Tuesday, 29 March 2016

Adverse Effects of Delayed Onset Muscle Soreness on Athletic Performance


Delayed onset muscle soreness (DOMS) is commonly seen in athletes after unaccustomed physical activities or when first return to activity after a period of reduced activity. The symptoms of DOMS can range from mild muscle soreness to severe pain. If the athlete decided to continue the activity without proper treatment to alleviate the discomfort or pain, DOMS may have significant effects on the performance. In some serious cases, DOMS may cause secondary injuries in athletes.

Eccentric activity which involves the elongation of the muscles during the performance is more likely to cause DOMS. Eccentric activity may change the muscle function and joint mechanics due to muscle and connective tissue damages during the activity. As a result of the muscle soreness, the compensatory mechanism for muscle soreness and muscular and connective tissue damages, a less than optimal training performance may be noted.

DOMS may lead to anatomical, physiological or psychological impairment in athletes. A decreased range of joint motion, decreased strength or muscle power and abnormal muscle recruitment patterns are the possible adverse outcome of DOMS. Research showed that muscle soreness from DOMS may impair the neuromuscular function. A reduction in joint proprioception and decreased precision of force production is observed in athletes after eccentric activity. This may pose the athlete at a higher risk of secondary injury.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Thursday, 24 March 2016

Application of Heat for Musculoskeletal Injury

Application of heat in any form that leads to an increase in tissue temperature is known as thermotherapy. Superficial or deep heat therapy can relax muscle spasm and reduce pain. Heat application is commonly used in musculoskeletal condition if you want to increase tissue temperature, blood flow, metabolic rate and connective tissue extensibility. Heat is normally used in subacute and chronic conditions. Caution must be exercised when applying thermotherapy as acute exacerbation of a chronic condition is frequently seen. Application of heat in such situation may not be suitable and may cause more pain.

Tissue healing can be enhanced as topical heat therapy increases blood flow. This increases the supply of protein, nutrients and oxygen to the site of injury. An increase in tissue temperature also increases the metabolism of the local tissues. Higher metabolic rate increases the rate of metabolic by-product removal and facilitate tissue repair. Research showed that low-level heat therapy is able to slow down and block the painful nerve signal in the brain, which will provide temporary pain relief.

Continuous low-level heat therapy has been found to be effective in treating musculoskeletal conditions such as delayed onset muscle soreness, joint contracture, muscle spasm and osteoarthritis. Topical heat application showed a significant effect in pain relief, muscle stiffness and muscle and connective tissue flexibility. Prolonged thermotherapy of high-level thermotherapy may cause burns or may increase pain due to increased inflammation.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Saturday, 19 March 2016

Heel Pain

The painful heel is a common pain syndrome which can cause severe pain and can be incapacitating in most people. Severe pain in the inferior or posterior aspect of the heel is aggravated by weight bearing and the first step in the morning will be worse. Detailed examination of the foot is required to distinguish the differential diagnoses for heel pain. Achilles’ tendinopathy and plantar fasciitis are the two more common diagnoses for heel pain.

Plantar fasciitis is a chronic inflammation of the plantar fascia in the foot. The main cause of this non-inflammatory tendinopathy is a mechanically induced irritation of the plantar fascia at the calcaneal insertion. The most commonly reported symptoms include pain at the first step in the morning and pain in the heel after or during exercise. Medial tubercle of the calcaneus on the inner side of the heel can be painful when a firm pressure is applied.

Diagnostic imaging methods such as X-rays, magnetic resonance imaging (MRI) and ultrasonography for the ankle and foot may help to rule out certain soft tissue and bone pathologies. Stress fractures, tumours and calcium deposits need to be ruled out with imaging studies to determine the main cause of the heel pain. However, heel spurs may also present in asymptomatic patients.

Patients who are obese, over the age of 30, and stand for long hours are at higher risk for plantar fasciitis. Structural and biomechanical factors such as pes cavus, flat foot and limited plantar flexion of the foot may also cause heel pain.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Monday, 14 March 2016

Cryotherapy – Application of cold modality for musculoskeletal injuries

Therapeutic application of substances that removes heat from the body and leads to a reduction in tissue temperature is termed as cryotherapy. Cryotherapy causes constriction of the small blood vessels, decreases tissue blood flow, reduces tissue metabolic rate, oxygen consumption, and inflammation and muscle spasm. Common methods of cold application include ice pack, vapo-coolant spray, ice massage and cold whirlpool. Cold application can be used in acute injury, chronic pain, muscle spasm, delayed onset muscle soreness and inflammation.

The cold-induced local anesthetic effect can be obtained via neurologic and vascular mechanisms at the spinal cord level. The temperature of the skin and underlying soft tissues can be decreased with topical cold application. This temperature reduction leads to a decrease in the nociceptor activation threshold and the nerve conduction velocity of the pain signals. The tissue blood flow and cell metabolic rate can be slow down with continuous cryotherapy. Reduced cell metabolism in turn prevent secondary hypoxic injury to the surrounding tissues by restricting the rate of oxygen utilization.

Extra care must be given when applying cryotherapy on patients with advanced diabetes as the diabetic neuropathy may result in serious complications. Peroneal, ulnar, axillary and lateral femoral cutaneous nerve injury after cryotherapy with compression has been reported. These superficial nerves are more likely to be damaged with prolonged cold compression. Other adverse treatment effects include frost bite, Raynaud’s phenomenon, cardiovascular effects and slowed wound healing.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Wednesday, 9 March 2016

The Basic Pathophysiology of Pain

Musculoskeletal injuries are one of the main reasons for children and adults to lose their days of school and work. Topical heat and cold application are used to treat musculoskeletal injuries such as bony, ligamentous, muscular and tendinous injuries. Topical heat and cold modalities are used along with physical therapy, chiropractic treatment, exercise and patient education for the multimodal treatment of musculoskeletal conditions.

The inflammation that occurs around the tissue injury site stimulates specialized nerve endings called nociceptors. Nociceptors transmit painful nervous stimuli through the spinal cord to the brain. The sensation of pain is perceived. At the same time, neurotransmitters, chemicals produced by our body to signal transmission, initiate a reflexive muscle contraction at the site of injury due to increased muscle activity and tonicity. This will lead to painful muscle spasm if the muscle contraction persists. Persistent muscle spasm causes secondary hypoxic tissue damage due to decreased blood flow and oxygen to the surrounding tissues. This pain-spasm-pain cycle must be interrupted as early as possible to prevent secondary damage and to manage the pain.

Specialized temperature-sensitive nerve endings called thermoreceptors can detect changes in the skin temperature. The nerve signals initiated by these thermoreceptors can block painful nociceptive information within the spinal cord. Proprioceptors that detect joint position sense through tissue pressure changes and movement also reduce the transmission of pain signals to the brain. Activation of thermoreceptors and proprioceptors through physical therapy and chiropractic treatment can decrease muscle tone and relax painful muscle spasm.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my


Friday, 4 March 2016

Chronic ankle instability in athletes

Ankle ligament injury is very common in sports activities such as basketball, football, ballet and dancing. The majority of ankle ligament injuries are due to sudden flexion and inwards rolling of the foot. This mechanism of injury usually causes damages to the lateral ligamentous and muscular structures. Inversion injury of the ankle tends to recur due to weakened ligaments and this can cause chronic ankle instability.

The two main causes of ankle instability:
  • Mechanical instability: Repeated injury to the ankle can cause structural loss of the supporting ankle ligaments
  • Functional instability: Loss of neuromuscular control such as impaired balancing ability and decreased proprioception (joint position sense). The athlete may have difficulty balancing on the injured foot.

Treatments for chronic ankle instability

1. Functional rehabilitation exercises:
  • Muscle strengthening and neuromuscular control enhancement
  • Improvement of joint position sense (proprioception can be trained by using uneven surfaces such as wobble board or rocker board)
  • Improvement of balancing ability (athletes should be able to perform heel-to-toe walk or one-leg stance with eyes opened or closed)
  • Improvement of posture control ability (strengthening of the peroneal muscle is important as the muscle acts as a lateral dynamic stabilization structure of the ankle)
2. Taping or bracing application for dynamic stabilizer facilitation, proprioception improvement or joint support

3. Ankle-foot orthotics to improve static balance ability (standing and simple linear walking) and posture control ability

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at www.mychiro.com.my