Category Archives: Pain Relief

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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Acupuncture

Acupuncture is a form of treatment which involves the insertion of tiny needles into the skin at very precise points throughout the body. The needles are solid, sterile, and single-use. No medication is injected. The presence of the needles creates a therapeutic effect by encouraging healing, reducing pain, and promoting energy.

Acupuncture

How does acupuncture work?
There are two approaches to acupuncture: classical acupuncture and anatomical acupuncture.

Classical acupuncture is rooted in Traditional Chinese Medicine (TCM). In TCM theory, energy flows through the body in predictable channels, called meridians. Pain and dysfunction occur when the flow of energy is deficient or out of balance. TCM theory proposes that acupuncture relieves pain and promotes good health by restoring the body’s energy balance. The acupuncture points are located along the meridians. Needles are inserted to correct energy imbalance and restore energy flow throughout the meridian. Therefore, pain and dysfunction in one part of the body can be treated with acupuncture points at a distant location in the body.

Anatomical acupuncture was developed based on Western anatomical and physiological concepts. In this theory, acupuncture has both local and distant effects:

  • Locally, acupuncture needles stimulate the release of endogenous opioids at the site of the needle. Endogenous opioids are natural painkiller molecules that are synthesized in the body and released to decrease pain. Blood supply to the area is increased, which promotes healing by improving the delivery of oxygen and immune cells to the injured tissue. Immune cells, such as mast cells, macrophages, and fibroblasts aid the natural process of tissue healing. The needles also suppress the local inflammatory response, which further helps to decrease swelling and pain.
  • Distal to the needle site, acupuncture stimulates peripheral afferent nerves. Afferent nerves carry sensation signals from nerve endings to the brain (such as sensations of touch, temperature, and pain). The acupuncture needle interacts with the afferent nerves to modulate and suppress the transmission of pain to the brain. This reduces the perception of pain.

What are the benefits of acupuncture?
Acupuncture is effective in treating a wide variety of neurological and musculoskeletal disorders, including:

  • Tendonitis and tendinopathy
  • Ligament sprains
  • Muscle strains
  • Myofascial pain and inflammation
  • Osteoarthritis
  • Nerve pain, such as sciatic pain
  • Low back pain and disc bulges
  • Whiplash and other neck pain
  • Muscle tension headache and suboccipital headache
  • Bell’s palsy and trigeminal neuralgia
  • Fibromyalgia

In Traditional Chinese Medicine (TCM), acupuncture is used to treat many other conditions:

  • Digestive problems (nausea, vomiting, constipation)
  • Respiratory problems (sinusitis, congestion, bronchitis)
  • Urinary problems
  • Menstrual pain
  • Insomnia
  • Anxiety and stress

What can I expect from acupuncture treatment?
The reaction to treatment is unique to each person. Some people feel relief immediately, while others notice improvement after hours or days. Some people require several treatments before noticing improvement. Some people do not respond at all. The number of treatments required varies for each patient and condition. Similar to most types of treatment, acupuncture works best if it is repeated a few times.

Are there any side effects?
There are usually no side effects to acupuncture treatment. The most common side effects are tenderness or slight bruising/bleeding at the needle site, but these only occur approximately 6% of the time. Occasionally, someone may feel nauseous, faint, or dizzy. This occurs less than 1% of the time.

Your physiotherapist will assess you thoroughly to ensure that you are a safe and appropriate candidate for acupuncture treatment.

Preparing for acupuncture treatment
Prior to treatment, have a light meal and be well-rested. Avoid alcohol or sedative medications for 4 hours before treatment, and avoid smoking tobacco for 1 hour before treatment. Continue to take medication as prescribed by your doctor.

After acupuncture treatment avoid alcohol, caffeine, and smoking tobacco for 1-2 hours. If you are being treated for pain relief, avoid strenuous activity for 1-2 days after treatment, even if you feel pain-free.

Conclusion
Acupuncture is a useful adjunct treatment to physiotherapy. It is effective for treating a wide variety of musculoskeletal and neurological problems, including acute and chronic conditions. Your physiotherapist will assess you thoroughly and create a treatment plan to address your unique needs.

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References
ZQ Zhao. Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology. (2008)

ZJ Zhang, XM Wang, GM McAlonan. Neural acupuncture unit: A new concept for interpreting effects and mechanisms of acupuncture. Evidence-Based Complementary and Alternative Medicine (2012)

SM Wang, ZN Kain, P White. Acupuncture analgesia: I. The scientific basis. Anesthesia and Analgesia (2008).

 

Physiotherapy for Temporomandibular Joint Disorder

Temporomandibular joint disorders (TMD) is a broad term that encompasses various disorders of the temporomandibular joint (TMJ). If you experience jaw pain with chewing, jaw clicking/popping, facial pain, or frequent headaches, you might have a TMD. Physiotherapists can diagnose and treat TMD.

Temporomandibular Joint (TMJ) Anatomy and Function

The TMJ is composed of two articulating bones: the temporal bone (part of the skull) and the condyle of the mandible (jaw bone). There is an articular disc located between the two bones. The disc is firm but flexible, and its purpose is to reduce friction and cushion the repetitive force between the two bones during chewing, talking, and any other joint movement.

During jaw opening, the condyle of the mandible and the articular disc normally slide forward in unison. The muscles surrounding the joint are responsible for moving the mandible and the disc in sync. If the condyle and the disc are out of sync with each other, this is called disc displacement and is characterized by pain and clicking sounds when opening the mouth.

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Symptoms

Symptoms of TMD can include the following:

  • Jaw pain when opening the mouth wide or chewing
  • Locking of the jaw
  • Limited range of motion, or unable to fully open the mouth
  • Painful clicking or popping when opening or closing the mouth
  • Tooth wear and tear from grinding or clenching the jaw
  • Facial pain
  • Headaches
  • Ringing in the ears

Causes of TMD

Often, there is no single cause of TMD. There is usually a combination of factors which predispose a person to TMD.

Poor posture of the neck, head, and shoulders contributes to muscular tension and strain. Poor posture may cause muscle imbalance and changes in muscle length in the neck and shoulders. These muscles pull on the jaw and can alter the resting position of the mandible in the joint, resulting in increased stress on the TMJ and disc. After prolonged time, the joints in the neck and back may become stiff and cause associated symptoms such as neck pain, limited range of motion, and headaches.

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In addition, jaw clenching or teeth grinding may contribute to the development of TMD. When the jaw is clenched, the muscles are under increased tension and may pull the disc out of position. It normally happens while the person is asleep, so they are unaware they are doing it. Clenching or grinding can also result from being under stress (e.g., at home or at work) for a prolonged period of time.

Finally, trauma or injury to the TMJ (such as a broken jaw) may predispose a person to TMD.

Treatment for TMD

Physiotherapists assess and treat TMD using non-surgical and drug-free techniques. The physiotherapists at BodyTech Physiotherapy will evaluate your condition to determine the underlying factors contributing to your pain. They will prescribe an individualized exercise and stretching program based on your unique needs. Our physiotherapists are also trained to correct biomechanical changes of the TMJ and neck using manual therapy.

Other options for treatment include:

  • Relaxation procedures
  • Acupuncture
  • Dietary modification to relieve jaw pain during chewing
  • Dental orthotics or mouthguards worn at night. These help to prevent teeth grinding and jaw clenching
  • Pain relief and anti-inflammatory medications
  • Medications to relax the muscles of the jaw
  • Surgery, in rare cases

Temporomandibular joint disorder is a complex and multifaceted condition. With all the factors that can contribute to TMD it is important to visit a physiotherapist for a detailed assessment to ensure treatment is individualized to your specific issues.  If you experience jaw pain and headaches, consider seeking help from a physiotherapist.

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Massage Therapy for Injury Prevention

image1When muscles become tight and sore, seeking out the help of a Registered Massage Therapist (RMT) is always a smart idea. But, why wait until things get bad before working with a RMT? Massage therapy is not only effective in relieving existing pain and discomfort, but it is also an important step in preventing symptoms from occurring in the first place.  Using massage therapy to help you address issues such as muscle imbalances, posture, repetitive strain injuries and stress can prevent future injuries and pain from affecting your daily life.

Massage therapy can be used to help maintain good posture by addressing shortened, tight or sore muscles. Good postural muscle balance is important because an imbalance in the muscles surrounding a joint can cause discomfort and thus lead to injury. Posture is affected by the way you hold your body when sitting, standing, or moving. Improper posture over time leads to changes in muscle length. Possible consequences of poor posture include neck, shoulder, and back pain, or headaches and jaw pain from increased stress on muscles, joints, tendons and ligaments. Muscles will become shortened and tight from being in a slouched position, and the muscles on the other side of the joints will become lengthened and weak from constantly being stretched. When this kind of muscular dysfunction occurs, joints and ligaments are not receiving the support they need from the surrounding muscles. Without this stability, the joints and ligaments become more vulnerable to injury. The resulting muscle imbalance limits range of motion, changing the way the body moves, which will affect work or sport performance. Regular massage therapy can be used to restore neutral posture and decrease muscle tension.

Repetitive strain injuries occur when the same motions are being repeated frequently. Common sites for repetitive strain injuries are in the wrists, elbows, shoulders, and low back. These types of injuries can be avoided by ensuring there is good muscle balance in the areas of the body that are being most frequently used. This will ensure the joints, ligaments, and tendons are being properly protected from injury.

Stress is one of the most common causes of tight and painful muscles seen by massage therapists. When your body is stressed, the natural reaction for your muscles is to tense up. This is the body’s defense mechanism against injury or pain. Stress can be physiological (ie. from chronic painful conditions), or emotional. Prolonged periods of stress and muscle tightness can cause abnormal muscle tension, as well as mental/emotional symptoms such as irregular sleep patterns, anxiety, and mood disorders. Receiving regular massage therapy has been proven to help relax muscles and restore normal muscle tension, as well as improve sleep quality, mood, and relieve anxiety.

Seeking preventative care from your Registered Massage Therapist is vital to maintaining normal range of motion, correcting posture, and reducing stress. Working with your massage therapist on a consistent basis throughout the year will ensure problem areas are identified before they become painful, and therefore prevent further injuries.

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Physiotherapy Treatment for Headaches

headacheMost of us have experienced a headache at some point in our life. For some people they are a more frequent occurrence and can have a significant impact on their daily lives. Over the counter medication is the most popular choice for immediate symptom relief, however for certain types of headaches, while medication may help to relieve the symptoms, the underlying cause of the headaches is not being treated, and symptoms are likely to return. What most people don’t realize is that Physiotherapists can treat the root cause of most headaches, not only relieving the immediate pain, but prevent it from reoccurring. Headaches can typically be grouped into three main types, tension, cervicogenic, and migraine. Each type is characterized by different causes of headache pain.

Tension Type Headache

Tension headaches are the most common. Pain from a tension headache is usually described as a dull pressure or tightening sensation. The pain is typically felt in the forehead, both temples and the back of the head. A tension headache can last anywhere from thirty minutes to seven days. A tension headache will not cause nausea but it may cause either increased sensitivity to light or sound. There are numerous causes or risk factors that can contribute to a headache. The most common triggers include muscle tension in the neck and shoulders, poor posture or sustained postures for an extended period of time, and eye strain. Stress, dehydration, hunger, and hormonal changes are additional factors that may contribute to tension headaches.

Cervicogenic Headache

Another common type of headache is a cervicogenic headache. Approximately 1 out of 100 people experience this type of headache. A cervicogenic headache, as the name implies, is cervical in origin. The headache pain is perceived as occurring in the head but the actual cause is in the neck. The pain is usually a dull, one sided ache that starts in the back of the head and spreads to the forehead, temples and behind the eyes. The person may experience pain in the neck, and possibly difficulty turning the head. This type of headache can last days or even months and can be constant or reoccurring. The most significant causes or contributing factors are stiff joints in the neck, temporomandibular joint dysfunction (TMJ), poor posture, upper back pain or stiffness, muscle weakness or tightness in the neck shoulder and back area, whiplash or other neck injury, and poor sleep positions. Additionally, cervicogenic headaches can develop months after a concussion or head injury indicating dysfunction in the joints of the neck.

Migraine

Migraine headaches, according to the international headache society, are a genetic neurological disease. Migraines can be categorized as being with or without an aura. An aura is described as visual or sensory symptoms or speech disturbance. Visual symptoms can be flickering lights, seeing spots or loss of vision. Sensory symptoms can include pins and needles, and numbness. The diagnostic criteria for a migraine states the aura must last longer than five minutes but less than one hour. A migraine headache can last from four to seventy-two hours. It is usually described as a one sided, pulsing type of pain. The pain is usually moderate to severe and aggravated with activity. A migraine may cause nausea, vomiting and sensitivity to light and sound. The sufferer may experience pre-headache symptoms such as food cravings, mood changes, and fatigue or muscle stiffness.

How Physio Can Help:

There are many other sub-categories of headaches, and although we have categorized them, it is possible for one type of headache to cause another type of headache. For example, a tension headache if left untreated can trigger a migraine for some people, making it more complex to diagnose what type of headache you have. Migraines are generally not treated by a physiotherapist, however if the you have pre-headache symptoms such as muscle tightness, pain or joint stiffness in the jaw, neck, upper back or shoulders these can often be the factor that trigger the migraine. The approach with physiotherapy in this case is to eliminate the muscle and joint issues to diminish the number of triggers.

Tension type headaches and cervicogenic headaches are the two main types that can be treated by physiotherapy. The most common contributing factors to these two types of headaches are poor posture, a combination of weak or tight muscles known as muscle imbalances, or joint stiffness which can be in the neck, jaw, back or shoulders. An issue in one or more of these areas is often the cause of re-occurring headaches because all of these areas are closely connected. If someone is experiencing headaches, but also has a shoulder problem, the two issues are not always considered in combination however, when it comes to treating headaches they should be linked as the muscles in the neck also help with movement or stability in the shoulder. In order to treat tension and cervicogenic headache a detailed assessment of the neck, shoulders, and upper and lower back would be required. The assessment should identify postural discrepancies, muscle dysfunctions such as weak, tight or overactive muscles, and joint mobility issues such as too much or too little movement.

Once specific areas of dysfunction have been identified, an individualized treatment approach can be developed. Treatment should include postural education and correction for specific postural positions. Postural awareness training on how to activate the correct group of muscles to achieve optimal posture is crucial in decreasing this contributing factor. Posture can also be corrected with specific taping techniques that can either help you turn on certain muscles or prevent you from falling into a poor posture. Taping can provide quick relief of discomfort but is only used temporarily until you are able to stretch and strengthen to achieve a good posture actively.

The next step in treatment is usually specific active and passive stretching of the shortened and tight neck and shoulder muscles. Stretching improves the muscle balance in the neck and will reduce the tension in the muscles surrounding the joint and thereby relieve pain. Stretches should be specific to isolate one muscles instead of general neck stretches which can further aggravate a headache.

Once the muscle tension has been reduced, strengthening of the weak neck, back and shoulder muscles should be started. Strengthening is important to help correct posture and eliminate strain of the muscles and joints when in certain positions. Weakness in certain muscles is often the cause of ongoing pain and inability to maintain good postural alignment. The focus with strengthening should start with the deep stabilizing muscles of the neck and back; these muscle require a combination of strength and endurance to support our upright postures throughout the day.

For tension and cervicogenic headaches, stretching and strengthening exercises alone are not enough to reduce the occurrence of a headache. Underlying the muscle tightness and weakness is usually cervical spine joint stiffness or lack of movement. This lack of movement in the neck joints needs to addressed in order to decrease the strain in the neck. Physiotherapists that are trained in manual therapy can help to loosen a stiff or locked joint through a technique called joint mobilization. Joint mobilization is a specific technique used to improve movement in a joint to restore range of motion and decrease the tension in the muscles around the area as well as reduce pain.

In addition to manual therapy and exercise there are other modalities a physiotherapist can use to help relieve pain. The application of a heating pad to the neck, shoulders and back can help to reduce muscle tension by increasing circulation in the area. The reduction in muscle tension provides relief of pain. Interferential current (IFC) can be used to provide immediate pain relief. IFC is the application of mild electrical stimulation to the muscle and nerve endings that cause pain. This blocks the pain receptors and decreases the pain, which in return helps to relax the muscles in the area.

Acupuncture is a common modality used to help relieve headaches and muscle tension. Acupuncture stimulates an increase in blood flow, which relieves muscle tension and thus relieves the pain in the surrounding area. It also helps in stimulating the production of our natural pain killers and anti-inflammatories. Often patients are too sore or tender to tolerate stretching or massage in the affected area; acupuncture is a great option to decrease the local soreness and allow treatment to continue.

To effectively treat headaches all of the contributing factors must be considered and addressed. Active participation from the patient is a necessity to be successful. Just as important is correcting or modifying aggravating activities or postures to decrease the severity and occurrence of pain. Additionally, continual prevention is an important step, if you are aware of stressors that contribute to your headaches you should try to modify or change these factors.

Prevention

It is important to follow through with a prevention or maintenance program to reduce reoccurrence of future headaches. There are many options when it comes to preventative measures including massage therapy, relaxation and stress management techniques, postural awareness, workplace ergonomics, stretching and strengthening programs, regular aerobic exercise, and a headache diary.

A massage every couple of months can aid in reducing tension in the muscles, will help to maintain good posture and will also provide relaxation and stress relief. Regular massages can also help to point out problem areas before they become a pain causing structure. This will help with headache management as it may signify the need to restart certain exercises or visit your physiotherapist.

The ability to de-stress and relax is very important for headache sufferers as stress can affect blood flow and cause muscle tension. For some people stress may be one of the main contributing factors of their headaches. Yoga is an effective method to relax, stretch and de-stress the mind and body. Regular aerobic exercise is another effective method to help increase blood flow to the muscles which will help to reduce tension. When it comes to relaxation it is an individualized approach, and each person should strive to find what works for them.

If posture was identified as a main contributing factor for headache pain, steps should be taken to ensure your workplace station or home office is set up ergonomically for your body. An individualized ergonomic set-up will aid in maintaining good posture throughout the work day and decrease the stress and strain on your muscles and joints. Stretching frequently throughout the day will also reduce tension, as well as avoiding prolonged sustained positions will help to decrease stiffness and strain. Stretches should be held at a comfortable position, not into pain, for a minimum of 30 seconds and repeated throughout the day as necessary.

A headache diary can help to identify triggers or contributing factors. If you know what these factors are it is easier to avoid or modify them and will help reduce or eliminate your headaches.

A detailed physiotherapy assessment and complete physiotherapy treatment approach are necessary to address all of the contributing factors and therefore the root cause of a headache. Over the counter medications only treat the symptoms of the headache and not the pain. If headaches have become a normal part of life for you or someone you know, a physiotherapy assessment with a trained manual therapist should be considered to help solve the underlying issues.

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519-954-6000

Running Injuries Part 3: Achilles Tendinopathy

Achilles tendinopathy is an overuse injury that commonly affects competitive and recreational athletes involved in running or jumping sports. The incidence of Achilles tendon injuries is highest in runners at any level of experience due to the repetitive nature. The term tendinopathy encompasses both tendonitis and tendinosis, which are the different stages that may occur with this condition. Tendonitis refers to inflammation of the tendon as a result of micro tears from increased stress caused by repetitive loading, overloading and even natural aging. Tendinosis is a degeneration of the tendon as a result of chronic overuse and lack of adequate healing time. Achilles tendon rupture can occur with improper healing of the Achilles tendon or a premature return to sport. When the Achilles tendon has been stressed repeatedly, it becomes difficult for the tendon to withstand further tension and can result in an injury. Exposure to repetitive micro trauma to tendon tissue overwhelms the tendon cells and decreases their ability to repair the fibre damage, causing the tendon tissue to be fatigued. Furthermore, the structure of the tendon becomes disrupted; the collagen fibers begin to slide past one another, breaking their cross-links and weakening the tissue, resulting in inflammation.

Calve muscles and tendonsThe Achilles tendon is the largest tendon in the body. This tendon originates at the junction of the two calf muscles: gastrocnemius and soleus, and then inserts into the heel. The gastrocnemius-soleus musculotendinous unit is responsible for plantarflexion of the ankle and flexion of the leg at the knee. We use these powerful calf muscles for explosive activities like running and jumping, and the Achilles tendon transmits these forces down to the ankle joint. These constant stresses placed on the Achilles tendon increase the chance of injury. Additionally, due to the poor blood flow of the tendon, overuse or overloading in combination with inadequate healing time can lead to injury.
Achiles TendonitisSymptoms begin gradually as a mild ache or stiffness in the back of the lower leg and will eventually progress to constant sharp pain with each step. Pain may be worse when you first wake up in the morning. Runners may experience pain at the start of their run, which eases during the run, followed by an increase in pain after the run. Pain may be accompanied by tenderness around the tendon as well as swelling in the area.

A detailed assessment of the lower limb should include assessment of alignment in standing and during movement to look for any muscle imbalances or incorrect muscle recruitment. Both walking and running mechanics should be assessed for obvious errors. Several factors may contribute to the development of Achilles tendinopathy. Lack of mobility of the hip, knee, foot and ankle may lead to increased strain on both the muscles and tendons of the lower leg. Alternatively, too much mobility in the foot and ankle such as over pronation can also increase the stress through the tendon. These changes to the lower extremities can impact different phases of the gait pattern and running stride, which would then change the workload of the tendon. Additionally, training errors such as sudden changes in intensity, speed, distance, surface, or improper footwear cause overloading of the tendon. As well, not having an effective warm up and cool down for runs can result in injury. Previously untreated injuries to the foot and ankle, such as plantar fasciitis and ankle sprains, can also lead to Achilles tendon issues.

The initial goal of treating Achilles tendinopathy would be to relieve symptoms by controlling inflammation while correcting training errors, muscle weakness and limb alignment. Therapeutic ultrasound is one modality that can be used to reduce inflammation and promote blood flow to the Achilles tendon, facilitating appropriate healing. Other treatment options include bracing or taping to support the tendon while healing and can be used to prevent further injury. During physiotherapy for Achilles tendinopathy your treatment plan will consist of hands on manual therapy to restore movement, and a personalized set of strengthening and stretching exercises. Similar to recovering from other running injuries, gradual return to running would ensure adequate recovery from the initial injury, and help prevent reoccurrence of injury. Incorporation of dynamic warmups before activity is another great way to help prevent injury. Stay tuned for the next topic in our running series, which will show a simple and effective dynamic warm-up for runners.

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Running Injuries Part 2: Iliotibial Band Friction Syndrome

A common complaint among runners is knee pain; the first part of our running series covered patellofemoral pain syndrome, commonly known as runner’s knee, as one possible cause. For the second part of our series, iliotibial band friction syndrome will be explained as another possible cause of knee pain. This can affect seasoned runners almost as much as beginners, so awareness and prevention is key for every runner.

Iliotibial-bandThe Iliotibial band (ITB) is a thick band of fascia that runs down the outside of the thigh and on the outer aspect of the knee as it continues down to attach on the tibia. Both the tensor fasciae latae and gluteus maximus muscles insert on the ITB. The attachment of the ITB below the knee joint allows the tensor fasciae latae to abduct, medially rotate and flex the thigh, and gluteus maximus to externally rotate the thigh. Both muscles also function to stabilize the knee during extension in walking and running.

Iliotibial band friction syndrome is an overuse injury as a result of the ITB becoming irritated and inflamed as it moves over bony structures on the femur. As the knee extends the ITB moves anteriorly, and it moves back posteriorly during flexion, thus causing friction. Symptoms begin with a gradual onset of dull aching pain that can progress to a sharp, stabbing pain on the outside of the knee or hip. Over time any running or descending stairs becomes painful, and snapping or swelling of the ITB may also occur on the outside of the knee. Sitting for prolonged periods with the knee in a flexed position will also be painful, similar to runner’s knee.

ITB syndrome and runner’s knee share many symptoms, however it is important to note that the mechanisms of injury and therefore the treatments are not the same. Distinguishing between the two is key for an effective and speedy recovery. With runner’s knee the pain is focused around the patella, while the pain with ITB syndrome is felt on the outside aspect of the knee. This makes sense when considering the anatomy – the ITB runs down the outside of the leg, which is where the irritation and pain is felt at the knee. Once the correct condition is identified, targeted treatment and recovery can begin.

At BodyTech Physiotherapy our assessments are focused on identifying the underlying causes of your running injury, ensuring focused treatment aimed at an effective recovery and prevention of your injury from reoccurring in the future. One contributing factor is tightness of the ITB, which can be felt as a tension down the outside of the thigh. The ITB itself cannot lengthen, however tension can be released through foam rolling. Tightness of the muscles that insert on the ITB can also create tension, and stretching of these muscles will help to relieve stress on the ITB.

Another contributing factor is tension on the ITB caused by internal rotation of the thigh. This can be due to both biomechanical and anatomical factors. Gluteus maximus functions to externally rotate the thigh at the hip, along with the piriformis muscle and a number of smaller muscles around the hip joint. If these muscles are weak then they will be unable to effectively stabilize and prevent excessive internal rotation of the thigh during walking and running. The resulting repetitive stress on the ITB can contribute to the development of ITB friction syndrome. Once the weak muscles are identified, a personalized strengthening program will correct the weak areas and reduce stress on the ITB.

Anatomical factors that can cause the thigh to rotate internally include over pronation of the foot or leg length discrepancy. Both of these can be improved with orthotics. Stress on the ITB can also be caused by an increase in running distance, or other training changes such as more hill work, speed work, or change of running surface.

Weakness of the gluteus medius muscle may also contribute to a tight ITB. Gluteus medius functions similar to the smaller tensor fasciae latae muscle that attaches to the ITB. If gluteus medius is weak then the tensor fascia latae will become more active to compensate, placing tension on the ITB. Additionally, if gluteus medius becomes fatigued during a longer run then the tensor fasciae latae muscle will become more active, further contributing to tension on the ITB.

As with any running injury, if running cannot be done without pain during or after the workout, then rest is necessary to allow inflammation to settle and prevent the condition from worsening. Throughout a break from running, cross training is good to maintain fitness provided it does not aggravate the condition. A gradual return to running following active rest and recovery will reduce the chance of the same or new injuries from occurring. During physiotherapy for ITB syndrome, your treatment plan will include hands on manual therapy, and a progression of stretching and strengthening exercises. Some helpful additions to treatment include taping of the knee to relieve tension on the ITB, ultrasound to reduce inflammation and help with healing, and acupuncture to relieve pain. Stay tuned for part three of our running series that will focus on another complex running injury; Achilles tendonitis.

BodyTech Physiotherapy

BodyTech Physiotherapy
519-954-6000

Running Injuries Part I: Runner’s Knee

Sunset RunSpring is a great time for outdoor running with the melting snow and rising temperatures however runners should be cautious when switching from indoor to outdoor surfaces. Increased mileage and change in footing as runners move outdoors increases the risk of developing an injury. One of the most common complaints is knee pain, which can be a symptom of multiple injuries. The first part of our running injury series will focus on one of those injuries; patellofemoral pain syndrome, commonly known as runner’s knee.

Runner’s knee is an umbrella term used to describe anterior knee pain, pain behind or pain around the kneecap mainly as a result of misalignment of the patella and muscle imbalances. Symptoms begin with a gradual onset of dull aching pain and swelling that usually starts during a run. Over time any running, descending stairs, kneeling and squatting become painful from the resulting stress on the patellofemoral joint. Sitting for prolonged periods with the knee flexed will also be painful, and grinding noises called crepitus may be present.

There are a number of contributing factors to the development of runner’s knee, which can make it challenging to treat. Any activity that increases the stress on the patellofemoral joint can contribute to the development of runner’s knee as the surrounding tissues become irritated and painful. This can occur with new runners or those who increase the intensity, speed and duration of their runs. Additionally, downhill running and running on firm surfaces, such as asphalt and concrete, increase the stress on the patellofemoral joint.

Muscle tightness, weakness or anatomical/biomechanical abnormalities in the leg can alter the distribution of force through the knee and affect the alignment and tracking of the patella, placing increased stress on the patellofemoral joint. The main areas to consider are the quadriceps muscle, gluteus medius muscle, gluteus maximus muscle, and iliotibial band.

One key muscle is the quadriceps. The four heads of the quadriceps femoris converge into a single tendon that inserts on the patella and continues through the patellar ligament to insert on the tibia, functioning to extend the leg at the knee and stabilize the hip. Another key muscle is the gluteus medius that originates on the hip and inserts on the femur, which also helps to stabilize the pelvis when the opposite leg is raised. If the quadriceps and gluteus medius muscles are weak and unable to stabilize the hip during running, normal force distribution throughout the knee and leg will be altered.

If the gluteus maximus muscle is tight, it will externally rotate the thigh, altering its angle relative to the lower leg, which will disrupt normal tracking of the patella. The iliotibial band runs down the outside of the thigh and inserts on the tibia, but it also connects to the patella via patellar tendons. Tightness of the iliotibial band can pull the patella slightly laterally, increasing stress on the patellofemoral joint.
Additionally, any tight muscles around the knee can affect movement of the patella, potentially causing excessive stress on the joint. Over pronation of the feet causes the leg to drop and internally rotate with each step, which can alter normal movement of the patella.Knee

The first step in rehabilitation is to determine all of the underlying and contributing factors. A detailed physiotherapy assessment will reveal areas of tightness and weakness, as well as any anatomical and biomechanical factors. Tight muscles will be addressed with education on correct stretching techniques and a personalized stretching program. Specific strengthening of weak muscles and correction of biomechanical changes will be addressed with a progression of strengthening exercises from isometric to dynamic, and eventually functional and activity specific. Any hip, pelvis or lower back restrictions will be treated through joint mobilizations. It is important to consider more than just the structures immediately surrounding the knee because stiffness in these other joints will cause biomechanical changes that become more evident with running, and may cause the condition to reoccur if these areas are not addressed. Corrective taping to keep the patella in proper alignment can relieve pain and help to prevent aggravation of the condition during a gradual return to running. Evaluation and correction of footwear, gait and running stride will help to improve running form and improve biomechanics during running.

The goal following physiotherapy treatment is for a pain and injury free return to the previous level of running. Maintenance or improvement of hip, lower extremity and trunk flexibility as well as strength will not only prevent a reoccurrence of runner’s knee, but also protect against other running injuries. Stay tuned for part 2 of our running injuries series to learn about a different cause of knee pain; iliotibial band friction syndrome.

BodyTech Physiotherapy

BodyTech Physiotherapy
519-954-6000