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.
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
Hand Infections
May 11, 2010
When discussing about sports injury, we tend to focus on the big traumatic stuff like fractures, broken bones, dislocations, torn ligaments or massive swellings. Minor injuries are often brushed off especially with the more physical contact sports. After all, isn't discipline and perseverance part of the game?
As a result we tend to overlook hand infections, particularly lacerations (cuts and grazes) and for the more contact sports, bite wounds are not uncommon.
Lacerations
Cuts and grazes to the hands and fingers are a common occurrence in sports as a result of accidental contact with equipment, playing surfaces and between players or participants.
All cuts and grazes have the potential to become infected and should therefore be taken seriously.
Standard practice should be wash and clean all cuts and grazes hygienically with antiseptic solution monitored carefully for a number of days for any signs of infection.
If an infection develops the following signs symptoms may be present:
- severe , throbbing pain
- fever
- movement of fingers reduced with pain
- swelling and redness in the hand
If two or more of the above signs and symptoms are present then the risk of an infection is high and you should immediately report to the nearest doctor or hospital.
Bite Wounds
Skin of the hand broken by human teeth is a particularly dangerous wound. Human saliva contains such high levels of bacteria that these injuries should always be presumed to be contaminated. Skin is broken either from a punch to the mouth or a bite wound.
It is highly recommended that a course of a broad spectrum anti-biotic be administered by a doctor immediately and the wound not covered over or closed.
Why taken lacerations and bite wounds seriously?
Because due to the continuity of tendons of the hands into the wrist and forearms, infections can spread rapidly if not treated. Consequences can be highly destructive and hand infections frequently require hospital admissions for more specific anti-biotic therapy and or surgical intervention. In serious cases the tissue can become necrotic and die.
So please do take these sometimes rather innocuous and minor wounds seriously and seek medical treatment immediately if required.
How to prevent ankle sprains from happening … again
April 30, 2010
Have you ever wondered that maybe there is a way to change this?
Did you know that 85-90% of untreated ankle sprains will be recurrent, but with correct management after the first occurrence those number of cases can be brought down to only 35%?
What happens in an ankle sprain? Which structures are involved?
As a result of continued rolling, turning or instability of the ankle, the ability to make rapid adjustments in the position of the foot on uneven surfaces (proprioception) becomes limited. If this happens, the likelihood of a more severe ankle sprain occurring increases.
A sprain is actually a tear that occurs in the outer supportive ligaments of the ankle. As these ligaments are stretched, a critical point is reached beyond which ligaments do not return to their normal elastic function and a tear of the ligament occurs. Sprains can range from the relatively minor to completely torn ligaments where the ankle can be quite loose.
The common diagnosis for pain on the outer side of the ankle is an inversion sprain. This usually occurs when the foot lands in an awkward manner and rolls inwards, creating stress on the outside ligaments. When this stress is severe enough, an ankle sprain occurs.
There are three major ligaments attached to the outside of the ankle: the anterior and the posterior talofibular ligaments (ATFL and PTFL), and the calcaneofibular ligament (CFL). The ATFL is the most common ligament to sprain due to the mechanics and the limited support at the front of the ankle.
The other type of ankle sprain is an eversion sprain for pain on the inner side of the ankle. This happens when the foot is twisted outwards. The inner ligament, called the deltoid ligament, is over-stretched.
What can I do after spraining my ankle?
If you are unable to put weight or walk on it, you may have a small fracture. It is advisable for you to get it X-rayed. However, if you feel like you simply rolled over the ankle and putting weight on it hurts a little, apply RICE (Rest, Ice, Compression and Elevation) immediately. Head home and avoid walking on it as much as possible. Fill a wet thin towel with crushed ice or with a bag of frozen peas, and apply to the painful area for 10-15 minutes. Do not apply ice directly to your skin for more than five (5) minutes as it can cause cold-burns. Keep this up every 2-3 hours for the first 48 hours. This will help to minimize pain and control swelling in the area, limiting the extent of damage to the ankle.
For the ligaments to heal the ankle needs to be immobilized with either a cast or a boot. For minor sprains a brace can be applied to the ankle. Make sure it is tight enough to stop the swelling from going down into your ankle but not enough to make your toes turn blue. However, remember to take it off at night but put it back on even before you leave your bed. Keep your foot elevated at night by placing pillows underneath the affected foot to give you just enough elevation to sleep pain-free. Foot pumping exercises (continuously bending and pointing your foot out) are also especially useful when the foot is elevated to help push the fluid away from you and back to your heart. Strictly adhere to the RICE regiment for another 2-3 days or until the swelling is about 75% gone.
How do I prevent a recurrence?
If this is not the first time you have sprained the ankle, the bad news is that once a ligament has been overstretched and not taken care of, it loosens and will never go back to its original length. Not only do ligaments hold bones together, but they also part of your balance-control system by sending messages to your muscles (via the brain), telling them how to react to maintain your balance and prevent excessive movement
The basic philosophy of any rehabilitation programme is to retrained your ligaments to sense and send the required balance signals and strengthen the muscles. This restores and improves the balance around your ankle to help prevent recurring sprains and protect it from the stresses of everyday life.
A physiotherapy rehabilitation treatment programme may include:
1. Therapeutic ultrasound would be administered to promote healing and decrease in pain.
2. Soft tissue massage to aid lymphatic drainage and remove any residual swelling.
3. Individualised exercise programme which may include:
a. Calf stretch alphabet exercises – moving the ankle in multiple directions by drawing alphabets in lowercase and uppercase motions.
b. Isometric strengthening exercises, such as pushing against an immovable object (e.g. wall or floor) or with the unaffected foot, can begin.
c. Balancing exercises such as standing on your affected leg and try to hold your balance. You will probably notice at first that your injured foot is much more wobbly, which will get better with practice.
Finally, your physiotherapist would also work closely with you to plan a proper activity based training programme to get you back to sport or normal daily activities. You can follow this whole recipe for old recurrent sprains.
Tennis Elbow Video
April 25, 2010
Have you ever wondered how Tennis Elbow occurs? If yes, click on the animation below to know more.
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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.
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Lenia Teo, B.HSc(physio)
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