Friday, 22 July 2016

Tendinopathy of the Hamstring Origin

Hamstring origin tendinopathy is one of the causes that will result in pain in the buttocks region and the back of the thigh. An acute tear of the hamstring with inadequate treatment or an overuse injury of the hamstring may result in tendinopathy of the hamstring origin near the ischial tuberosity. 
Overuse injuries of the hamstring is more commonly seen, especially in sprinters.

The onset of the pain is usually insidious after a session of sprinting, or there may be a sudden onset of sharp pain. There is often a local tenderness on hamstring upon palpation. Stretching of the hamstring muscle and resisted contraction of the muscle may reproduce the pain. The injured and painful site may be found at the attachment near the ischial tuberosity, within the tendon or at the musculotendinous junction.

Management goals for this condition include reduction of inflammation, healing of soft tissue injury and rehabilitation stretching and strengthening. Reduction of inflammation and soft tissue healing can be improved with ice, manual therapy and therapeutic modalities. Manual therapies such as deep transverse friction, stretching, trigger point therapy to the area of palpable abnormality are effective in releasing muscle tension.

Significant muscle tightness and weakness of the hamstring muscles can present in chronic hamstring origin tendinopathy. Stretching and progressive strengthening of the muscle are needed to prevent reoccurrence of the condition. The antagonist muscles such as rectus femoris and psoas are shortened and tight in chronic tendinopathy cases. These muscles need to be stretched as well.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at

Sunday, 17 July 2016

Ulnar Nerve Compression and Injury at the Wrist

Carpal tunnel syndrome and ulnar nerve compression are the two most common neurological pathology that results in numbness and paresthesia in the wrist. As the ulnar nerve passes through the tunnel of Guyon’s in the hand, it can be compressed and irritated at this site. The radial side
of the tunnel of Guyon’s is bounded by the hook of hamate whereas the ulnar side of the tunnel is bounded by the pisiform. The most common symptoms of ulnar nerve compression include pain, tingling and numbness in the little finger and half of the fourth finger on the ulnar side. Weakness usually develops in the later stage or in certain severe cases. There may be difficulty in opening jars, holding objects or performing fine movements of the hand and fingers such as typing or playing a musical instrument.

Ulnar nerve injury is very common in cyclists with poor bike fit or those who did not perform relaxed handlebar grip positions. These will result in injury and nerve damage as the hands need to support the body weight throughout the whole duration of the ride. Baseball players, particularly catchers, are more prone to ulnar nerve injury from repeated trauma when catching a ball. This can happen in karate players too.

Conservative treatment involves splinting, correction of cyclist’s grip on the handle bars, physiotherapy to reduce inflammation and swelling and chiropractic treatments.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at

Tuesday, 12 July 2016

Physiotherapy and Chiropractic Treatment for De Quervain’s Tenosynovitis

Tendons of the abductor pollicis longus and extensor pollicis brevis muscles pass in their synovial sheath in a fibro-osseous tunnel at the level of radial styloid. Inflammation of the synovium at this level causes pain at the radial side of wrist. Local tenderness and swelling may extend into the hand or forearm along the course of the tendons. Crepitus may be felt with movements of the wrist in certain cases. Positive Finkelstein’s test is diagnostic for De Quervain’s tenosynovitis. The thumb is bent and placed in the palm while the wrist is slowly brought towards the ulnar side. Pain can be felt at the base of the thumb near the radial styloid.

This radial-sided tendinopathy is very common in athletes, especially those who participate in racquet sports, ten pin bowlers, rowers and canoeists. Additional stress is exerted on the left thumb of a right-handed golfer during a golf swing and this will result in injury and pain.

Conservative treatments for De Quervain’s tenosynovitis include splinting of the wrist and thumb to prevent further damage from excessive movements. Local electrotherapeutic modalities are helpful in reducing swelling and inflammation. Manual therapy such as stretches and trigger point therapy are able to relax the forearm muscles. Graduated strengthening exercises for the muscles in the wrist and hand are important to prevent the reoccurrence of the condition.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at

Thursday, 7 July 2016

Patellofemoral pain

Pain in and around the patella, or more commonly known as the knee cap, is referred to as patellofemoral pain. Similar terms used to describe the pain in and around the knee cap include patellofemoral joint syndrome, anterior knee pain and chondromalacia patellae. Without the present of other pathologies around the knee joint, all peripatellar or retropatellar pain are considered as patellofemoral pain. However, it is necessary for all health care providers to identify the sources of pain in order to provide appropriate treatment for patellofemoral pain.

There are numerous intra- and extra-articular structures in the patellofemoral joint which are susceptible to damage and can result in pain. Patellofemoral articular cartilage may not be a direct source of pain as there is no direct nerve supply to the articular cartilage. However, a cartilage lesion may result in chemical or mechanical synovial irritation which can lead to pain. Other than that, a cartilage lesion may lead to subchondral bone pain through oedema or erosion. Inflammation of the peripatellar synovial can be one of the sources of patellofemoral pain.

Soft tissue structures around the knee joint such as the lateral retinaculum can be considered as one of the potential causes of patellofemoral pain. The infrapatellar fat pad is one of the most commonly irritated soft tissue structures in the knee. It has plenty of nerve supply and is closely related to the pain-sensitive synovium.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at

Saturday, 2 July 2016

Complete Rupture of the Achilles Tendon

Complete rupture of the Achilles tendon typically presents in male athletes in their 30s or 40s. The site of rupture may or may not be at the watershed area with poor blood supply. Most of the patients may claim that they felt like they were being kicked or hit in the back of the leg. An audible snap may be noted. Pain may not be a major concern. However, the patient will notice grossly diminished function of the leg.

The patient will be limping but will not be severely disabled as normal movements of the leg are maintained through the use of compensatory muscles. Most of the patients are able to walk, but will have difficulty standing on the toes.

The following four clinical tests are most commonly used to examine complete rupture of Achilles tendon:
  1. Upon careful observation of a patient lying face down (prone) with both ankles fully relaxed, the foot on the side of ruptured tendon hangs straight down as there is no muscle-tendon tone; whereas the foot on the healthy side will be slightly plantarflexed.
  2. There may be an obvious palpable gap in the tendon, approximately 3-6 cm.
  3. There will be a significant reduction of the strength of plantarflexion.
  4. Simmond’s or Thomson’s calf squeeze test will be positive. The foot will not have the plantarflexion movement when pressure is applied on the calf.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at

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.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at

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.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at