Managing an acute injury

Knowing how to immediately look after an injury for the first few days can speed up its recovery. In this blog we look at a more up to date protocol on how to help you manage it.

Many of us are well versed on the R.I.C.E acronym (Rest, Ice, Compression, Elevation). Which eventually was upgraded to P.R.I.C.E (P = Protect). Over the last few decades the advice on the management of acute injuries has rarely been contested. However, with growing research there has been a change in the way clinicians deliver advice on acute injuries to patients. With more recent research there is a new acronym called P.O.L.I.C.E. Standing for Protect Optimal Loading Ice Compression Elevation.

What’s changed?

The term REST can be completely misinterpreted. While it’s important to have a balance of rest AND loading. Too much rest can lead to
deconditioning of tissues, stiffness and weakness. By OPTIMALLY LOADING tissue it provides the right levels of stress to encourage tissue healing, while assisting with the drainage of swelling.

What is the right amount of load?

Firstly, you must listen to the pain and not try to push through it. But if in doubt seek advice from a health professional, whether it be a Dr or Physio. Assessing the injury will help clear any serious problems, like fractures or ruptures. After having the serious issues cleared, you can be guided on the appropriate movements or weight bearing exercises to perform.

If in doubt seek advice from a Health professional

Additionally, to help provide the right loading you may require a moon boot, crutches, brace or strapping for support. Before being gradually weaned off.

Ice

I’ve previously questioned the value of applying ice for reducing swelling. There is growing evidence that shows that we need some swelling to aid in the healing process and  by using ice to minimise swelling, we could be slowing down the rate of tissue healing. 

See: hold the ice in RICE

But using the ice instead to reduce pain, by limiting nerve conduction and lowering tissue temperature. This can be effective within 5-10 minutes of application. Doing this every hour will bring pain levels down allowing you to move or load the tissue as tolerated.

Side note: Make sure you regularly check tissue quality while icing to avoid frost bite.

Compression and Elevation

These two are the least controversial in their benefit of recovery from acute injuries. Having compression helps maintain swelling to a manageable level and the area can still move normally. Making sure the compression is tight but not causing pain or numbness. You can use crape bandaging or a tubigrip.

Elevation, particularly for the lower limb helps again at minimising excessive swelling. While elevated it helps to be gently moving the
area, which also assists with tissue healing and swelling.

Anytime you’re dealing with a new injury it’s important follow the most up to date advice to help you recover as quickly and safely as possible. By seeking physio, we can offer you that guidance and support as you progress. At Fundamental Physio Newmarket, you’ll be thoroughly assessed to identify the extent of your injury, then put on the right treatment plan to help you return to normal activity. 


References

Bleakley et al 2012 PRICE needs updating, should we call the POLICE? Br J Sports Med 

Algafly et al. 2007. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med

Malanga et al 2015. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med

Understanding your Nervous System

A healthy nervous system allows us to perform at a high level. Using particular methods we can tap into the subconscious side to improve the running of vital bodily functions.

You can’t control the wind, but you can adjust your sails

Our nervous system has a connection to all structures in the body. Without a healthy working nervous system most bodily functions suffer, our performance in life situations and sport are hindered and recovery from injury is impacted.

The Nervous system

Part of our central nervous system, within our subconscious is a mechanism for handling stressful situations. This is called the Autonomic Nervous system. It branches into two parts; the Sympathetic NS (SNS) and Parasympathetic NS (PNS). The SNS stimulates the bodily functions preparing us for the “fight, flight or freeze” in life threatening situations. The PNS is the other branch that prepares us for “rest, digest and heal”. It’s the PNS that should be the primary driver of our physiology.

B_B6BaNUsAAC6-G

Using the mailman and dog as an example. Most canines are territorial and when unknown visitors arrive they become defensive, will bark and jump at the door. It’s ready to fight. When the postman leaves, the dog quickly forgets what happened and is able to fall asleep within minutes. It recognises the threat has gone and can immediately relax.

Consider yourself in the same situation, feeling threatened of an intruder. You might shout at them to leave or prepare to engage with them. When the person retreats could you relax straight away or will you be on edge for hours or even days?

The SNS is important but only has a purpose for the short term, to allow us to deal with threatening situations. Unfortunately with hectic lives, our brain interprets these physical and mental stresses as life threatening, which frequently triggers the SNS on a daily basis. Constantly stimulating SNS can lead to chronic issues…

  • Anxiety
  • Fatigue
  • Irritability
  • Sleep disorder
  • Non-working muscular tension
  • Hyperventilation
  • Adaptation failure
  • Cognitive dysfunction

The brain struggles to identify physical stress’ and imagined stress’. Anxiety of an electricity bill, job cuts at work or relationship issues will fire up the SNS.

Throughout exercise/sport our PNS and SNS working in balance. Depending on particular stressors like speed, distance, duration, the SNS may start to have a greater influence. It’s important to get into our PNS state for improved decision making, better oxygen delivery and for achieving optimal recovery.

Ways of Activating the Parasympathetic Nervous System

The PNS is the system we should be using most frequently . Therefore finding methods of staying in this state even when put under perceived levels of stress are important.

1. Breathing Mechanics

The way we breath has a deep connection to the autonomic nervous system. Shallow, apical breathing has a direct link to our SNS. But taking Deep diaphragmatic breaths stimulates the PNS. Using breathing exercises daily can help train you into a more relaxed state.  Methods such as….

Wim Hof Method

Apnea Breathing

Kapalbhati Breathing

2. Meditation Practices

Through channeling your thoughts and breathing, meditation can help induce a state of relaxation. Following this 5-10 minutes daily can help improve many different functions. Easy to use apps for this are…

Head Space

Wildflowers

                      SoundCloud – Mindfulness Works

3. Muscle relaxation

Using methods like meditation or yoga are ways of achieving muscle relaxation. Having massages and soaking in a hot bath also offers a way of relaxing muscles. The release of tight muscles indirectly sends signals to the brain to activate the PNS and switch off the SNS.

Continue reading “Understanding your Nervous System”

Lets stop calling it tennis elbow

This injury affects more than just tennis players. Unlike its name the treatment for lateral elbow pain has advanced.

Lateral elbow pain is a regular complaint from athletes to manual workers, even office workers are exposed to the risks of these injuries. Sometimes this injury can be difficult to shake off without the necessary changes being made.

Why tennis elbow and what should we call it?

The diagnosis of “tennis elbow’ dates back to 1882 described as “lawn tennis arm”. While it effects up to 50% of tennis players throughout their careers there are many other activities other than tennis that cause this problem.

Lateral Elbow Tendinopathy (LET) is a more appropriate and clinical description of the injury. It encapsulates both a tendinitis (inflammation of the tendon) and tendinosis (micro-tears of the tendon).

With repetitive use of the arm, whether you’re doing a swing, cleaning a 60KG barbell, hammering together a fence or typing up endless reports. As the muscles in the forearm are being used continuously without rest the immune and metabolic bi-products cause micro tears in the tendon, leading to scarring, swelling and lateral elbow pain over time.

What can cause LET?

Forearm anatomny.jpg

The most common cause for LET is mentioned above, the small tearing of tendon inserting into the lateral epicondyle (outer elbow). Most commonly the tear occurs with the small muscle Extensor Carpi Radialus Brevis due to its weak insertion into the extensor tendon. But there are several other wrist extensors that can also overload this tendon complex.

For a long time, it was thought the sole problem was with the tendon and its connecting muscle. But the most recent model of LET suggests that as well as inadequate muscle power and endurance, there are also external factors influencing the pain.

These external factors could be…

  • Neck and mid back dysfunctions – Particularly the lower Cervical spine, the nerves that supply the lateral elbow have nerve roots at this level (C5-6). If nerve roots are irritated at these levels it can enhance the feeling of pain in its pathway down the arm, into the elbow. Following the Law of Denervation (This is a whole other blog!).
  • Posterior shoulder trigger points – Following that same C5-6 nerve root into the shoulder, it supplies posterior shoulder muscles. The development of trigger points in these muscles can irritate the nerve branches travelling down the arm causing enhanced pain into the elbow.
  • Thoracic Outlet Syndrome – This is another condition that effects the nerves supplying the arm. The pressure places on these nerves can also cause pain in the elbow.

As you can see all these external factors add a nerve component to the elbow pain and should be cleared in assessment to ensure they’re not involved or treated appropriately.

How long it takes to recover?

Like all injuries, it will vary. Depending on the severity and how irritable you are this could be a few weeks to a few months. Following the guidance and management of the injury from physio you will have greater success than treating it on your own.

If symptoms persist, with no overall improvement over 12 weeks an ultrasound scan may be indicated, followed by an assessment from an orthopaedic specialist.

How do I prevent LET?

LET is a silent assassin, it’s one of these conditions that develops unknowingly (with scarring and tissue inflammation) until it’s too late (when you feel pain).

If you’re involved in sport or work that uses repetitive motion at the elbow, you’re already a candidate for this type of injury. Consider that your warning and take control.

Firstly, those forearm extensors need to be managed. Taking regular breaks to stretch and strengthen the wrists will help. Rolling the lacrosse ball into the forearm and back of the shoulder to reduce tightness. Consider your posture when sat at work or in the car, aim for your head to be over the shoulders.

For those in the gym, look at your wrist position. Most movements other than front rack and press positions, you want to maintain a neutral wrist. Look at your kettle bell swing or pull up, keeping the wrist close to neutral will reduce the force through the muscles of the forearm.

How can physio help?

Depending your presentation when assessed there are a range of treatments that could include…

  • Soft tissue manipulation of the wrist extensors, neck and shoulder
  • Joint mobilisations to the elbow, cervical and thoracic spine
  • Dry needling of forearm wrist flexors/extensors, deep neck extensors, posterior rotator cuff.
  • Mobilisations with movement for the elbow, neck and shoulder
  • Strapping of rigid or kinesio tape
  • Prescription of elbow brace/clasp
  • Specific exercises to strength and stretching exercises for the wrist, shoulder and cervical spine
  • Mobility exercises for thoracic and cervical spine

There are many treatment options available but to help with a quick recovery it’s important to provide a tailored treatment plan to meet your individual needs.

For an appointment, call on 095290990

Recovering from DOMS

Delayed muscle soreness after intense exercise is expected. There are proven ways of reducing these pains quickly to get back into your normal level of training

Your future is created by what you do today, not tomorrow

So we’ve discussed the specific differences of muscle soreness after a workout and soreness from an injury. When you get Delayed Onset Muscle Soreness (DOMS) it is quite annoying trying to continue with training. Knowing that with DOMS we get the following problems.

  • Strength can be reduced by up to 50%
  • Range of movement will be limited
  • Pain will last between 48-72 hours

Understanding these limitations, its important to scale the weight, the depths and distances to accommodate for these temporary draw backs. But there are ways of accelerating the recovery or at least making it more tolerable.

Protein BCAA glutamine1Proteins 

Amino acids are the building blocks of proteins. As muscle damage is the precursor to DOMS, supplying it with a good source of Amino acids has been show to assist in recovery. While having a well balanced diet, additional supplements of glutamine and BCAA’s can reduce the inevitable weakness post workout. It may even help with soreness. (1,2,3,4)

Vitamin D

vitamin-d-en-fb.jpgGetting a little bit of sunshine might not be enough. The latest NZ Ministry of Health stats showed 32% of the population had lower than normal Vit-D levels. There is a link between people low in vitamin D and increased pain sensitivities (5). Taking supplements of Vitamin D3 may help additional soreness.

1023029.jpgHeat

Jumping in the spa pool or a using the hot water bottle. Heat is always soothing but it has longer lasting benefits to use heat with DOMS for the overall recovery (6,7).

Tart Cherry Juice

Tart cherry Juice muscle.jpgThis one is an unusual remedy but the benefits have been shown in this study (8). Following Exercise there was a 22% less weakness from the cherry drinking group, but no effect on pain. There are many natural anti inflammatory agents in cherries that is thought to help.

CoffeeCoffee Muscle soreness

I for one am pleased this is on the list, it gives me more reason to drink it! Studies have shown that caffeine helps lower pain levels and improve weakness during DOMS (9,10). Also helping increase number of reps compared to control groups.

Compression sleeveCompression Garments

Not necessarily for training, but post workout studies show that wearing compression tights or tops can reduce weakness and pain levels (11,12).

backsquat technqueTraining with DOMS

Even following the above strategies you will still have soreness and weakness. Consider this when training. You want to ensure your training for quality not quantity. Studies show training with soreness is acceptable and will temporarily reduce pain levels (13,14).

Myofascial Rolling (Foam Roller/Lacrosse ball)

Using foam rollers and lacrosse balls into tight tissues is a good way of preparing tissue for working through full ranges of movement. Through changes to mechanorecptors and nociceptors. There are studies showing benefit post workout and regular intervals during 48-72hours of DOMS (15,16).

References

  1. Song-Gyu, (2013), Combined effect of branched-chain amino acids and taurine supplementation on delayed onset muscle soreness and muscle damage in high-intensity eccentric exercise. J Int Soc Sports Nutri
  2. Volek et al, (2013), BCAAs reduce muscle soreness (DOMS) J Int Soc Sports Nutr.
  3. Tajari et al, (2010), Assessment of the effect of L-glutamine supplementation on DOMS Brit J Sports Med
  4. Glyn et al, (2012), Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study. J Int Soc of Sports Nutri
  5. Plotnikoff et al, (2003), Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc
  6. Mayer et al. (2006), Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehab
  7. Petrofsky et al, (2017), The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness. Cl J of Sport Med
  8. Connolly et al, (2006), Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damageBr J Sports Med.
  9. Maridakis et al, (2007), Caffeine attenuates delayed-onset muscle pain and force loss following eccentric exercise. J Pain
  10. Hurley et al, (2013),  The Effect of Caffeine Ingestion on Delayed Onset Muscle Soreness. J Strength Cond Res
  11. Hill et al, (2014), Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Brit J of Sports Med
  12. Armstrong et al (2015), Compression socks and functional recovery following marathon running: a randomized controlled trial. J Strength and Con Res
  13. Zainuddin et al, (2006), Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Appl Physiol Nutr Metab
  14. Trevor et al, (2008), Effects of a 30-min running performed daily after downhill running on recovery of muscle function and running economy. J Sci and Med Sport,
  15. Pearcey et al, (2015), Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Ath Training
  16. MacDonald et al, (2014). Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports & Exs

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.

Coping with stress – Part 2

Trying to change the environment and cause of stress can be challenging. But there are some basic strategies to lighten the level of stress you feel.

It’s not the Load that breaks you down, it’s the way you carry it.

Right, so we understand the main causes of stress, its impact on bodily functions and affect on pain sensitivity when we have an injury. How do we learn to cope with different types of stress? What can I do to make it easier? A “stress free zone” may be impossible but a “stress reduced zone” is better than nothing.

Recognising stress

You might notice your muscles getting tighter when training in the gym. To prevent a strain of the muscle and relieve the tightness, you would stretch or use a foam roller. The same applies to emotional stress. We all respond differently to stress and it sometimes can be the subtle changes that we need to recognise.

Changes like shallow breathing, palpitations, tense muscles, perspiring. If things like this start to happen it’s important to stop for a moment and consider “is this stress benefiting me or another person?”. Remember, stress is a system to save us or someone else from a life threatening situation.

Question your stress – is the feeling beneficial to me or someone else?

Stress is a great response to have, for example if someone was chasing after you with a knife or you needed to save someone from being run over. Consider the stress felt if you’re receiving more emails than normal, having relationship difficulties or have demanding kids. Is this stress response beneficial to anyone?

Managing stress

Look at the following strategies, some may be easier said than done but if it helps alleviate a small amount of stress it’s a start:

  • Take charge of the situation, make changes where possible, including the way you react to it
  • Tune out negative thoughts, adapt to more moderate/positive views
  • Step back from the situation to gain perspective
  • Take regular breaks – diffuse your brain from constant activity
  • Set realistic Goals
  • Keep hydrated, healthy eating and sleeping
  • Find a healthy outsource to down regulate, exercise, deep breathing, meditation

Strategies for dealing with stress

Lung iconBreathing

Focusing on something as simple as breathing is a way to off load demand on our nervous system. Allowing full expansion of the lungs changes the flow of blood through the body and the stretch response on the lung tissue decreases the sympathetic nervous system allowing stress factors to be relieved (1).

Sitting down, place a towel around the ribs and hold it tight at the front. Breath down to the lower ribs to get them to expand. Take in a slow but normal deep breath and exhale at the same speed.

Slsleep-icon-29.jpgeeping

We’ve heard 8 hours of sleep is good for us. How many of you stick to that practice? Sleep deprivation impacts our hormones that regulate stress levels (2) and can have many other health implications (i.e. diabetes, obesity).

Structure your sleep, be consistent with when you go to bed, try not to eat 2 hours before hand, avoid staring at a screen 1 hour before.

*There should be no guilt with napping. Your body clock (circadian clock), follows a rhythm through the day and twice our body temperature drops slightly to prepare us for sleep. Once in the evening and 8-10 hours after we wake up (mid-day slump). Our busy lives during a working week restrict us from napping. But at weekends a siesta can be of benefit (3,4).

Circle-icons-water.svgHydration

Cortisol is a stress regulating hormone in the body and has been found to increase when poorly hydrated (5). Trying to maintain 2 liters of water a day, obviously more if you have been training.

exercise-icon-19Meditation

Giving your self time to step back from your busy life and switch off can be hard. Meditation has been shown to reduce stress and anxiety levels (6). Meditation can come in a number of forms; from formal classes, youtube videos, even to walking or running in the park. The idea remains the same, to switch off your overactive brain.

 exercise-icon-19 (1)Exercise

Exercise comes in all types and it’s been well published to help not only with physical but also mental health (7). Find a way of fitting in some exercise each day whether it be high intensity, a team sport or just getting out for a run.

Many of the suggested strategies are essential to our own existence. But how often do we think about full diaphragmatic breathing, prioritising sleep and hydration? These are suggestions to reduce stress levels, the causes of stress will continue to be demanding if not changed.

  1. Eckberg, D. L. (2003). The human respiratory gate. The J of Physiology
  2. Spiegel (1999) Impact of sleep debt on metabolic and endocrine function. Lancet
  3. Murphy (1997) Night time drop in body temperature: a physiological trigger for sleep onset? Sleep J
  4. Monk et al, (1996) Circadian determinants of the post-lunch dip in performance. Chronobiol Int
  5. Maresh Et al (2006) Effect of hydration state on testosterone and cortisol responses to training-intensity exercise in collegiate runners. Int J Sports Med
  6. Schmidtman et al, (2006) Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders The J Neuropsychiatry and Clinical Neurosciences
  7. Anderson et al, (2013) Effects of Exercise and Physical Activity on Anxiety Front Psychiatry

Coping with Stress – Part 1

We all suffer with stress and it’s becoming a growing problem where people struggle to cope and burnout. Stress impacts my patients on a number of levels, mainly with pain perception. When under control we have better recoveries from injury.

The Greatest weapon against stress is our ability to choose one thought over another.

Everyone can recognise stress in their daily life. Some people seem to have more stress than others, or is it simply their reaction to events that creates stress? What is stress? And why is a physio talking about stress?

What is stress?

Fight or flight is stress at its very basic. It’s an important mechanism our brain has to cope and be ready for any perceived threat. This causes many bodily changes to prepare us for action, such as increased neural activity, muscle tone, heart rate, breathing pattern disrupted sleep etc. But stress is also emotional and responds with the same physical response. There are two forms of stress positive and negative. It helps to have a balance of both to make logical decisions.

Positive: It can motivate us into action and achieve our goals.

Negative: Too much causes anxiety and other health issues.

There are many forms of emotional stress. Everyone manages stress differently, making it easier for some people to cope with than others. Below are the leading causes of negative stress.

  • Workplace environment, too many emails, phone calls, long hours
  • Divorce/breakups/relationship difficulties
  • Demands of family/children (sleep patterns, household duties, balancing activities)
  • Car accidents. Being stuck in traffic
  • Theft, burglary, loss of personal property
  • Loss of employment or business
  • Death of a family member or close friend
  • Cash flow problems
  • Poor academic performance/work overload

How can stress impact my injury?

When we’re injured we have the mechanical pain from the damaged structures. But carrying negative stress causes increased sensitivity of our pain receptors and decreases the inhibitory interneurones in the central nervous system that regulate how much pain we feel (1,2). If we find ways to channel our stress better the pains we feel from injury become more tolerable.

  1. Donello et al, (2011) A peripheral adrenoceptor-mediated sympathetic mechanism can transform stress-induced analgesia into hyperalgesia.
  2. Corcoran et al, (2015) The Role of the Brain’s Endocannabinoid System in Pain and Its Modulation by Stress.

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 

Improving overhead position

Often we are restricted with overhead movements as it is an action we don’t use often enough. Try these exercises to increase movement if your tight reaching above your head.

So from the last blog we’ve learnt there are 4 positions of high torque when we wind up the shoulder capsule and surrounding muscles. By utilising these positions they will produce better pathways to move from and minimise the risk of injury.

We’ll start off with the over head positions. In every day life we don’t take our hands above our shoulders often enough. It’s understandable the shoulder will feel tight in these positions. But with a little regular mobilising we should be able to feel more comfortable holding our arms up there.

In the shoulder we have big internal rotators and some small external rotators which can cause a bit of an imbalance. Both internal and external rotation needs to be stretched to achieve full over head movement.

The other thing restricting our overhead movements is thoracic mobility. Another area that often gets stiff with a sedentary life. Additional extension at the Thoracic region without hyper extending at the lower back will give us better shoulder flexion.

Below are some basic mobility drills to improve Thoracic extension.

Foam Roller – Slowly moving over the foam roller, trying to extend over the top, keeping steady breathing throughout. Try to keep the neck in a stable position avoiding hyper-extending, also avoid rolling into the Lumbar spine.  Try this for up to 2 minutes. Once you find some stiffness, stay on that point and lift your arms straight above your head. 1 minute.

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T spine extension – Kneeling, put both elbows up on the step/box. Drop the chest down to the ground. Feeling a stretch at the Thoracic spine and lats. Hold the stretch for 2 minutes. Try to stay strong at the lumbar spine avoiding extending.

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Below are just some stretches you can do to access both the internal and external rotation restrictions at the shoulder.

Pec major stretch – Using a resistance band, taking up the slack with the hand behind, turn your body away, producing a large stretch in the chest. Hold for 2 minutes.

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Under arm stretch – Attach a light resistance band to the opposite frame. Hold the other end with your hand behind the neck, pull into the opposite rack and drive the armpit into the poll. You’ll get a good triceps and lats stretch. 2 minutes.

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Infraspinatus LaX ball smash – Direct the ball into the shoulder blade. With the pressure, take the hand across the body and over head. 1 minute each direction.