Repetitive Strain Injury. August 23, 2011
Posted by Joanna Wilson in Uncategorized.Tags: carpal tunnel syndrome, dupuytrens contracture, Phsyiotherapy, physiocare, physiotherapy, physiotherapy reading, raynauds, repetitive strain injury, RICE, RICE Treatment, rotator cuff injury, rsi, shoulder bursitis, tendonitis, tennis elbow, writers cramp
add a comment
Repetitive Strain Injury (RSI) is a general term to describe chronic pain in any part of your upper body caused by overuse. It commonly affects arms, elbows, wrists, hands, fingers, neck, shoulder and the upper back. It is caused by doing an activity repeatedly over a long period of time.
The term RSI covers a number of muscoskeletal injuries such as
- tendonitis
- carpal tunnel syndrome
- tennis elbow
- rotator cuff syndrome
- dupuytrens contracture
- writer’s cramp
- bursitis
- Raynauds phenomenon
Symptoms will be dependent on the anatomy and diagnosis of your condition but may include; stiffness, tingling, sharp or dull ache, pain in the muscle or joints, numbness, weakness, cramp or swelling.
Initially symptoms may only be present when performing the task and improve on resting, this may last for several weeks , but without treatment, your symptoms will get progressively worse.
Diagnosis of your symptoms will be made by your G.P. Repetitive strain injury is categorised into two types – Type 1 is when the doctor can diagnose a recognised medical condition such as the above list. Type 2 is where the doctor cannot diagnose a specific medical condition usually because there are no specific symptoms just a feeling of pain.
There are numerous causes of RSI dependant on your job or location of the injury. Some causes include repetitive activities, doing an activity which involves force i.e. carrying of lifting heavy objects, poor posture, awkward working position or carrying out an activity for a long period of time without an adequate break. Other causes are cold temperatures, working with vibrating equipment and stress.
Treatment will also be dependent on diagnosis but generally R.I.C.E treatment will be the initial management. Rest for a few days then begin mobilising the joint on the advice of your G.P. or physiotherapist. Applying ice-packs or heat packs may help alleviate your symptoms and reduce any swelling. Elastic supports or a splint could be used on the wrist or the elbow to give support. Your doctor may prescribe anti inflammatory medication to help with pain relief. If you are on other medication or suffer from stomach problems or asthma medication on the advice of your doctor only.
After this treatment, physiotherapy will be recommended. They will give you advice on posture, exercises to strengthen or relax muscles and can also perform TENS, ultrasound and infrared sessions.
If your symptoms are work related, look at ways to improve your working life. Talk to your manager about your problems and they can carry out a risk assessment. This may report that you need a new chair or a different keyboard, or they may be able to accommodate a new role that will help to relieve your symptoms.
Os Trigonum Syndrome June 28, 2011
Posted by Joanna Wilson in Uncategorized.Tags: ankle injury, ankle sprain, football, football injuries, football injury, os trigonum, os trigonum syndrome, Phsyiotherapy, physiocare, physiotherapy, physiotherapy reading, RICE, RICE Treatment, Sporting injury, sporting injury reading, Sports injury, sports injury reading
add a comment
Os trigonum is an extra bone that develops behind the talus (ankle bone). It is connected to the talus with a fibrous band. This bone is present from birth but does not fuse with the talus, and is not normally diagnosed until adolescence in approximately 10% of people.
This extra bone only causes problems if the affected foot is pointed downwards regularly, for example ballet dancers or footballers. When this bony prominence is crushed between the tibia and the heel bone, the tissue surrounding the os trigonum can become trapped leading to inflammation and swelling. This condition is known as os trigonum syndrome.
The symptoms include pain at the back of the ankle and tenderness over the ankle bone. The area to the front of the Achilles tendon can be painful to the touch and the bony prominence may be palpable. Pain will be present on pointing the foot downwards. Some swelling around the ankle area may be present.
The symptoms can present like an ankle or Achilles tendon problem, therefore diagnosis is made by x-ray where the extra bone will be evident.
Once the diagnosis of os trigonum syndrome is made, rest is advised. Continuing activity will only aggravate the condition. Ice should be applied every few hours, not directly to the skin but wrapped in a towel, to help with pain and reduce inflammation. Anti-inflammatory medication may be prescribed by your doctor if the pain is severe. Immobilisation by a walking boot to restrict ankle movement may also relieve symptoms.
Conservative treatment can work for the majority of cases. However if you are a professional athlete or symptoms are not relieved by the above treatment, surgery may be needed. During surgery, the os trigonum is removed completely. This will make no difference to the foot movement or stability as it is an accessory bone. A splint will need to be worn for two weeks following surgery. Following the splint removal an extensive course of physiotherapy will be required for 2-3 months to regain muscle strength, stability and full range of movement to the ankle and leg.
Achilles Tendinopathy. May 17, 2011
Posted by Joanna Wilson in Uncategorized.Tags: achilles tendinopathy, football injuries, football injury, Phsyiotherapy, physiocare, physiotherapy, physiotherapy reading, RICE, RICE Treatment, Sporting injury, sporting injury reading, Sports injury, sports injury reading
add a comment
The Achilles tendon joins the heel bone (calcaneum) to the calf muscles. Its function is to flex the foot up and down. Formally referred to as Achilles tendonitis, Achilles tendinopathy is a more accurate name for this condition as it is now thought it is not an inflammatory condition.
Achilles tendinopathy can be an acute or chronic condition. Acute conditions occur over a period of a few days and are usually a result of increase in activity, whereas chronic condition occurs over a longer period of time. Usually, degeneration of the tendon leads to decreased strength leading to injury. The condition can occur at the point of attachment to the heel or midway up the tendon and healing of the tendon is slow due to the poor blood supply.
The cause of Achilles tendinopathy is usually repeated tiny micro traumas to the tendon, followed by incomplete healing, occurring over time building up to injury. For example, overuse with excessive training, training in inappropriate footwear, spending a lot of your training running uphill, or constantly wearing high heels that shortens the Achilles tendon, then training in flat shoes causing excess strain on the tendon.
Achilles tendinopathy is more common in men than women, and more commonly occurs to those over 40. Symptoms begin gradually with pain at the back of the ankle especially when exercising, running uphill or climbing stairs. Pain will be worse in the morning or after a prolonged rest. The tendon will be tender on palpation and there may be some swelling and thickening of the tendon.
Diagnosis will be made by a doctor and you may have an ultrasound or MRI to rule out an Achilles tendon rupture. Self treatment will begin with R.I.C.E. Resting the foot will prevent further injury whilst applying ice and elevating the foot will help with swelling and pain. Ice should be wrapped in a towel before applying, do not apply ice directly to the skin. A compression bandage may help be giving support to the foot and ankle. Your G.P. may also prescribe painkillers to help alleviate symptoms. Always consult your doctor before taking medication to ensure they are suitable.
An extensive rehabilitation program will be recommended by your physiotherapist. The physio may use different techniques including massage, acupuncture, and ultrasound or taping. They will also recommend a series of stretching and strengthening exercises and advise of when to begin your training regime. It may take as long as 3 months to return to high impact sport. The physiotherapist will also observe your gait to assess if you have a mobility issue i.e. flat feet, which you may need an orthotic shoe insert to prevent increased pressure on your Achilles tendon.
Symptoms are usually gone in 3-6 months using these methods. If after this time you are still experiencing problems, there are other methods available but generally at the moment not on the NHS. These include extracorporeal shock-wave therapy, using sound waves to promote healing, Injection using autologous (your own) blood, which stimulates healing and using a glyceryl trinitrate patch for symptom relief and healing. These treatments are only recommended after a thorough consultation.
Approximately 1 in 4 people with Achilles tendinopathy will get no relief from any of the above and will need surgery. This usually removes nodules or adhesions on the tendon and a rehab program by a physiotherapist will follow post-op.
Shoulder Bursitis. April 5, 2011
Posted by Joanna Wilson in Uncategorized.Tags: Phsyiotherapy, physiocare, physiotherapy, physiotherapy reading, RICE, RICE Treatment, shoulder bursitis, shoulder pain, Sporting injury, sports injury reading, tennis injury, volleyball injury
2 comments
A bursa is a tiny fluid filled sac that acts as a gliding surface to reduce friction between tissues of the body. There are 160 bursae in the body located in the large joints, for example, knees, hips and shoulders. The bursa in the shoulder is located in-between the four muscles that make up the rotator cuff and the arch of the subacromial space, providing it with its name, subacromial bursa.
Bursitis is an inflammation of a bursa caused by injury or less commonly, infection. Shoulder bursitis is caused by repeated overhead movements causing the bursa to be squashed or impinged between the muscles and bones. A short spell of sport, where overhead movement is involved i.e. volleyball, when you are not used to it can cause bursitis.
Symptoms can come on gradually or be instantaneous. Localised pain or swelling, tenderness and pain with motion of the joint will indicate that you have a problem. Pain will be located at the tip of the shoulder and can radiate down the arm. You will not be able to raise your arm over your head. Pain can become worse if you lie on the affected side at night.
Diagnosis will be made by your G.P. or physiotherapist. An x-ray or MRI may be needed for diagnosis, to rule out other causes of the pain i.e. rotator cuff tear.
Treatment will depend on how far the bursa has developed. If it has just started, physical therapy can cause improvement. Ice therapy will be recommended by your physiotherapist, for 20 minutes every few hours. Never put ice directly on the skin, always wrap in a towel. This will reduce pain and inflammation along with resting the joint. Anti-inflammatory medication will help with the pain, under the supervision of your G.P.
A physiotherapist will then give you exercises to restore range of movement and increase muscle strength and stability. These may begin quite gently as pain allows but will build up to resistance exercises using a resistance band.
Occasionally these treatments will not reduce your bursa and a doctor will be required to drain it with a syringe in sterile conditions. You will then begin your physiotherapy as explained above.
Trigger Finger February 22, 2011
Posted by Joanna Wilson in Uncategorized.Tags: Phsyiotherapy, physiocare, physiotherapy, physiotherapy reading, RICE, Sporting injury, sports injury reading, trigger finger
add a comment
Stenosing tenosynovitis, or trigger finger, is a common disorder of late adulthood, whereby the finger or thumb bends towards the palm of the hand and the tendon gets stuck and the finger clicks or locks. Tendons are tissues that connect muscles to bone. When muscles contract, tendons pull on bones. The muscles that move the fingers and thumb are located in the forearm, above the wrist.
About 2-3% of the population will develop trigger finger and it is more common in females than males. It is more prevalent in people over 40 and has been linked with some medical conditions such as diabetes or rheumatoid arthritis. Although it has not been proven, repetitive gripping occupations such as working with power tools could also contribute to this condition.
The symptoms of this condition include catching, snapping or locking of the involved finger on movement. Pain at the base of the affected finger on movement or when pressing the area. A nodule may develop at the base of the finger. The finger may eventually be bent towards the palm of the hand or stiffness and clicking when trying to move the finger will occur.
Treatment of the condition depends on the severity of the symptoms. Non surgical intervention is used if the symptoms are not too severe. Rest is advised of the hand and you may be prescribed non-steroidal anti-inflammatory medication to relieve pain and inflammation. Splinting may help to relieve symptoms, either by keeping the finger straight or bent, and stopping movement of the finger to decrease inflammation.
In more severe cases, a corticosteroid injection may be recommended for symptom relief. In extreme cases, surgery may be recommended to cut the affected tendon and release the finger from its bent position.
In either case, mild or post surgery, hand therapy will be recommended. A physiotherapist will perform this and give you exercises to do at home. A physiotherapist may perform manipulation, massage, electrotherapy or hydrotherapy to help relieve symptoms. Exercises will be given to increase range of movement, these will be demonstrated by your physiotherapist and will need to be continued on the road to recovery.
Longitudinal Meniscus Tears. February 8, 2011
Posted by Joanna Wilson in Uncategorized.Tags: football, football injuries, football injury, knee cartilage tear, meniscus tear, Phsyiotherapy, physiocare, physiotherapy, physiotherapy reading, RICE, RICE Treatment, Sporting injury, sporting injury reading, sports injury reading
add a comment
The meniscus is a piece of fibro cartilage that sits between your femur and tibia, and helps to absorb shock and stress in your knee. Longitudinal tears to the meniscus are the most common type of meniscal injury and occur in young adults usually during sporting activities. The sufferer can almost certainly pinpoint the time of the incident, and three factors will have been present. The knee was weight bearing, flexed and twisted when the injury occurred.
The meniscus having been trapped between the femoral condyle and tibia splits longitudinally. The site of the split is dependent on the degree of knee flexion and how severe the injury is. Most commonly the tear involves the mid portion of the meniscus. If the tear is extensive, the inner limb of the torn meniscus may become displaced into the centre of the joint causing the bucket handle tear. Further transverse tearing of the meniscus results in the parrot beak tear. Tears of the anterior third are uncommon.
There is normally a specific athletic incident that can be recalled as the cause of the injury. This can be a painful, twisting injury or simply by rising from a kneeling or crouching position. Symptoms include pain, occasionally severe, locking of the knee where the joint may be flexed but encounters resistance when trying to extend the leg fully. The inability to weight bear or the sensation of the knee giving way accompanied by rapid swelling localised to the joint is indicative of a meniscal tear.
Initially, treatment should be by the R.I.C.E method. Rest the affected leg and apply ice every 2-3 hours to reduce the swelling. Strapping can be used for stability and elevation to help with swelling. Diagnosis of a meniscal tear will be made using the McMurray’s test, which involves rotating the tibia on the femur with the knee fully flexed. If there is any doubt, a MRI will be ordered to confirm diagnosis.
If surgical intervention is not needed, your physiotherapist will give you range of motion exercises to keep your quads strong and help with the pain and swelling. If surgery is required it is usually performed arthroscopically and the meniscus may be trimmed. Post surgery, your physiotherapist will help with strengthening and range of movement exercises to help you get back to full fitness.
Acromioclavicular (AC) Joint separation. January 25, 2011
Posted by Joanna Wilson in Uncategorized.Tags: ac joint, ac joint separation, football injuries, football injury, Phsyiotherapy, physiocare, physiotherapy reading, RICE, RICE Treatment, Sporting injury, sporting injury reading, Sports injury, sports injury reading
add a comment
A shoulder separation or acromioclavicular joint (AC) separation is a common sports injury, not to be mistaken with a shoulder dislocation as these are two different types of injury. A shoulder separation is caused by direct contact, for example, in rugby, or by landing on your shoulder, elbow or outstretched arm. The AC joint is the connection between the acromion of the scapula (shoulder blade) and the end of the clavicle (collar bone). The two bones are attached by the AC ligament but injuries can involve other ligaments i.e. the coracoclavicular (CC) ligament which joins the clavicle to the coracoid process, another protrusion on the scapula. The ligaments surround and support the AC joint forming the joint capsule.
Symptoms are immediate and can be severe. These include pain at the end of the clavicle, swelling and bruising. A step deformity may be visible. Pain may be felt when moving the shoulder especially when trying to raise the arm above shoulder height.
Diagnosis of this type of injury will be made after x-ray rules out any fractures to the bones around the shoulder. AC joint injuries are graded into six categories according to severity.
- Grade one is an injury to the capsule that surrounds the AC joint. The bones of the shoulder are not out of position
- Grade two is an injury to the capsule and ligaments that stabilise the clavicle.
- Grade three is the same as grade two but more significant. There will be a large bump over the injury.
- Grade four is an unusual injury. The clavicle is pushed behind the AC joint.
- Grade 5 is an exaggerated type of grade three. The muscle above the AC joint is punctured by the clavicle.
- Grade six is rare. The clavicle is pushed down and is lodged below the coracoid of the scapula.
Treatment initially is by the R.I.C.E. method. Rest the shoulder and apply ice frequently. This will help to reduce the swelling. The injury may be taped for two-to three weeks and immobilised in a sling. Anti-inflammatory medication may help will the pain at the advice of your doctor.
A physiotherapist will have a number of methods to help with symptom relief and rehabilitation. Ultrasound may be used on a minor injury or if the injury is more severe a TENS machine may help. Range of movement exercises should be started when pain eases followed by a program of strengthening exercises. A physiotherapist will advise you on the best exercise techniques for a speedier recovery. Surgery may be required for grades 4,5, and 6 but these are the most uncommon type of injury.
Colles Fracture December 28, 2010
Posted by Joanna Wilson in Uncategorized.Tags: colles fracture, Phsyiotherapy, physiocare, physiotherapy, physiotherapy reading, RICE, RICE Treatment, Sporting injury, sporting injury reading, Sports injury, sports injury reading, wrist sprain
add a comment
With the increasing bad weather throughout the country, the chances of falling, especially for the unsteady or elderly, become more prevalent. A slip on the ice can lead to several injuries, one of which being a Colles fracture. A Colles fracture is a fracture of the radius bone of the forearm, just above the wrist, and is caused by falling with an outstretched arm. This type of fracture is named after Abraham Colles, an Irish surgeon who noted the symptoms of this fracture in 1814 before the use of x-ray.
Symptoms are felt immediately and include pain, tenderness, bruising and swelling. The wrist may also be bent into what is known as the ‘dinner fork’ deformity. If a fracture is suspected, a trip to accident and emergency is required. An x-ray will be performed to confirm diagnosis.
The severity of the injury will determine treatment. Initially, ice will be applied to help reduce swelling. If the fracture is well aligned and the bones are close, the wrist will be immobilised in a cast for about 6 weeks. The arm should be elevated to help reduce swelling. Once in a cast, finger sensation and colour should be observed. If the cast becomes very tight, the fingers become dusky coloured or there is any loss in sensation to the fingers, medical attention should be seeked immediately.
If the x-ray shows the fracture to be undisplaced and unaligned, the wrist will have to be manipulated into position. This will be done under anaesthetic and then put in a plaster cast for 6 weeks and the treatment then continues the same as non-surgical intervention.
During the period in plaster, rehabilitation exercises will be given by a physiotherapist to prevent stiffness in shoulder and elbow joints and you will be encouraged to wiggle your fingers regularly. After the six weeks in plaster, rehabilitation of the wrist and forearm muscles will begin. A physiotherapist will give you stretching and strengthening exercises for the wrist muscles to rebuild them up after being encased in plaster. A wrist brace may be provided for the first few weeks to wear in-between exercises until the wrist is stronger.
Sprained Ankle. December 14, 2010
Posted by Joanna Wilson in Uncategorized.Tags: ankle sprain, football, football injuries, football injury, Phsyiotherapy, physiocare, physiotherapy, physiotherapy reading, RICE, RICE Treatment, Sporting injury, sporting injury reading, Sports injury, sports injury reading, sprained ankle
add a comment
One of the most common orthopaedic injuries is a sprained ankle. It can happen during sporting activities or during everyday activities. It occurs following a sudden sideways twist of the foot or landing on an uneven surface. It is caused by injury to the ligaments of the ankle where they become partially or completely torn.
An inversion sprain is caused by the foot twisting inwards stretching one of the three lateral ligaments too far and account for about 90% of ankle sprains. The other 10% is caused by an eversion sprain where the foot is twisted outwards causing the medial ligament to be stretched.
Sprains are graded into three categories, mild, moderate and severe. Grade 1 is a mild stretch of the ligament and causes minimal pain and swelling. Grade 2 is a partial tear to the ligament causing moderate to severe pain, swelling and some bruising and some instability to the ankle joint. Grade 3 is a complete tear to the ligament causing severe pain, extensive swelling and bruising and the inability to weight bear. Other symptoms include the sensation of the ankle giving way and a popping sound heard at the time of injury.
Initially treatment should be by the R.I.C.E. method. Rest the ankle for 48-72 hours avoiding physical activity. Apply ice packs wrapped in a towel for 20 minutes every 3 to 4 hours to help with swelling. An elastic bandage should be applied from toe to knee to give stability and reduce swelling and bruising. Advice can be provided by a pharmacist to ensure correct fitting. The bandage should be firm but not tight enough to cut of circulation to your foot. Elevate the affected leg as much as possible in the first few days to decrease swelling. Pain can be dealt with by taking regular analgesics.
Complete immobilisation should be avoided for long periods because scar tissue healing will make the ligament tighter and therefore your ankle will be stiffer delaying recovery. Severe injuries of injuries taking longer to heal will benefit from physiotherapy. A physiotherapist will give you a full range of exercises to stretch and strengthen the ligaments whilst they are healing. They may use techniques such as heat, ultrasound and massage. Exercises will also be given to strengthen the surrounding muscles to give the ankle more stability.
Inadequate recovery time or inappropriate treatment can lead to reinjury. There are a few things you can do to prevent further injury. A short term solution is to strap your ankle before activities but it is more beneficial to strengthen your ankle muscles. Have an adequate warm up routine and wear shoes that support your ankle. Balancing exercises can cut your risk of spraining your ankle again. A physiotherapist can advise you on suitable exercises.
Cricketers Rotator Cuff injury November 30, 2010
Posted by Joanna Wilson in Uncategorized.Tags: bowling injury, cricket injury, Phsyiotherapy, physiocare, physiotherapy, physiotherapy reading, RICE, RICE Treatment, rotator cuff injury, shoulder injury, Sporting injury, sporting injury reading, Sports injury, sports injury reading
add a comment
The shoulder joint comes under tremendous strain during any sporting activities. None more so than fast bowling cricketers. The shoulder rotates in many directions and has a great range of movement. The motion involved in over-arm bowling strains the shoulder joint and tears in the muscle can develops over time. It can start as a minor tear but with overuse can quickly develop into a major restricting injury.
The rotator cuff is made up of a group of four muscles called the subscapularis, supraspinatus, infraspinatus and teres minor. These four muscles combined are called the rotator cuff. Shoulder sport injuries to your rotator cuff are usually caused by two things – tendonitis, an inflammation of the tendon, or a tear to the muscle caused by sudden trauma.
An acute tear happens suddenly whilst doing an activity e.g. bowling a ball, when a tearing sensation is felt in the shoulder followed by pain down the arm. A chronic tear develops over a period of time
The main symptom of a rotator cuff injury is pain which limits range of movement. The pain in your shoulder will be particularly severe when the arm is raised out to the side or you try to reach behind you. The pain may radiate down the arm to the elbow and can be worse at night. The shoulder may feel weakened and simple everyday tasks like dressing will become troublesome.
Initially treatment should be using the R.I.C.E method. Rest your shoulder for a few days avoiding the activity which causes you pain. Apply ice packs to your shoulder for about 20 minutes three to four times a day to help reduce inflammation. Never apply ice directly to the skin, wrap in a towel to prevent damage to the skin. A sling may be used for a few days to help give support to the shoulder but should not be over used as the shoulder needs gentle movement to prevent stiffness. Anti inflammatory analgesics should be taken under the advice of your G.P. to help with the pain.
If symptoms persist more than 2-3 days seek help and advice from a physiotherapist. A sports injury specialist can assess your injury and set out a treatment plan. They may give you stretching exercises to do at home to relieve symptoms and strengthen muscles to prevent further injury.
Physiotherapy and Sports Injury Blog 