Planning for Recovery

People often say to me ”I took a month off but when I returned to playing I got injured again”!  This is frustrating for many people but it occurs partly because people make the mistake of confusing ”this no longer hurting” with their body being completely healed and back to ”normal”.  There are a couple of things to consider that might help to make planning for recovery easier:

1)  Injuries often are healed fairly quickly but the tissue that has replaced/repaired has not been subjected to normal stresses and may well be locally stiffer, more sensitive and generally weaker than it originally was.

2)  Even when strength,sensitivity and mobility have returned to normal levels you will have lost the conditioning to the affected part of your body because you haven’t been able to train properly.  Even if you healed completely you still haven’t recovered your skills/co-ordination. You can often get by without much training before returning to competition if you aren’t hurt too badly or you are only doing things at a low activity level.  You do still run a higher risk of re-injury if you don’t do some prepatory training.

3)  Ok, you now have a healed injury and your co-ordination appears to be back to normal and you are ready to go!  Well almost.  The last consideration is that with a substantial lay off you also have the chance that you have lost some of the capacity you have built up over the years from participating in whatever activity you do. This isn’t a big factor if the injury has been recent and you have gone through a conditioning program before returning to what you do.  On the other hand, if you have had a long time off ( due to injury or just inactivity) your body has lost some of it’s built up ”toughness”. This means that you might find things get sore/injured again because you have less resilience.  Part of avoiding this would be to get back on a regular graded training program  before moving on to higher levels of participation or competition.  Adults who have played a sport for years and then stopped , say to have children, and then returned a decade later find that they seem to initially get injured relatively easily to what they expected.  This is partly due to the body naturally getting weaker/stiffer when not challenged to keep up optimum strength and flexibility.

To minimize problems each of these concerns need to be reviewed.  If you need help to check things find a health care practitioner to help you go through and see that strength, range and co-ordination are back to normal and comparable from side to side.  If you aren’t sure about your conditioning then either a health care practitioner or a personal trainer might help you check your fitness (strength and conditioning) levels.

So before rushing back onto the pitch, or even back to a hard labor intensive job, consider the things listed.  With a bit of planning and training you have a good chance of recovery with minimal problems.

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

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.

Canadian Back Institute

Although I obviously would like to see patients in my office I think that any organisation that promotes patient self education should be supported.

One excellent group is Dr Hamilton Hall’s Canadian back institute (http://www.cbi.ca/web/cbi-health-group/ilibrary).

Dr Hall has always written excellent books that are plain speaking and informative.  Likewise his website offers information including an online self assessment package to help you to understand what might be going wrong and how to deal with what you find the source of your complaints to be.

Years ago, before I was a physio myself, I got tired of having problems and finding that the information I needed wasn’t available. Treatments were not always helpful ( I tried chiropractic, massage etc) and too often a passive approach left me soon back in pain again and wondering what to do.

Its worth giving Dr Halls site a view and seeing if what he tells you helps you to understand things a bit better. I know in my case it was very beneficial.

Best wishes and good health!

Ross