Monday, 27 June 2016

Pain in the Back of the Heel

The Achilles tendon connects the gastrocnemius-soleus complex to the calcaneum in the foot. The calcaneum and the retrocalcaneal bursa are very closely related at this site of tendon insertion. A prominence of the calcaneum or a soft tissue tightness will increase the risk of mechanical irritation of the bursa and the tendon. A significant amount of stress will be loaded on the posterior aspect of the Achilles tendon where it inserts on the calcaneum with dorsiflexion of the foot. Prolonged irritation of the tendon at the insertion site will lead to permanent damage and a change in the nature of those tissues.

The prominence of the posterolateral calcaneum is known as the Haglund’s deformity. Haglund’s disease is presented with a prominent and painful retrocalcaneal bursa, mostly on the outside of the posterior heel, and is commonly associated with a prominent calcaneum (the Haglund’s deformity). Asymptomatic Haglund’s deformity can be an incidental finding on X-rays and this is not an indication for treatment.

Insertional Achilless tendinopathy is most commonly considered as a tendinosis without inflammation of the tendon. There is local revascularisation inside and outside of the distal tendon. The retrocalcaneal bursa sits in between the calcaneus and the Achilles tendon. It acts as a lubricant and cushion as the tendon moves across the bone. Repeated irritation of the bursa can result in inflammation of the bursa. The presentation of retrocalcaneal bursitis can be very similar to Achilles tendinitis.

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Wednesday, 22 June 2016

Chiropractic Treatment and Physiotherapy for Achilles tendinopathy

The clinical presentations of Achilles tendinopathy may vary depends on the severity of the condition. The onset of pain may be sudden or gradually over a period of time. The severity of the pain can range from a mild discomfort to profound pain with severe activity limitations. Swelling around the Achilles tendon may be visible or may be absent. Some of the patients may be able to pinpoint the exact location of the pain but some patients may report of pain throughout the Achilles tendon.

Conservative managements of Achilles tendinopathy include relative rest, orthotics such as heel lift and change of shoes, therapeutic modalities, physical therapy and chiropractic treatment. The first stage of treatments will focus on pain reduction, followed by restoring joint mobility and muscle strength. Stretching exercises and joint mobility exercises should be performed as soon as the pain subsided. Strengthening exercises for the calf muscles can be performed in the later stage of the treatment.

One of the eccentric training for Achilles tendon injury include heel-drop exercise. This consists of the gastrocnemius drop and the soleus drop. For the gastrocnemius drop, patient stands on one leg over the edge of a platform with the heel raised and knee straightened. The patient slowly lowers the heel until the foot is level with the ground. For the soleus drop, patient stands on one leg with the heel raised and the knee flexed to 45 degrees. Then the patient slowly lowers the heel until the foot is parallel with the ground.

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Friday, 17 June 2016

Risk Factors for Achilles Tendon Injuries

Achilles tendon damage occurs as a result of an excessive load applied to the Achilles’ tendon, either in a single episode or over a period of time. Midportion and insertional Achilles tendinopathy have different prognosis and response to treatment. Hence, it is important to distinguish between the two diagnoses. Macroscopic discontinuity of a portion of the tendon is known as a partial tear or rupture of the tendon. These tears do not normally occur in normal tendon tissue. These tears are most likely found in a region with pre-existing pathology such as collagen fiber disarray and they show increased blood supply without signs of tissue repair.

There are a few risk factors that predispose patients to Achilles’ tendon injuries. People with years of running history are more likely to have chronic Achilles’ tendinopathy. A sudden increase in the intensity of activity including distance, speed and gradient of the activity may increase the risk of injury. A decrease in recovery time between training sessions may result in symptomatic Achilles’ tendon injury. A change of running surface or foot wear with lower heeled spike or shoe with heel tab may cause damage to the Achilles’ tendon. Poor foot wear with inadequate heel counter, increased lateral flaring or decreased forefoot flexibility will put more stress on the Achilles’ tendon.

Poor muscle flexibility of the calf muscles such as tight gastrocnemius can increase the load applied to the tendon. People with excessive pronation will result in excessive load applied on gastrocnemius to supinate the foot for toe-off. Restricted dorsiflexion of the ankle or a weakness in the calf are the risk factors too.

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Sunday, 12 June 2016

Stretching and strengthening exercises for tennis elbow

Tennis elbow is a condition where gripping and twisting of the hand and forearm is painful. There are a few exercises to increase the flexibility and strength of the forearm muscle in order to minimise and prevent the occurrence of tennis elbow.

Stretch the muscles that extend and flex the wrist. Straighten the arm with the palm facing the floor and the ceiling respectively, push the palm down and gently stretch the forearm muscles. Hold the stretch for 15 to 30 seconds, repeat the procedure 2 to 3 times.

Strengthening exercise for the wrist extensors. Sit in a chair with the forearm resting on the arm rest. Hold a light weight (1-2kg) with the palm facing the floor. Slowly drop your wrist and hand towards the floor then slowly bring the hand up towards the ceiling. Hold the position for 5 to 10 seconds. Repeat the procedure 10 to 15 times.

Strengthening exercise for the wrist flexors. Sit in a chair with the forearm resting on the arm rest or your thigh. Hold the weight with the palm facing the ceiling. Slowly drop your hand towards the floor then slowly bring it up towards the ceiling. Hold the position for 5 to 10 seconds. Repeat the procedure 10 to 15 times.

Strengthening exercise for the muscles that twist and turn the wrist. Hold the weight with the thumb pointing the ceiling. Slowly turn the wrist inwards as far as possible then slowly turn the wrist outwards.

No pain or minimal amount of pain should be felt during the exercises mentioned above. 

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Tuesday, 7 June 2016

Physiotherapy and Chiropractic Treatment for Diskogenic Wry Neck

Acute wry neck, also known as acute torticollis, has two most common types with different causes. Apophyseal wry neck is a result of joint damage and inflammation of the soft tissues around the joint. Apophyseal wry neck is frequently associated with sudden onset of pain due to a sudden movement. Diskogenic wry neck occurs more gradually and typically happens after a long sleep in an awkward posture. Middle-aged adults tend to be more susceptible to this condition. The pain is felt in the lower neck or upper back region. There may be radicular pain into the medial scapular region or in between the shoulder blades. Patients may describe the pain as a pain deep inside the neck or shoulder blades.

The patient typically presents with an antalgic posture – sideways tilting, rotation and forward bending of the head and neck. The patient may have a history of degenerative joint disease of the lower neck (C4-C7). It is important to differentiate diskogenic wry neck from a locked apophyseal wry neck. If a practitioner failed to do so may result in aggravation of the condition. Some of the treatments for apophyseal wry neck may not be appropriate for diskogenic wry neck, for example, manipulation of the cervical spine.

Mobilisation of the cervical spine helps to improve the range of motion. Gentle cervical traction can reduce the pain and muscle spasm. Physiotherapeutic modalities are good in reducing inflammation and promote healing. Postural retraining and motor control exercises should begin as soon as the pain subsides.

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Thursday, 2 June 2016

Chiropractic Treatment and Physiotherapy in Acute Wry Neck

A sudden onset of sharp neck pain with restricted neck movement that typically occurs after a sudden quick movement or on waking is known as an acute wry neck. There may or may not be unusual movements or prolonged awkward positions prior to the onset of neck pain. There are two most common types of acute wry neck which can be very similar in presentation. A detail history and examination is required to differentiate the apophyseal joint and the diskogenic wry neck.

The apophyseal joint wry neck is more commonly found in children and young adults. The most common segment involved is the C2/3 level. A sudden movement prior to the sharp pain is commonly reported. Locking of the upper neck segments such as C0/1 and C1/2 with trauma involved may need further investigation as the craniovertebral ligaments may be involved. The patient typically presents with the neck tilting towards the left or the right and slightly tilting forward. This antalgic posture exerts the least amount of pressure on the damaged joint. The patient is unable to bring the head and neck to the centre due to pain and muscle spasm.

Joint mobilisation and/or manipulation can be helpful in reducing the pain and restoring joint mobility. Lateral flexion and manual traction with a minimal amount of pain can be effective in treating this condition. Manual therapy followed by the range of motion and motor control exercises can be employed. Ice, ultrasound and electrotherapeutic modalities can be effective in reducing the swelling and inflammation. There may still be some limitation of movement immediately after treatments due to inflammation around the muscles and joints.

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Saturday, 28 May 2016

Getting a Suitable Tennis Racquets

Wrist and elbow injuries are very common in tennis players. One of the main causes for tennis-related elbow pain is incorrect stroking technique, especially the backhand swing. Different type of tennis racquet may increase the risk of injury in the wrist and elbow. The velocity of the swings, the speed of the incoming ball, the qualities of the racquet, the spot where the ball struck the racquet, the string tension and t
he stroke mechanic affect the force that reaches the player’s arm.

Older style wooden racquets are good in absorbing shock on impact as they were heavy and flexible. Modern wide-body racquets are designed to generate more power as they are lighter and stiffer but they are poor in reducing the shock on impact.

If the ball is stuck at the center of percussion or the ‘sweet spot’ of the racquet, the initial shock produced will be minimal. If the ball is hit outside of the sweet spot, the force transmitted to the hand wrist and elbow will be far greater and can cause more damage to the structures.

There are a few modifications can be done in order to reduce the shock at impact and minimize the force transmitted to the player’s arm. For example, lower the string tension, increase the flexibility of the racquet, increase the size of the racquet head, increase the weight of the racquet by adding lead tape, increase the grip size and grip on the higher side of the handle.

The largest comfortable grip size prevents the player from gripping too tightly on the racquet. Optimal grip size should be equal to the distance from the proximal palmar crease to the tip of the ring finger. The grip should only be squeeze firmly during the acceleration phase of the stroke. If not the players should loosen their grip whenever it is possible.

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