Category Archives: Conditions, Injuries & Advice

What Causes Muscle Cramps?

The involuntary, painful muscle contractions that are cramps can be temporarily debilitating and can occur suddenly. Cramps can occur in any muscle but most commonly occur in the calf and hamstring muscles. There is common belief that muscle cramps are caused by dehydration and sodium chloride/salt losses during exercise in hot conditions however this is not actually the case. Other popular theories such as low potassium levels or insufficient carbohydrate intake are also becoming more unlikely. The hypothesize with the most backing behind it suggests that cramps result from changes in nerve activity which is triggered by fatigue. This is all well and good but I hear you asking: “How can get rid of my cramps??” If a cramp comes on, stretching the muscle can instantly relieve your symptoms. As cramps are related to fatigue, correcting biomechanical abnormalities, improving muscle imbalances and posture, and conditioning your body via specific training can help prevent muscular cramps from occurring. Physiotherapy can help by addressing the postural, biomechanical and muscle imbalance issues but also to provide soft tissue therapy to release any muscle trigger points and reduce muscle tightness which may be contributing. A specific eccentric strengthening exercise program can also be prescribed by your physiotherapist to help prevent cramps. By Todd Purser

Dry Needling Explained

Dry needling is a treatment modality used by suitably trained physiotherapists to assist with pain, tightness and function. Dry needling is based on western medicine and the knowledge of anatomy and neurophysiology. It targets muscle, nerve connections, tendons and other soft tissues. Dry needling is beneficial for a number of musculoskeletal and sports injuries including neck and back pain, headaches, shoulder and knee conditions, tennis elbow, shin pain and many more. The most common form of dry needling targets trigger points in muscle (hypersensitive lumps or ‘knots’ that can be felt in muscle). Dry needling is different from acupuncture in a number of ways: acupuncture is based on traditional Chinese medicine and energy channels and needles are often left in place for a certain amount of time. Dry needling uses the same fine needles, however needles are often inserted and moved slightly aiming to achieve a small muscle twitch which usually results in a reflex relaxation of the muscle. During dry needling, patients often experience an aching or a sharp twitch when the needle is altered. It is common after dry needling to experience an ache and/or be tired for a day, like you have done a heavy gym workout. Some patients feel relief straight away while others feel better a day or two later once the ache has settled. Dry needling works by relaxing trigger points/tension in muscle as well as reducing pain and improving tissue repair by regulating chemical and nerve signals. Dry needling is very safe for most people (pregnant women and those with medical conditions should discuss the risks with their physiotherapist first) and is best used in conjunction with manual therapy and an exercise program. By Jessica Norton

More to Muscles Than Meets the Eye

Back pain is one of the most common and debilitating conditions that strikes the population today.  In this day and age we put more stress on our backs by sitting at desks for hours on end, standing in jobs, lifting, bending and various sports where we push our bodies to the limit.   It costs the community as a whole, hundreds and thousands of dollars per year in lost income, treatment and insurance payouts to name a few. It can haunt us forever if not properly managed by both the therapist and the individual involved.  It is the therapist’s job to not only mobilise and massage but to give the patient the tools to treat themselves by a series of home exercises. While sit-ups will make us look good on the beach in our swimmers and maybe attract a few from the opposite sex, it does nothing to protect our backs from pain and dysfunction.  It is the deep stabilising or “core” muscles that are important in treating low back pain.  It is almost guaranteed that these muscles are not working properly in someone with back pain.  Pain causes the inhibition of these muscles until eventually they “switch off”. The exercises need to be progressed in stages.  Firstly, the exercises need to be given in a “basic” position such as lying down.  It is important to activate the muscles and learn the pattern of movement. Then the exercises need to be progressed to activate the muscles in a standing or sitting position. Finally, the exercises need to be progressed to a “functional” level.  As your muscles being working better they need to be challenged to work in ‘normal’ conditions such as walking or running. They also need to be ‘specific’ for example during gardening or lifting; which are two activities that may cause back pain. These muscles need to be trained for the specific environment or sports undertaken. There is no point being able to activate your ‘core’ while sitting on a Swiss ball unless you are involved in a seated sport such as motor racing or paddling. For example, golf, tennis and football are three activities which require different demands on our muscular system.  Therefore, we need to train our ‘core’ specifically in these environments.  By lying on a Swiss ball or Pilates reformer it will only partially improve the control and may not fully treat the problem. By Melanie Roberts

Training to Prevent Osteoporosis

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-deterioration of bone tissue leading to bone fragility and increased risk of fracture.  It is estimated that there are over 1.5 million fractures per year in this high risk group.  The health care costs associated with fractures in this group of Caucasian women are estimated to be as high ad $45.2 billion over the next ten years. Some of the most common sites for fracture are the wrist, spine and hip with hip fractures being the most devastating.  The loss of independence, prolonged immobility and death due to multi-system failure are some of the complications of hip fractures.  Only one-quarter of hip fracture patients regain full independence. The biggest focus is looking at how to prevent osteoporosis and to decrease the incidence of fractures.  Preventative measures include lifestyle changes, such as altering nutrition and exercise. Bone mass density changes across the lifespan of females with a gradual loss throughout adult years and a steeper decline with menopause. Research suggests that athletes involved in activities requiring high impact loads have higher bone mass than those involved in endurance training. Those activities that involve muscular involvement without gravitational forces, for example, swimming, are associated with lower bone mass density than those with a weight bearing component. The impact of training should be at the bone site of interest since loading has a localized effect.  Overload means that the training stimulus must include forces much greater than that afforded by habitual activity and reversibility indicates that in the absence of the training stimulus, the positive effect will be lost. Studies show that there is improvement in spinal bone mass density in postmenopausal women with a program consisting of vigorous, progressive exercises including walking, jogging, stair climbing and rowing.  Discontinued participation showed reversal in bone mass, confirming that the benefits of training only persist as long as the stimulus is applied. Intervention which includes dynamic resistance training 2 days/week on pneumatic machines demonstrates improvements in muscle strength, muscle mass, bone mass and dynamic balance in oestrogen-deplete postmenopausal women. It takes about 9 – 12 months to detect significant change in bone mass.  The change may be a > 1% increase, since the average rate of loss is 0.5 – 1% per year. The program should include squats, lunges, chair raises and jumping which helps with strengthening the hip abductors and extensors.  It also helps with lateral stability and decreases the risk of falls.  Balance exercises are an important part of the exercise program, as a common reason for the fractures is due to falls.  Physical activity that involves twisting, bending or high impact should be avoided for those already diagnosed with a low bone mass density and sports like golf and tennis apply torsional stresses to weakened bones.  Therefore, patients at risk should be involved in swimming, water aerobics, dancing, low impact aerobics, walking, cycling and light resistance weight training. Get out there and stimulate those bones and have some fun! By Melanie Roberts

Are We Contributing to Our Pain?

The importance of choosing appropriate equipment for any athletic pursuit is of utmost importance in preventing pain and dysfunction. Whether activity involves a 30 minute walk in the park with your dog or a highly competitive game of tennis, choosing the correct equipment can be the difference between pain or gain. Equipment may range from simple footwear to more complex racquets or sticks; to expensive and highly sophisticated items such as bicycles and motor vehicles. Three major pieces of equipment play a major role in the development of sports injuries – footwear, racquets and bicycles. Over the past two decades running shoes have become increasingly more complex and specialised.   The assessment of foot type and function is imperative in deciding the most suitable shoe.  They must fit correctly and the laces must be firm enough for motion control.  Running shoes need to be changed every 1,000 km which is approximately every 6 – 9 months for runners and 12 months for walkers. The constructions of many types of football boots provide inadequate support for the lower limb.  They should be of adequate depth in the upper, have a rigid heel counter, sufficient forefoot flexibility and have a wide sole with ‘cleats’ placed to allow forefoot flexibility.  Netball and tennis shoes require support for sideways movement.  Wearing running shoes for these sports may lead to ankle sprains, while wearing tennis or netball shoes for running may lead to problems such as ‘shin splints’. Racquets are used in sports such as tennis, squash, badminton and table tennis.  The choice of a tennis racquet may be a contributing factor to ‘tennis elbow’.  Things that need to be considered include string tension, flexibility of the racquet, size of head, weight and grip size. Overuse injuries in cycling may be associated with incorrect bike set up.  Seat height, saddle position, handlebar position, pedal resistance and peddling technique if incorrect may contribute to musculoskeletal pain such as neck and back pain, shoulder and wrist pain and knee pain to name a few. When choosing any piece of equipment you need to get correct advice from a professional to avoid unnecessary pain and injury. By Melanie Roberts

Arthritis – Physio Treatment Options

Arthritis is a condition that affects millions worldwide. Osteoarthritis is a form of arthritis that affects the joints throughout the body. There is a layer of cartilage that lines the bones of our joints. As we age, this cartilage loses water and becomes less resilient and more susceptible to wear and tear. Once this cartilage layer starts to degenerate, bone becomes damaged beneath this cartilage and bone spurs bone may form causing pain, swelling and stiffness. Osteoarthritis is common in hands, feet, spine and especially weight bearing joints such as hips and knees. Symptoms of osteoarthritis include pain, stiffness and reduced mobility. Pain is often worse when it’s cold and when weight is put through the joint (ie: walking). In those with mild to moderate arthritis, the pain usually gets better after moving about or “warming up”.   Physiotherapy can help those suffering from osteoarthritis. While you cannot change the fact that the arthritis has developed, physio can help with the pain, lack of strength and reduced mobility that is associated with arthritis. ‘Hands on’ physio, such as soft tissue massage to the muscles about the affected joint, can help relieve any tightness and restore movement. Your physiotherapist can also provide you with some simple exercises to help strengthen the muscles around the joint to ensure that the joint is moving as freely as possible. These exercises are also important to strengthen those muscles to ensure there is enough strength to minimise any unnecessary strain on the joint in future. Physiotherapy can help delay the need for a knee replacement.   By Jessica Norton

Squats – Are they Symmetrical?

Symmetrical squats are important and this means that when viewed from the side both kneecaps will end up in the same place – with good alignment, your bottom does not drop more to one side, your pelvis does not twist to one side or drop down and that if you have weights on your shoulder the bar does not lean over to one side. When viewed from behind the bottom will come straight back and not twist to one side on the way down or up.  Some of the below list may affect the symmetry of the squat. Ankle Dorsiflexion – this is to do with ankle stiffness.  Can you move your body over the ankle?  If the ankle is stiff perhaps from a past injury this will limit the amount that your body can move forward over the ankle unless you stand on a wedge. Knee Pain – when your knee goes into flexion especially if your body is coming over too far it will load the knee joint.  If you have some arthritis in the knee or the kneecap this may cause pain.  Also, any tears in the cartilage may also cause pain and therefore the weight bearing may not be even. Hip Pain – If you have a tear in the labrum (cartilage) or some anterior impingement in the joint it will affect the way you squat through the hip.  It may make you squat with your legs wider and turned out to avoid pain.  You could also weight bear less on this side. Groin Tightness – this tightness on the left side for example will cause the pelvis moving to the left in the bottom position. Piriformis Tightness – at the top of the squat this will make the left hip appear externally rotated if tight on the left side.  In the lower part of the squat it will make the pelvis move to the left, again causing asymmetry. Posterior Capsule Tightness – this will appear like the piriformis tightness but at the bottom of the squat the pelvis will move to the right not the left. Leg Length Difference – this depends on if the leg length difference is actual or apparent.  Both will have an effect on the symmetry of the squat but for different reasons. Scoliosis – this depends if it is structural (bony growth) or apparent due to asymmetry of muscles, that is, functional or apparent. Hip Muscle Strength – this can be due to muscle weakness – it may be in glut max where you will move to the stronger side or it may be in the quadriceps muscles which will show up especially in the up phase of the movement moving weight across to the other side.  There may also be some weakness in the deep pelvic stabilisers which may cause a pelvic drop on the opposite side. Upper Limb Tightness – tight latissimus dorsi or pect major will have an effect looking at the upper body and the way the bar moves (is it symmetrical through range?). By Melanie Roberts.

Soft Tissue Response to Injuries

So what actually happens when we injure the soft tissues in our body? Understanding the processes and time frames involved can give you a basic idea of what to expect should you encounter an injury. Common soft tissue injuries involve structures such as muscles, tendons, and ligaments. The following three stages are how typical soft tissue injuries will respond: The acute stage usually lasts around 0-72 hours and involves local inflammation, bleeding and the initial formation of scar tissue. The repair stage begins on day 2 and can continue until week 6 and involves scar tissue being formed to ‘close’ the damage. The remodeling stage can begin after 4 weeks and can last up to 12 months. During this stage, the tissue slowly returns to it’s pre-injured state. The initial extent of the injury will influence the amount of scar tissue formed along with healing times. Muscles will lose strength in relatively short periods of time due to the inflammatory process and being immobilized. Scar tissue can be broken down effectively using soft tissue therapy techniques performed by a physiotherapist. This can speed up recovery time and promote muscle elasticity which can reduce the risk of re-injury. Each injury presents differently and although each injury will go through the above stages, the time frames can differ depending on the severity of the injury. By Todd Purser.

Hamstring Strain Management

Hamstring strains are common in sports such as soccer, AFL, rugby league as well as common physical activities like running. The hamstring muscle group is comprised of three muscles which act to extend the hip and bend the knee. When the tension within the muscle is too high due to too much force or repetition then the muscle fibres tear. Hamstring strains commonly happen while running, just before the foot strikes the ground. In this position the hamstring is in a lengthened position and is required to produce a lot of force to prepare the foot for impact. Hamstring strains are graded 1-3 depending on their severity, with grade 1 being a minor strain with only a few fibres torn compared to grade 3 which involves over 50% of the muscle fibres being torn and may involve full rupture of the muscle. Signs and symptoms of a hamstring strain vary depending on the severity of the injury and may include pain when walking, pain on stretch, bruising, tightness and weakness. Hamstring strain recovery times also vary, with on average 6-8 weeks required for a grade 2 strain. Management includes soft tissue therapy and a gradual strengthening program to restore full range and strength. A return to sport program is important to ensure a smooth transition back to playing/exercising. Management also includes addressing any contributing factors such as weak glut and hamstring muscles, poor flexibility, inappropriate shoes, poor technique, unbalanced training program etc. Proper management of a hamstring strain is vital as inadequate rehabilitation leads to an increased risk of injuring the hamstring again.   By Jessica Norton  

Achilles Tendinopathy

Achilles tendinopathy is a common condition that results from degeneration of the Achilles tendon. The term Achilles tendinopathy means pathology within the tendon and has replaced the term tendinitis as research has found the condition to involve degeneration of the tendon, rather than an inflammatory response.  A tendons role is to transmit force from the muscle to bone as well as absorb any external forces from over straining the muscle. To achieve this, a tendon must have adequate strength, flexibility and elasticity as well as adequate recovery time. Achilles tendinopathy usually results from repetitive or prolonged activities such as excessive walking, running etc that overloads the capabilities of the tendon. Beginning an aggressive training program after being sedentary for a period is also seen as an aggravating factor for Achilles tendinopathy. As a result of aggravating factors, the tendon substance changes causing a reduction in tensile strength of the tendon.  Inflammation of the paratendon (sheath around the tendon) is occasionally seen. Signs and symptoms of Achilles tendinopathy include pain at the beginning and end of exercise with pain easing once warmed up. Stiffness first thing in the morning and after being seated for a period of time is also common. As the condition worsens, pain will be felt earlier into exercise or will not ease after warming up. Management of Achilles tendinopathy includes addressing all of the contributing factors which could be calf tightness, overpronation of the foot, inappropriate footwear, poor technique, muscle weakness and many more.  Since tendon repair and remodelling is stimulated by load, complete rest can be detrimental to Achilles tendinopathy. A period of ‘modified rest’ (Ie: rest from aggravating and painful activities) while completing a gradual strengthening program under the advice of your physio, is an important part of successful rehabilitation.   By Jessica Norton