All Posts tagged physio

Back Pain : Prevent it with good lifting technique

Back Pain : Prevent it with good lifting technique

If there is one thing worth mastering to avoid injury it is the art of lifting. Setting yourself up correctly before attempting to lift something will keep you injury free. To achieve this it is best to practice the movements as an exercise to train the body so that correct posture and execution become second nature. The suitability of the pick up options below will depend on your physical condition so it is important to pick the right technique for the right situation.

The Golf pickup for lifting

Suitable for light items that can be picked up with one hand only. Saves on the effort of a squat for picking up something small like a pencil. Be sure to use your leg to counter
balance your weight. This technique is great for those who have some degree of stability and flexibility. Using a prop such as a chair, wall or table to stabilise yourself is also a good idea.
The Squat for lifting

A squat is something we often do without paying much notice to how well it is being performed. For those who lift items as part of their job, the squat is an integral part of manual handling duties.
As an exercise it is particularly good for your legs and one of the best to develop leg strength, working the kinetic link from the ankles all the way up to the hip. Stronger legs also offer greater support for the back, as performing better squat technique helps maintain correct spinal control.
So as well as strengthening our legs the squat exercise is also working our spine. As such the back should stay straight whilst the hips do the bending.
To performing a correct squat it is important to have the correct equal bend though our hip and our knees, making sure that the level of our knees is in line with but behind the level of our toes. Lowering yourself enough to create a ninety degree angle through both hip and knee, sticking the bottom down and back, plus maintaining a neutral position through the back is essential.

The Lunge for lifting

Whereas the squat offers a wide base of support and a higher power output for lifting, the lunge in contrast requires greater balance and is better for lifting smaller items.
The lunge is more like a variation of the squat. It works the same muscles but in a different way, challenging balance and control with an uneven load. Rather than both legs taking an equal load the front leg is working a lot harder to keep the body stable. The same posture principles of a squat apply, so ensure that there is an equal ninety degree bend through the hip and the knee whilst keeping your back straight. Remember when lunging it is important for the front knee not to go past the level of the front foot toes. In order to get down far enough the back heel will need to come up. When completing the lunge be sure to go down as far as is comfortable.
Remember that the co-ordination involved in performing these techniques for lifting and the use of momentum will lessen the need for isolated muscular strength and aid injury prevention. Also by switching on your core stabilising muscles on before doing any of these movements you will have greater control over the movement.

By doing a mixture of squats, lunges and golf lifts you will benefit from working a variety of muscles in different ways. Also if you happen to acquire an injury then having options as to how you pick something up will better enable you to rely on other muscles whilst the injured area recovers.

Incorporating these exercises into a routine and performing them correctly, will ensure that when you do need to use them in a practical manner throughout the day, that you are moving correctly.

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IMS/ dry needling: Frequently asked questions

IMS/ dry needling: Frequently asked questions

Dry needling involves the application of very fine sterilised acupuncture needles into muscle and surrounding tissues to assist in the release of myofascial trigger points, reduce tightness and spasm, improve muscle function and relieve pain. It is commonly used as an adjunct to physiotherapy and myotherapy techniques to improve treatment outcomes.

There are two types of Dry Needling, the first called Superficial Dry Needling (SDN) works by inserting the needle only 5-10mm under the skin. Secondarily is Deep Dry Needling (DDN) where the needle is inserted to the depth required to penetrate the targeted myofascial trigger point.

How does it work?
Myofascial trigger points are hyper-irritable, taut bands within muscles, which are painful to touch and can contribute to muscle shortening, weakness and pain (both locally and referred). They often develop following muscle, joint or nerve injury and sometimes persist well after the initial tissue injured has healed. This leads to persistent pain and discomfort.

Dry needling releases these trigger points by encouraging local blood flow to the trigger point and by modulating nerve pathways that erroneously cause them to persist. The needling also stimulates your body’s own endorphin system to provide pain relief and help allow the muscle to relax.

Dry needling can be extremely effective in the treatment of:
Needles used in dry needling are much thinner than those you receive when you see your GP for an injection and so usually cause much less discomfort. This does vary depending on what techniques your therapist uses. You may also experience the very satisfying response of the muscle twanging and releasing quickly. A sure sign of a successful trigger point release.

The initial treatment is conservative to determine the patient’s response. This varies from person to person. It is expected that there will be some post treatment soreness during the first 24-48hrs and sometimes minor bruising is experienced.

What sorts of conditions can Dry Needling be beneficial for?
Dry needling can produce excellent results as an adjunct to standard physiotherapy and manual therapy treatment. It can be used in both acute and chronic painful conditions.

Dry needling can be extremely effective in the treatment of:

Back, neck and shoulder pain
Hand and wrist pain
Headaches
Muscle strains
Knee pain
Tendinopathy pathologies i.e. Tennis elbow, Achilles pain
Many other musculoskeletal injuries (You can discuss dry needling with your therapist to see if it may be useful for your condition)

What is the difference between Dry Needling and Acupuncture?
Dry needling revolves around Western Medicine philosophy and involves inserting needles into muscular trigger points palpated by your therapist and consistent with your area of pain.
Acupuncture is based on ancient Eastern Medicine, with needle placement over specific points along meridian lines or ‘energy’ lines which are thought to associate with particular illness and disease.

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Knee Pain, Physio as effective as Surgery

Knee Pain, Physio as effective as Surgery

Exercise therapy is as effective as surgery for middle aged patients with a common type of knee injury known as meniscal tear (damage to the rubbery discs that cushion the knee joint), finds a study in The BMJ this week.

The researchers suggest that supervised exercise therapy should be considered as a treatment option for middle aged patients with this type of knee damage.

Every year, an estimated two million people worldwide undergo knee arthroscopy (keyhole surgery to relieve pain and improve movement) at a cost of several billion US dollars. Yet current evidence suggests that arthroscopic knee surgery offers little benefit for most patients.

So researchers based in Denmark and Norway carried out a randomised controlled trial to compare exercise therapy alone with arthroscopic surgery alone in middle aged patients with degenerative meniscal tears.

A randomised controlled trial is one of the best ways for determining whether an intervention actually has the desired effect.

They identified 140 adults (average age 50 years) with degenerative meniscal tears, verified by MRI scan, at two public hospitals and two physiotherapy clinics in Norway. Almost all (96%) participants had no definitive x-ray evidence of osteoarthritis.

Half of the patients received a supervised exercise programme over 12 weeks (2-3 sessions each week) and half received arthroscopic surgery followed by simple daily exercises to perform at home.

Thigh muscle strength was assessed at three months and patient reported knee function was recorded at two years.

No clinically relevant difference was found between the two groups for outcomes such as pain, function in sport and recreation, and knee related quality of life. At three months, muscle strength had improved in the exercise group.

No serious adverse events occurred in either group during the two-year follow-up. Thirteen (19%) of participants in the exercise group crossed over to surgery during the follow-up period, with no additional benefit.

“Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term,” say the authors. “Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option.”

How did this situation — widespread practice without supporting evidence of even moderate quality — come about, ask two experts in a linked editorial? “Essentially, good evidence has been widely ignored,” say Teppo Järvinen at the University of Helsinki and Gordon Guyatt at McMaster University in Canada.

“In a world of increasing awareness of constrained resources and epidemic medical waste, what we should not do is allow the orthopaedic community, hospital administrators, healthcare providers, and funders to ignore the results of rigorous trials and continue widespread use of procedures for which there has never been compelling evidence,” they conclude.

Journal Reference:
1.Nina Jullum Kise, May Arna Risberg, Silje Stensrud, Jonas Ranstam, Lars Engebretsen, Ewa M Roos. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ, 2016; i3740 DOI: 10.1136/bmj.i3740

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Foot Orthotic benefits

Foot Orthotic benefits

The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis.

Source: J Orthop Sports Phys Ther. 2002 Apr;32(4):149-57.

Division of Physical Therapy, Program in Human Movement Science, University of North Carolina at Chapel Hill, 27599-7135, USA. mtgross@med.unc.edu

Abstract

STUDY DESIGN:

Single-group, pre-, and post intervention repeated measures design.

OBJECTIVE:

To determine the impact of custom semi rigid foot orthotics on pain and disability for individuals with plantar fasciitis.

BACKGROUND:

Few studies have examined the efficacy of foot orthotics for plantar fasciitis, and no single study has yet examined the effects of semirigid foot orthotics on an established quality-of-life instrument.

METHODS AND MEASURES:

Eight men and 7 women (mean ages 44.7 +/- 9.0 years) who reported having plantar fasciitis symptoms for an average of 21.3 +/- 23.7 months participated in the study. Subjects were timed for a 100-m walk at a self-selected speed, then they rated the pain they experienced during the walk using a 10-cm visual analog scale. Subjects also completed the pain and disability subsections of the Foot Function Index questionnaire. All measures were acquired before the fabrication of custom semirigid foot orthotics and 12 to 17 days following onset of foot orthotic use.

RESULTS:

Postorthotic 100-m walk times were not significantly different (t = 0.39, P = 0.70) than preorthotic values. Postorthotic pain ratings (mean = 0.7 +/- 0.7) for the 100-m walk were significantly less than (Wilcoxon t = 1, P < 0.005) preorthotic pain ratings (mean = 3.0 +/- 1.7). Postorthotic Foot Function Index pain subsection ratings (Wilcoxon t = 0, P < 0.005) were significantly less than preorthotic ratings, demonstrating a 66% reduction in pain ratings. Postorthotic Foot Function Index disability subsection ratings (Wilcoxon t = 0, P < 0.005) were significantly less than preorthotic ratings, demonstrating a 75% reduction in disability ratings.

CONCLUSION:

Custom semirigid foot orthotics may significantly reduce pain experienced during walking and may reduce more global measures of pain and disability for patients with chronic plantar fasciitis.

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