Disc Prolapses that Reabsorb

A recent study shown that re-absorption of disc prolapses is higher than previously thought.

Zhong 2017

The Concern and fear that the words “slipped disc” “disc bulge” or “degenerative disc disease” can be worse than the actual symptoms of pain. The image of being broken and not being able to recover. But as previously noted in another blog about MRI scans, a large number of the general public suffer with a disc prolapse without symptoms. They manage to carry out a normal fulfilled life.

This new study of pooled data from the UK and Japan showed a significantly high number of lumbar disc re-absorption. To be precise it was 66.6% (82.94% in the UK I might add!!). All patients received conservative treatment, there was no invasive treatments like surgery or steroid injections.

This goes to show that with patience in your recovery and the right guidance, spinal problems will resolve without being too hasty for surgery.

 

Original Abstract

BACKGROUND: Lumbar disc herniation (LDH), a common disease, is often treated conservatively, frequently resulting in spontaneous resorption of the herniated disc. The incidence of this phenomenon, however, remains unknown.

OBJECTIVE: To analyze the incidence of spontaneous resorption after conservative treatment of LDH using computed tomography and magnetic resonance imaging.

STUDY DESIGN: Meta-analysis and systematic review of cohort studies.

SETTING: The work was performed at The Suzhou Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine.

METHODS: We initiated a search for the period from January 1990 to December 2015 using PubMed, Embase, and the Cochrane Library. Two independent reviewers examined the relevant reports. The references from these reports were also searched for additional trials using the criteria established in the PRISMA statement.

RESULTS: Our results represent the pooled results from 11 cohort studies. The overall incidence of spontaneous resorption after LDH was 66.66% (95% CI 51% – 69%). The incidence in the United Kingdom was 82.94% (95% CI 63.77% – 102.11%). The incidence in Japan was 62.58% (95% CI 55.71% – 69.46%).

LIMITATIONS: Our study was limited because there were few sources from which to extract data, either in abstracts or published studies. There were no randomized, controlled trials that met our criteria.

CONCLUSIONS: The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH. More large-scale, double-blinded, randomized, controlled trials are necessary to study the phenomenon of spontaneous resorption of LDH.

Chiro.jpg

Reference

Zhong et al, (2017) Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician

Recovering from an ankle injury

Ankle sprains are a common injury in sport. If not assessed by the physio and guided correctly through the recovery they often struggle to get back to normal levels and are more likely to re-injure the joint.

Ankle sprains

Ankle sprains account for up to 30% of all sports injuries (1). When the ankle joint is put under strain from sudden twisting forces or landing in an uneven position it causes too much stress on the supportive ligaments, resulting in a tear. More commonly seen in sports with lateral movement and jumping, such as basketball or volleyball. But everyday life, misjudging steps or walking on uneven ground.

Symptoms:

  • Severe pain
  • Swelling
  • Bruising
  • Difficulty walking
  • Stiffness
  • Weakness
  • Loss of balance

What structures get damaged?

Fractures

The ankle consists of 3 bones, the Tibia,ankle fractures Fibula and Talus. Depending on the force from the injury we can have fractures of the tibia and fibula. 25% of ankle sprains could have some form of fracture (2), whether it be a complete break, a chip of the bone or the ligament pulling the bone from its attachment. An Xray would help eliminate this diagnosis and help guide your rehab.

Ligaments sprains

The ankle is the pivot point for the foot and the leg, it gives us a range of different movements. We have ligaments aligning in various directions to provide support for the ankle. When movement is taken too far ligaments can be damaged. On the outer part of the ankle we have 3 ligaments, the inner part has a large dense ligament and the tibia and fibula have connecting ligaments.

An ankle sprain can have more than one ligament involved, but the most common ligament to get strained is the Anterior Talo-Fibila Ligament (ATFL), affected by up to 73% of ligament injuries (3). Most commonly brought on from rolling the ankle.

The degree of damage to ligaments is classified by grades 1-3. Grade 1 meaning small tears of the ligament fibers, Grade 2 a partial tear of the ligament between 10-90% and grade 3 being a complete rupture. All grades have different recovery times and need to be guided appropriately for the best outcome.

Management of my ankle sprain

In the first 72 hours you will go through the first stage of healing. During this time you want to move the ankle within your comfort level, don’t push into sharpness. Compress and elevate the joint to manage the swelling. If you wish to use ice (5 minutes minimum) and NSAID’s, use it sparingly only to control the pain. See my blog about ice for more info.

Diagnosing an ankle sprain and rehab

If you have sprained an ankle it’s important that you are assessed by a Dr or Physiotherapist. Taking a detailed history and clinically assessing your ankle will help us come to a clear diagnosis of your injury. Xrays and ultrasound scans may also be required.

Someone that sprains their ankle is 5 times more likely to sprain their ankle again (4)

Once we understand the severity of the injury, treatment can be more specific to achieve the quickest recovery. Physio can assist in number of ways:

  • Education – Understanding the tissue recovery, the mechanics of the ankle, knowing your treatment plan and the stages of your rehab.
  • Gait re-training – You may start off on crutches or a moonboot, but then weaned off and guided to walk normally.
  • Exercise prescription including sport specific training – As you improved you will be provided the appropriate exercises. Including exercises relating you your sport to make a better transition.
  • Balance exercises – Progressing balance is essential to preventing further ankle sprains.
  • Taping – There are a number of strapping techniques for swelling/bruising in the initial stage. Strapping can ease you back safely into sport.
  • Soft tissue massage – This helps stimulate blood flow and encourage healing. Also, helps desensitise the nervous system to encourage better movement.
  • Mobilisations – to assist in better movement of the joint and gives you more confidence to use it.

For an appointment, call on 095290990 

  1. Fong et al, (2007)A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007
  2. Luciano et al, (2012) Epidemiological study of foot and ankle injuries in recreational sports. Acta Ortop Bras
  3. Woods et al, (2003) The Football Association Medical Research Programme: an audit of injuries in professional football: an analysis of ankle sprains. A Br J Sports Med.
  4. McKay et al, (2001) Ankle injuries in basketball: injury rate and risk factors. Br J of Sports Med.

What’s wrong with my knee?

Knee injuries are very common during sport and at work. For a faster recovery see your Dr or Physio to understand what structure you have damaged and how to rehab the injury effectively.

A knee sprain managed correctly will allow the tissue to heal fast and strong. Getting you back into what you enjoy most.

The knee is one of the most common joints injured in the body. A joint that absorbs a huge amount of force when running, jumping and lifting. Fortunately the femur and tibia are surrounded by many structures, but it’s usually these supporting structures that take the stress when we have an injury.

What could I have damaged?

Ligaments: About 40% of injuries to the knee involve ligaments either by a sprain or tear. These structures help give extra stability to the knee. When it has been put under excessive tension it damages the fibers. This results in pain, swelling and instability.Ligament injury knee

Patellofemoral: 24% of injuries are involving the knee cap. The patella sits within a small channel and if not guided correctly from surrounding muscles and ligaments pain can develop. This becomes particularly sore when squating, running and even basic functions like climbing stairs and sitting.Patella dysfunction

Meniscus:  11% involve the meniscus. It is fibrocartilage that sits within the knee, providing a level of stability to the ligaments and an element of shock absorption when weight bearing. This can cause a lot of swelling, pain and restrictions. In some cases the knee may lock in certain positions.

Knee injury meniscus

Other Injuries: The remaining 25% consists of fractures to knee, dislocation of the patella, Iliotibial band syndrome, hamstring and quads strains/tears etc.

What to do if I’ve injured my knee?

Firstly if you’ve just injured your knee and struggling with weight-bearing seek medical attention, where a Dr may consider an Xray, prescribe medication and will likely refer you to a physiotherapist. If the symptoms are not too severe, but you’re still concerned, come straight to physio. At Fundamental Physio Newmarket I can provide you with the following:

  • A detailed assessment of your knee using a range of tests to identify the structures involved, also looking at the mechanics of the hip and ankle.
  • Manual therapy to encourage normal movement and faster rate of healing.
  • A personalised exercise program for your identified weakness’. This may involve strength exercises, stretches and balance exercises.
  • Biomechanical assessment and correcting movement dysfunctions that may delay your recovery.
  • Providing you with an understanding of the structures affected and a treatment plan to meet your overall goals.
  • If recovery is slower than expected referrals can be made for Xrays/scans to sports or orthopaedic specialist.

Fundamental Physio Newmarket is supported by ACC. If you have hurt the knee during an accident, whether it was at home, work or on the sports field you will receive treatment cover for the injury.

For an appointment, call on 095290990 

CrossFit – How can Physio help?

CrossFit has its share of injuries like any sport. An experienced physio with knowledge of the training can get an athlete functioning pain free quickly and performing back to their best.

To perform at your best you need a strong mindset, great coaching staff that are strict with your technique and an experienced physio to prevent aches and pains

Most Kiwi’s are pretty tough, with a ‘she’ll be right” mentality when it comes to injury. You’d think that would be a perfect combination with the image CrossFit portrays. But when you’ve been carrying that niggle for so long and it starts getting worse, it could shut you down completely from training.

Physio and CrossFit work well together

Physio’s are specialists in movement analysis and CrossFit itself is a training regime that goes through gross fundamental movement patterns. So putting yourself through these movements and identifying your weakness’ gives me a lot more insight into where your problem could be coming from.

What are the common complaints?

There have been interesting studies done over the last few years into injuries within CrossFit. Interestingly the studies correlated similar with the same common areas being involved:

  • Shoulder
  • Lower back
  • Knee

Some injuries being severe enough to stop some from working, training and competing. These are the most common areas of injury I see come into the clinic from CrossFit, but I also see others suffering from:

  • Neck and thoracic strains
  • Ankle sprains and hypomobility
  • Hip impingement
  • Patella dysfunction from quad heavy squats
  • Wrist strains

How can Physiotherapy help?

As a physio it’s my job to get you functioning pain free as quickly as possible. Being a Crossfitter myself, who performs daily and understands the training styles, philosophy and terminology I can relate to the frustrations that you may face with limitations in training. Also working on site I can take you into the gym, look at techniques of different movements and provide you with additional drills to perform before your WOD.

What do I offer a CrossFit athlete?

  • An assessment of your movement patterns looking for weakness, asymmetry and any underlying mobility issues.
  • Hands on therapy for immediate pain relief, this may involve soft tissue massage, joint mobilisations and dry needling.
  • Localised taping of problem areas to assist you during your next training session
  • Diagnosis and ongoing management for acute or severe injuries, including referrals for further tests such as x-rays/ultrasounds, scans or to a specialist.
  • Educating you on what caused your injury or pain and steps to prevent further problems.
  • A personalised rehabilitation program – listing corrective, strengthening and stretching exercises to assist your recovery.
  • Liaising with and providing regular updates of your progress directly to your coach or trainer to ensure you get a coordinated approach to your rehabilitation. This also ensures that you are scaling or modifying WOD’s as required.

For an appointment, call on 095290990 

Montalvo et al (2017) Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit. Journal of Sports Science and Medicine

Keogh et al (2016) The Epidemiology of Injuries Across the Weight-Training Sports. Sports Medicine

Weisenthal et al (2014) Injury rate and patterns among CrossFit athletes. Journal of Orthopaedic Sports Medicine, Arthroscopy, and Knee Athroplasty

Trigger points – what are they?

Trigger points are the most common source of muscle pain. There are many factors that affect a trigger point and for best results they should all be identified.

I’m going to put a wild bet out there that everyone has a trigger point in at least one muscle of their body. Some have more than others. Who of you are regularly rubbing their shoulders or elbows? More and more we are sitting at the computer or looking down at our phones (sorry for writing this blog) causing prolonged tension on muscles around the neck and shoulder, resulting in the development of trigger points.

What is a Trigger point?

It is defined as a hypersensitive palpable nodule in taut bands of muscle fibers. Meaning very small bundles of muscle fiber have become contracted/”knotted” due to a chemical imbalance within the tissue.  The area is very painful and can cause you to jump or cramp on palpation. It can cause referred pain, weakness and restriction through movement. Which makes doing normal activities and training difficult.

Triger Point diagram
Diagram of trigger points within a muscle

Trigger points of individual muscles have a very specific referred pain pattern and can mimic other problems. For example pain in the forearm and wrist can be referred from Infraspinatus, a shoulder muscle. Without a detailed assessment and clearing other areas this could be misconceived as a tennis elbow.

What causes a trigger point?

A TP can be brought on in a number of ways. 

  • Poor postures held for a prolonged period, causing certain muscles to work harder while trying to support structures like the head, eventually causing TP’s.
  • Repetitive strain on muscles from overuse over multiple days, weeks and months. How many clicks of the mouse or typing are your doing? How much swiping of the smartphone? These repetitive movements take their toll.
  • Emotional stress and poor sleep can cause muscle tension. Particularly the neck and shoulder muscles.
  • A lack of movement will develop TP’s when sitting or on bed rest for a prolonged time.
  • Heavy lifting can cause the development of TP’s when the muscle is placed under excessive loads which it is not familiar with.
  • Trauma to a muscle, either as a reflex to pain or overcompensating for the weak and injured structure. This is quite common with car accidents or sports injuries.

Our muscles sit within a biochemical “soup” of  hormones, nerve transmitters and chemicals, all affecting the PH and Oxygen levels of the tissue. Your body knows the perfect recipe to keep everything balanced, but when we overload it with one or more of the above, it causes changes to the recipe, resulting in a drop in PH (becoming more acidic) and reduces the oxygen supply. This leads to the development of TP’s.

How do we treat a trigger point?

Your desire to change must be greater than your desire to stay the same. 

The following treatments for trigger points will help settle them down, but if we provide the same environment they will return.

  • Trigger point release – sustained manual pressure applied to the trigger point causes increased blood flow to remove toxins from the area, interrupts the pattern of pain and spasm and encourages the production of natural pain relieving endorphin’s.
  • Trigger point dry needling – There is a growing evidence base for trigger point dry needling. The needling causes local twitch responses which are a central nervous system reflex. This helps disrupt the pain feedback loop but also reset the acidic biochemical “soup” the muscle is sitting in, back to its normal levels.
  • Myofascial release – the surrounding tight myofascial tissue that feeds into and over the trigger points could also be restricted, causing further exacerbation of the area. Using this technique will give some length back to these structures and can alleviate the trigger point.

Once the hands on therapy has been applied it is not the end of treatment. The muscles with the TP’s will need to be stretched to help prevent their return. Postural correction and stability exercises for surrounding muscles may need to be followed. Changes ergonomically may need to be enforced to prevent falling back into poor habits. Also looking at ways of alleviating stress through improved sleep, meditation, breathing techniques and increase of general exercise.

All of these factors will need to be considered to provide long lasting benefit and avoid their return.

  1. Travell & Simon (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual
  2. Shah et al (2008) Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies
  3. Simons, (2008), New Views of Myofascial Trigger Points: Etiology and Diagnosis, Archives of Physical Medicine and Rehabilitation

Myofascial Release

Myofascia interweaves through our muscles and takes up to 80% of muscle mass. Consider this when you’re doing your stretching and but not getting the results you wanted, it’s possibly due to fascial restrictions.

What is Myofascia?

Fascia is the largest system in the body with the appearance of spider’s web. Fascia is very densely woven from the top of the head to our toes, covering and interpenetrating every muscle, bone, nerve, artery and vein, all our internal organs including the heart, lungs, brain and spinal cord. In this way, you can begin to see that each part of the body is connected to every other part by the fascia, like a fitted suit.

How would it affect me?

Myofascia interweaves through our muscles and takes up to 80% of muscle mass. Consider this when you’re doing your stretching and but not getting the results you wanted, it’s possibly due to fascial restrictions.

I’d like you to try something. Reach behind your back with your right hand, grab a handful of the shirt/top in the middle of your back. Now try and lift your left hand above your head, it will likely be restricted and wind up in certain areas. Think about the tightness and restriction you might feel doing an overhead lift or in the back when squatting, it could be the fascia pulling on these areas.

One study has shown that tightness in the posterior neck muscles can cause a significant decrease in hamstring length and strength. (1)

What causes it to get tight?

Postural adaptations, trauma, inflammatory responses, and surgical procedures create myofascial restrictions that can produce tensile pressures of approximately 2,000 pounds per square inch on pain sensitive structures that do not show up in many of the standard tests (x-rays, MRI scans, etc.)

What does Myofascial release involve?

The MFR technique appears quite light as it puts a slow sustained shearing force on the superficial layer of fascia that lies beneath the skin. The superficial layer taps into other deeper structures within muscle and other systems of the body. There is no oil used as it allows for more feedback detecting for fascial restrictions into the therapist’s hands. There is extensive evidence that shows myofascial release is an effective tool in improving flexibility and reducing pain (2,3,4,5)

How does it differ from a deep tissue massage?

With DTM this is more directed to muscle tissue that has adhesions or is tightened and needs deep pressure to bring back some length and lower its tone. Although the deep pressure can be painful depending on how sensitive the tissue is and pain tolerances of the individual.

 

  1. McPartland et al (1996) Rectus capitis posterior minor: a small but important suboccipital muscle, Journal of Bodywork and Movement Therapies
  2. Hsieh et al,  (2002) Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Spine.
  3. Wong, K.-K. et al, (2016) Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men – a study of dynamic ultrasound. Physiotherapy
  4. LeBauer et al, (2008) The effect of myofascial release (MFR) on an adult with idiopathic scoliosis. J Bodyw Mov Ther.
  5. Ajimsha et al (2012) Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Arch. Phys. Med. Rehabi.
  6. Ajimsha, M.S. et al, (2014) Effectiveness of Myofascial release in the management of chronic low back pain in nursing professionals Journal of Bodywork and Movement Therapies