Category Archives: Pain Relief

Concussion Management Part 1: The Role of Physiotherapy

By Cassandra Kroner, PT

What is a Concussion?

Concussions are a type of mild traumatic brain injury. Common causes include car accidents, sports, falls, or workplace accidents. Concussions can result from direct impact to the head, or from forces elsewhere in the body such as sudden acceleration or deceleration that cause an  injury to the brain and brain-stem.  The result is damage to cells and chemical imbalances that disrupt normal brain function.

Concussion Head imageImmediately following injury a sequence of chemical processes occur as the brain attempts to restore its normal balanced state. This increased activity in the brain is happening at a time when blood flow is decreased to the site of injury, creating an increased demand for energy. The resulting impairments in neurological function can cause a variety of signs and symptoms:

Physical Behavioural/Emotional Cognitive
Headache Drowsiness or fatigue Feeling foggy
Nausea Irritability Trouble thinking clearly
Vomiting Depression Feeling slowed down
Blurred or double vision Anxiety Difficulty concentrating
Balance problems Sleeping more than usual Difficulty remembering
Dizziness Difficulty falling asleep Trouble finding words
Sensitivity to light or noise Sadness Confusion

 

First Steps Following Injury

Concussions are often under-reported and misdiagnosed, and it is important to note that loss of consciousness is not necessary for a diagnosis. Contributing to the difficulty in identifying concussions is the lack of imaging or other tests to aid in diagnosis. Unless there is bleeding or swelling in the brain, the changes that occur with a concussion are not visible on a CT or MRI. If a concussion is suspected, an evaluation by a physician is recommended, and unless symptoms are severe or quickly worsening it is usually not necessary to visit the emergency room. Once the diagnosis is established and conditions requiring further medical treatment are ruled out, treatment should begin immediately.

Early Management

HeadacheTimely intervention following a concussion is essential to ensure optimal management and recovery. An outdated approach to concussion treatment is to stay in a quiet dark room until symptoms are resolved. With a growing demand for evidence-based treatment strategies, there is a wealth of new research that refutes this old-fashioned ‘dark room’ approach. Although complete rest is recommended for the first 48-72 hours after injury, research supports a more active approach to recovery following the initial rest period. Prolonged physical rest can lead to de-conditioning, depression and fatigue, making it more difficult to return to the previous level of physical activity.

Complete physical and cognitive rest immediately following a concussion is critical to ensure adequate energy supplies for the brain as it attempts to heal. Excess physical or cognitive exertion at this time will use precious energy that the brain needs and can result in exacerbation of symptoms and prolonged recovery. Physical rest means no exercising and caution with exertion around the house. Cognitive rest should focus on refraining from activities that require concentration (schoolwork, reading), as well as visual attention (television, video games, computer or phone use). Alternative options are listening to music or audio books.

Importance of Physiotherapy

A visit to a physiotherapist with advanced concussion management training is recommended for a detailed assessment following a concussion. Your physiotherapist will take a thorough history and can assess visual and vestibular symptoms, balance, cognitive function, and any additional injuries sustained at the time of concussion. Recommendations for the initial rest period as described above will be tailored to each individual, and further suggestions for management of symptoms will be provided.

Treatment plans involve a carefully monitored graded program of exertion to assist with a safe return to work/school and then sport. Every individual will experience a different set of symptoms following concussion, and as a result there is not a ‘one size fits all’ approach to treatment. This is why having a professional guide you through recovery is valuable. Specific and progressive exercises will be provided to target deficiencies in the vestibular and visual systems. To facilitate a gradual return to school or work, suggested accommodations would be provided to minimize symptoms and maximize participation. Additionally, manual therapy to address complaints such as neck pain or headaches can be part of treatment. Once the individual has returned to school or work, physical exertion testing is the last step before being cleared for sport.

Recovery time frames vary between individuals, but for many people, symptoms resolve in a month or less. However, there are a number of factors that can delay or prolong recovery. Stay tuned for part 2 of the concussion management blog series to learn more.

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Physiotherapy after a Fracture

By Courtney Lacey, PT

fractureIf you have recently broken a bone, you may be wondering when you will be able to return to all of your normal activities. While it typically takes 4-8 weeks for a bone to heal, you will likely require physiotherapy to help get you back to full function.

How do fractures happen?

A broken bone, also known as a fracture, can occur in many ways. Most often, broken bones are the result of a traumatic mechanism of injury such as a fall, motor vehicle accident or contact during a sporting event. Fractures can also occur from repetitive motions which place stress on the muscles and bones. A common example of this is stress fractures in the legs from running. Finally, fractures can more easily occur in people with osteoporosis – a disease which weakens bones and makes them more likely to break.

How do you know if you have a fracture?

These are some signs and symptoms which may indicate that you have a fracture:

  • Immediate and severe pain following a fall or accident
  • A “pop” or “click” heard or felt during the incident
  • Swelling in the area
  • A bump or deformity
  • Unable to weight-bear through the injured limb

If you suspect you have a fracture, you will need to see a doctor who will order an X-ray to confirm the diagnosis. Often, those who experience an injury causing a fracture will go to the hospital to be evaluated.

Does a fracture heal?

While bone healing takes approximately 4-8 weeks, the timeline depends on both the person and the type of fracture.  In order for a bone to heal properly, it has to first be set in the proper position, which is called reduction. The doctor may be able to reposition the bones without surgery, which is called a closed reduction. Sometimes, surgery may be required to bring the ends of the bone close together, which is called an open reduction. Pins, plates or screws may also be used to keep the bones in place. If the fracture did not cause any part of the bone to shift out of place, no reduction is needed. Once the doctor has determined the bones are in a good position to allow for healing, the area will be immobilized in a cast or a splint.

When can the cast come off?

To determine if you are ready to have the cast removed, you will have an X-ray done with the cast or splint in place. The doctor will look for the formation of a callus, which demonstrates that healing has taken place. The doctor will then remove the cast and may recommend that you have physiotherapy. Physiotherapists play a key role in returning you to your full function as quickly as possible after a fracture.

Why do I need physiotherapy?

There are several reasons why physiotherapy is needed after fracture. Depending on the amount of healing that has occurred, your doctor may have special instructions (how much weight to put through the limb, certain activities to avoid, etc.) that your physiotherapist can help you understand. Once the cast is removed, you may still have some swelling and pain around the fracture site. Physiotherapists may use modalities (such as ultrasound or TENS) to help decrease pain and swelling and improve your mobility and tolerance for using the injured limb in daily activities. If you had surgery, you may also have a scar which creates scar tissue and can disrupt movement. At BodyTech Physiotherapy your therapist will use manual therapy techniques to help mobilize the scar tissue and the areas around the injury as needed to  restore normal movement around the surgical site.

Physiotherapy is crucial to improve your functional mobility that you may have lost during your time in the splint or cast. Immobilization over 6-8 weeks will cause loss of range of motion and strength, which will make daily tasks difficult to do. Your physiotherapist will help restore your proper range of motion using manual therapy techniques. While the fracture site will be stiff and sore, you may also lose range of motion at surrounding joints that were moving differently during the healing process. For example, if you have broken your elbow, it is also necessary to  assess your shoulder, wrist and hand to ensure that these joints are moving properly. Not correcting the mobility around the fracture site can prolong your healing process and lead to future injuries as well.

Once your range of motion has been restored, you will need to regain strength in order to return to your pre-injury activities. Your physiotherapist will work with you to create a proper strengthening program to re-introduce your bones to loads and stresses that you encounter in your daily activities. Lack of strength or going back to activity too soon puts you at risk of re-injury or prolonging the healing process. Physiotherapy will help you understand the correct exercises to do and will tailor your program to the activities you plan to return to, whether it be high level sport or recreational activity.

How long until I am back to my regular activities?

Your rehab program will vary in length depending on the type of fracture, if there was surgical intervention, and the type of activity you plan to return to. Depending on the nature of the injury, physiotherapy can take anywhere from 8 weeks to one year for more complex fractures. Your physiotherapist will guide you through your rehab program, ensuring you are progressing at an appropriate rate and prevent complications or future injury.

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Frozen Shoulder/Adhesive Capsulitis

By Carla Cranbury, PT

What is it?

Frozen shoulder, also called adhesive capsulitis, is a gradual onset shoulder condition characterized by pain and limited range of motion. This is caused by inflammation and tightening of the shoulder capsule. Typical initial symptoms are pain midway between the shoulder and the elbow and difficulty reaching behind the back. Most women will report that they have difficulty doing up their bra and men difficulty putting on their belt.

Why does it happen?

Limited research has been able to discern one certain cause of frozen shoulder – in short, we don’t know. We do know that it is most common in middle aged women (aged 40-65) and people with diabetes. It also is more likely to occur after a virus, a lingering shoulder injury or after shoulder or upper limb surgery.

How long does it take?

Frozen shoulder goes through three main stages, each of which can take weeks to months:

  • Freezing – pain is noticed and range of motion becomes progressively limited
  • Frozen – pain is reduced, but range of motion is further restricted
  • Thawing – pain is reduced and range of motion gradually returns

Can physio help?

Physiotherapy cannot speed up the course of the condition – everyone has to go through each of the three stages in order to recover. The total process of frozen shoulder can take one to two years to resolve.

What physio can do is help you retain function while going through frozen shoulder, decrease some pain, and ensure a full recovery. Maintaining mobility through the process is important and is where physiotherapy can help the most. Physio will also help prevent other injuries that can be caused by compensating for the frozen shoulder – this is especially significant as it is common for the other shoulder to get the same condition.

Your physiotherapist will give you exercises to maintain as much movement as possible and instruct you on how to perform them properly to ensure you are not compensating for the limited range of motion. Hands on manual therapy will help stretch out the capsule to make the exercises easier to perform. Modalities such as ice, heat, TENS, and acupuncture can also be used to decrease pain.

Though frozen shoulder can be a lengthy and frustrating process, the right care can make it more manageable and prevent any further complications.

BodyTech Physiotherapy

 

Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4:193–6.[PubMed]
Greene WB. Essentials of musculoskeletal care. 2. Rosemont, IL: American Academy of Orthopedic Surgeons; 2001
Pal B, Anderson J, Dick WC, Griffiths ID. Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin dependent diabetes mellitus. Br J Rheumatol. 1986;25:147–51. doi: 10.1093/rheumatology/25.2.147. [PubMed] [Cross Ref]
Bridgman JF. Periarthrits of the shoulder in diabetes mellitus. Ann Rheum Dis. 1972;74:738–46.
Hazleman BL. Frozen shoulder. In: Rockwood CA Jr, Matsen FA III, editors. The shoulder. 2. WB Saunders: Philadelphia; 1990.
Harryman DT, Lazurus MD, Rozencwaig R. The stiff shoulder. In: Rockwood Cam Matsen FA, Wirth MA, Lippitt SB, editors. The shoulder. 3. Saunders: Philadephia; 2004.

The Sitting Solution

By Carla Cranbury, PT

Let’s face it, we sit a lot. Between working, commuting, and watching television, the Canada Health Measures Survey found that most Canadian adults spend 9 hours and 48 minutes of their waking time being sedentary. Most of us know that physical activity is good for us, but did you know that just sitting less (regardless of exercise) can also be beneficial in the long term?

A study published in 2009 followed more than 17 000 Canadians for 12 years. Over the twelve years they compared the participants’ daily sitting time and leisure time physical activity with mortality rates of various causes. What they found was that the amount of daily sitting time was positively associated with mortality rates from all causes, except cancer. Basically the more people sit, the higher the risk of mortality. This even includes people who are physically active, showing that high amounts of sitting time cannot be compensated for with exercise, even if it exceeds the current minimum physical activity recommendations.

Other studies have echoed similar findings. A seven year study reported that people who spend less than half their time sitting have a lower risk of mortality than those who spend more than half their day sitting. Another six year study reported that women who spend 16+ hours sitting per day have an elevated risk for cardiovascular disease compared with women who sit for less than 4 hours a day.

These studies are not to say that physical activity is not important – it still is, and it is still beneficial for your health. Physical activity also contributes to decreased time spent sitting.  What these studies are saying is the physiology associated with excessive sitting is different than the physiological benefits of exercise, and therefore excessive sitting cannot be compensated for with periods of exercise.

So now that you know, what can you do?

If you work at a desk most of the day, sitting can be hard to avoid. Some options are:

  • Ask your work if they can accommodate an ergonomically sound standing desk
  • Take frequent breaks from sitting to walk around
  • Go for a walk on your lunch break
  • Walk to your co-workers desk to talk to them instead of sending an email
  • Park at the back of the parking lot to get a few extra steps
  • Take the stairs!
  • Take frequent standing breaks throughout the day
  • Discover new ways to be active during your leisure time – ditch the TV and get outside

It’s the small changes to your daily routine that can add up and make a big difference. The best time to start is today!

BodyTech Physiotherapy

References

Katzmarzyk, Peter T. et al. “Sitting Time And Mortality From All Causes, Cardiovascular Disease, And Cancer”. Medicine & Science in Sports & Exercise 41.5 (2009): 998-1005. Web.

“Directly Measured Physical Activity Of Adults, 2012 And 2013”. Statcan.gc.ca. N.p., 2017. Web.

Manson, J.E., P. Greenland, and A.Z. LaCroix. “Walking Compared With Vigorous Exercise For The Prevention Of Cardiovascular Events In Women”. ACC Current Journal Review 12.1 (2003): 29. Web.

Weller, Iris and Paul Corey. “The Impact Of Excluding Non-Leisure Energy Expenditure On The Relation Between Physical Activity And Mortality In Women”. Epidemiology 9.6 (1998): 632-635. Web.

Shin Splints

RunnerMedial tibial stress syndrome, commonly called “shin splints”, is a term used to describe pain and tenderness felt on the inside, lower border of the shin bone. Shin splints are commonly experienced by athletes who take part in activities involving repetitive running and jumping, particularly after a sudden increase in activity level (either duration, distance or intensity). The repetitive stress placed on the bones, muscles and joints of the lower leg during these high impact activities may result in irritation and inflammation of the shin bone (tibia).

Shin splint pain is usually described as a dull ache. It usually develops slowly over time, first being noticed at the end of activity. Some athletes may complain of pain at the beginning and end of activity, but not affecting their performance. Over time, pain will commence during activity and eventually may be felt during regular day to day activities such as walking. As shin splints progress, they also make the lower leg sore to touch.

Bones- Shin SplintsThere are a number of factors that may predispose an athlete to develop shin splints including: flat feet, rigid arches, muscle weakness, and/or muscle tightness. Other contributing factors may include running downhill, running on hard surfaces, running in worn-out footwear, or playing sports with frequent stops and starts (e.g. basketball, squash, tennis). While the pain presentation is often similar across individuals, there are a variety of bio-mechanical abnormalities in the pelvis, hips, knees, and ankles that can also lead to the development of shin splints.

Proper treatment requires a detailed assessment by a registered Physiotherapist to identify and target the contributing factors as well as the location of pain. Treatment includes rest, ice, specific joint mobilizations, an individualized stretching and strengthening program, and if needed a gradual return to regular activity. During recovery, aerobic fitness can be maintained with low impact activities such as swimming and biking. If left untreated, the repetitive stress on the tibia may result in a stress fracture yielding a longer recovery time.

A physiotherapist can perform a full assessment to determine the exact cause of an athlete’s pain and develop a treatment program to relieve pain, facilitate return to activity, and prevent future injury.

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Physiotherapy for Carpal Tunnel Syndrome

Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is pain, numbness, and tingling, in the wrist and hand particularly in the thumb, index and middle finger. This syndrome affects approximately 3-6% of the general population. The carpal tunnel is a small passageway at the wrist that tendons and the median nerve run through as they travel into the hand. The tunnel is surrounded by bone and connective tissue so it does not easily stretch or expand, making structures within it susceptible to irritation which can cause the median nerve to be compressed. If left untreated and the condition worsens, symptoms may progress to include weakness in the hand.

Causes and Risk Factors
A combination of several of the following factors can increase the risk of developing carpal tunnel syndrome:

  • Chronic stress on wrist/hand – typically affecting the dominant hand, often due to working posture or repetitive motions (eg. using computers for several hours a day, assembly-line workers, musicians, using vibrating power tools)
  • Trauma to the wrist (eg. fracture, sprain) – can cause damage to the nerve or swelling to other structures that will narrow the carpal tunnel
  • Pregnancy – hormonal changes can affect tendons and cause swelling
  • Arthritis – bony growths into the tunnel narrow the space
  • Congenital Predisposition – women and smaller individuals may have narrower carpal tunnels, reducing space for the nerve
  • Diabetic or Metabolic Disorders – negatively affect the body’s nerves

Symptoms
The most common symptoms of carpal tunnel syndrome include:

  • Gradual onset of pain, burning, tingling, numbness or itching in the palm, thumb and/or index and middle fingers
  • Feeling of weakness and swelling in the hand, with difficulty grasping small items, making a fist and performing fine motor tasks
  • Urge to shake out the hand to relieve the tingling sensations

In the early stages, symptoms will often be intermittent. However, as the condition worsens symptoms are more severe and begin to persist for longer periods of time. Pain and numbness tends to be worse at night for a lot of individuals.

Treatment
It is advised to seek treatment from a professional as soon as carpal tunnel symptoms arise as the condition will not typically resolve on its own.

Medication: Over the counter anti-inflammatory drugs (eg. Ibuprofen) may provide short term relief from mild symptoms. Corticosteroid injections are a much stronger anti-inflammatory, and may also be a temporary option to help relieve pressure and symptoms for those with relatively mild symptoms.

Physiotherapy: Seeking help from a registered physiotherapist is one of the best options for treatment of carpal tunnel syndrome. Physiotherapy will include manual therapy on your wrist to improve the mobility of the joints and stretch tight muscles and tendons in the wrist and fingers, helping to remove any scar tissue buildup that may hinder recovery. The Physiotherapist will also incorporate nerve gliding techniques to help improve the mobility of the median nerve through the carpal tunnel. Ultrasound may be used over the carpal tunnel area to reduce inflammation which helps to relieve symptoms. Your physiotherapist may also suggest a brace or splint to immobilize the wrist while working or performing aggravating activities. They will provide education about activity modification to avoid aggravating positions, such as holding the wrist in a flexed (bent) position. Your physiotherapist will also prescribe specific stretching and strengthening exercises for the fingers, thumb, hand and arm to progress through later stages of recovery. They will provide education on proper posture while working to prevent relapse.

Surgery: With very severe cases of carpal tunnel syndrome where nonsurgical treatment does not provide any relief, surgery may be an option. The surgery typically consists of cutting the roof of the carpal tunnel, to provide more room for the tendons and median nerve and decrease compression. Full recovery back to original strength in the hand may take 6-12 months.

While carpal tunnel is a relatively common condition, it is often misdiagnosed, thus it is a good idea to seek treatment from a registered physiotherapist upon the onset of symptoms in order to have the best chance of full recovery and to prevent irreversible damage. Your physiotherapist will be able to recommend appropriate treatment options, whether that be manual therapy, bracing, or if necessary, surgical intervention.

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Tennis Elbow

Tennis Elbow

Lateral epicondylitis, more commonly referred to as “tennis elbow”, is a term used to describe pain just above the elbow joint on the outer side of the arm. Contrary to popular belief, tennis elbow is not a condition that is exclusive to tennis players or athletes. The term tennis elbow was coined from the fact it can be a significant problem for as many as 50% of tennis players during their careers. However, less than 5% of reported cases of tennis elbow result from playing tennis!

More specifically, tennis elbow is a tendinopathy at the origin of the extensor carpi radialis brevis tendon (the tendon that is responsible for wrist extension). This tendinopathy is due to degeneration of, or damage to the tendon causing inflammation and subsequently, pain. In order to understand what causes tennis elbow, it is important to first understand tendons and how they function. Tendons are like “ropes” made of collagen tissue. They are flexible, but do not stretch when pulled. It is the job of the tendon to connect muscle to bone. In the case of tennis elbow, the area on the bone where the tendons attach, just above the elbow on the lateral side (or outer side) of the arm, are sometimes incapable of handling the force of the arm muscles. Strong forces or sudden impact to the tendons at this point of attachment are what cause damage, like small tears in the fibers of the tendon (similar to a rope becoming frayed).

Activities that exacerbate tennis elbow symptoms are those that involve repetitive motion of the arm, forearm, wrist, and hand. Movements that are commonly associated with the development of tennis elbow are: lifting, gripping something tightly in combination with inward or outward rotation of the forearm, jerky throwing motions, swatting with the hand, and simultaneous rotation of the forearm and bending of the wrist. Racquet sports may be the most “popular” activity to associate with tennis elbow, but as previously mentioned most cases are the result of a wide range of actions that include, but are not limited to: painting/plastering, excessive and repetitive use of a computer mouse, carpentry work, gardening and repetitive lifting and carrying.

Tennis elbow can be suspected when performing routine tasks, such as gripping objects or turning doorknobs, become painful. A physician or physiotherapist can diagnose tennis elbow by discussing symptoms and examining the affected arm. Diagnostic tests are not typically necessary for an accurate diagnosis, however, a physician may request an X-ray or MRI imaging if symptoms do not improve with treatment.

Treatment options for tennis elbow include modifying activities that exacerbate symptoms. Movements that cause an increase in pain should be avoided to help allow the tendon to heal. Pain management is also important to consider. Anti-inflammatory painkillers are commonly used for some symptomatic relief, however physiotherapy remains the most successful tool in the treatment of tennis elbow long-term. A physiotherapist will perform manual therapy on the affected arm, to mobilize the underlying stiff joints and tight structures. Modalities such as ice, and ultrasound, as well as taping may be used to ease pain and encourage healing. A physiotherapist will implement stretching and strengthening exercises to help restore normal function of the arm, and also prevent tennis elbow from occurring in the future.

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