Is the Outcome of ACL Surgery really better than Conservative Management?
August 28, 2010
If you have sustained an ACL ( Anterior Cruciate Ligament of the knee) tear and is considering an ACL surgery, you would find it useful to know more about the latest research discussion on ACL surgery versus Physical therapy management.
Knock Knees – Can I reverse it? (Part 2)
August 19, 2010
In the previous entry for Knock Knees, we discuss about the different types of knock knees and the contributing factors of it. Now, we will talk about the problems of this condition and ways we could get rid of it.
The Problems of this condition
The alignment of the knee joint in someone with knock knees is such that there is an increased force on the medial (inner) part of the knee joint. This can predispose the knee joint to osteoarthritis because of the increased loading on the medial compartment.
Symptoms from this may not even present within the knee joint, you may have ankle problems or hip problems as a result of having knock knees.
How do I get rid of it?
External aids:
1. Orthotics
The knee joint may appear to be misaligned if the foot is not biomechanically sound. This means that someone with a very pronated/inverted/flat feet may be at risk of developing a symptoms similar to someone with knock knees. Placing an insole or orthotics device may help correct the foot position, and indirectly the alignment of the knee joint.
2. Knee braces
These can help prompt correct alignment of the knee joint, but may create a degree of dependency.
3. Strengthening
A physiotherapist can design an exercise program to help strengthen weak muscles. By focussing on the specific muscles that require strengthening, you will put your body is a safe healthy direction, and will be able to train for all types of sporting challenges and limit your risk of injury.
4. Stretching
Stretching is an important component of knock knee reversal. When a joint has spent all it’s time in a misaligned position, certain structures will shorten and become stiff. Stiffness in the joints and muscles will make it very difficult to train and strengthen the area. A physiotherapist can assess the position of your knee, ascertain which structures are tight, and give you an appropriate stretching program.
I have corkie (bruise)? What should I do?
August 12, 2010
Almost everybody experiences corkies or bruises during his lifetime. Some people are more prone to develop corkies than others. In many cases you don't have to worry about a corkie but it is important to know at which stage you should see a doctor.
What are Corkies?
Corkies are also known as bruise or contusion. They are a type of a relatively minor bleeding (hematoma) of your tissues in which small blood vessels are damaged after a trauma. Bruises can occur at different layers of the body and include skin, deeper tissue, muscles and bones. Most bruises happen after a fall, hitting an object or getting a hit during sports. In many cases it takes a while till you notice a corkie and you will not immediately feel the symptoms right after an incident. Typical areas for corkies are at the front of the thigh, shin, at the frontal pelvic bone (hip pointer or iliac crest) and on your forearms.
How do I know I have a corkie/bruise and what are the symptoms?
A corkie presents with the following symptoms:
- initially short severe pain during trauma (hit, fall as mentioned above)
- later the pain reduces and becomes more of a local tenderness
- swelling (not always)
- bleeding (hematoma- dark blue colored spot on the skin)
- pain during action /use
What are the contributing factors?
The size and shape of a bruise is influenced by several factors such as age, condition- color and type of tissue. Furthermore the location, striking force of a hit or blood disorders (coagulation problems) have an impact on the size and shape of a corkie.
What should I do when I have a corkie?
The treatment of light corkies includes:
- RICE (Rest, Ice, Compression, Elevation) to reduce pain and swelling
- painkillers
- soft stretching after a few days when the pain settled down
- after the inflammatory phase (3-5days) heat to loosen up tight muscles
When should I see a doctor?
You should see a doctor if you have a moderate-severe corkie/bruising. This is indicated if:
- you have severe pain and tenderness
- you develop a massive swelling
- movements of the affected area are very painful
- you have a big corkie without any explanation/reason
Note: If you have unexplained bruises which occur very frequently over a long period of time it is advisable to see a doctor to rule out skin or blood disorders (platelet or coagulation disorder). Furthermore unexplained bruising may also be a warning sign of child abuse, internal bleeding or other serious health problems. The usage of several drugs (e.g. steroids, blood thinners) can cause easier bruising.
How long does it take for the corkie to disappear?
Normally light bruises heal within 2-3 weeks. Depending on the severity and the individual healing process it can take longer. Deeper bruises take more time to heal.
Maybe it’s not Plantarfasciitis but Heel Fat Pad Syndrome
July 29, 2010
Do you have heel pain? And think it is Plantar Fasciitis?
Maybe not, it might be another type of heel pain called the Heel Fat Pad Syndrome.
What´s the difference between the Plantar Fasciitis and Heel Fat Pad Syndrome?
As shown in the illustration, both structures are in the same area of the heel whereas the plantar fascia (illustrated as plantar apponeurosis) is covered by the fat pad. The plantar fascia attaches at the toes and forms the medial (longitudinal) arch of the foot. It provides static support of the medial arch and dynamic shock absorption. The main functions of the fad pad is shock absorption of stress during heel strike (heel contact during walking).
While both the heel fat pad and plantar fascia can be a source for heel pain, the contributing factors, clinical signs and symptoms and management for them differ.
Plantar Fasciitis
Plantar fasciitis is an overuse condition of the plantar fascia.
Contributing factors: It is often seen in people with foot deformities e.g. flat feet (low arches) or pes cavus (high arches). This deformities can lead to an excessive strain at the fascia during walking and hence cause pain. Other risk factors which can lead to increased stress in the fascia are inappropriate or non-supportive footwear, reduced ankle mobility, obesity and work related weight bearing.
Clinical signs and symptoms: A typical clinical sign is swelling of the plantar fascia and can be confirmed by ultrasound investigations. People with plantar fasciitis classically have a gradual onset of symptoms and feel their pain more on the inner side of the heel. Further symptoms are acute tenderness of the inner side of the heel, a tight plantar fascia and pain during stretching of the fascia. Especially the first steps in the morning or after rest are painful. The pain seems to decrease after a few minutes, and returns as the day proceeds and time on the feet increases.
Management: Due to the tightness of the plantar fascia that leads to pain, treatments involve stretching and massaging to release the tight fascia and calf muscles. Other management include avoiding aggravating activities (e.g. wearing heels), cold therapy (R.I.C.E), anti-inflammatory drugs, taping to to relief pain and lastly it is crucial to strengthen calf muscles that have weakened during the pain process. Some patients who are still symptomatic after conservative treatment might need surgery.
Heel Fat Pad Syndrome
Heel fat pad syndrome is often caused by a decreased elasticity of the fat pad. A fall onto the heel from a height or chronically excessive heel strike with poor footwear can also lead to heel pain.
Contributing factors: Increased age and weight decreases the elasticity of the fat pad.
Clinical signs and symptoms: Compared to plantar fascitis, fat pad related heel pain is felt more at the outer side of the heel especially when the heel gets loaded (heel strike). MRI investigations will reveal changes in the fat pad showing signs of swelling.
Management: Treatments aimed at unloading the heel by avoiding aggravating activities. In an acute situation the R.I.C.E. rule (Rest Ice Compression Elevation) should be applied and anti inflammatory drugs are given. Further treatment includes taping, the use of a silicone gel heel pad and use of appropriate footwear.
References:
- Brukner, P & Khan, K 2007, Clinical Sports Medicine, 3rd edition, Tata McGraw Hill, Australia .
For Swimmers : Common Injuries, Treatment and Prevention tips
July 7, 2010
Do you swim leisurely or competitively? If yes, continue to read on.
Recently, one of our physiotherapists, Chng Chye Tuan was interviewed by Style:Men on the common musculoskeletal injuries face by swimmers in the July's issue. Do read on to find out what he has to share.
What are the common problems competitive/regular swimmers face?
The most common swimming injury is the rotator cuff impingement / tendonitis.
- Ball joint of the shoulder compress the tendon against the roof of the socket (acromion) in 2 phases of freestyle – the pullthrough and recovery phase.
- Pull-through phase in the freestyle stroke involves the arm pulling against the resistance of the water. The outstretched arm with internal rotation of the shoulder stresses the tendon and pinched it against the acromion. The pinching can irritate the tendons and give a sudden catching kind of pain.
- The recovery phase involves a body roll and raising the elbow up and out to allow the upper limb to recover out of water efficiently otherwise the shoulder will be working harder at an awkward position to pull the hand out of water.
- Repeated pinching will give rise to inflammation and fraying of the soft tissues.
What are the usual causes?
The usual contributing factors are mainly due to over training, poor technique, poor core muscles and unilateral breathing.
- Over training – when muscles are fatigued, the stabilising component from the rotator cuff muscles becomes compromised thus increasing the chances of the humeral head translating upwards and impinging the rotator cuff tendons. The ball component has to be centralised within the socket of the shoulder to optimise stability and muscle function.
- Technique – the freestyle and backstroke requires the swimmer to roll their trunk such that the drag is minimise and the propulsion force can be maximised. Too much drag will increase the resistence, tiring out the shoulder muscles sooner.
- Strong core muscles and truck control enable the swimmer to do a body roll along the longitudinal axis so that it is easier for the shoulder to pull the upper limb out of water.
- Unilateral breathing can develop a muscle imbalance leading to improper muscle activation and overuse.
What kind of treatments do you recommend?
An assessment of the shoulder girdle, spine and core strength will be performed to be able to properly manage a swimmer’s shoulder.
A key treatment to approach the swimming shoulder is to rehabilitate the rotator cuff muscles to be able to centralise the humerus at different shoulder positions.
Exercises will be prescribed to specifically target these rotator cuff muscles, correcting any imbalances. These exercises include strengthening the weak muscles to improve dynamic support and also stretching exercises to the tight muscles pulling the joint out of position.
As most competitive swimmers will not be able to cease training completely, kinesiotaping complements the rehabilitation therapy by improving the rotator cuff’s ability to stabilise the shoulder joint via better joint awareness from the corrective
Are there preventive measures that swimmers can take to minimise such problems?
Regular stretching exercises, core stability training and work on the techniques. During the early stage of feeling the impingement (catching or pinching) pain, seek help from a sports physician or physiotherapist as soon as possible.
Management for ITB friction syndrome
June 16, 2010
Training methods
Biomechanical Gait issues
Why Badminton Players Get Tennis Elbow?
June 15, 2010
- Diffuse pain over lateral elbow just below the lateral epicondyle;
- Reduced grip strength;
- Reduced ability to lift a heavy object; or
- In racquet game players, reduced ability to perform a backhand.
- Some people with tennis elbow also experience tingling sensation or numbness spreading over the forearm and hand.
- Therapeutic ultrasound, heat-retaining braces;
- Soft tissue therapies like deep tissue massage, trigger point treatment, myofacial release;
- Stretching of the tight wrist muscles;
- Specific mobilization techniques combined with gripping exercises;
- Taping, corticosteroids injection, and acupuncture are sometimes helpful;
- Neck and nerve mobilization can also be considered if necessary.
- Focus should be put to achieve good control of the wrist to prevent wrist from functioning at extreme ranges, either into extension or flexion;
- Racquet technique needs to be carefully assessed to correct any technical faults, especially wrist arm control in back hand strokes;
- Encouraging gripping that focuses on hand muscles (the Duck grip), rather than gripping that only focuses on forearms muscles (the Finger grip).
Skier’s thumb? Gamekeeper’s thumb?
June 11, 2010
Injuries usually occur as a result of a sporting mishap. It is commonly seen in skier’s, footballers and rugby players. The ligament may also be directly damaged as a direct result of a fall or other trauma.
- Pain and tenderness over the base of the thumb
- Swelling and or bruising over base of the thumb
- Pain with movement of the affected thumb and difficulty gripping objects
- Instability or catching of the thumb on movement
Treatment is highly varied and dependent on a number of factors.
- Severity/grade of the injury
- How long ago injury occurred
- Patient age
- Physical demands of the patient
- Likely adherence of patient to protocols
If only a partial rupture has occurred patients are either placed in a mild cast or wrist splint (known as thumb spica) for 4 to 6 weeks.
Following surgery, patients will be placed in a cast for four to six weeks to protect the repaired ligament. During this time gentle range of movement exercises will be commenced progressing to stretching and strengthening exercises. Return to sports and full activity usually occurs 3 to 4 months after surgery.
Running, Not Doctors…
June 9, 2010
One great fear of runners is visiting a doctor for their injuries and being told to stop running. This news article in the New York Times (Sports Injuries: When to Tough It Out) covers some of the issues surrounding the question, "should I or shouldn't I see a doctor for my pain?".
But the article left a few gaps for those aches and pains that don't seem serious enough to warrant a visit to the doctors.
Closing the Gap
One of the first thing to do is to ease off and reduce your training intensity. You can ease off in one of these four areas
- Duration – shorter runs
- Speed – slower or constant
- Frequency – fewer sessions per week with more rest in between
- Terrain – less challenging terrain – flat ground rather than uphill
Another thing is to stretch more regularly. If pain is new, do apply MICER. MICER is explained here in a post reply to a reader's question.
When to see the doctor?
Ease off your training intensity for a few weeks and monitor closely. If the pain persist, you may have to see a doctor or therapist to determine the underlying problem. Assuming that is not something serious like a torn ligament, there may a underlying bio-mechanical fault that needs to be identified and corrected.
Eccentric ankle evertor muscle strengthening is better than concentric strengthening after a lateral ankle sprain
May 29, 2010
-
Popular Articles
- Posterior Pelvic Pain (Sacroiliac Joint Pain) in Pregnant Women
- Nerve Stretches
- 5th Metatarsal Fractures
- Multifidus - Smallest Yet Most Powerful Muscle
- See a Therapist
- Sports Taping - Knee
- Myofascial Release
- Pregnancy - Changes and Aches
- Jaw Pain - What other causes besides the teeth and jaw?
- Sports Taping - Wrist
- Manual Therapy - Spinal Vertebra Mobilisation
- Ankle Replacement Surgery
- Patellar Tendinitis
- Does Bad Posture Lead to Scoliosis?
- Belt Up Your Unstable SIJ
- Iliotibial Band Friction Syndrome
- The Buckling Knee
- Sway Back No More
- Lumbar Spinal Stenosis
- Simple Exercises For Plantar Fasciitis Sufferers
See the Therapist
For an appointment to consult with one of our physiotherapist for treatment, kindly call us at : +65 6226-3632 (4 Lines)
or SMS us at +65 9232 2661 or email us at enquiry@coreconcepts.com.
Find out more about our various divisions at group.coreconcepts.com.sg/divisions.
Ask the Specialists
"Hi MCR, I keep hearing about ultrasound therapy but I get confused with the seemingly different answers I get about them. There appears to be one for healing... Read more »
If you have an question, feel free to drop us line. If the answer to the question is something more than a few people would be interested in, we will feature it.
-
RSS Feeds
Editorial Team
Editor
Lenia Teo, B.HSc(physio)
Accreditation
|
|
Blog Listing
Top pain blogs
