Keep moving with kneecap painPain in the front of the knee, around the kneecap can be a common issue in people presenting to Physiotherapy. This issue can be caused by an irritation of the patellofemoral joint, the joint between your kneecap and the base of your thigh bone. Often pain can occur in this joint when running, walking up or down stairs or during other exercise such as squatting. Pain in this area often relates to pressure on the kneecap as it articulates with the bottom of your thigh bone – your femur. The force on this joint is mainly influenced by two things: the amount of force being produced by the quadriceps muscles on the top of your thigh, and the amount of knee bend or flexion that occurs when the joint is under load.
Here are a few strategies you could implement to reduce your patellofemoral pain whilst continuing to exercise:
- Choose exercise activities that gradually expose the knee to greater stresses.
- Modify your current exercise program to reduce the stress on the knee joint.
Lateral hip pain
Pain on the outside of the hip is a common complaint especially for those who have shifted towards an increase in their physical activity or ceased physical activity leading to a stress to the tendons that surround the hip.
Some times this pain can also be a result from an inflamed bursa in the hip but it is important to note that there is often an issue with the glute tendon itself and so this muscle and tendon also needs to be addressed in order to restore pain free movement.
To help manage this pain it is important to reduce compressive loads on the outside of the hip, so try to avoid sleeping on that side or crossing your legs, as this stretches and puts pressure on these structures. If you do sleep on your side, place a pillow between your knees. Also try to avoid stretching out the glutes as this also puts compressive pressure on the area of pain. Until you build more strength around the hip, it is best to reduce walking up hills and stairs. Putting an ice pack or frozen peas right over the widest part of the hip is helpful to reduce the pain.
A really helpful exercise in the early management of this pain is a simple exercise using a belt or a tied up scarf around your thighs. You can do this in sitting or laying on your back with the feet on the bed and the knees bent up. Once you have the belt around your thighs, simply press the affected side into the belt and hold. This is called an isometric exercise, where you switch on a muscle and keep it switched on so as to stimulate blood flow and it is also a really good way to desensitize the area of pain. It is a gentle way to begin activating these glute muscles so that you can then progress slowly with more challenging glute exercises once the pain settles more and more.
Be patient with yourself, lateral hip pain can be tricky and can sometimes take a while to get on top of. There are other treatments that can help, such as shockwave therapy and corticosteroids injection but as this pain is often a result of an issue in your glute tendon, it is important that you rebuild the strength and control around your hips.
Why can neck pain cause vertigo, dizziness and/or headaches
There have many different hypotheses for this conundrum over the past few decades. Few have stood the test of scientific rigor. Below are a few that have:
1) Proprioception. This occurs more often in acute traumas like whiplash from car accidents. Where the damage in a joint or tissue can lead to abnormal afferent input into the vestibular nucleus. In turn disturbing vestibular input. In normal terms it kinks the balance link between the inner ear, brain and muscles. This is times by 10 due to the fact we have significantly more proprioceptors in the upper cervical joints then any other joint in your body.
2) Sympathetic dysfunction. Your sympathetic part of your autonomic nervous system controls the survival mechanism of our body hence the "fight or flight". When damage occurs to your cervical spine it may stimulate sympathetic nerve fibres changing blood volume in the vestibular arteries supplying the brain stem. Hence constricting blood vessels in the vertebro-basilar system resulting in dizziness and/or vertigo. We have many of these sympathetic nerve plexuses around our spinal column.
3) An obstruction in the vertebral artery. A stenotic obstruction in this artery can lead to all of the above symptoms. Neck rotation can block this artery leading to VBI (vertebral artery insufficiency).
4) Cervicogenic vertigo associated with chronic migraines. The trigeminal nerve which is one of the cranil nerves has reciprocal connections to the vestibular nuclei. The trigeminal nerve innervates a lot of the upper cervical area in which could be an explanation to the symptoms stated above
Feeling The Pinch?
The Stubborn Shoulder Impingement SyndromeDo you get a sharp, debilitating pain in your shoulder when you are performing tasks like brushing your hair, putting on certain clothes or showering? During these movements, where you raise your arm out to the side and then upwards over your head, do you alternate between no pain and pain? For example, during the first part of the moment you don’t feel any pain, and then suddenly your shoulder “catches” and there is sharp pain, followed by no pain again as you continue to move your arm upwards. These are all signs of a condition called Shoulder Impingement Syndrome (SIS), where the tendons of the rotator cuff muscles that stabilise your shoulder get trapped as they pass through the shoulder joint in a narrow bony space called the sub-acromial space. Impingement means to impact or encroach on bone, and repeated pinching and irritation of these tendons and the bursa (the padding under the shoulder bone) can lead to injury and pain. Shoulder complaints are the third most common musculoskeletal problem after back and neck disorders. The highest incidence is in women and people aged 45–64 years. Of all shoulder disorders, shoulder impingement syndrome (SIS) accounts for 36%, making it the most common shoulder injury. You shouldn’t experience impingement with normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen, a condition called rotator cuff tendonitis. Likewise, if the bursa becomes inflamed, you could develop shoulder bursitis. You can experience these conditions either on their own, or at the same time. The injury can vary from mild tendon inflammation (tendonitis), bursitis (inflamed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness tendon tears, which may require surgery. Over time the tendons can thicken due to repeated irritation, perpetuating the problem as the thicker tendons battle to glide through the narrow bony sub-acromial space. The tendons can even degenerate and change in microscopic structure, with decreased circulation within the tendon resulting in a chronic tendonosis.
What Causes Shoulder Impingement?Generally, SIS is caused by repeated, overhead movement of your arm into the “impingement zone,” causing the rotator cuff to contact the outer tip of the shoulder blade (acromion). When this repeatedly occurs, the swollen tendon is trapped and pinched under the acromion. The condition is frequently called Swimmer’s Shoulder or Thrower’s Shoulder, since the injury occurs from repetitive overhead activities. Injury could also stem from simple home chores, like hanging washing on the line or a repetitive activity at work. In other cases, it can be caused by traumatic injury, like a fall. Shoulder impingement has primary (structural) and secondary (posture & movement related) causes: Primary Rotator Cuff Impingement is due to a structural narrowing in the space where the tendons glide. Osteoarthritis, for example, can cause the growth of bony spurs, which narrow the space. With a smaller space, you are more likely to squash and irritate the underlying soft tissues (tendons and bursa). Secondary Rotator Cuff Impingement is due to an instability in the shoulder girdle. This means that there is a combination of excessive joint movement, ligament laxity and muscle weakness around the shoulder joint. Poor stabilisation of the shoulder blade by the surrounding muscles changes the physical position of the bones in the shoulder, which in turn increases the risk of tendon impingement. Other causes can include weakening of the rotator cuff tendons due to overuse, for example in throwing and swimming, or muscle imbalances between the shoulder muscles. In summary, impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity. When your rotator cuff fails to work normally, it is unable to prevent the head of the humerus (upper arm) from riding up into the shoulder space, causing the bursa or tendons to be squashed. Failure to properly treat this instability causes the injury to recur. Poor technique or bad training habits such as training too hard is also a common cause of overuse injuries. Over time pain can cause further dysfunction by altering your shoulder movement patterns which may lead to a frozen shoulder. For this reason, it is vitally important that shoulder impingement syndrome is rested and treated as soon as possible to avoid longer term damage and joint deterioration.
What are the Symptoms of Shoulder Impingement?Commonly rotator cuff impingement has the following symptoms:
- An arc of shoulder pain approximately when your arm is at shoulder height and/or when your arm is overhead
- Shoulder pain that can extend from the top of the shoulder down the arm to the elbow
- Pain when lying on the sore shoulder, night pain and disturbed sleep
- Shoulder pain at rest as your condition worsens
- Muscle weakness or pain when attempting to reach or lift
- Pain when putting your hand behind your back or head
- Pain reaching for the seat-belt, or out of the car window for a parking ticket
Who Suffers Shoulder Impingement?Impingement syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height also increase the risk of rotator cuff impingement.
How is Shoulder Impingement Diagnosed?Shoulder impingement can be diagnosed by your physical therapist using some specific manual tests. An ultrasound scan may be useful to detect any associated injuries such as shoulder bursitis, rotator cuff tears, calcific tendonitis or shoulder tendinopathies. An x-ray can be used to see any bony spurs that may have formed and narrowed the sub-acromial space.
What does the Treatment Involve?There are many structures that can be injured in shoulder impingement syndrome. How the impingement occurred is the most important question to answer. This is especially important if the onset was gradual, since your static and dynamic posture, muscle strength, and flexibility all have important roles to play. Your rotator cuff is an important group of muscles that control and stabilise the shoulder joint. It is essential the muscles around the thoracic spine and shoulder blade are also assessed and treated as these too work together with the entire shoulder girdle.
To effectively rehabilitate this injury and prevent recurrence, you need to work through specific stages with your therapist.These stages may include:
- Early Injury: Protection, Pain Relief & Anti-inflammatory Treatment
- Regain Full Shoulder Range of Motion
- Restore Scapular Control and Scapulohumeral Rhythm
- Restore Normal Neck-Scapulo-Thoracic-Shoulder Function, including posture correction
- Restore Rotator Cuff Strength
- Restore High Speed, Power, Proprioception and Agility Exercises
- Return to Sport or Work
THE ART OF THE BREATH Breathing correctly promotes a sense of calm, helps us to de-stress and also promotes physical healing. We are all breathing all day everyday but most of us are not breathing correctly! Some common mistakes are: -breathing too quickly -breathing too shallow using our neck muscles rather than our diaphragm -breathing unevenly with lots of sighs and yawns -breathing through our mouth Start learning to breath properly again by focusing on the following: 1. Be sure to breathe through your nose - in and out all the time, even when exercising. Your nose is designed to filter air and make it the perfect temperature and humidity. 2. Focus on each breath becoming smoother and slower. We should aim to breathe 12 times per minute (many of us are breathing 16+ times per minute) 3. Your breathe should be even and silent - avoid noisy sighs and yawns 4. use your diaphragm and belly muscles to breathe. Your shoulders should not move up and down to breathe. Learning to improve your breathing will help improve so many physical and psychological ailments.
The low down on Hip Replacement
The current state of affairsHip replacements are becoming increasingly common. Currently 1.3 people in every 1,000 will undergo a hip replacement operation, and more than 1.2 million are carried out each year worldwide. The biggest risk factors for needing a hip replacement are age and arthritis, with 85% of people having a hip replacement, also having osteoarthritis. In terms of gender, women have a higher risk of needing a hip replacement (58%) compared with men (42%). Hip replacement surgery in patients aged 45-54 has also doubled in the past 10 years.
What can we do, to reduce the risk of needing a hip replacement?Physical activity helps. Running decreases your risk of developing osteoarthritis by 18% and as osteoarthritis is present in 85% of people who undergo a hip replacement, this has a knock-on effect in reducing your risk of needing a hip replacement by 35-50%. And if you’re not up for running that’s OK, walking can also reduce the risk of needing hip surgery, although by a smaller percentage (23%). Almost half of the protective effective of being physically active comes from weight control. The higher your BMI, the greater your risk of needing a hip replacement.
And what can you do if you’re already experiencing hip pain?If you need a hip replacement then the sooner you have it, the better the outcome is likely to be and the quicker you will recover from your operation. This is because the more pain you suffer prior to having surgery, the more compensations and adaptations the muscles and soft tissues will have made around the joint, in an effort to try and protect it and you from that pain, and the harder that will be to re-train once you’ve had the operation. That’s not to say it can’t be done, it will just take a bit longer and need a bit more of an investment in your time and energy. The good news is that outcomes from hip replacements are very good. Developments in materials and surgical techniques, mean that the artificial hips are lasting longer, and success rates are very good, with more than 80% of people experiencing pain relief and functional improvement, meaning their daily lives become easier and they’re able to do more.
We hope you find this information helpful and if you have any questions or queries, please feel free to get in contact with us 6676 4000 or 6676 4577.
We are running the GLA:D program as a preventative for surgery for hips and knees with osteoarthritis.
Headache If you’re one of the 47% of the global population who experiences regular headaches, you’ll know they’re no laughing matter. For some people, they’re just a minor inconvenience, for others they can be utterly debilitating, condemning you to a dark, quiet room for hours, and sometimes even days. The trouble is that successfully diagnosing a headache gets complicated, because more than 130 distinct disorders have been identified along with over 300 triggers, which makes a headache almost as unique as an individual. Luckily at Pottsville and Cabarita Physio we specialise in treating headache and can confidently determine if Physiotherapy will help you within the first session. Headache is a unique condition in that you can also simultaneously suffer one, two or more types of headache or a migraine at the same time, where one may cause another, or overlap with each other. These are known as mixed or multi-source headaches and can take longer to resolve as your therapist works through treating the different causes. For example, a dysfunctional painful neck can cause an increase in surrounding muscle spasm, which will increase your blood pressure. In this scenario, you could have a cervicogenic (neck) headache, with a tension headache and a resultant migraine! The most commonly diagnosed headaches are:
- Migraines (12%)
- Tension headache (75%)
- Cervicogenic headache (originating from the neck) (18%)
- Sinus headaches
- Some foods
- Skipped meals
- Lack of sleep
- Muscular tension
- High blood pressure
- Hormonal influences
RUN: Better, Faster, Longer, StrongerDo you dream of being that runner where every step of every mile is 100% pain free? No aches, no twinges or niggles, no lingering soreness from yesterday’s session. You are not alone; research shows that as many as 79% of runners get injured at least once during the year. Stop. Think about that number for a moment; nearly 8 out of every 10 runners you see at your next race have been or will be injured sometime that year. Think of running pains in terms of a spectrum. At one end you have severe, full-blown injuries, we’ll name that the red zone, which includes stress fractures that require time off. The other end, where you're in top form, is the green zone. Mild, transient aches that bug you one day and disappear the next sit closer to the green end. Unfortunately, many runners get stuck in the middle, in the not-quite-injured but not-quite-healthy yellow zone. Your ability to stay in the green zone depends largely on how you react to that first stab of pain. Often a little rest now, or reduction in training mileage and intensity, with some treatment, can prevent a lot of time off later. Developing a proactive long-term injury-prevention strategy, such as strength training, stretching, regular massage and foam-rolling can help keep you in the ‘green.’ Physical therapy is a lot like homework, not all of us like having to do it, but if you don't do it, you’re sure to get in trouble at some stage!
What Causes Running Injuries?There are a lot of theories as to what causes running injury but it seems the answer is fairly obvious: running! Research has stated that “running practice is a necessary cause for RRI (Running Related Injury) and, in fact, the only necessary cause.” With running being the key risk factor for running injuries what other factors influence risk? Historically a lot of emphasis was placed on intrinsic factors like leg length discrepancy, pronation (flat foot), high arches, genu valgus/varum (knock knee or bow legged) and extrinsic factors like ‘special’ running shoes being stability shoes or anti-pronation shoes, lack of stretching. However, recent studies have shown there is no one specific risk factor that has a direct cause-effect relationship with injury rate or injury prevention. Whilst warming up, compression garments, acupuncture and massage have some evidence in reducing injury rates it is all a little grey. Leaving you with a multifactorial buffet of probable contributing causes to running injuries. There is however one specific factor that has been proven, and that is training error. Estimates suggest that anywhere from 60 to as much as 80% of running injuries are due to training errors. Runners become injured when they exceed their tissues capacity to tolerate load. A combination of overloading with inadequate recovery time. Poorly perfused tissues, such as ligaments, tendons and cartilage, are particularly at risk because they adapt more slowly than muscles to increased mechanical load. Factors that affect how much training load a runner can tolerate before injury will also have a role. There are 2 key factors that appear to play a part in this – Body Mass Index (BMI > 25) and history of previous injury, especially in the last 12 months. While high BMI and previous injury may reduce the amount of running your body can manage, strength and conditioning is likely to increase it. There is a growing body of evidence supporting the use of strength training to reduce injury risk and improve performance. Training error and injury risk share a complex relationship - it may not be that total running mileage on its own is key but how quickly this increases, hill and speed training. The old saying of “too much, too soon” is probably quite accurate. Injury prevention is really a ‘mirror image’ of the causes of an injury. So, if you understand the primary reasons for getting injured then you are heading in the right direction to staying healthy this running season. What are The Most Common Injuries to be Aware of? Body tissues such as muscles and tendons are continuously stressed and repaired on a daily basis, as a result of both 'normal' functional activities and sport. An overuse injury often occurs when a specific tissue fails to repair in the time available, begins to breakdown initially at microscopic level and then over time develops into a true injury. So, the first time you feel a soreness, a stiffness or a pain is not necessarily when it all began. The most common injury is ‘runners knee’ or patellofemoral pain syndrome and accounts for over 40% of running injuries. This is followed closely by plantar fasciitis, achilles tendinopathy and then ITB (iliotibial band syndrome), shin splints and hamstring strain. These injuries generally need complete rest or at least a reduction in training volume and intensity. Followed by physical therapy to promote tissue healing and mobility. Although these are overuse injuries there is frequently an underlying muscle weakness and/or flexibility issue that needs to be addressed with specific rehabilitation exercises. If you do pick up an injury (including 'tightness' 'irritation' or 'niggle') that you’re worried about then we can help, the sooner it’s treated the better. And don’t forget to check out our Facebook page https://www.facebook.com/pottsvillephysiotherapy
• Correct your posture: think tall all the time, avoid sitting and holding your head up with your hands. • Consider your ergonomics especially your computer set up and how you use your digital devices. In particular, avoid a forward chin position and sustained head and neck rotation. • Learn to breathe properly: gentle breathing in and out through the nose with movement occurring at the solar plexus not in the shoulder region. Breathing should be silent and invisible. You should feel the sides of your chest wall expanding as you breathe in, not your shoulders rising or your belly expanding. • Manage your stress levels, you may need to start a meditation practice. There are many great apps (e.g.- head space, smiling mind etc) to help you get started. This is particularly important if you clench or grind your teeth. • Get adequate sleep. Aim to sleep with your head in a neutral position not rotated or side flexed. Aim for an absolute minimum of 8 hours every night. • Eat clean food: avoid processed food, excess alcohol and coffee. Eat plenty of vegetables! • Drink a lot of water (at least 33ml per kg of body weight / day) add an extra 250ml for every caffeinated drink (such as coffee) you have. • Avoid carrying anything other than a very light bag on your shoulder • Avoid extending the head / looking up for long periods • Watch the position of your head while exercising – ensure you maintain a neutral head position, (i.e. – not look up or around). • Do not over do it when exercising particularly when using your arms and upper body.