Monday, 26 September 2016

Lower Back Pain and Degenerative Disc Disease

Degenerative disc disease of the lumbar spine is one of the most common causes that is associated with lower back pain. It has been shown that the degeneration and deterioration of the lumbar disc can lead to a symptomatic lower back condition. A progressive degenerative disc disease can result in acute or chronic back pain with an associated clinical instability of the spinal segments. This can lead to abnormal spinal segmental movement, misalignment of the spinal joints, spinal stenosis.

The basis of initial evaluation involves plain radiographs (X-rays) of the lumbar spine. Reduced disc height and narrowing of the facet joints are very common findings on the X-rays in degenerative disc disease and osteoarthritis of the spine. Osteophytes and sclerosis of the upper and lower endplates are frequent radiographic findings for degeneration. Narrowing of the lateral recesses and the spinal canal can be visible on CT or MRI of the spine. Radial or concentric tears, cystic spaces and disruption of the annulus fibrosus can be identified with MRI which is showing better resolution for soft tissues.

Learn more about degenerative disc disease.

Instability of the spine results in a lack of normal spinal segmental displacement pattern under physiologic loads. Hence, there is an increased risk of neurological deficits, incapacitating spinal deformity and pain.

According to Kirkaldy-Willis and Farfan, there are three functional phases of degenerative disc disease:
  1.        Temporary dysfunction without instability;
  2.        Unstable phase;
  3.        Stabilisation phase following calcification of ligaments and spondylophyte support.

During the early phases of degenerative disc disease, there is an increased microscopical structural deterioration resulting in an increased functional impairment.

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Wednesday, 21 September 2016

Physiotherapy and Chiropractic Treatment for Metatarsal Stress Fracture

Treatment management of the metatarsal stress fractures should include a multi-modal approach addressing each component of the injury. Relative rest from weight-bearing exercises is required to prevent aggravation and re-injury of the stress fracture. An air cast may be helpful in reducing the pain if the patient needs to be in a weight bearing position excessively. Exercises can be re-introduced gradually if the athlete experienced no pain while walking and no tenderness at the site of fracture. A graduated rehabilitation exercise program with the goal of returning the athlete to full training and competition should be commenced as soon as possible without risking re-injury of the fracture. Foot orthoses may be needed to correct abnormal biomechanics in the joints of the foot. Abnormal stress may be imposed on the foot if there is an instability in the joints of the foot. Chiropractic adjustments maybe helpful in correcting restricted joints and restoring normal range of motion in the joints of the foot and ankle.

Learn more about other causes of foot pain.

The fracture of the base of the second metatarsal affecting the joint is commonly seen in ballet dancers. The treatment for this injury should involve non-weight-bearing rest on crutches for about four to six weeks until the pain and tenderness subside. Chronic joint synovitis may present with the similar signs and symptoms and is commonly confused with this fracture.

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Friday, 16 September 2016

Physiotherapy to Relieve Pain in the Forefoot

There are three main sites where the fracture of the the fifth metatarsal can occur. The uncomplicated avulsion fracture of the tuberosity at the base of fifth metatarsal is commonly associated with an acute ankle sprain. If there are no other complications resulting from the avulsion fracture, the pain can be relieved by a short period of immobilisation.  

Jones’ fracture is the fracture of the shaft of the fifth metatarsal. This is a serious fracture and it takes a longer time to recover. Patients usually involved with an inversion plantar-flexion injury, or this can be a result of overuse injury. Patients with a Jones’ fracture may need a non-weight-bearing cast immobilization of six to eight weeks to recover. Surgical fixation with percutaneous insertion of a screw and bone grafting may be needed if an immediate return to activity is required. A confirmation of full radiographic healing is recommended before returning to sport to prevent re-fracture of the injury.

Learn more about other causes of foot pain.
Fouette fracture is an acute spiral fracture of the distal third of the fifth metatarsal. This is commonly seen in dancers who went off-balance while on demi pointe and rolled over the outer border of the foot. Non-complicated injury without the displacement of the fractured fragments can be treated with weight-bearing rest. Complicated displaced fractures may need non-weight bearing cast immobilisation of four to six week to relief the pain.

Physiotherapy rehabilitation of the foot and ankle maybe required once the pain has subsided and the injury has healed. The mobility of the joints must be maintained to prevent stiffness and joint restriction. Muscles in the foot and ankle need to be strengthened to provide sufficient stability at the joints. 

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Sunday, 11 September 2016

Chiropractic Treatment for Upper Crossed Syndrome

Upper crossed syndrome may involve neck pain with or without radicular pain into the upper limbs. Some patients may even complain of numbness or tingling sensation in the upper limb. Muscle imbalances as a result of prolonged static posture are one of the main cause that leads to pain and paresthesia. Patients normally present with anterior head carriage and rounded shoulders. This can result in muscle tightness in the pectoralis muscles, the anterior chest muscles, and the suboccipital muscles near the base of the skull. Muscle weakness of the deep neck flexors and rhomboids or mid and lower trapezius is commonly found in a person with upper crossed syndrome.

Treatment for upper crossed syndrome should include a multi-modal approach to addressing each and every component of the problem. This involves chiropractic treatment and physiotherapy such as therapeutic rehabilitation exercises, manual therapy, ergonomic advice and postural retraining. Joint mobilization or manipulation can improve segmental spinal mobility and reduce neck stiffness. Removing trigger points and release of tight muscles in the neck and upper back such as suboccipital muscles with myofascial release techniques help to improve neck and shoulder mobility. Stretching of the anterior chest muscles is important to prevent rounded shoulders.

Learn more about physiotherapy.

Postural training plays a major role in improving the signs and symptoms of upper crossed syndrome. The treatment program should include re-education and correction of the cervical, thoracic and scapular position. However, many health care providers often ignored the importance of postural training of the lumbar spine and pelvis, as this can affect the position of the thoracic spine and head as well. Taping may serve as a great tool in postural retraining.

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Tuesday, 6 September 2016

Chiropractic and Upper Crossed Syndrome Neck Pain

Upper crossed syndrome, or cervical postural syndrome, usually presents with a typical posture of protruding chin and increased upper cervical lordosis. Patients normally adopt the anterior head carriage posture with restricted thoracic extension, restricted shoulder movements, rounded shoulders and tight anterior chest muscles. This is commonly seen in athletes of certain sports that require them to be in this posture for a prolonged period of time. Cyclists, baseball catchers and hockey players are more susceptible to this neck pain related to upper crossed syndrome. This can happen in the workplace as people are working in front of the computer screen for prolonged hours with an incorrect posture. Painters and production line workers may have similar problems too. However, neck pain arising from workplace can be greatly benefited from ergonomic assessment.

Learn more about neck pain.

Typical signs and symptoms of upper crossed syndrome include burning or aching pain across the shoulders and neck or suboccipital pain at the bottom of the skull around the muscle attachment site of the trapezius and upper cervical extensors. The pain is normally aggravated after a prolonged period of static posture and is relieved by movements.

Examination of the neck normally reveals restricted range of motion of the lower cervical and upper thoracic spine. The suboccipital muscles are usually tight and tender with the presence of trigger points. Muscle weaknesses are commonly found in the deep neck flexors, serratus anterior, mid and lower trapezius and rhomboid muscles. There may be an increased neural tension in the peripheral nerves as the tight muscles are irritating the nerves.

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Thursday, 1 September 2016

Stress Fractures of the Metatarsals

Metatarsals are the second most common location where a stress fracture can occur. Tibia is the most common bone where stress fracture occurs. The neck of the second metatarsal is most commonly involved in stress fractures due to certain reasons. In the pronating foot, the first ray is usually dorsiflexed, this leads to greater force being applied to the second metatarsal. When Morton’s foot is present, the second metatarsal is subject to greater force as the first ray is shorter than the second. The base of the second metatarsal is firmly fixed in placed by adjacent cuneiform bones, this increases the risk of stress fracture. The likelihood of stress fracture is increased if the third metatarsal is longer than the second. Stress fractures of the metatarsals are very common in ballet dancers.

Metatarsal stress fracture normally presents as forefoot pain which is aggravated by activity such as running or dancing. The pain may not be as significant initially but may gradually worsen as the activity continues. Focal tenderness may be noted upon examination of the metatarsal. A radiolucent line or periosteal thickening may be reported on the X-rays if the fracture has been there for a few weeks. An isotopic bone scan may confirm the diagnosis if X-ray is negative.

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Friday, 26 August 2016

Chiropractic Treatment and Referred Buttock Pain

Abnormalities of the structures in the lumbar spine may result in a referred pain in the buttocks. Part of the management of referred pain from the lumbar spine should address the abnormalities in the lower back. However, in some chronic long standing cases, the area of referred pain may need to be treated in order to achieve maximum medical improvements.

In chronic cases of referred pain, local areas of tenderness may be revealed upon palpation of the muscles in the buttock. Soft tissue abnormalities are most commonly found in gluteal muscles, external rotators of the hip and lumbar multifidus. Taut fibrous band and muscle tightness are very common. Active or latent trigger points can be found within the muscles.

Integrated approach for the management of lower back pain to address the abnormalities in the lumbar spine are shown to yield significant improvements. Local electrical stimulation therapy can decrease inflammation and pain. Mobilisation and manipulation of the spine can remove joint movement restrictions. Soft tissue therapy can reduce muscle tension and pain around the lower back and buttocks region. Home stretches for the tight muscle should be given to improve the flexibility of the muscle. Strengthening exercises for the lumbar spine should be commenced gradually and progressively to prevent reoccurrence of the injury.

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