuries occur 2-8 times more frequently in females than in males.
- Previous history of a previous ACL injury (in either knee).
- Poor coordination or jumping and landing strategies – knees twisting inward on landing.
- Joint stiffness (particularly the ankle or hip) or maintaining the knee in a greater degree of extension.
Surgical Considerations:
Aggressive physical therapy intervention may restore the knee to a condition close to its pre-injury state; and with activity modification and bracing may lead to an acceptable level of function and pain control without surgery. This is a reasonable consideration if:
- There is a partial tear and no instability symptoms
- There is a complete tear and no symptoms of knee instability during low-demand sports in individuals who are willing to give up high-demand sports such as skiing/football
- Who do light manual work or live sedentary lifestyles
- Whose growth plates are still open (children)
However, many people who choose not to have surgery may experience secondary injury to the knee due to repetitive instability episodes. Surgical treatment is usually advised in dealing with combined injuries (ACL tears in combination with other injuries in the knee).
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy:Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist.During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the knee, it is with the joint in a few degrees of flexion. If you are a runner but still need to get a cardio workout in, try swimming or riding a bike.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress:Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate:Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self-treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches:
- Stretch #1: Quadriceps
- Stretch #2: Hamstrings
- Stretch #3: Hip flexors
- Stretch #4: Tensor Fascia Lata
- Stretch #5: Deep lateral rotators of the hip
Stage 3: Weak Link Strengthening:
- Strength exercise #1: Glut maximus – squats and dead lifts to start and then progress to lunges and golfers lifts.
- Strength exercise #2: Glut medius – clamshell and then progress to side lying SLR and Monster walks.
- Strength exercise #3: Hamstring curls (on physio ball).
- Strength exercise #4: Proprioceptive training on unstable surface.
ANTERIOR KNEE PAIN
Description:
Anterior knee pain is also commonly called patellofemoral syndrome or chondromalacia patella. It is characterized by pain or tenderness beneath or at the sides of the kneecap. The kneecap is a moving part that slides up and down in a groove in the femur (thigh bone).The pain is caused by inflammation when the kneecap is not riding smoothly over the knee. Occasionally you may hear or feel a grinding sensation in the back of the kneecap. The pain often occurs going up or down stairs, of when sitting at the movies.
Causes:
The problem may be caused by anything that prevents the patella from sliding smoothly in its groove. This may vary from a patella that is slightly misshapen, to fatigued or weakened quadriceps muscles, a muscle imbalance between the quadriceps and the hamstrings or poor flexibility. Malalingment problems such as knock-knees, bowlegs, or over pronation (flat feet) can also cause the kneecap to track improperly. The knee is also a common site for overuse injuries to occur.
Prevention: If your patella is misshapen then surgery will rarely be required. More commonly a brace or support will be recommended. In the majority of cases a series of exercises to restore a balanced amount of flexibility and strength will be all that is required. The most common cause of malalignment is over pronation of the foot. Ask your therapist if you would benefit from specific shoes or custom foot orthotics.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy:Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist.During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the patellofemoral joint it is with the knee in a few degrees of flexion.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress:Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate:Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self-treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches
- Stretch #1: Quadriceps
- Stretch #2: Hamstrings
- Stretch #3: Deep medial rotators of the hip
- Stretch #4: Calf muscles
Stage 3: Weak Link Strengthening
- Strength exercise #1: Quadriceps with a focus on the VMO
- Strength exercise #2: Glut max variations such as bridging, dead lifts, golfers lifts
- Strength exercise #3: Glut medius variations such as clamshell, Monster walks, or kicks
MENISCAL TEAR
Description:
A meniscus is a C shaped piece of fibrocartilage that acts as a cushion in your knee joint. Each knee joint has two menisci, one medial and one lateral. Injuries occur much more frequently to the medical meniscus than the lateral.
The tear is often accompanied by a popping sensation followed by pain, usually on the medial (inside) of the knee. There is usually a small amount of swelling, difficulty straightening the knee, and some people experience a sensation of the joint locking in place or even giving way suddenly. It is often difficult to go up or down stairs, squat or kneel.
Causes:
Meniscal tears can occur with any activity that causes a twisting motion in the knee such as sudden changes of direction in sporting activities, or a normal activity of daily living (ADL) as simple as squatting down to pick something up. It also occurs more frequently as we age due to wear and tear or degenerative changes.
Other factors that may contribute to a meniscal tear are:
- Muscle imbalances
- Poor biomechanics
- Poor balance/proprioception
- Inadequate rehabilitation following a previous knee injury
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy:Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist.During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for a meniscal tear it is with the knee in a few degrees of flexion – you may want to use a cane or crutches in the early stage so you can partial weight bear (PWB) through the leg. If you are a runner but still need to get a cardio workout in, try swimming or riding a bike.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress:Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate:Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self-treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures.
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches
- Stretch #1: Quadriceps
- Stretch #2: Tensor Fascia Lata
- Stretch #3: Hamstrings
Stage 3: Weak Link Strengthening
- Strength exercise #1: Quadriceps setting
- Strength exercise #2: Glut medius – clamshell – side lying SLR – monster walks
- Strength exercise #3: Glut maximus – dead lifts to golfers lifts; squats to lunges
- Strength exercise #4: Hamstring curls
Foot and Ankle Injuries
PLANTAR FASCIITIS
Description:
The plantar fascia is a fibrous structure that runs the entire length of the bottom of the foot. It helps maintain the arch of the foot. Irritation results in a persistent pain located on the bottom and medial aspect of the heel (calcaneus) bone. The pain is usually most noticeable first thing in the morning, but eases with continued walking after about 5-10 minutes. It may also be more noticeable during the first few steps after sitting for an extended period of time. This problem is also commonly called a heel spur because the pulling of the plantar fascia on the heel bone causes a bony growth (bone spur). However, it is the inflammation and not the bone spur that causes the pain.
Causes:
Plantar fasciitis is the most commonly diagnosed foot complaint. It is more common in people with very high arched rigid feet, or flat/over pronated feet. The most common precipitating event is a sudden increase in activity level, such as with training for a running event (or a new job which involves a lot of time on ones feet). It also occurs in people who participate in sports that put significant loads through their feet such as runners and dancers. This can be worsened if wearing a poorly fitted or worn shoe. Trauma is not a common cause, but it may be brought on by such activities as shoveling when the foot is repetitively banged against the blade of the shovel.
Other factors that may contribute to developing plantar fasciitis are:
- being overweight
- leg length differences
Prevention:
Proper footwear plays an important part in prevention and treatment of plantar fasciitis. Make sure you check with your therapist as to the proper type of shoe for your foot shape. Running shoes should be replaced every 6 months or 600 Km. Many individuals have found that a silicone heel cushion helps prevent reoccurrence. Regular stretching of the foot keeps the fascia flexible. If you are overweight you are at greater risk because the pressure going through your foot is anywhere from 2-8x your body weight depending on your activity level. For example, for every kilometer we walk we take about 1000 steps; if you are 20 pounds overweight then that is at least 40,000 pounds extra stress through the fcot for each kilometer.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy:Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist.During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Since it is difficult to rest the foot, once the problem has developed a vicious cycle occurs with the situation being aggravated with each step. Proper footwear in conjunction with custom orthotics to control the abnormal mechanics of the foot is an essential first step in the treatment of plantar fasciitis. Your activity level must be modified, using pain as a guideline. Replace painful weight bearing exercises with cycling or deep-water running. Vary your work positions and avoid prolonged standing or walking on hard surfaces.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress:Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate:Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self-treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches
- Stretch #1: Gastrocnemius
- Stretch #2: Soleus
- Stretch #3: Plantar fascia stretch
Stage 3: Weak Link Strengthening
- Strength exercise #1: Foot intrinsic workout
- Strength exercise #2: Glut maximus – Squats and dead lifts
- Strength exercise #3: Glut medius – Monster walk or kicks
SHIN SPLINTS
Description:
The term shin splints is a catch all term used to describe pain along the tibia (shin bone). General complaints are of a dull, throbbing ache or tenderness along either side of the shinbone. It is usually aggravated by running, especially when the foot hits the ground.
Causes:
Any activity that causes constant pounding especially on a hard surface. Poor biomechanics of the foot along with footwear that has poor shock absorbing capabilities and inadequate medial arch support. Another major cause is poor flexibility especially in the calf muscles.
Prevention:
Stretching and strengthening for the muscles of the lower leg. Proper footwear with excellent shock absorption and good medial arch support. If you are a runner, then shortening your stride and increasing your cadence will reduce the loads going through the foot and leg.
Treatment:
Stage 1: Pain control/PRINCE Principal:
Protect/Physiotherapy:Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist.During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Since it is difficult to rest the foot, once the problem has developed a vicious cycle occurs with the situation being aggravated with each step. Proper footwear in conjunction with custom orthotics to control the abnormal mechanics of the foot is an essential first step in the treatment of shin splints. Your activity level must be modified, using pain as a guideline. Replace painful weight bearing exercises with cycling or deep-water running. Vary your work positions and avoid prolonged standing or walking on hard surfaces.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress:Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate:Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self-treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches
- Stretch #1: Glut Maximus
- Stretch #2: Tensor Fascia Lata
- Stretch #3: Deep lateral rotators of the hip
Stage 3: Weak Link Strengthening
- Strength exercise #1: Toe raises (not calf raises)
- Strength exercise #2: Foot intrinsic
- Strength exercise #3: Monster walk or kicks
- Strength exercise #4: Squats or dead lifts
ANKLE SPRAIN
Description:
A ligament is a strong fibrous band that attaches bone to bone. In the ankle joint there are three lateral ligaments that join the fibula to the talus and calcaneus. By far, the most common sprain in the ankle involves these lateral ligaments, as we roll over on the foot (inversion). Less commonly, the ankle rolls inward and the foot outward in an eversion injury, damaging the ligaments at the inside of the ankle. The high ankle sprain is the least common. It can happen when the foot is forced to rotate toward the outside, or when the foot is planted and the leg is rotated to the inside.
A lateral ankle strain/tear is a relatively common sporting injury characterized by tearing of the fibrous bands that make up the ligament. Ligament strains range from a grade 1 to a grade 3 strain and are classified as follows:
- Grade 1: a small number of ligament fibres are torn resulting in some pain but allowing near normal function.
- Grade 2: a significant number of ligament fibres are torn with moderate loss of function.
- Grade 3: all ligament fibres are ruptured resulting in major loss of function. At this level of injury other structures in and around the ankle may also be injured.
It is usually associated with a sudden pain or pulling sensation in the ankle. Depending on the severity of the strain you may or may not be able to continue with the activity. In cases of a complete rupture of the lateral ligaments, pain is usually severe at the time of injury, and is associated with a rapid onset of swelling and bruising in the ankle joint. It is also common to feel a snap or pop in the ankle at the same time. The majority of ankle sprains are grade 2.
Causes:
By far the most common cause of an ankle sprain is “going over” on the ankle. The foot is planted on the ground and the ankle goes out as the foot goes in. This may occur because of stepping on uneven ground, or placing the foot down incorrectly (due to poor balance or proprioception). It occurs in sports where there are rapid changes of direction particularly on uneven surfaces, or when there is a lot of jumping. In jumping sports they may occur as a result of landing awkwardly or landing on another player’s foot.
Other factors which may influence the development of an ankle sprain are:
- poor proprioception or balance
- inadequate rehabilitation following a previous ankle sprain
- inappropriate training surfaces
- poor biomechanics or foot posture
Prevention:
Properly fitted shoes, especially ones that extend above the ankle joint if appropriate for your sport or activity. Since the NBA initiated a policy requiring players to wear ankle top basketball shoes there has been a significant reduction in the number of ankle injuries. If prone to ankle sprains it is a good idea to avoid uneven terrain. Strengthen the ankle muscles especially those on the outside, and ensure that you have good balance.
Treatment:
Stage 1: Pain Control/PRINCE Principal:
Protect/Physiotherapy:Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to orthotics. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage. HURT DOES NOT NECESSARILY EQUAL HARM.
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist.During stage one; your therapist will also apply treatment techniques to assist you in resolving your pain a quickly as possible. These techniques may include exercise, electro-therapy such as TENS, IFC, Cold Laser, or ultrasound.
Rest: This does not mean bed rest – it is the art of resting the body sufficiently that it is able to heal itself, while staying active enough that we do not become too deconditioned. Every tissue in the human body has a resting position – for the ankle joint it is with the joint in a few degrees of plantar flexion. If you are a runner but still need to get a cardio workout in, try riding a stationary bike.
Ice: Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. Use crushed ice or a bag of frozen peas and apply to the area for 15 minutes, repeating every two to three hours. Don’t apply ice directly to the skin as over time, frostbite may occur.
NSAID: The use of anti-inflammatory drugs has become controversial recently because of the trend towards the belief that inflammation is a natural part of the healing process. Speak to your family physician about the pros and cons of this treatment.
Compress:Compression applied externally helps to decrease the amount of swelling and bleeding into the injured area. Using a tensor bandage, begin wrapping below the injured area and work upwards, unwinding the bandage evenly without too much tension. Do not apply ice or compression if you have circulatory problems or trouble distinguishing hot from cold
Elevate:Raising the injured area helps prevent swelling and aids in draining the swelling into large blood vessels. If pain and swelling do not begin to resolve in one or two days, consult your physician or physiotherapist.
Stage 2: Recovery of Movement
Foam Roller: Muscle Relaxation
Have ever had your doctor, therapist, or chiropractor test your reflexes? We take a small rubber hammer and rapidly apply a force to a tendon to stretch the muscle attached to it. What does the muscle do? It jumps back or contracts. However, if you do just the opposite; apply a deep pressure slowly to the muscle; it will have just the opposite effect. The muscle will actually release or relax. This is the idea behind therapeutic massage and trigger point release treatments.
While it is nice to get a massage on a regular basis, it is also convenient to learn how to do some type of release technique on yourself. Very rarely can we predict those occasions when we are really in need of releasing muscle tension that has gotten out of control. This is especially helpful when we are away on holidays and do not have access to the therapist that we know and trust.
The two most commonly used self-treatment techniques are the foam roller and the small release ball. One is not better than the other; it really comes down to a matter of personal preference and/or what you have easy access to. Do you have a friend that has a foam roller? Try it out and see if you like it before you buy it. Also, talk to your health care practitioner to find out what they like and where you can purchase the item.
Foam rollers come in several different sizes and shapes. The most common is the 36 inch long, 6 inch round roller. You can get them shorter or longer, or even in a half round version. The release balls come in a three different sizes, typically 5-6-7 inches in diameter. The larger ball is softer and a little more user friendly for people who are in discomfort. The smaller ball gets into tighter spaces and put more pressure on the spots. This is more applicable for the more advanced individual such as the sports enthusiast.
Basic Principles:
- To produce the effects of a massage you use your own body weight by lying or sitting on the foam.
- Find the tender point and hold the position for 30-60 seconds, or until the muscle release. You may also want to roll up or down the length of the muscle to accentuate the massage effect.
- Avoid rolling over joints, tendons, or boney structures
- Make sure you pay attention to your posture. Apply your Spine Sparing Strategies when positioning yourself.
- Work both sides of the body as equally as possible. You may notice that different muscles are tight and/or tender on opposite side of the body.
- If you cannot breathe in a slow relaxed manner, you are pushing it too hard.
Stage 2: Recovery of Movement
Stretch: Muscle Flexibility
- Before beginning your stretching program, it is best if you have previously warmed the muscles up by performing about 5 minutes of light aerobic activities. Warm muscles promote flexibility and improve joint lubrication.
- Perform all stretches slowly and gently. The more rapidly the stretches are done the more they fight the movement, thus increasing the likelihood of straining the tissues. Start with a short stretching interval and gradually increase the time the stretch is maintained as your body adjusts to the new activity.
- We believe in a “NO PAIN” approach. Do each stretch carefully, avoiding the tendency to rush or push too far. Move slowly and only try to increase the range as your flexibility increases.
- Repeat each exercise 2-3 times before moving on to the next stretch. In addition, remember to perform an equal number of repetitions on each side, this keeps your muscles in balance.
- Do not be discouraged if you find the exercises somewhat demanding at first or that your flexibility is not improving as rapidly as you had hoped. Your body will yield gradually and it will become progressively easier to achieve the same degree of stretch.
The most effective stretches are those that are performed slowly and for a long period of time. Gradually increase your stretches to 20-30 seconds of longer. They should never be too uncomfortable to hold for a long period of time.
When you have normal movement the emphasis is on maintaining what you have. The stretches are still performed in the same manner; however, they only need to be completed once daily.
Stage 2: Weak Link Stretches
- Stretch #1: Gastrocnemius and Soleus (calf)
- Stretch #2: Plantar flexion inversion (yes – this is the direction that you twisted your ankle)
Stage 3: Weak Link Strengthening
- Strength exercise #1: Calf raises
- Strength exercise #2: Ankle dorsiflexion with Theraband
- Strength exercise #3: Ankle eversion with Theraband
- Strength exercise #4: Proprioception training.