Friday, 29 January 2016

Delayed Onset Muscle Soreness (DOMS)


Delayed onset muscle soreness predominantly affects the muscle after unaccustomed physical activities. This exercise-induced condition happens after a period of reduced activity or can occur when certain types of activities are first introduced. The discomfort can range from mild muscle tenderness to severe debilitating pain. Mild muscle soreness and joint stiffness usually disappear with mild to moderate intensity daily activities. The intensity of the pain usually increases within the first 24 hours and the pain can remain up to 72 hours. Most of the time the pain will subside 5 to 7 days post-exercise with relative rest.

DOMS is a type I muscle strain injury. A prolonged period of unfamiliar high force muscle work can cause the onset of DOMS. Eccentric exercises that require muscle contraction at a lengthened position cause more micro-damage to the muscle. Some of the examples of eccentric activities include downhill running, resisted cycling, ballistic stretching, stepping and eccentric resistance training.

There are a few hypothesised theories proposed for the cause of DOMS such lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. One single theory cannot explain the onset of DOMS. The integration of several theories in unique sequences can better explain the onset of DOMS in detail.

The performance of an athlete can be affected by DOMS as the joint range of motion, shock attenuation ability and peak torque of a joint is reduced. Muscle ligaments and tendons are at a higher risk of injury as muscle sequencing and recruitment patterns are altered. This can result in abnormal stresses placed on ligaments and tendons. Therefore, premature return to sport may precipitate further injury.

For more information or inquiries, please contact us at 03-2093 1000. 


Sunday, 24 January 2016

Structures That May Cause Pain in Spondylolisthesis

Spondylolisthesis is a forward or backward slippage of a vertebra over another. Spondylolisthesis can be found in people with no pain. However, treating a person with lower back or neck issues complicated by spondylolisthesis can be challenging as there may be pain coming from different sources at the same time. Locating the major pain generators is important in providing an effective treatment plan. The majority of the spinal problems has several pain sources. Therefore, it is important to recognize and acknowledge each and every of the pain generators. Recent research has shown that multidisciplinary treatment program has a higher success rate in managing and treating musculoskeletal problems.

A disc sits in between two adjacent spinal vertebrae. The outer one-third of the disc has nerve fibers that can carry pain signals. Over-stretching or motion of the disc can cause activation of these nerve fibers and results in pain. Inflammation that occurs in the disc and spine can irritate the nerve fibers and cause pain too.

Irritation of the nerve fibers in the facet joint capsule or the bone near the joint can be a major source of pain. Stretching of the joint capsule, abnormal loading of the facet joint or inflammation around the joint may irritate exiting nerve roots. The pain is usually aggravated with neck rotation and extension. People with degenerative spondylolisthesis have extra bone spurs around the joints, and hypermobile joint is more susceptible to nerve root irritation due to narrowing of the space where the nerve roots travel through.

Irritation of the disc or facet joint may result in radicular pain. In the lower back, the pain may travel down into the buttocks or the legs. In the neck, the person may be complaining of a headache or upper back pain.

For more information or inquiries, please contact us at 03-2093 1000. 


Tuesday, 19 January 2016

Spondylolisthesis and spondylosis

Spondylolisthesis is the slippage of one spinal vertebra over another. Spondylosis is a bony defect at the junction of the superior and inferior articulating processes, pars interarticularis. A vertebra may slip forward as a result of this bony defect and may cause neurological signs and symptoms. This condition is more commonly seen in males. Spondylolisthesis is more likely to be unstable and the forward slippage may progress during adolescence.

Classifications of spondylosis and spondylolisthesis are based on the factors resulting in these conditions. Type 1 is due to a congenital deficiency of the bony architecture of the spinal vertebra. This bony weakness can cause the forward slippage of L5 on S1 vertebra. Type 1 dysplastic spondylolisthesis has a higher genetic association. So the first-degree relatives of the affected individual are more predisposed to spondylolisthesis. Type 2 isthmic spondylolisthesis involves a damage in the pars interarticularis. This is most commonly seen at L5/S1 level. Chronic stress fracture, chronic repetitive stress leading to elongated but intact pars, or acute pars fracture can cause defect at pars interarticularis. Type 3 is due to intersegmental instability from chronic degenerative changes and usually involves L4 and L5. Type 4 has a traumatic factor and type 5 involves other pathologic factors.



Spondylolisthesis may cause or complicate lower back conditions. Symptoms of spondylolisthesis may include lower back pain, pain or numbness in the lower limbs, weakness in the legs or loss of bowel and bladder control in severe cases. Some spondylolisthesis may not cause any symptoms until later years in life.


For more information or enquiries, please contact us at 03-2093 1000. 

Thursday, 14 January 2016

Tennis Elbow – Treatment and Prevention


Tennis elbow is a chronic overuse injury of the forearm extensor muscles. Repetitive contraction and movement of the wrist extensors are the main actions that result in tennis elbow. Repeated supination and pronation of the forearm (twisting motion of the forearm) and gripping required to perform certain tasks can be painful in individuals with tennis elbow. The grip strength may be reduced in some cases as a result of the pain when exerting force. People with past history of rotator cuff injury, carpal tunnel syndrome, and De Quervain’s syndrome are at higher risk of developing tennis elbow on the same side. Oral corticosteroids consumption and history of smoking are risk factors for tennis elbow.  



Ice and relative rest from activities that will cause pain are essential during the acute stage of injury. There are two types of bracing that can be used for tennis elbow, the wrist extension splint, and the counterforce forearm strap. The use of a splint with the wrist in 30 to 45 degree of extension may reduce the tension on the forearm muscles, especially the extensor carpi radialis brevis. The forearm strap can be used to improve pain-free grip strength as the strap may help to redistribute forces distal to the irritated muscles.

A graded program of gentle stretching and isometric exercise progressing to an isotonic exercise of the wrist is necessary for managing and preventing the condition. Physical therapy such as ultrasound therapy, interferential, manual therapy, and mobilization are effective in treating this condition.

For more information about the best tennis elbow treatment in Malaysia, please contact us at 03-2093 1000.


Saturday, 9 January 2016

Tennis elbow – Lateral epicondylitis


You do not need to be a tennis player in order to get a tennis elbow. If you are involved in a repetitive sport or occupational activity and you are having lateral elbow pain, you may have a tennis elbow. Tennis elbow, also known as lateral epicondylitis, is an overuse injury to the origin of the forearm muscles. Activities that involve repeated forceful gripping and twisting of the wrist and forearm can cause damage to the extensor muscles origin, especially the extensor carpi radialis brevis origin.


Individuals who are active in tennis or other racquet sports are more likely to get tennis elbow. Amateur tennis players with the poor backhand technique are at higher risk of tennis elbow. Whereas forehand or serving may be the cause of tennis elbow in professional tennis players. Patients often complained of lateral elbow pain caused by or aggravated by the repetitive strenuous use of the hand and forearm such as gripping a screwdriver or lifting a heavy load. Meat cutters, plumbers, and carpenters are examples of those who are more likely to be affected.

Resisted wrist extension or middle finger extension may be weak and painful. Stretching of the forearm extensor muscles may be painful. The range of motion of the wrist may be limited due to pain. Positive chair test is another indicator of tennis elbow. The patient is required to lift up a light chair by the chair back with the palm facing the floor. Most of the patients with tennis elbow are unable to perform the test due to the pain in the forearm.

To learn why our chiropractors and physiotherapists are your best choice for elbow pain in Malaysia, please contact us at 03-2093 1000



Monday, 4 January 2016

Whiplash Injury


Whiplash injury is commonly seen in motor vehicle accidents. Rear-end collision can result in this acceleration/deceleration injury of the neck. The patient may suffer from a broad range of symptoms immediately after the accident or after several symptom-free days. Hyperextension of the neck may or may not happen. However, inter-segmental hyperextension of the cervical spine may be the most likely cause of whiplash injury. The instantaneous axis of rotation is being changed and more compressive forces are being placed on the facet joints and disc of the lower cervical segments.  The most common signs and symptoms of whiplash injury include neck pain with muscle spasm, limited range of motion of the neck, loss or reversal of cervical lordosis curvature, headache, numbness or weakness in the upper limbs, vertigo and tinnitus.


Rear-end collision usually involves a sequence of events resulting in whiplash injury. They are divided into phases.

Phase 1 – When a motor vehicle is hit from the rear, the passenger’s body is forced back into the seat. The body moves upward simultaneously and result in straightening of the curvature of the neck. Then the head and neck begin to move backward.

Phase 2 – The vehicle reached its peak acceleration when the head and neck are extending backward. Additional acceleration to the body as a result of extra energy stored in the seat from the backward movement of the torso. Acceleration may be prolonged if the driver has released the brake.

Phase 3 – Deceleration occurs and the head and body are thrown forward. This will be accentuated if the driver’s foot is reapplied to the brakes.


Phase 4 – The seat belt and shoulder harness will restrain the body and the head will decelerate forward. 

Get the best whiplash and neck pain treatment in Malaysia today by calling 03-2093 1000