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Keep moving with kneecap pain
Keep moving with kneecap pain
Pain 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
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.
Exercise Guidelines
Exercise Guidelines
Many clients ask how much exercise should I be doing? It is a question that is often asked and not many people seem to be able to answer. In many cases, injuries are caused by deconditioning and muscle atrophy, which leads to problems with pain and loss of physical function. It is important that people get sufficient exercise to maintain their level of function and current fitness levels, however it is important that people know how much activity they should be doing.General Exercise Guidelines
The Australian Government department of health states that adults between the ages of 18-64 should accumulate a total of 300minutes of vigorous exercise per week, including completing specific muscle strengthening exercise on 2days. For people aged 65 years + it is recommended that people complete 30 minutes of moderate intensity exercise every day.What is vigorous exercise?
Vigorous exercise is counted as exercise where you are breathing hard and fast, with a moderate increase in your heart rate.What is moderate intensity exercise?
Moderate-intensity aerobic activity means you're working hard enough to raise your heart rate and break a sweat. One way to tell if you're working at a moderate intensity is if you can still talk but you can't sing the words to a song.Is walking enough?
People often ask if walking is enough. If you are walking at a moderate intensity as described above, for 30 minutes per day, then you should be meeting recommended exercise guidelines for people aged 65 +. However, if your physio advises strengthening a muscle group or area, then walking is not sufficient.How to build strength?
https://www.youtube.com/watch?v=2tM1LFFxeKg Strength is often recommended to rehabilitate an injury and protect an area of the body. Strength is built by placing the tissue under stress so that you are causing microscopic damage to the tissue. Once this damage occurs, the body will heal the area, making it stronger and able to withstand greater stresses in future. Our bodies have adapted to be able to cope with the demands of everyday activities, so it is important that when strengthening a muscle you are placing it under sufficient loads that are greater than what the body typically experiences. If you are not meeting the recommended exercise guidelines including 2 sessions of muscle strengthening per week, you may be vulnerable to muscle loss or atrophy, and may be developing a greater risk of injury. In summary, completing adequate levels of activity are important for maintaining physical functional and limiting the effects of injury. Physiotherapists are experts in instructing people on how to exercise in the presence of injury or pain. If you are unable to meet your activity levels due to injury, then ask the physio how to work around the injury whilst we help the body to heal.Remedial massage
Remedial massage
The intention in remedial massage is to ‘remedy’ the body. This style of massage holistically looks at the entire body, with its focus being treating pain, structural dysfunctions and helping in injury rehabilitation. Remedial massage therapists use assessments and tests to find out what structures are causing your pain or your postural dysfunction. Usually muscular pain such as low back pain, is caused by either weak muscles, overactive muscles or compensating muscles. Once the remedial therapist has found the cause of your pain/discomfort, the massage will then be focused around treating the muscles that are causing the pain in your body. Therefore remedial massage is specifically tailored to each individual unlike most relaxation massages. A remedial massage will involve a variety of techniques, targeting specific muscle groups. Some techniques include trigger point therapy, PNF stretching, Myofascial release and muscle stripping. The pressure in remedial massage can be at times deeper than in relaxation massage, but always working in what is tolerable for the client. People who will benefit from a remedial massage include anyone who is experiencing muscle tension, or anyone experiencing acute or chronic pain, some examples being low back or neck pain. Like relaxation massage remedial massage is also beneficial at stimulating blood flow throughout the body and assisting in toxin removal. Although remedial massage may not be considered as relaxing at a relaxation massage, it’s still very effecting at calming the mind and body. Especially seems as remedial massage treatments can take away your musculoskeletal pain, which has a direct effect on your mental and emotional state.What can Physio’s do for jaw pain?
What can Physios' do for jaw pain? The idea of seeing a physiotherapist for jaw pain may seem a bit out of context. You might think a dentist may have the tools to help. Physiotherapy for jaw pain has been around for a long time now. We treat Jaw issues from locking, pain, jaw deviations on opening and closing, and clicking sounds. These issues may come from a dental procedure, clenching/grinding at night, neck referral pains, degenerative disc, a physical altercation after having a rowdy night at the pub. Physiotherapy treatment can include:
- Soft tissue therapies to the surrounding muscles, potential even the pterygoid muscles inside your mouth (wearing gloves of course)
- Joint mobilisations e.g. gentle tractions for a stiff locked joint
- Exercise prescriptions
- Dry needling
- Neck treatments
- And of course, education and advice
What is degenerative disc disease
What is degenerative disc disease
Degenerative disc disease is commonly seen in lower back and neck CT’s and MRI’s. It is a radiological term used for explaining anatomical changes in a disc rather then a pathology. Having this in mind when degenerative disc disease is coupled with pain it is most commonly due to issues with surrounding structures e.g. weakness and/or stiffness. Having degenerative disc disease does not always mean that it is causing pain output. Weaknesses of surrounding structures can lead to shear, compressive or tensile forces which make the more vulnerable discs stress. The protocols to then treat a painful back with a history of degenerative discs is to make sure surrounding structures are strong and supple. This will take away the forces on the vulnerable discs. It does not mean though that those discs will heal it only means a better managed pain state. These discs will always be structurally vulnerable due to their lifetime of stressors. Do not wrap yourself in bubble wrap to avoid this natural wearing of discs as it will most likely happen quicker. Be aware of remaining constantly active throughout your lifetime and treat your body with the respect it deserves.Lateral Hip Pain
Lateral Hip Pain
Have you recently started to get pain in the side of your hip? Has it been there before and then come back again? Have you had corticosteroid injections that have relieved pain temporarily or not at all? If so, read the blog below to help you get on-top of your stubborn hip pain and start the pathway back to performance. Lateral hip pain can be referred to as Greater Trochanteric Pain Syndrome, Trochanteric Bursitis, Glute Medius Tendinopathy or Hip Bursitis. All these terms are used to describe pain inside the hip and buttock region, on the bony part on the side of your hip (greater trochanter) and sometimes down the outside of the thigh. The hip pain can be aggravated by sitting cross-legged, prolonged walking, prolonged sitting, climbing stairs/hills and lying on the painful hip. Ultrasound imaging of lateral hip pain often illustrates inflammation or thickening of the trochanteric bursa or ‘bursitis’. A bursa is a small fluid-filled sac that provides a cushion between bones and tendons throughout the body to minimise friction. You may have been given a corticosteroid injection into your bursa to ease this inflammation. These injections can be effective in reducing your pain, but this may only be short-lasting! Often trochanteric bursitis is a secondary reaction to a Gluteus Medius/Minimus tendinopathy or weakness in this hip muscle group. Dysfunction in these muscles can increase the compression force on the bursa and tendons. Prolonged and repeated compression of these structures without suitable exercise and lifestyle modifications can cause thickening and inflammation of the bursa, and potentially tendon degeneration.Why can neck pain cause vertigo, dizziness and/or headaches
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
Tendinopathy
Tendinopathy
Tendinopathy refers to an unhealthy tendon characterised by overuse and the presence of tiny tears along with the breakdown of collagen fibres and other changes to the intracellular structure of the tendon. Here are some vital facts to know about tendinopathies. 1) Tendinopathy does not improve with rest. Pain may settle temporarily but returning to activity is often painful again because rest does nothing to increase the tolerance of the tendon to load. 2) There is NO good evidence that these injuries are caused by inflammation. Therefore, anti-inflammatories often have limited effectiveness for these injuries. 3) The main factor for tendinopathy is overuse or simply too much of certain activities. Activities that require the tendon to store energy such as walking, running, jumping, along with loads that cause compression are the most common causes of tendinopathy. Tendon pain is sometimes caused with only subtle changes in activity. 4) Exercise is the most evidence-based treatment for tendinopathy – tendons need to be loaded progressively so that they can develop greater tolerance to load. In a vast majority of cases tendinopathy will not improve without this. 5) Modifying load is important in settling tendon pain. This often involves reducing tendon load that involves energy storage and compression. 6) Pathology on imaging is NOT equal to pain. This is one of the things that most people have the most difficulty understanding about tendon injuries. You can have severe pathology or tearing of the tendon, but this will not determine the amount of pain you will have or necessarily affect your recovery. Tendon pathology is also common in people without pain, 7) Tendinopathy rarely improves long term with only passive treatments such as corticosteroid injections, massage, acupuncture, dry needling, etc. Exercise is the most important treatment and passive treatments should only be used as adjuncts. There is lots of evidence to support this and if you are interested, more information can be found in the links provided. 8) Exercise needs to be individualised to a person’s pain and presentation. There must be progressive increase in load to enable restoration of function whilst respecting pain. 9) Tendinopathy responds very slowly to exercise. You need to have patience, ensure that exercise is correct and progressed appropriately, and try and resist the common temptation to accept ‘short cuts’ like injections and surgery. There are no short cuts.References
Abate M, Gravare-Silbernagel K, Siljeholm C, et al.: Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research and Therapy. 2009, 11:235.
Cook J, Purdam C: Is compressive load a factor in the development of tendinopathy? British Journal of Sports Medicine. 2012, 46:163-168.
Littlewood C, Malliaras P, Bateman M, et al.: The central nervous system–An additional consideration in ‘rotator cuff tendinopathy’and a potential basis for understanding response to loaded therapeutic exercise. Manual therapy. 2013.
Malliaras P, Barton CJ, Reeves ND, Langberg H: Achilles and Patellar Tendinopathy Loading Programmes. Sports Medicine. 2013:1-20.
WHAT CAN AN EXERCISE PHYSIOLOGIST DO FOR YOU?
12.01.21
