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Structural Imbalance

Structural Imbalance. We often hear this phrase used along with the diagnosis of our aches and pains. But what does it mean? The best way to explain it is to start from the opposite end, "Structural Balance".

Structural Balance refers to the optimal positioning of our bones and joints. This means when weight or pressure it applied that part of the body, it is effectively passed through the "structures", e.g. bones and joints. These structures are design to hold weight well in a particular direction and not so great in other directions. Structural imbalance is simply when bones and joints are not in their optimal position when weight is applied.* Read more

My bunion is stopping me from running! Help!

A bunion, also known as hallux valgus, can sometimes be a painful deformity of the bones and the joint between the foot and big toe. It is an enlargement of bone or tissue around the base of the big toe.

Under repetitive pressure, the joint between the foot and the big toe (first metatarsal joint) can move out of place, swell and turn inward, resulting in a painful and stiff bony protrusion on the side of the foot.

Overpronators tend to excessively roll their feet inwards, and this can actually have an effect on the development of bunions. This is because with too much rolling in of their feet, overpronators can put excessive stress on the metatarsal joint during push-off phase of running.

For Asians, we tend to have a wider forefoot. Wearing shoes with narrow toebox can sometimes cause or worsen bunions. Hence, it is important to have a good fitting shoe with a roomy toebox.

Besides wearing proper shoes, the pain and stress on the bunion can be reduced by taping the foot in a normal position before a run. A toe-separator can also be placed between your big and second toe with a padding taped to the big toe.

Modifying your running style can also help reduce the stress on your big toe. When you run, avoid going up on your toes, which puts pressure on the big toe. Instead, try to land with your midfoot down with every step.

However, the above measures are mainly to address the symptoms than to correct the actual deformity. If the discomfort is severe enough, or the correction of deformity is desired, a surgery may be performed.

H.A.R.M.

You often hear about avoiding H.A.R.M. to sports related injuries.

H.A.R.M is an acronym that stands for things to avoid:

• Heat,
• Alcohol,
• Running and,
• Massage

Here is a useful poster that you can print for your own use or your clubs and sporting organisation.

Related to H.A.R.M is R.I.C.E.R

 

R.I.C.E.R

You often hear about applying R.I.C.E.R. to sports related injuries.

R.I.C.E.R is an acronym that stand for things to do:

• Rest,
• Ice,
• Compression,
• Elevation and,
• Refer

Here is a useful poster that you can print for your own use or your clubs and sporting organisation.

Related to R.I.C.E.R is H.A.R.M

 

Myofascial Release

Myofascial Release is a form of hands-on therapy used to relieve pain and to relax muscles and tissue. “Myo” refers to the muscle, and “fascial” refers to the smooth tough tissue that covers all the muscles.

In a normal healthy body, the fascia is relaxed and soft. It can stretch and move without restriction. However, it becomes tight and restricted when our body experience physical trauma or inflammation of the fasica. Trauma such as a fall, whiplash or habitual poor posture can have a cumulative effect over time to tighten the fascia.

Myofascial release is applied directly on the body and uses slow and sometimes deep pressure to restore the proper health of the fascia. Myofascial release has been used effectively in the treatment of:

• Low back pain
• Headaches
• Neck Stiffness
• Sports injuries

Physical Therapists offer Low-Cost Solutions to High-Cost Expenditures for Spinal Conditions

Research by the American Physical Therapy Association found that Physical Therapy (physiotherapy in part of the world) is an effective treatment of choice for many back pain patients. Read the full article here

Manual Therapy - Spinal Vertebra Mobilisation

One physiotherapy modality is fast becoming de rigeur in the treatment of referred pain cause by stiff joints is manual therapy. Today, manual therapy is the main stay of modern physiotherapy moving away from the dependency on Electro Therapy Agents such as Ultrasound, Short Wave and TENS as the primary treatment modalities.

 

Referred pain is a very unpleasant sensation localised to an area separate from the site of the causative injury or other painful stimulation. Often, referred pain arises when a nerve is compressed or damaged at or near its origin. In this circumstance, the sensation of pain will generally be felt in the territory that the nerve serves, even though the damage originates elsewhere.

Manual therapy consists of a range of interventions, including hands-on techniques such joint mobilisation. Joint mobilisation is thought to help maintain or improve extensibility and tensile strength of the articular tissues, reduce the effects of mechanical limitations, elongate hypomobile capsular, ligamentous and connective tissue. It also stimulates mechano-receptors and therefore may be responsible for inhibiting the transmission of nociceptive stimuli and in doing so, reduce pain perception. (Kisner and Colby 2002).

In Singapore, there are two common concepts of manual techniques used for spinal mobilisation– the Maitland Concept and the Mulligan Concept.    

Maitland Concepts

Maitland’s Concepts (often also referred to as the Maitland Technique) involve the application of passive and accessory oscillatory movements to spinal and vertebral joints to treat pain and stiffness of a mechanical nature. The techniques aim to restore motions of spin, glide and roll between joint surfaces and are graded according to their amplitude.

Grade I is a small amplitude movement performed below the range of resistance and is suitable for treating highly irritable conditions. Use of Grade I enables the slack in collagen to be taken up when connective tissue is not under load and can relieve pain by working on neural structures (Threlkeld). 

A Grade II mobilisation is wider in amplitude but still below resistance. Use of Grade I and II are appropriate when palpation elicits pain before restriction of movement.

Grade III and IV are used when resistance to movement is encountered before pain. A Grade III is a large amplitude movement performed within resistance and generally used to improve range of motion.

Grade IV is a small amplitude movement performed within resistance used for chronic aches of low irritability. 

Grade V is a high velocity thrust used in manipulation.

Application of Maitland techniques to the vertebrae is along an anterior-posterior axis or transverse irrespective of the angle of the joint. Peripheral joints are similarly treated with Maitland techniques on planes appropriate to the condition, usually on the plane where there is pain or restriction. These may be anterior- posterior, transverse or longitudinal.

Mulligan’s Concept

Maitland argues that the comparable pain response “is nearly always found with the unphysiological movement rather than the physiological movement”. Conversely, Brian Mulligan applies movement in sympathy with physiological movement. Mulligan is guided towards restoration of correct physiological tracking by the absence of pain. His techniques are designed to deal with problems of restricted or painful movement but are not highly irritable. These techniques are therefore used for conditions that are not acute when the biomechanics of the joint may be altered without inducing pain. The appropriateness of the technique is judged against Maitland’s criteria of severity, irritation and nature of the condition.

Mulligan does not prescribe grades of movement or oscillatory movements. He prescribes taking the joint through its full range of movement and this entails taking it into resistance. The physiotherapist superimposes an accessory movement onto the patient’s active physiological movement with the aim of over-riding the obstruction and re-establishing correct alignment. The accessory movement takes the joint through what would be the normal physiological movement of the joint. The pre-injury joint tracking is re-established reasserting the ‘joint memory’ or prior conditioning of the healthy joint.

Mulligan’s principle techniques are NAGS, SNAGS and MWMs. NAGS are Natural Apophyseal accessory Glides applied to the cervical spine with the patient passive. SNAGS are Sustained Natural Apophyseal accessory Glides whereby the patient attempts to actively move a painful or stiff joint through its range of motion whilst the therapist overlays an accessory glide parallel with the treatment plane. MWMs are Mobilisations With Movement and are applied to the peripheral joints.  The underlying principle to MWMs is derived from Kaltenborn (1989 in Exelby 1995) who argued that joint surfaces are not fully congruent, physiological movements are a combination of rotation and glide, and glide is essential to pain free movement. Glide occurs in the direction of bone lever movement where its articulating surface is concave and in the opposite direction when convex. The treatment plane lies at a ninety-degree angle to the concave articulating surface of the bone and treatment is applied parallel to the treatment plane. The anterior-posterior and posterior-anterior movements used in Maitland’s techniques follow the same planes in peripheral joints.

However, in treating the spine Maitland will follow the planes of the intervertebral body joints whilst Mulligan techniques follow the plane of the zygapophyseal joints.

Exelby argues that the zygapopheseal joints guide the spine and so improving their glide by applying NAGs and SNAGs will improve the range of spinal movement. Applying treatment on the plane of the intervertebral body joints results in compression on the zygapopheseal joints and will not promote glide.

Taking a Micro-Break

A common advice that we get for workplace health issues related repetitive stress injuries (RSI) is to take frequent breaks. Usually, people suggest that a 5-minute break every 45 to 60 minutes. But what about 10-second breaks? Read more

Language Translation




Ask the Specialists

If I have a knee pain, should I get it manipulated?

  If I have a knee pain, should I get it manipulated? - Alex, Singapore Read more »  Read More →



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