Category Archives: Conditions, Injuries & Advice

Lateral Hip Pain – What is it Really?

It is a common complaint especially in those who have started an exercise program, such as walking or running and more common in peri or post menopausal women to suffer from lateral hip pain.  It occurs in people with OA of the hip and in 20-35% of people with lower back pain.  It is made worse by activities that require pelvic stability such as walking/running and going upstairs and when it is more severe affects daily activities such as sleeping on your side, prolonged sitting and walking or single leg stance.  It is due to a tendinopathy of the Gluteus Medius tendon which inserts into the lateral (outside) hip.  It is quite often misdiagnosed as Greater Trochanteric Bursitis (there may be bursal distortion, but no histological signs of inflammation).  It develops due to tendon compression from a lack of pelvic stability (causing relative hip adduction) and weakness/poor activation of the deep hip and pelvic stabilisers.  It is due to an overactivity and hypertrophy in the outer hip muscles as a compensation for this weakness.  This overactivity in the muscles, as well as the poor hip/pelvic control causes the compression of the tendon.  It is correctable with changes in everyday lifestyle such as sleeping with pillows between the knees, walking and going upstairs with a wider base of support and not sitting with legs crossed.   Stretching of the hip/glut muscles is commonly prescribed by physios causing compression and therefore aggravation of this condition.  This whole process of correction involves an analysis of activities of daily living and changes in lifestyle/training techniques.  To correct the problem long term, rest is not advised as the tendon becomes weaker, but a specific series of progressive non painful exercises. By Melanie Roberts

What is Rehabilitation – From a Musculoskeletal Physio Point of View?

Rehabilitation is basically the act of correcting dysfunction that is causing pain or restriction of range.  It is important to correct this dysfunction to gain a long term response to your treatment.   If you are merely treating the symptoms of pain or stiffness then this will return once you stop the treatment.  It may mean a series of corrective exercises to target the deep neck flexors in someone with neck pain or the “core” muscles in someone with lower back pain or stiffness.  It may be to correct the technique of weight training and give more appropriate exercises in someone with shoulder pain. The important thing about rehabilitation exercises is that they are progressive.  Firstly, you must get the activation of the muscle, perhaps in isolation such as with the deep neck flexors, not bringing in the large neck muscles on the outside, then, you need to learn to turn the muscle on in more difficult situations and for longer periods of time.  It may be strength or endurance you are looking for, depending on the type of muscle and its function.  You then need to make sure the muscle is turning on functionally.  It is great to have the muscle activate lying on a bed but does it work when you go running?  All of these exercises and the postural correction and joint range of motion exercises should all form part of your rehabilitation with a physiotherapist. By Melanie Roberts

Dry Needling – What is it?

Dry needling is similar to acupuncture (uses acupuncture needles) however quite different in its approach and background.  The reason it is called “dry needling” is because there is nothing injected (previously cortisone and saline were injected but with no increased effect).  It is used for people who have myofascial pain brought about by trigger points or tender bands in a muscle due to some sort of “overload” in the muscle.  The needle is inserted directly into the trigger point (rather than an acupoint in acupuncture) and may stimulate a local twitch response in the muscle, which is an involuntary spinal reflex.  Dry needling that elicits this involuntary  local twitch response (LTR) will normally give a better outcome as it is thought to release endogenous opioids, however, can lead to some increased treatment soreness.  It is also possible to do a gentler form of treatment whereby the needle is inserted into the trigger point and then twisted to “lock” the needle (more similar to acupuncture) and left in place for a period of time.  To perform dry needling the practitioner should be trained by an accredited training centre and hold a certificate to practice with professional indemnity insurance. By Melanie Roberts

Posture

Have you ever noticed yourself slouching or standing with one leg out to the side?  Your day to day posture can have more of an effect on your posture than you think.  Having poor posture can result in an award wear through your joints and ligaments, muscle fatigue, tightness and weakness throughout multiple areas of your body.  These can then lead to aches and pains such as headaches, shoulder impingement, lower back pain, disc problems, tendonitis and plantar fasciitis to name a few.  Your physio can assess your posture and resolve your underlying issues to correct your postural dysfunction and prevent these problems from being a long-term problem. By Charlotte Fisk

Choosing the Correct Pillow

It is very important to choose the correct pillow to support the weight of your head.  Did you know that your head weighs around 5kg?  That is a lot of weight to have unsupported on your neck.  If the pillow is too high your neck will be overly stretched on the bottom (close to the bed) and the vertebra compressed at the top if the pillow is too low their will be little support and the vertebra overly compressed on the bottom (close to the bed) and stretched at the top.  This puts strain on the muscles, the joint capsule, the nerve structures to name a few.  Over a period of time you can imagine what it is doing to your neck.  Long term use of the wrong pillow can contribute to cervicogenic headaches (headaches from your neck) or chronic neck pain.  If you are seeing a physio or chiro and you have not had your pillow looked at, this would be my first suggestion in getting better.  The density of the pillow need to be firm enough to support the 5kg and should be the correct height to keep your spine in a neutral position.  A feather pillow just does not work by the way!!! By Melanie Roberts

Physio Tips for Using a Computer

  1. Buy the best chair you can afford which is height adjustable.  It must be comfortable. 2.Pull your chair close to the desk and adjust the height of the chair so that your feet are flat on the floor with elbows, hips and knees at approximately 90º.  Use a foot stool if necessary to keep your feet flat.  Your forearms should be parallel to the desk or slant down slightly. 3.Make sure you sit up straight with a good lumbar support.  If your chair does not have a good support some inexpensive supports can be obtained from your physiotherapist. 4.Have your computer at a comfortable viewing distance with the screen in front of you, not to one side which will mean your neck is always turned.  Keep the top of the screen below eye level. 5.Do not use a laptop / notebook for extended periods as generally you are looking down.  You can prop it up on a few books if need be.  You can plug in a normal sized keyboard if you do use it for longer periods. 6.Make sure the computer screen is easy to read, not too small and does not have a large amount of reflection.  Adjust the position of the screen or lighting to assist with the glare. 7.Take a break every 30 minutes.  Stand up and stretch your neck side to side, rotate left and right and have a short walk around. You should also stretch your elbows and wrists.  Stand up and bend backwards to stretch your lower back. 8.If you feel any aches and pains in your neck, back or shoulders – take a short break to stretch and check your posture.  If pain persists contact your physiotherapist. By Melanie Roberts

How to Prevent Recurrent Ankle Sprains

Ankle sprains are one of the most common injuries. An ankle sprain occurs when the ankle is rolled or turned past its normal range of limits. This usually happens when the foot is planted awkwardly, twisted on an uneven surface or an unusually high force is applied to the ankle. Ankle sprains are common in sports such as soccer, netball and touch footy, but can also occur in daily activities such as walking or stepping off a curb. During an ankle sprain, the ligaments holding the bones together are ‘overstretched’ or sprained causing an inflammatory reaction and pain. As a result of the swelling and pain, movement at the ankle joint is restricted, muscles such as the calf become tight, and a limp is often noticeable. Ice should be applied to the area immediately after an ankle has been sprained. Rest from painful movements, elevation of the ankle and a compression bandage will also be helpful for the next 48 hours. If an ankle sprain does not heal properly then the joint may become unstable, stiff and may lead to further injury. After an ankle sprain, your physiotherapist can help reduce pain and swelling, restore full movement, strength and proprioception. Once you sprain your ankle and ligaments are damaged, your proprioception (balance) is affected. Proprioception is your body’s ability to sense where a joint is in space. If you have poor ankle proprioception then your body doesn’t know when your ankle is getting into an overstretched or bad position and then your muscles don’t have the ability to correct your position and prevent re-injury. Poor proprioception is one of the biggest risk factors for re-injuring your ankle. Treatment of an ankle sprain may include soft tissue massage to reduce swelling and tightness within the calf, joint mobilisations to regain full movement at the ankle. Your physio can also provide you with some exercises to strengthen the muscles around your ankle joint as well as some exercises to improve your proprioception. A couple of tips for preventing further re-injury include: Proprioceptive, strength and stretching exercises as shown by your physio Wear shoes with good support Avoid training on uneven surfaces Ensure adequate warm up   By Jessica Norton

Headaches and Physiotherapy Treatments

The first three nerves of the neck supply the three upper joints of the neck and their supporting ligaments as well as the muscles.  They supply the sensation of pain to the head and face during a headache if there is some dysfunction in any of these top three joints.  This is called referred pain.  The joints may have been damaged during trauma such as a “whiplash” injury or just stiffness due to degeneration with arthritis or poor posture. Long term stress or bad posture can cause a tightening of the muscles around the neck which can go into spasm and the overactivity in these muscles can cause a headache.  The tight muscles can also cause a pulling on the vertebra which can cause changes in movement patterns or even rotation of the vertebra.  This may affect the nerve and cause an irritation and referral into the head or face. The headache may be felt at the base of the neck, in the temples or above or behind the eyes.  It may be only on one side.  The distribution of the pain will help to determine which of the upper three vertebral levels is most affected.  The headache may be made worse by sustained bad posture or holding the neck bent forwards for extended periods such as with reading, writing or sitting on a computer. Sleeping may also make headaches worse if you do not have the correct pillow or you sleep on your stomach. Physiotherapy treatment for headaches will consist of mobilising or manipulating the affected joints, massage and soft tissue releases, correcting posture at the computer and during sleep as well as a strengthening program to assist with the overall neck posture and strengthen the deep stabilising muscles of the neck called the deep neck flexors. By Melanie Roberts

Iliotibial Band Friction Syndrome

Iliotibial band friction syndrome, or “ITB syndrome” is widely accepted as one of the most common lower limb overuse injuries among runners and cyclists. The iliotibial band is a dense, fibrous tissue that serves as a point of connection between muscles of the hip and thigh and the knee joint. Excessive bending and straightening of the knee (i.e. during running or cycling) can result in high amounts of friction near the band’s attachment at the outside of the knee or less commonly, the hip. This may cause inflammation of various structures in the affected area, manifesting as pain most commonly felt at the front, outer aspect of the knee, just beside the kneecap. If the problem is at the hip, the outside of hip may be painful to touch. Oftentimes pain is experienced at a particular distance or time during exercise but if left untreated, this condition can lead to persistent problems and affect normal day-to-day activities. Predisposition to ITB syndrome can include muscle strength and/or length imbalances of the hip and knee, poor running style, and incorrect bicycle set-up.  A physiotherapist can identify which factor is causing your pain and can determine appropriate intervention to relieve the symptoms and prevent pain from coming back in the future. By Jake Bagley

Lower Back Pain and Your “Core”

Exercise can be used for pain relief in people with low back pain.  The aim is to control back pain and prevent its reoccurrence through a series of exercises to enhance muscle control of the spinal segment.  With low back pain, the deep stabilising muscles of the spine “switch off” and do not turn back on again without specific exercises and retraining.  Our bodies are good at adapting and start using the outer muscles of the abdomen and back (which should move the spine and then switch off) to stabilise. When the inner layer or “core” muscles stop working the outer layer overworks and becomes tight, which leads to back muscle tightness and lack of flexibility.  People with back pain have trouble relaxing these muscles and must learn to do this by working the inner layer and turning that layer on first so the outer muscles do not have to work so hard at “bracing”.  “Core” exercises do not use “bracing” or sit ups, but a series of initially very basic exercises learning to turn the muscle on and then train the muscle functionally. By Melanie Roberts