Basics on progressing your stretches

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

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

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

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

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

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

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

Ross

Scars? Physiotherapy can help you!

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

Why should a scar be remodeled?

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

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

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

hand scar acu

gua_sha_tools.

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

If you have concerns about a scar then consider speaking to your family medical doctor or your physical therapist regarding having the scar assessed. There is no reason why you should have to suffer without some help/advice considering the amount of knowledge that is available these days.

Ross

What can an Assessment do for you?

People aren’t always sure of what a physiotherapist does or whether they have a complaint that might be helped by a physiotherapist. Personally I treat mainly musculoskeletal problems (sports/spinal/arthritis…) but physio’s are involved in a number of areas. When someone comes in with a problem that I feel would be treated by a physiotherapist with a different speciality I send them to the appropriate person (Pat in our office has a focus on Occupational Health as one sub-speciality). Specialities include neurological conditions, women’s health, occupational health and a number of other areas.  When we do an assessment we try to focus in on what a person’s problems might be and whether one of our physio’s can help or not.  The assessment can clarify if there is a serious problem or if a person might be able to just get on with things themselves using just some information for guidance.

If you would like to have something looked at or discuss a particular problem I am offering a free 15 minute assessment for anyone able to come to my office. If you are interested please follow this link http://form.jotformeu.com/form/41794272933361 to book your free assessment.

Looking forward to seeing you and hopefully giving you a hand!

Ross

 

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

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

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