YOU can be a body mechanic!

I’m going to sound like a broken record (if you are old enough to know what that is) as I’m sure this is something you have all heard but I am going to say it again.  You need to get involved in your own self management because when people don’t do anything they rust!

Not literally, but in effect we often suffer from the little bits of stiffness/weakness and incoordination that we pick up in our daily lives. Knee patients often have a poor walking pattern due to stiffness in their hips or ankles. Forefoot pain, such as metatarsalgia or Morton’s neuroma, develop after a person starts to walk with their foot in over-pronation to again reduce strain produced by tightness higher up the limb. Wrist pain may occur when there has been an elbow injury that has healed but the person has not fully recovered their strength and mobility forcing the wrist to work at an odd angle. We often seem to be too busy to take the time to stretch out tight tissues, reduce tension and recover strength when we have had an incident that has set us back.

Some cultures, such as in India or China, developed methods of dealing with this sort of problem and came up with yoga and tai chi. In the west we had a history of physical culture exercises and callisthenics that were once performed by a variety of people to keep themselves relatively fit and flexible. These days many of those practices have fallen out of favour although yoga, tai ch and more recently pilates have been taken up as attempts to keep ourselves going.

Whatever the method that suits you, I think it would be a good investment. Physically anything that keeps you moving and tries to maintain normal strength and flexibility will help to limit how easily you get injured from just being inactive. Financially you will save yourself all sorts of money being less likely to need treatment from any type of therapist or physician. Your body is no less in need of regular maintenance than your car and deserves , at the very least, regular attention to make sure it is functioning normally. I am sure there are lots of methods others could suggest and I would be happy to hear them. The most important thing is to start now and don’t wait until something breaks down and you end up needing treatment. One oil company has an advertising slogan that amounts to you can pay a little bit now (be active) or you can pay a lot later (to whatever type of practitioner). Not a bad concept to keep in mind.

Regards, Ross

Walking stick blues..

One of the things that make me a bit crazy are walking sticks. I see people using them incorrectly all the time and have to resist the temptation to run across the street and teach them how to do it properly. You wouldn’t have thought that something as simple as using a stick could be so complicated.

The first thing that I notice is that people never seem to have their sticks cut to the proper length. Some have them so short that they are leaning forward and bent over. The stick is supposed to take some of the effort out of walking and this won’t happen when you are in a semi-unbalanced state all of the time. Other people have the stick so high that their arm is held bent and they can’t actually take any amount of weight through the stick. You should be able to put some weight through the stick with a straight elbow while the stick is at your side, not too far forward or to far to the side.  You will find that having the stick tip around 5-10 centimetres (2-4 inches) in front and to the side will be about right.  The actual distances will vary somewhat depending on your own size and shape.  You need to be able to fully straighten your elbow when using the stick so that your arm muscles can work efficiently.

Measuring a walking stick.

(For a complete description of how to measure a walking stick go to stick measurement . This shop has a full description of how to measure a walking stick and a variety of different and interesting types of sticks that will show you just what is available.)

The stick also needs to be used correctly. You should not overload the stick and certainly not lean on top of it. It is commonly used to take weight off of one side of your body and should be held in the opposite hand. Using the stick in the opposite hand helps to lessen the load by allowing weight to be distributed between the two sides of the body or by lessening the work needed by the muscles on the affected side to hold you up. A good example is when a person has a sensitive hip the muscles in the hip area will compress the joint and make the joint more sensitive. If the stick is pushing your weight up from the other side the muscles don’t have to work so hard and there is less compression in the joint. If you have a sore knee or ankle the stick can be used to lessen the amount of weight that is being applied by shifting it to the opposite arm and leg.

When cutting or adjusting a stick you need to take into consideration whether there will be a rubber or metal ferrule (the rubber tip or possibly metal studs for using the stick on ice) that will be added on afterwards as this will make the stick longer again and this can also cause you to push inefficiently with your arm.

For some a stick will be a temporary assist to allow injuries to settle down, heal and get a rehabilitation program started. For others, a stick may be a necessity to allow a person to continue to function because of age, illness or permanent injury.

Remember that a stick is to assist and not to take all of your weight. If you lean too heavily you risk falling either because the stick breaks or because the tip might slip if it is not placed down flat.

What ever your reason for having a stick, it’s best to have it measured correctly and to use it properly.  I will be back soon with some information on ways to walk with a stick or crutches to help you get moving as quickly and safely as possible.

Ross

 

 

An easy treatment for arthritic pain in base of your thumb.

Many people get soreness at the base of their thumbs.  Sometimes it can hurt up the outside of your forearm or perhaps up the thumb itself.  It may start out as an ache that never quite goes away.  You might wake in the morning with some stiffness in the thumb that eases after a few minutes or up to an hour later.  As the day goes on it may behave and you might just get occasional twinges. In the evening the ache may be back again constantly.  Over time your thumb start to ache all of the time and the pain may not go away.  Eventually you may find the pain eases as your thumb becomes progressively stiffer…

This is a very truncated description of how wear and tear arthritis may behave.  In the beginning the joint has had a sprain due to being a bit worn and may swell up.  As the swelling goes away the joint is left a bit stiff. This leaves you susceptible to a re-injury and over time, if you do nothing, you can arrive at the result I just described.

Luckily, if you catch things early there is a chance you can minimise or even prevent this condition from becoming a problem. The basic exercise program is as follows:

  • 1. Use an elastic band or something similar to provide a slight resistance to the movements that need to be performed.
  • 2. Start out by just performing movements in simple planes and be gentle. The exercises are meant to be painless and should be carried out painlessly.
  • 3. The resistance needs to be below the two obvious joints , above the wrist but below the knuckle level.
  • 4. Use the elastic to provide a little resistance, do not try to stop your thumb moving. This is not supposed to be a battle.
  • 5. The thumb can move up and down vertically or in and out horizontally. You need to resist both directions. Repeat each movement 6-10 times, 2-4 times a day.
  • 6. Don’t forget to try not to overload the thumb while it is sensitive/stiff. If necessary you can wear a temporary support or use strapping to limit the movement of the joint so it does not take any weight in a position where it is sensitive.

I have used these exercises myself after spraining my thumb a number of times in sport and I have also given them to elderly patients who have had no difficulty performing them as instructed. Give it a try but be sure that you allow yourself a week or two before you decide if the exercises are helping or not. Your body often has had a long time to develop a problem even if you only recently noticed it. You need to give it time to recover if you want it to work more comfortably.

Ross

What to do when you have an acute attack of neck pain.

1.Some people find cold packs can reduce how sensitive the area is and allow the muscle to relax. Alternatively, you may use some heat on the neck and shoulder muscles to help them relax eg hot water bottle, hot pack or shower. Often it is easiest to apply something for 10 minutes every hour but you can leave things on your neck for 20-30 minutes as long as you let the neck return to normal temperature before repeating the treatment again. Be careful if you have sensitive skin not to get a either a heat or cold burn.

2.Lie down flat and REST as much as possible for the first 24-48 hours while the pain and stiffness is very bad. This too will allow the muscles to relax and so ease the pain.

3.A temporary collar may be needed for a short period of time. Usually for the first 24-48hours. This again will rest the neck muscles and allow them to relax.

If your neck isn’t feeling too sore you can try to regularly remove the collar and gently move your neck to try to prevent things stiffening up too much.

Here is an easy way to make a temporary collar.:

Take a pillow case, fold it in half length wise
Next fold that three times so you end up with a pillow case that is
one sixth normal width.
Wrap this folded pillowcase around your neck and then tape in place.
You can wear this while up or sleep with it on.

an easy temporary neck support

4.The type and number of pillows you use can have quite an effect on the amount of pain you will have. Usually it’s best to sleep with a lower pillow but you may need to start with a couple and work your way down to a thin pillow over a day or two Some pillows, particularly foam ones, will compress and flatten while you are sleeping. . If you end up with your head tilted all night it can really irritate things. Which ever type of pillow you have, you can modify the pillow to make sleeping easier:

Take a towel and fold it to make a 2-4 cm pad.

Stick this in your pillow case under the pillow and it will stop your head from tilting over into a painful position while you sleep.

You can also take a small towel and roll it up and put this in the leading edge of the pillowcase to support the curve of your neck.

5.If you can’t tolerate something around your neck then an alternative it to use a sandbag. You can put a sandbag (or equivalent) beside your head when you are lying on your back so that you can’t turn your head in the most painful direction.

6.When you lie down the weight of your legs will pull on your spine whether on your back or on your side. You can sleep with 1-2 pillows between/under your knees to stop your spine being pulled sideways while you sleep.

7.All of these measures can be useful during the initial attack of neck pain and may get you to the point where you can progress further with self treatment or to the point where you can tolerate being treated by a professional. After numerous years of contact sports (including wrestling/rugby/judo) as well as numerous car accidents (I was driven into 5 times in the first 5 years here in the UK!) I can tell you from personal experience that these methods can be effective.  I know that there are many approaches to dealing with neck pain and I am sure that some of what I have said will be a bit controversial.  Tell me your thoughts or suggestions. I am always happy to hear of ways to improve what I have to offer my patients.

I hope this information is helpful for you.

Regards,

Ross

 

An exercise in seeing…

One thing that has always surprised me is how different a patient’s posture can be from the way patients see themselves. I ask people if the are sitting up straight and they reply yes yet they have their neck leaning forward at a 20 degree angle. I ask people to stand on one leg and tell me if they are standing up straight and again the answer is always a resounding ‘yes’. It seems that we believe what we think until we are forced to do a reality check which is something that rarely happens before coming to me.

So I thought maybe if I gave you a couple of things to try out on your own you might start to get a better idea of what reality is like for you, before you necessarily have any complaints. Ready to have a go?

First, you will need at least one if not both of the following tools. I like a mirror because it is in effect dynamic and will show you exactly what you are doing. Preferably a full length mirror because it leaves you with no where to hide and exposes any faults that might be present. Alternatively, you could use a camera (still or video) which also will tell you similar information. Unfortunately with cameras it is harder to get immediate feedback unless you have it connected to a large screen monitor or TV (which is not always convenient). (note – if you have any health problems that restrict your ability to exercise then please check with your health care provider before attempting to try out these exercises)

Ok now once you have your tool(s) it’s time for a couple simple tests.. Try standing in front of the mirror: hips straight and pelvis not rotated, feet pointing straight forward and placed under your shoulders, knees slightly flexed over the middle of your feet with the weight distributed equally. Try to set yourself up without looking in the mirror and then look up and see if everything is where you think it would be. Common faults are having one foot turned out, one arch flattened/raised, more weight on one leg, the trunk leaning off to one side, one knee pointing either towards the middle or away from mid-line.. the list goes on!! At first it might not be obvious to you what you are doing and a photo or video recording may allow you to relax and review what your posture is like after. It is good to look for natural vertical lines (or you can hang a string behind you to act as a plumb line) so you can compare where you are positioned to what I have asked for.

Happy with where you are? Okay then lets progress to the next step. If not, then see if you can work on getting your body to take on this basic posture.

Now that you think can find a balanced position it’s time to add a bit of chaos :’ ).

Stand on one leg with the knee slightly bent and see if you can once again line yourself up with everything straight as in the first test. Can you do it? No? Well, many people can’t and this time faults are even more obvious. You may find that on one side it is easy to do but on the other your knee twists in quite a bit, the foot twists out, the pelvis rotates, you lean over quite a bit to one side… again the list can be extensive!! You may need some help from a friend who can look at what you are doing and give you honest feedback to help you correct your positioning. A healthy adult should potentially be able to stand up straight without leaning/twisting for up to 2 minutes without huge difficulties. Most people won’t be able to do this but that does not mean that they are not capable.  If you can get into this posture then see if you can relax and breath comfortably and hold the position with the least amount of effort. You should not have to strain yourself when you doing these exercises.

Sometimes I will do things to see if I can identify what the potential cause of the leaning/twisting is. For example, if I think that the person has weakness in their hip muscles then I give them a weight (a couple of kilos/up to 5 pounds) to hold onto on the same side they lean to. If this makes the list go away then the weight is doing what the hip muscles are supposed to be doing and I tell them that they should be doing something to strengthen the hip to see if that makes controlling the movement easier. I also like to see if the list happens before they actually try to shift their weight which might be more a habit than something their bodies are forcing them to do.

There are more things that can be tested/evaluated but you can at least start to see ,from what I describe, the process that needs to be carried out to improve your performance of these tests.

These sort of postures are similar to what people may do in some yoga, qigong and tai chi classes. I am not pretending to be teaching these arts but what I think is that someone in the past decided to provide simple preventative posture exercises that would be useful in keeping up one’s strength and coordination. I personally feel they are a useful tool and still have a use for most of the population these days.

Dealing with an acute low back pain attack

People always ask what to do when they have acute back pain. There are many answers depending on the exact nature of your problem but one thing people forget about is that pain is a perception and not a thing.

One common way of looking at how you perceive pain is to visualize your nervous system being like a telephone exchange. When a signal comes into the spinal cord it is prioritised according to the speed it comes in at, it’s intensity and what other competing signals are arriving at in roughly the same time period. Sensations , such as temperature(hot or cold),vibration, auditory information etc, arrive on insulated nerves and move at a fairly quick pace. Pain travels on uninsulated fibres and thus tends to arrive less quickly and can be blocked out by the faster signals that arrive first. A perfect example is a toothache that you hardly notice all day as you are bombarded by other information yet it is felt as a pounding toothache once you get into bed. Once the other signals are absent your nervous system becomes focused on what is left and you perceive the remaining pain as much stronger than you might have during the day. This is one reason why so many treatments have a short term effect that reduces what you feel yet don’t really get rid of the underlying problem. If you put on a heat rub/ice pack, have a massage, use a TNS machine then you will have some relief but only as long as the effect of the treatment remains. If there is still an underlying irritation it will all come back until you have dealt with the thing that is irritating your body in the first place.

The simple answer is when you first have an attack of back pain the best thing is to find a comfortable neutral position (usually lying on your back with your legs up on a stool/couch or on your stomach with a couple of pillows underneath) and apply any form of treatment that provides an alternative sensation to help settle down how much your nervous system is focusing on your back pain. Once you have had a day or so to let things settle then you have a wide choice of treatments that might help depending on what has gone wrong. With acute attacks many things will help including manipulation, massage, exercises and possibly other treatments such as acupuncture.

In the long run, you are best to calm your back down, have some form of treatment to settle your back further and then go back and focus on the things that really matter. Most back pain occurs because of bad habits, poor posture, trauma or working too long at something your body does not tolerate well. If you learn to take care of yourself better in your day to day activities you will find you have less (or maybe no) attacks and be better prepared to get on with your life.

Best of luck with taking care of yourself!!

Ross

Be careful what you wish for….

These days we are inundated with information. One problem is trying to decide how much information you really need and what do you do with it once you have it?

Take for example imaging of work or sports injuries. We can see what the cause is and should be able to provide better treatment. Right? Well it’s not that clear cut.

A couple of recent studies come to mind. The first, a study on low back pain, found that patients who had been given MRI scans took the same amount of time to heal as people who had not been scanned. Straightforward and what you would expect. What was surprising was that the MRI group suffered more and had much higher disability scores during the healing period compared to the non-scanned group. Knowing the intricate details of their injuries seemed to disturb more than re-assure the MRI scanned patients. The second study looked at what injuries/problems a doctor could see as possibly being present from evaluating an MRI scan of a shoulder. A variety of injuries were observed in 40% of the participants including significant muscle tears. This study sounded straight forward as well except for one small problem. The subjects in the second study were all high level athletes with no symptoms or reported complaints and at 5 years follow-up no problems had been reported.

The moral? The human body is extremely adaptive and we get by in spite of various injuries that may really just become quiescent rather than totally disappear. Sometimes knowing more than really necessary can create anxiety that make someone’s suffering worse than it could be. We need to trust that our bodies will tell us when something is truly amiss. So, before you go to your doctor asking for a scan or x-ray for an injury you might want to think, is there anything to indicate that this is really serious enough to need imaging? It’s not always good to know everything..

It’s sometimes said that what you don’t know can hurt you but sometimes what you do know can hurt you too!! Be careful what you wish for, what you get/find out isn’t always good for you. ;’ )

Ross

http://ajs.sagepub.com/content/31/5/724.abstract

http://www.ncbi.nlm.nih.gov/pubmed/22415000

Gardening in spite of your Arthritis

It’s nice to be outdoors in good weather. When you have the pain and limitations of arthritis it may prevent you from enjoying the fruits of gardening. Here are some general tips for you to help save your joints this season:

Break the project into steps – avoid overdo anything.

Take frequent breaks – rest at least every half hour or less if you have pain.

Use larger muscle groups when possible – leg muscles are larger (and stronger) than the arm muscles, and shoulder muscles are larger than hand muscles.

Use the leg muscles when possible to lift/carry objects, and use shoulder and elbow to help move things as opposed to the hand joints for gardening

Use foam kneeling pads or a foot stools to reduce the load on your hip, knees or back.

Ask a neighbour, family member, or friend to turn your soil. If you can’t get anyone else to help and have to work on the soil yourself, be sure you use the larger muscle groups, i.e. – your leg muscles.

Use hand tools with larger handles to take the stress of the finger/hand joints. If you can’t find larger  handles, use towels, pieces of foam or rags to build up the smaller handles – it will save your hand joints.

Consider planting in pots instead of the garden. This will allow you to work at table height and eliminate stressful bending on the back, hips, and knees.

Use a cart with wheels to carry plants, tools, soil, etc., to avoid the stressful bending and lifting.

Spread your plants out in the garden, so you have less holes to make, fewer plants to plant and less work.

Plan your gardening before you start out and then you can organise which things to take out from the shed or cupboard and avoid unnecessary trips.

Stop when your body tells you to! It is easy to overdo things starting out.

If you follow at least some of these ideas you could find yourself enjoying your gardening a lot more and suffering a lot less!

What about sex?

Sex

Everyone talks about it but no one talks about what happens when you have a bad back…

Sometimes, even if you are in pain, you want to please yourself or your partner. For the person with a bad back this can seem like a difficult, if not potentially disabling activity. Actually this is far from the truth is you are aware of what you are suffering from and follow a few rules.

Most peoples pain is actually a combination of the pain they have from an injury (new or old) and the bodies attempts to compensate or protect them from further irritation. Most pain can be broken down into 3 categories and there are rules on what is potentially possible in each category.

Generalisations (pinch of salt please)

– Pain that worsens with bending or sitting movements may originate
in some sort of disc problem.

– Pain that is one sided and worsens
with walking and standing up tends towards more of a facet type
problem.

– Pain that goes down your leg when you bend forward and may
have some concurrent pins and needles sensation tends towards a nerve
root origin.

Given that these are only generalisations you can still use the information to help you accomplish your goals :’ ).

First if your pain is more likely disc based then you need to avoid being bent/twisted so any approach where the active partner is behind while the other person is face down. This would work for the more passive partner this would also avoid any bending as well although a pillow under the tummy might help to avoid too extreme a position.

If your pain is is more likely facet based then a variation on a seated position might be useful for either partner as there are no backward pressures. Traditional positions like the missionary position might work for the more passive partner or the more active partner can switch to a more submissive position on their back(knees bent) and let the other partner position themselves appropriately.

If you experience leg symptoms then sideways foetal positions offer an opportunity to be active with no stretch to the nerve roots for either partner.

 This is just a quick list of possibilities to give you some ideas but necessity being the mother of invention it may help you to determine what might work for you.

There are lots of variations that can be tried. I do have a set of descriptions with diagrams that can be sent to you if sent me a note at my e-mail address :  pt4u@linsladephysiotherapy.co.uk

Best of luck in all of your endeavours!!

Ross

stretching localization

People often come to me and tell me that they have been performing routine exercises to keep themselves flexible.  Oddly enough they often report that inspite of their efforts they still feel very stiff.

One reason that is often overlooked is that they are actually trying to stretch the wrong area/tissue.  If you want to improve flexibility, whatever your particular strategy, you need to stretch the correct area.

An example: People often try to stretch their hamstrings by putting one leg on a stool and then bending their  heads down towards their knee.  When you bend forward you are actually releasing the pressure on the hamstrings as you use the flexibility in your spine to get your head closer.  If you want to stretch one area (and this is not always the case) then it is best to localise your stretch.  To get the hamstrings you can first keep your back straight and push your shest out to remove all spinal flexion.  You then put one leg on a stool and then  lean forward like you were a waiter bowing (this is only one of the many ways to stretch the hamstrings).  You should worry less about how far you go and more about where you actually feel the stretch.  You wil get mostly the hamstrings if you leave your foot relaxed. You will get the calf muscles as well if you pull your foot up towards you.   Further load can be applied by turning your pelvis/hip/leg so that everything is kept square and there is no where else that can give way to relieve the load on the hamstrings.  I could give you more variations but this would be a could starting stretch.

Add some relaxed breathing, sustained holding and a bit of patience (repeating 3-4 times for 10 + seconds ,3-4 times a day)and over a few weeks you will feel your hamstrings getting looser.

The important thing to remember is that if you don't feel a stretch in the right area when stretching then you aren't really stretching…

Good luck with your health and fitness.

Ross