Please feel free to scroll through my rather extensive blog - Philip

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome, like Carpal Tunnel Syndrome in the wrist, is a compression of the nerve inside the tunnel. It is less common than its counterpart in the wrist and is sometimes simply wrapped into the foot neuropathy diagnosis. The pressure can come from injuries resulting in deformities, inflammation of the protective sheath, tumours, or other impingements on the nerve. The compression on the nerve interferes with the signals sent through the nerve, causing pain and other neuropathy in the foot.

Treatment

Reducing pain and inflammation:

  • Rest. This may mean complete rest, staying off the foot with the aid of crutches or it may mean simply modifying normal training activities. It really depends how severe the pain and injury is. Switching from running to swimming or cycling for a while may be sufficient.
  • NSAID’s (non-steroidal anti-inflammatory drugs) such as ibuprofen may help in reducing inflammation and pain.

Correction of biomechanical dysfunction

  • If the athlete over pronates or the foot rolls in when running or walking then this may aggravate the condition. If they were to rest and not correct any possible causes then the injury is likely to return when normal training resumes.
  • For mild over pro nation a motion control shoe may be sufficient. These are running shoes which have a dual density midsole. The harder material on the inside of the sole helps prevent the foot from rolling in.
  • For greater pronation control an orthotic device may be required.
  • There are 23 bones in the feet. Each bone articulates with at least one other bone. All these joints need to function normally. Your osteopath will be able to evaluate these joints and correct any dysfunction.

Exercises

Stretching

Gastrocnemius muscle stretch

  • This is done by placing the heel of the back leg on the floor and stretching forwards.
  • Hold for ten seconds, repeat three to five times and repeat the set three times a day.
  • Gradually hold the stretch for longer (up to 45 seconds).

Soleus muscle stretch

  • In addition to the above stretch this one will stretch the Soleus muscle lower down in the back of the leg.
  • The same principles apply but it is important to bend the stretching leg at the knee.
  • This takes the Gastrocnemius muscle which attaches above the knee out of the stretch.

Plantar fascia stretch by rolling

  • The plantar fascia can be stretched by rolling it over a round or cylindrical object such as a ball, bar or rolling pin.
  • Roll the foot repeatedly over the ball applying downwards pressure.

Stretching on a step

  • Stretch by standing on the edge of a step and allowing the heel to drop.
  • Hold for at least 15 seconds.
  • You should feel a gentle stretch.

Plantar fascia stretch

  • This can be done by sitting and using your hand to pull the bottom of the foot towards you.
  • Hold the stretch for about 30 seconds.
  • Repeat five times and aim to stretch 3 times a day.

Strengthening

Static toe flexion

  • With the feet flat on the floor, press the toes downwards into the floor.
  • Do not allow them to curl, or the ankle to move whilst performing the exercise.
  • Hold for the count of 3, repeat 10 times.
  • Perform this exercise 3 times a day if possible.
  • Progress the exercise by holding the contraction for longer.

Spreading the toes

  • Place feet flat on the floor.
  • Spread the toes as far as they will go and then return them together.
  • Repeat this 10 times, rest and the perform a further 2 sets of 10 repetitions.
  • Aim to repeat this exercise 3 times a day.

Toe lifting

  • Place feet flat on the floor and try to lift each toe up in turn.
  • Aim to keep the others flat on the floor - not easy, is it?
  • Perform three sets of each toe.
  • Try to perform this exercise twice a day - at least once.

Pencil lifting

  • Pick up a pencil in the toes.
  • Hold for count of 6, repeat 10 times.
  • Aim to perform this exercise 3 times a day.
  • An alternative version of this is to repeatedly scrunch up a towel in the toes.

Walking on the toes

  • Simply walk about on tip toe.
  • Do not wear shoes but perform the exercise barefoot.
  • Aim for 8 sets of 15 to 20 seconds with 20 seconds rest between.
  • Complete the exercise 2 times a day.
  • Progress by increasing the duration of the walks.

 Walking on the heals

  • As above but walk on the heals.
  • Aim for 8 sets of 15 to 20 seconds with 20 seconds rest between.
  • Complete the exercise 2 times a day.
  • Progress by increasing the duration of the walks.
April 19th 2019

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder, also known as Adhesive Capsulitis, is a condition that affects the shoulder joint capsule and results in loss of movement and pain in the shoulder joint. It is different from rotator cuff injury or shoulder tendonitis in that frozen shoulder affects the joint capsule, whereas the other two conditions affect the muscles and tendons of the shoulder joint.

Symptom of Frozen Shoulder

The most common symptoms of frozen shoulder are severe pain and difficulty raising the arm in any direction. The normal progression of frozen shoulder has been described as having three stages.

  • Stage one, (the freezing phase) the patient begins to develop pain and stiffness in the shoulder joint. This stage can last up to four months.
  • Stage two, (the frozen phase) the difficulty moving the arm remains but the pain begins to decline. This stage can last from four months to nearly a year.
  • Stage three, (the thawing phase) the full range of movement begins to return to the shoulder joint. This stage can last four months.

Without adequate treatment, most sufferers of frozen shoulder will be fully recovered in 12 to 18 months but some cases have lasted for up to three years, although these are extremely rare. With osteopathic treatment, most cases will clear up in 3 to 6 months. Pain control is only required if the pain interferes with sleep or daily activities. The easiest method is applying ice packs to the shoulder for 20 to 30 minutes at a time. Higher levels of pain may require cortisone shots or medication prescribed by your doctor. Pain control also means avoiding shoulder motions or positions that are painful. Such motions include activities that raise the arm to the side or rotate the arm outward. Daily activities that might aggravate the pain include reaching overhead, reaching into the back seat of a car, trying to open a heavy door, and driving a car. Osteopaths believe that trying to push through painful activities can actually prolong the course of the disease. Once you identify your own particular set of aggravating activities, try to find other ways to do them. For example, open the heavy door with both hands or push the door open with your buttocks. When driving, don’t hold your hands near the top of the steering wheel. If your right shoulder is affected, avoid using a car that has a manual transmission. For activities in which you reach overhead, stop doing them, use the other arm, or use a step stool or ladder.

Exercises

  • Flexion: Stand upright and hold a stick in both hands, palms down. Stretch your arms by lifting them over your head, keeping your elbows straight. Hold for 5 seconds and return to the starting position. Repeat 10 times.
  • Extension: Stand upright and hold a stick in both hands behind your back. Move the stick away from your back. Hold the end position for 5 seconds. Relax and return to the starting position. Repeat 10 times.
  • External rotation: Lie on your back and hold a stick in both hands, palms up. Your upper arms should be resting on the floor, your elbows at your sides and bent 90°. Using your good arm, push your injured arm out away from your body while keeping the elbow of the injured arm at your side. Hold the stretch for 5 seconds. Repeat 10 times.
  • Internal rotation: Stand upright holding a stick with both hands behind your back. Place the hand on your uninjured side behind your head grasping the stick, and the hand on your injured side behind your back at your waist. Move the stick up and down
  • your back by bending your elbows. Hold the bent position for 5 seconds and then return to the starting position. Repeat 10 times.
  • Shoulder abduction and adduction: Stand upright and hold a stick with both hands, palms down. Rest the stick against the front of your thighs. While keeping your elbows straight, use your good arm to push your injured arm out to the side and up as high as possible. Hold for 5 seconds. Repeat 10 times.
April 18th 2019

de Quervain’s Tenosynovitis

Tenosynovitis is inflammation of the sheath that surrounds a tendon as opposed to inflammation of the actual tendon itself (tendinitis or tendonitis). de Quervain’s Tenosynovitis is inflammation of the synovium of the abductor pollicis longus and extensor pollicis longus muscles as they pass through the wrist (on the thumb side of the wrist).

Symptoms

  • Tenderness and swelling on the thumb side of the wrist where the tendons pass.
  • Crepitus may be felt (a creaking of the tendon as it moves).
  • Finkelstein’s test may be positive (thumb is placed in the palm of the hand and wrist moved laterally towards the little finger to stretch the tendons - pain may be felt).

Wrist Exercises

  • Rest your elbow on a level surface. A desk or table works well for this exercise. Elevate your forearm until it is vertical with your chosen surface, and then bend your wrist (palm toward the table) so that your hand and forearm make about 90-degree angle. With gentle pressure from your other hand, hold this position between 15 to 30 seconds, and then return your wrist to its original position.
  • Keeping your arm in this same position, bend your wrist back in the other direction. With gentle pressure from your other hand, press down on your fingers to counter-stretch the wrist, holding this position between 15 to 30 seconds. Repeat these two stretching exercises until you’ve completed 3 sets of each.
  • With the next exercise, drop your forearm until it rests on the level surface with the outside of the hand touching the table (your thumb should be pointing toward the ceiling). Place a weighted object in the palm of this hand, making sure you can comfortably hold it. Canned goods work well for this exercise. Keeping your forearm on the table, lift the object up and then return your hand to its original position. Repeat this movement for 3 sets of 10 repetitions.
  • Maintaining your grip on the weighted object, roll your forearm so the palm of your hand now faces the level surface. This exercise is very similar to the previous one, because you’ll lift the can up off the table so that the back of your hand faces you and then lower it back down. Repeat this movement for 3 sets of 10 repetitions.
  • Still maintaining your hold on the object, roll your forearm so the back of your hand now rests on the level surface. Bend your wrist up off the table, lifting the object toward you, and then return it to its original position. Repeat this movement for 3 sets of 10 repetitions.

Thumb Exercises

  • Keep the back of your hand on a table, bring your thumb and little finger together and hold for 5 seconds. Repeat with your ring finger, middle finger and index finger, holding each for 5 seconds. Repeat these movements until you’ve completed 10 repetitions for each finger.
  • With the back of your hand on the table, place a rubber ball in your palm. Squeeze the object, holding anywhere between 5 to 10 seconds, and then release. Much like the other exercises, repeat this movement for 3 sets of 10 repetitions.
  • Set the ball aside and wrap a rubber band around your fingers so that it cups the thumb and little finger of your affected hand. Stretch your fingers as wide as possible, holding for 5 seconds, and then release. Repeat this movement for 3 sets of 10 repetitions.
April 17th 2019

Subacromial Bursitis

Shoulder bursitis symptoms typically include tenderness at the outer shoulder, especially when raising the arm above the head. A person with shoulder bursitis may find it painful to raise the arm, get dressed, or put pressure on the side of the affected shoulder. It is located below a part of the shoulder blade called the acromion (hence the name “subacromial”). If this bursa becomes inflamed it is called shoulder bursitis or subacromial bursitis.

A diagnosis of shoulder bursitis is often accompanied by a diagnosis of tendinitis or shoulder impingement syndrome. These are separate but often overlapping conditions that affect the soft tissue around the shoulder joint.

Exercises

Posterior stretching exercise

  • Hold the elbow of your injured arm with your other hand.
  • Use your hand to pull your injured arm gently up and across your
  • body. You will feel a gentle stretch across the back of your injured
  • shoulder.
  • Hold for at least 15 to 30 seconds. Then slowly lower your arm.
  • Repeat 2 to 4 times.

Up-the-back stretch

  • Note: Your osteopath may want you to wait to do this stretch until you have regained most of your range of motion and strength. You can do this stretch in different ways. Hold any of these stretches for at least 15 to 30 seconds. Repeat them 2 to 4 times.
  • Put your hand in your back pocket. Let it rest there to stretch your shoulder.
  • With your other hand, hold your injured arm (palm outward) behind your back by the wrist. Pull your arm up gently to stretch your shoulder.
  • Next, put a towel over your other shoulder. Put the hand of your injured arm behind your back. Now hold the back end of the towel. With the other hand, hold the front end of the towel in front of your body. Pull gently on the front end of the towel. This will bring your hand farther up your back to stretch your shoulder.

Overhead stretch

  • Standing about an arm’s length away, grasp onto a solid surface. You could use a countertop, a doorknob, or the back of a sturdy chair.
  • With your knees slightly bent, bend forward with your arms straight. Lower your upper body, and let your shoulders stretch.
  • As your shoulders are able to stretch farther, you may need to take a step or two backward.
  • Hold for at least 15 to 30 seconds. Then stand up and relax. If you had stepped back during your stretch, step forward so you can keep your hands on the solid surface.
  • Repeat 2 to 4 times.

Shoulder flexion exercise while lying down

  • Note: To make a wand for this exercise, use a piece of PVC pipe or a broom handle with the broom removed. Make the wand about 30 centimetres wider than your shoulders.
  • Lie on your back, holding a wand with both hands. Your palms should face down as you hold the wand.
  • Keeping your elbows straight, slowly raise your arms over your head. Raise them until you feel a stretch in your shoulders, upper back, and chest.
  • Hold for 15 to 30 seconds.
  • Repeat 2 to 4 times.

Shoulder rotation exercise while lying down

  • Note: To make a wand for this exercise, use a piece of PVC pipe or a broom handle with the broom removed. Make the wand about 30 centimeters wider than your shoulders.
  • Lie on your back. Hold a wand with both hands with your elbows bent and palms up.
  • Keep your elbows close to your body, and move the wand across your body toward the sore arm.
  • Hold for 8 to 12 seconds.
  • Repeat 2 to 4 times.
April 16th 2019

Plantar Fasciitis

Plantar Fasciitis is a common athletic injury of the foot. While runners are most likely to suffer from plantar fasciitis, any athlete whose sport involves intensive use of the feet may be vulnerable. The risk of plantar fasciitis increases in athletes who have a particularly high arch, or uneven leg length, though improper biomechanics of the athlete’s gait and simple overuse tend to be the primary culprits. Cases of pf can linger for months at a time, with pain increasing and decreasing in an unpredictable pattern. Often, pf discomfort may nearly disappear for several weeks, only to re-emerge full- blown after a single workout. About 10 per cent of individuals who see an osteopath for plantar fasciitis have the problem for more than a year.

Exercises

I. Stretching Routines

A. The Rotational Hamstring Stretch

Stand with your weight on your left foot and place your right heel on a table or bench at or near waist height. Face straight forward with your upper body and keep both legs nearly straight. As you stand with your right heel on the table and your left foot on the ground, rotate your left foot outward (to the left) approximately 45 degrees, keeping your body weight on the full surface of your left foot (both heel and toes are in contact with the ground). You are now ready to begin the stretch. Lean forward with your navel and shoulders until you feel a steady tension (stretch) in the hamstring of your right leg. Don’t increase the stretch to the point of pain or severe discomfort, but do maintain an extensive stretch in your right hamstring while simultaneously rotating your right knee in a clockwise - and then counter-clockwise - direction for 20 repetitions. As you move the right leg in the clockwise and counter- clockwise directions, stay relaxed and keep your movements slow and under control. After the 20 reps, remove your right leg from the table and rest for a moment. Then, lift your right leg up on to the table and repeat this clockwise and counter- clockwise stretch of the right hamstring, but this time keep the left (support) foot rotated inward (to the right) approximately 10 degrees as you carry out the appropriate movements. Perform 20 repetitions (clockwise and counter-clockwise) before resting. Finally, repeat this entire sequence of stretches, but this time have the right foot in support and the left foot on the table for the repetitions (do 20 clockwise and counter- clockwise reps with the left foot on the table and the right (support) foot turned out 45 degrees, and 20 more reps with the right foot turned in).

B. The Tri-Plane Achilles Stretch

Stand with your feet hip-width apart and your left foot in a somewhat forward position compared to your right foot (it should be about six to 10 inches ahead). Shift most of your weight forward onto your left leg and bend your left knee while keeping your left foot flat on the ground. Your right foot should make contact with the ground only with the toes. You are now ready to begin the stretch. Move your left knee slowly and deliberately to the left. As you do so, also attempt to ‘point’ the knee in a somewhat lateral direction. You should be able to feel this side-to- side and rotational action at the knee creating a rotational action in your left Achilles tendon. Bring the knee back to a straight-ahead position, and then move it toward the right. As you move the left knee to the right, again rotate the knee somewhat, this time to the right, creating more rotation at the Achilles tendon. When you bring the left knee back to the straight-ahead position, you have completed one rep (you should perform 20 total repetitions). Make sure that you keep most of your weight on the left leg while performing this exercise. Repeat the entire action described above for 20 reps, but this time with your right leg bearing your body weight and doing the side-to-side and rotational movements.

C. The Rotational Plantar Fascia Stretch

Stand barefoot, with your feet hip-width apart and with your left foot in a slightly forward position - two to three inches ahead of your right foot. The bottoms of the toes of your left foot should be in contact with a wall in front of you (the wall should be creating a forced dorsiflexion of the toes, so that the sole of the left foot is on the ground but the toes are on the wall), and your left knee should be bent slightly. Keep your weight evenly distributed between your right and left foot to start the exercise (see note below). You are now ready to begin the stretch. Slowly rotate your left foot to the inside (pronation) so that most of the weight is supported by the 'big-toe side’ of the foot. Then, slowly rotate your left foot to the outside (supination), shifting the weight to the 'little-toe side’ of your foot. Repeat this overall movement for a total of 15 repetitions. Next, simply repeat the above sequence with your right foot.

II. Strengthening Exercises for the Plantar Fascia

A. Toe Walking with Opposite-Ankle Dorsiflexion

Barefoot, stand as tall as you can on your toes. Balance for a moment and then begin walking forward with slow, small steps (take one step every one to two seconds, with each step being about 10 to 12 inches in length). As you do this, maintain a tall, balanced posture. Be sure to dorsiflex the ankle and toes of the free (moving-ahead) leg upward as high as you can with each step, while maintaining your balance on the toes and ball of the support foot. Walk a distance of 20 metres for a total of three sets, with a short break in between sets.

B. Toe Grasping

Stand barefoot with your feet hip-width apart. In an alternating pattern, curl the toes of your right foot and then your left foot down and under, as though you are grasping something with the toes of each foot. Repeat this action (right foot, left foot, right foot, etc.) for a total 50 repetitions with each foot. Rest for a moment, and then complete two more sets. Try pulling yourself across the floor (smooth surfaces work best) for a distance of three to six feet as you become more skilled at this exercise.

April 15th 2019

Meralgia paresthetica

Meralgia paresthetica occurs when the lateral femoral cutaneous nerve — which supplies sensation to the surface of your outer thigh — becomes compressed, or pinched. The lateral femoral cutaneous nerve is purely a sensory nerve and doesn’t affect your ability to use your leg muscles. In most people, this nerve passes through the groin to the upper thigh without trouble. But in meralgia paresthetica, the lateral femoral cutaneous nerve becomes trapped — often under the inguinal ligament, which runs along your groin from your abdomen to your upper thigh.

Common causes of this compression include any condition that increases pressure on the groin, including:

  • • Tight clothing, such as belts, corsets and tight pants
  • • Obesity or weight gain
  • • Wearing a heavy tool belt
  • • Pregnancy
  • • Scar tissue near the inguinal ligament due to injury or past surgery
  • • Nerve injury, which can be due to diabetes or seat belt injury after a motor vehicle accident, for example, also can Risk factors

The following might increase your risk of meralgia paresthetica:

  • • Extra weight. Being overweight or obese can increase the pressure on your lateral femoral cutaneous nerve.
  • • Pregnancy. A growing belly puts added pressure on your groin, through which the lateral femoral cutaneous nerve passes.
  • • Diabetes. Diabetes-related nerve injury can lead to meralgia paresthetica.
  • • Age. People between the ages of 30 and 60 are at a higher risk.

Exercises

Reducing hip tightness is one way to alleviate the symptoms of meralgia paresthetica by improving flexibility and building strength. Bridging consists of lying flat on the floor and lifting your bottom up while tightening your gluteal muscles. Hip extensions involve lying on your belly and lifting your leg up while tightening the gluteals. Standing hip abduction requires standing upright while slowly lifting each leg to one side, keeping the knee straight. Such exercises should not cause any thigh pain.

Quadriceps Stretches

The quadriceps muscles are located next to the sensory nerve involved in meralgia paresthetica. Stretching these muscles can improve flexibility and strength in the upper thigh. A traditional quad stretch involves pulling the heel of your foot back toward your buttocks while standing, stretching the length of the upper thigh. Again, stretching should cease if pain occurs.

Lunges

Lunges strengthen both the hips and quadriceps muscles to help prevent thigh pain. These start by standing upright and stepping forward with one foot, lowering the body until the opposite knee touches the ground at a right angle. The exercise then can either be reversed or proceed forward by stepping with the opposite leg.

Resistance Bands

More advanced outer thigh exercises can incorporate resistance bands to improve flexibility and strength. A resistance band is looped around the ankle and tied at the other end to a solid, immovable object. A variety of exercises can then be accomplished, including extending the hip backward, outward and forward. These should only be conducted when outer thigh pain is completely gone.

Considerations

While exercises are important to recovery, the most immediate response to meralgia paresthetica should be rest. Athletes might try cross-training as a way to maintain fitness without aggravating the condition. Weight loss and wearing loosely fitting clothes, will also help relieve symptoms.

April 14th 2019

Chondromalacia and Runner’s Knee

Chondromalacia, or runner’s knee, is a condition where the articular cartilage, located underneath the kneecap (patella), starts to soften and break down. This cartilage is usually smooth and allows the knee joint to move freely as the knee bends. However, as chondromalacia worsens, the cartilage breaks down, causing irregularities and roughness on the undersurface of the patella, which leads to irritation and pain underneath the patella, or kneecap. Activities like walking, running and especially squatting, kneeling or jumping will cause increased pain and discomfort.

Causes of Chondromalacia?

Overuse (or doing activities that your knees aren’t conditioned for), is the major cause of chondromalacia, or runner’s knee. Activities that involve a lot of running, jumping or rapid change of direction are particularly stressful to the knee joint. Participants of basketball, volleyball, skiing, soccer, tennis and other running related sports are particularly vulnerable to runner’s knee. Other factors also contribute, including: being overweight; pronation or inefficient foot mechanics; and insufficient warm up before exercise. Although chondromalacia can occur to anyone at any time, there are two distinct age groups that are most susceptible.

  • The over 40’s; where general wear and tear of the knee joint is occurring due to age and degeneration.
  • Teenagers; (especially girls) where rapid growth is causing structural changes to the legs and knees.

Exercises

  • Short-arc extensions are done sitting up or lying down. Use a rolled-up towel to support your thigh while you keep your leg and foot in the air for 5 seconds. Lower your foot as you bend your knee slowly. Repeat 10 times for each leg, twice a day.
  • Straight-leg raises are done lying down. Lift your whole lower limb at the hip with the knee extended, and keep it up in the air for 5 seconds. Then lower slowly. Repeat 10 times for each leg, twice a day.
  • Quadriceps isometric exercises are done sitting up, with your legs extended in front of you. Tighten your quadriceps muscles by pushing the knees down onto the floor. Hold for 5 seconds. Repeat 10 times each leg, twice a day.
  • Stationary bicycling on low tension setting improves your exercise tolerance without stressing your knee. Adjust your seat high enough so that your leg is straight on the down stroke. Start with 15 minutes a day and work up to 30 minutes a day.
April 13th 2019

Shin Splints

Although the term shin splints is often used to describe a variety of lower leg problems, it actually refers specifically to a condition called Medial Tibial Stress Syndrome (MTSS). To better understand shin splints, or MTSS, let us have a look at the muscles, tendons and bones involved. There are many muscles and tendons that make up the lower leg, or calf region. It’s quite a complex formation of inter- weaving and over-crossing muscles and tendons. The main components of the lower leg that are affected by the pain associated with shin splints are:

  • The Tibia and Fibula. These are the two bones in the lower leg. The tibia is situated on the medial, or inside of the lower leg. While the fibula is situated on the lateral, or outside of the lower leg.
  • There are also a large number of the muscles that attach to the tibia and fibula. It’s these muscles, when overworked, that pull on the tibia and fibula and cause the pain associated with shin splints. Specifically, the pain associated with shin splints is a result of fatigue and trauma to the muscle’s tendons where they attach themselves to the tibia. In an effort to keep the foot, ankle and lower leg stable, the muscles exert a great force on the tibia. This excessive force can result in the tendons being partially torn away from the bone.

What Causes Shin Splints?

While there are many causes of shin splints, they can all be categorized into two main groups.

1) Overload (or training errors): Shin splints are commonly associated with sports that require a lot of running or weight bearing activity. However, it is not necessarily the added weight or force applied to the muscles and tendons of the lower leg, but rather the impact force associated with running and weight bearing activities. In other words, it’s not the running itself, but the sudden shock force of repeated landings and change of direction that causes the problem. When the muscles and tendons become fatigued and overloaded, they lose their ability to adequately absorb the damaging shock force.

Other overload causes include:

  • Exercising on hard surfaces, like concrete;
  • Exercising on uneven ground;
  • Beginning an exercise program after a long lay-off period;
  • Increasing exercise intensity or duration too quickly;
  • Exercising in worn out or ill-fitting shoes; and
  • Excessive uphill or downhill running.

2) Bio-mechanical Inefficiencies: The major bio-mechanical inefficiency contributing to shin splints is that of flat feet. Flat feet lead to a second bio-mechanical inefficiency called over-pronation. Pronation occurs just after the heel strikes the ground. The foot flattens out, and then continues to roll inward. Over-pronation occurs when the foot and ankle continue to roll excessively inward. This excessive inward rolling causes the tibia to twist, which in-turn, over stretches the muscles of the lower leg.

Other bio-mechanical causes include:

  • Poor running mechanics;
  • Tight, stiff muscles in the lower leg;
  • Running with excessive forward lean;
  • Running with excessive backwards lean;
  • Landing on the balls of your foot; and
  • Running with your toes pointed outwards.

How to Prevent Shin Splints

1. Warm-up. A thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the lower legs, which will result in a lack of oxygen and nutrients for those muscles

2. Stretching. Flexible muscles are extremely important in the prevention of most lower leg injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.

  • Kneeling position, the runner points his toes out behind and gently sits back on  heels pressing the tops of the feet towards the ground.
  • Standing arm’s length from the wall, place hands on wall, keep feet and knees straight, lean forward as far as possible.
  • Standing with feet flat, bend knees forward as far as possible keeping heels on floor.

3. Strengthening and conditioning

  • resistance on their toes, have them lift their toes up.
  • Sitting with left ankle on right knee, apply pressure to inside of     foot (near large toe) with hand, and turn foot up and in, using leg     muscles.
  • Same position as above, apply pressure to outside of foot (near small toe) with hand, and turn foot down and out using leg muscles.
  • Same position as above, apply pressure to top of foot (near toes) with hand, and lift foot using leg muscles. Repeat with right ankle on the left knee.
  • Sitting on a table or chair attach a weight (a bucket filled with rocks works well) around the foot. Without bending your knee move the foot     up and down from the ankle.
  • Anchor one end of an elastic band to the leg of a table or sofa. Stretch the band, and then loop it around the end of the foot. Move the foot up and down and side to side against the bands resistance.
  • Draw each letter of the alphabet with the big toe of each foot in the air.
  • While standing erect raise up and down onto your toes several times. If that is too easy you can make it more challenging by performing the same exercise while standing on a step and allow your calves to     stretch over the edge of the step.
  • In a sitting position lower and raise the feet with the heels on the ground as high and quickly as possible for 60 seconds. I have athletes do this exercise during the school day while sitting at their desk.
  • Walking down steep hills.
  • Walking on toes.
  • Walking on heels.
  • Walking with feet turned inward and outward.
  • With socks off, gather up a towel that is flat on the floor, using only the toes.
  • Pick up marbles using the toes.
  • Off-season training. One of the most effective ways to eliminate shin splints is to do some type of running in the off season. An increase in distance should never exceed more than 10% per week.
April 12th 2019

Piriformis Syndrome

Piriformis syndrome is a condition in which the piriformis muscle becomes tight or spasms, and irritates the sciatic nerve. This causes pain in the buttocks region and may even result in referred pain in the lower back and thigh. The piriformis is a small muscle located deep within the hip and buttocks region. It connects the sacrum (lower region of the spine) to the top of the femur (thigh bone) and aids in external rotation (turning out) of the hip joint.

What Causes Piriformis Syndrome?

Piriformis syndrome is predominantly caused by a shortening or tightening of the piriformis muscle, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.

Overload (or training errors): Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, piriformis syndrome is not only found in athletes. In fact, a large proportion of reported cases occur in people who lead a sedentary lifestyle. Other overload causes include:

  • Exercising on hard surfaces, like concrete;
  • Exercising on uneven ground;
  • Beginning an exercise program after a long lay-off period;
  • Increasing exercise intensity or duration too quickly;
  • Exercising in worn out or ill fitting shoes; and
  • Sitting for long periods of time.

Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to piriformis syndrome are faulty mechanics of the sacroiliac joints, lumbar spine, hip, knee and foot, gait disturbances and poor posture or sitting habits. Other causes can include spinal problems like herniated discs and spinal stenosis. Other biomechanical causes include:

  • Poor running or walking mechanics;
  • Tight, stiff muscles in the lower back, hips and buttocks;
  • Running or walking with your toes pointed out.

Exercises

  • Lie on the back with the legs flat. Pull the affected leg up toward the chest, holding the knee with the hand on the same side of the body and grasping the ankle with the other hand. Trying to lead with the ankle, pull the knee towards the opposite ankle until stretch is felt. Do not force ankle or knee beyond stretch. Hold stretch for 30 seconds, then slowly return to starting position.  
  • Lie on the floor with the legs flat. Raise the affected leg and place that foot on the floor outside the opposite knee. Pull the knee of the bent leg directly across the midline of the body using the opposite hand or a towel, if needed, until stretch is felt. Do not force knee beyond stretch or to the floor. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.
  • Lie on the floor with the affected leg crossed over the other leg at the knees and both legs bent. Gently pull the lower knee up towards the shoulder on the same side of the body ( until stretch is felt. Hold stretch for 30 seconds, then slowly return to starting position.  
  • Buttocks stretch for the piriformis muscle: Begin on all fours. Place the affected foot across and underneath the trunk of the body so that the affected knee is outside the trunk. Extend the non-affected leg straight back behind the trunk and keep the pelvis straight. Keeping the affected leg in place, scoot the hips backwards towards the floor and lean forward on the forearms until deep stretch is felt. Do not force body to floor. Hold stretch for 30 seconds, then slowly return to starting position.  
April 11th 2019

Medial Collateral Ligament (MCL) Sprain

The medial collateral ligament is a flat ligament on the inside (medial) of the knee that connects the tibia (lower leg bone) to the femur (thigh bone). The medial collateral ligament is very important in providing stability to the knee joint. The most common cause of medial collateral ligament sprain is a blow or sudden impact to the outside (lateral) of the knee joint. This causes the outside of the knee to collapse inward toward the midline of the body and the inside of the knee (where the medial collateral ligament is located) to widen and open up. This opening up stretches the ligament, which results in the injury.

Medial Collateral Ligament Sprain Prevention

  1. Warm Up properly. A good warm up is essential in getting the body ready for any activity. A well- structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity.
  2. Avoid activities that cause pain. This is self-explanatory, but try to be aware of activities that cause pain or discomfort, and either avoid them or modify them.
  3. Rest and Recovery. Rest is very important in helping the soft tissues of the body recover from strenuous activity. Be sure to allow adequate recovery time between workouts or training sessions.
  4. Balancing Exercises. Any activity that challenges your ability to balance, and keep your balance, will help what is called, proprioception: - your body’s ability to know where its limbs are at any given time.
  5. Stretching. To prevent MCL injury, it is important that the muscles around the knee be in top condition. Be sure to work on the flexibility of all the muscle groups in the leg.
  6. Footwear. Be aware of the importance of good footwear. A good pair of shoes will help to keep your knees stable, provide adequate cushioning, and support your knees and lower leg during the running or walking motion.
  7. Strapping. Strapping, or taping can provide an added level of support and stability to weak or injured knees.
  8. Strengthening exercises:
  • Short-arc extensions are done sitting up or lying down. Use a rolled-up towel to support your thigh while you keep your leg and foot in the air for 5 seconds. Lower your foot as you bend your knee slowly. Repeat  10 times for each leg, twice a day.
  • Straight-leg raises are done lying down. Lift your whole lower limb at the hip with the knee extended, and keep it up in the air for 5 seconds. Then lower slowly. Repeat 10 times for each leg, twice a day.
  • Quadriceps isometric exercises are done sitting up, with your legs extended in front of you. Tighten your quadriceps muscles by pushing the knees down onto the floor. Hold for 5 seconds. Repeat 10 times each leg, twice a day.
  • Stationary bicycling on low tension setting improves your exercise tolerance without stressing your knee. Adjust your seat high enough so that your leg is straight on the down stroke. Start with 15 minutes a day and work up to 30 minutes a day.
April 10th 2019

Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome is caused by the entrapment and compression of the median nerve. This nerve runs from the forearm to the hand where it branches to supply the thumb and the first two fingers.  At the wrist, the nerve passes through the carpal tunnel, which is composed of the carpal (wrist) bones and the transverse carpal ligament. The carpal bones make up the base and sides of the tunnel so that a semicircular shape or valley is formed. Stretched across this is the tough transverse ligament. The median nerve, along with nine tendons that give the thumb and fingers movement, and their synovial sheaths pass through the tunnel and into the hand.

Causes of Carpal Tunnel Syndrome

If any of the tendons or synovial sheaths in the carpal tunnel become swollen and inflamed, this puts excessive pressure on the median nerve because of the limited amount of space within the tunnel. Other ways in which the pressure becomes increased is when the tough transverse carpal ligament becomes thickened, a callus from a bone fracture or swelling from a rheumatic disease. When the median nerve becomes compressed, the nerve signals that are normally transmitted through the nerve become slowed which results in abnormal sensations in the affected hand.

Symptoms

  • Weakness in the affected hand which affects grip.
  • A feeling of numbness or tingling in the thumb, index and middle fingers and the thumb- side of the palm.
  • Impaired coordination of the thumb, index and middle fingers so that fine movements become difficult.
  • Pain in the wrist and hand that can stretch up as far as the elbow.

Exercises

These exercises are more successful in patients with mild symptoms, and are not recommended for patients with severe symptoms. Patients who have persistent symptoms despite these exercises should discuss treatment with their osteopath.

  • Extend and stretch both wrists and fingers acutely as if they are in a hand- stand position. Hold for a count of 5. Straighten both wrists and relax fingers.
  • Make a tight fist with both hands. Then bend both wrists down while keeping the fist. Hold for a count of 5. Straighten both wrists and relax fingers, for a count of 5.

The exercise should be repeated 10 times. Then let your arms hang loosely at the side and shake them for a few seconds.

April 9th 2019

Sever’s Disease

Sever’s disease is a common cause of heel pain in active children. Sever’s disease, also called calcaneal apophysitis, occurs when the growth plate of the heel is injured by excessive forces during early adolescence. Sever’s disease can be diagnosed based on your history and symptoms. Clinically, your osteopath will perform a “squeeze test” and some other tests to confirm the diagnosis. Some children suffer Sever’s disease even though they do less exercise than others. This indicates that it is not just training volume that is at play. Foot and leg biomechanics are a predisposing factor.
The main factors thought to predispose a child to Sever’s disease include:
• decrease ankle dorsiflexion.
• abnormal hind foot motion eg overpronation or supination.
• tight calf muscles.
• excessive weight-bearing activities eg running.

Sever’s disease is more common in boys. They tend to have later growth spurts and typically get the condition between the ages of 10 and 15. In girls, it usually happens between 8 and 13. Symptoms can include:
• Pain, swelling, or redness in one or both heels
• Tenderness and tightness in the back of the heel that feels worse when
the area is squeezed
• Heel pain that gets worse after running or jumping, and feels better after
rest. The pain may be especially bad at the beginning of a sports season
or when wearing hard, stiff shoes like soccer cleats.
• Trouble walking
• Walking or running with a limp or on tip toes

Treatment

The good news is that the condition doesn’t cause any long-term foot problems. With osteopathic treatment, the symptoms typically go away after a few months. Your osteopath will identify stiff joints within your foot and ankle complex that they will need to loosen to help you avoid overstress. A sign that you may have a stiff ankle joint can be a limited range of ankle bend during a squat maneuver. Your osteopath will guide you. It’s important to rest. Your child will need to stop or cut down on sports until the pain gets better. When she’s well enough to return to her sport, have her build up her playing time gradually.
Your osteopath may also recommend:
• Ice packs or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to relieve the pain
• Stretching and strengthening exercises. In severe cases, your child may need a cast so her heel is forced to rest.

Prevention

Once your child’s growth spurt ends, and she’s reached full size, her Sever’s disease won’t return. Until then, the condition can happen again if your child stays very active.
Some simple steps can help prevent it. Have your child:
• Wear supportive, shock-absorbing shoes.
• Stretch his calves, heels, and hamstrings.
• Not overdo it. Warn against over-training, and suggest plenty of rest,
especially if he begins to feel pain in her heel.
• Try to avoid lots of running and pounding on hard surfaces.
• If he’s overweight, help him/her lose those extra Kgs, which can increase
pressure on her heels.

April 8th 2019

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome can be defined as a Retro-patellar (behind the knee cap) or Peripatellar (around the knee cap) pain, resulting from physical and biomechanical changes on the patellofemoral joint. It should be distinguished from chondromalacia, which is an actual fraying and damage of the articular cartilage of the patella. People that have PPS have anterior knee pain that typically occurs with activity and often worsens when going down steps or hills. The pain can occur with sitting for prolonged periods of time, and affect one or both knees at the same time.

Exercises
If you are experiencing knee pain or have a knee injury or condition, ask your osteopath what exercises are appropriate (safest and most effective) for you.
Calf Muscles Stretch:
To stretch left calf muscle, step back with left leg, forward with right. Bend right knee (keep left leg and back in a straight line as you lean forward) until you feel a gentle stretch in the left calf. Do not roll foot out to side. Keep heel flat, foot forward. Hold 30 seconds. Repeat on other side.
Quad Muscle Stretch:
Stand. Bend right knee, grab front of right ankle and bring heel to buttocks with hand. Keep knees together. Do not arch back. Do not let leg go to side. Point knee toward floor. Tighten buttocks and tuck tailbone under to increase stretch.Hold for 30 seconds. Repeat on other side.
Hamstring Stretch:
Standing position. Keep one leg on ground; put one foot on chair with leg straight. Bend forward at the hip. Hold for 30 seconds. Repeat on other side. Do not attempt to touch your toes as this will stretch your back, and the goal of this exercise is to isolate your hamstring muscles in the leg that is being supported by the chair. Sitting in chair hamstring: Straighten one leg, keeping heel on floor. Lean forward at hips, keeping back straight. Don’t try to touch your toes. Hold for 30 seconds. Repeat on other side.
Iliotibial Band Stretch:
Standing. To stretch the right side, cross right leg behind left leg. Bending from the hip, lean torso to the left - pushing hips to the right. The stretch is felt on the outer right hip and thigh. Keep right leg straight, left knee slightly bent. Hold for 30 seconds. Repeat on other side. Sitting position: Sit in chair or on floor. Bring right foot to outside of left leg, bringing knee towards opposite shoulder so that the knee crosses the midline of the body. Hold for 30 seconds. Repeat on other side.
Hip Adductors (Upper Inner Thigh) Stretch:
Standing: Step off to the side with the right leg. Bend left knee slightly (do not extend knee beyond toe) and move your right foot further to right until your feel a stretch in your right inner thigh. Hold stretch for 30 seconds. Repeat on other side. Sitting position: Sit on floor, spread legs into a V position. Slowly lean forward from your hips, keeping your back straight, until you feel the stretch. Do not bounce. Then lean towards the right, foot then left foot. Hold for 30 seconds.
Hip Abductors (Upper Outer Thigh) Stretch:
Sit on the floor, legs extended in front of you. Bend right leg and place right foot on floor on outside the left knee. Twist upper body to right and use left elbow to gently push against outside of right knee until you feel a gentle stretch in the right hips, buttocks, and lower back. Hold for 30 seconds. Repeat on other side.
Hip flexors (front of hips) Stretch:
Tightness in these muscles can affect the alignment of the knee bones.Standing Exercise: Step forward with the right leg, bending right knee (to increase the stretch, take a larger step). Do not extend right knee past toes. Keep left knee slightly bent with heel off the ground. Keep back upright. This stretches the front of the hip on the left side. Push the left hip forward to increase the stretch. Hold for 30 seconds. Repeat on other side.
Gluteal Stretch (back of hips / buttocks):
Stand in front of chair, about two feet away from chair. Place left foot on chair, leg bent. Bring your chest towards your knee, keeping back straight. Hold for 30 seconds. Repeat on other side.

April 7th 2019

Iliotibial Band (ITB) Syndrome

Knee pain and knee injuries, as a result of Iliotibial Band Syndrome, can be an extremely painful and frustrating injury that puts a big strain on both the knee and hip joints. Knee injuries are very common among runners and cyclists. However, they don’t usually occur in an instant, like a hamstring strain or groin pull, but commonly start off as a twinge or niggle, and progress quickly to a debilitating sports injury.

What is Iliotibial Band Syndrome?

The iliotibial band is actually a thick tendon-like portion of another muscle called the tensor fasciae latae. This band passes down the outside of the thigh and inserts just below the knee. The main problem occurs when the tensor fasciae latae muscle and iliotibial band become tight. This causes the tendon to pull the knee joint out of alignment and rub against the outside of the knee, which results in inflammation and pain.

What Causes Iliotibial Band Syndrome?

There are two main causes of knee pain associated with iliotibial band syndrome. The first is “overload” and the second is “biomechanical errors.”

Overload is common with sports that require a lot of running or weight bearing activity. This is why ITB is commonly a runner’s injury. When the tensor fasciae latae muscle and iliotibial band become fatigued and overloaded, they lose their ability to adequately stabilize the entire leg. This in-turn places stress on the knee joint, which results in pain and damage to the structures that make up the knee joint.

Overload on the ITB can be caused by a number of things. They include:

  • Exercising on uneven ground;
  • Beginning an exercise program after a long lay-off period;
  • Increasing exercise intensity or duration too quickly;
  • Exercising in worn out or ill-fitting shoes; and
  • Excessive uphill or downhill running.

Biomechanical errors include:

  • Tight, stiff muscles in the leg;
  • Muscle imbalances;
  • Foot structure problems such as flat feet; and
  • Gait, or running style problems such as pronation.

Exercises

Repeat all stretches 3-5 times, 3 different times a day. With all these stretches you may feel it more up near the hip as opposed to down lower where you may be experiencing pain; this is normal.

  1. Pull foot up to back of buttocks. Cross the uninjured leg over the injured leg and push down, hold for 30 seconds.
  2. Cross injured leg behind and lean towards the uninjured side. This stretch is best performed with arms over the head, creating a “bow” from ankle to hand on the injured side (unlike how it is depicted).
  3. Cross injured leg over the uninjured side and pull the leg as close to your chest as possible.

Foam Roller: Roll your injured leg over the foam roller, add more time gradually each day to help mobilize your tissues and break up scar tissue.

Balance on One Leg Strengthening: You can start with just balancing on one foot when brushing your teeth. Gradually you can add challenges such as using a soccer ball and moving the ball in different directions. Another good method is to balance on one foot and play catch with yourself with a tennis ball against a wall or dribble a basketball. Start out with one minute at a time, and build up to 3-5 minutes.

Side Leg Lifts: Keep the back of the leg and buttocks against the wall. Slide the leg up the wall and hold at the top for 5 seconds then slide back down. Point toes down. Start with one set of 20 each leg, after 1 week add a second set of 5. Every 2 days add 5 more as long as it is being well tolerated until you build up to 3 sets of 20 lifts.

Strengthening with a therapy band: Loop one end and close in the door. Loop other end around the uninjured leg. Bend your knee on the injured leg and balance on the injured leg. Put your uninjured leg through a range of running motion, going up and back. Build up to 3-5 minutes, make sure to exercise both legs.

April 6th 2019

Calf Muscle Tear (Gastrocnemius Tear)

Calf (Gastrocnemius) muscle tears commonly occur in middle-aged recreational athletes while performing actions that require forceful contraction of the calf muscle (ex: basketball, hill running, tennis, etc.). Calf muscle tears have similar symptoms and occur by a similar mechanism to Achilles tendon ruptures. The difference is the location of the injury. Achilles tendon ruptures involve the actual Achilles tendon with pain located just above the back of the heel. Calf muscle tears occur higher up where the muscle belly attaches to the fascia (musculotendinous junction). Because of the similarities between the injuries, an Achilles tendon rupture must be ruled out in the diagnosis. Treatment of calf muscle tears is non-surgical. In most instances, initial treatment includes activity modification (limiting muscle- loading activities), wearing a boot (Cam Walker), and using crutches. As the muscle tear heals, physical therapy exercises are utilized to regain full range of motion and muscular strength. Significant improvement can be expected within the first two weeks, but full recovery can take up to 6-8 weeks. It may take many more months to regain muscle mass in the calf that had been atrophied (weakened) due to lack of use.

Treatment of Calf Muscle Tears

Treatment of Gastrocnemius muscle tears is usually non-surgical, and dependent upon the individual’s symptoms. In most instances, initial treatment includes activity modification (limiting muscle-loading activities), wearing a boot (Cam Walker), and using crutches. As the muscle tear heals, physical therapy exercises are utilized to regain full range of motion and muscular strength. Significant improvement can be expected within the first two weeks, but full recovery can take up to 6-8 weeks. It may take many more months to regain muscle mass in the calf. Occasionally, excessive scarring will form in the location of the tear. This can cause chronic pain in the area, or render it more likely for future tearing as the fibrotic scar tissue absorbs forces differently than regular healthy muscle tissue.

Initial (Acute Phase) Treatment Immediately after the injury (first 24-72 hours) treatment should include:

• Relative rest. Limit the use of the injured calf, by limiting standing and walking and possibly using crutches if needed.

• Ice applied to the injured area (10 minutes on, 10 minutes off and then repeat)

• Compression. Light compression with a wrap may be helpful

• Elevation. Elevate the leg at, or slightly above, the level of the heart. For example, by lying on a bed with the foot propped up by a couple pillows.

• Gentle foot and ankle range of motion (ROM) exercises can be carried out as long as the motion is relatively pain-free

• Immobilize the ankle in a neutral position. Studies have shown an increased rate of healing with the ankle braced in a neutral position.

Recovery Phase

Once pain free, the patient should progress from gentle plantar flexion (downward motion) exercises against resistance (use of resistance bands), to gradual introduction of stationary cycling, leg presses, and heel raises. Massage techniques can help to decrease swelling and prevent formation of scar tissue.

Maintenance Phase

Once pain-free strength and flexibility have returned, sport-specific activities can be introduced. The long-term goal of rehabilitation is to overcome the increased risk for re-injury by minimizing scar tissue formation and maximizing muscle strength and function. Calf strengthening and calf stretching should continue for several months.

Double Leg Heel Rises

Use your calf muscles to slowly raise both your heels off of the floor, then slowly bring your heels back to the ground and repeat again. If one leg is weaker or recovering from injury, then take the majority (70-80%) of the body weight on the uninjured side.

Perform the double leg heel rise exercises every second day (3-4 times per week). Start with a low number of repetitions (ex.5-10)and sets(3-5),and gradually work up until you are doing many repetitions (20-30) and many sets (10- 12). It can take many months to work up to doing a large number of repetitions. The calf muscle can be slow to regain strength, often requiring many months to regain most lost strength. Some patients may benefit from performing calf raises with their heels hanging off the edge of a rung of stairs. This works the calf muscle over a longer excursion.

Calf Stretch

Lean forward with your hands on the wall. Place the leg to be stretched back and keep the knee straight. Turn your foot inwards so that you feel the stretch in your calf,and not on the inside of your ankle.

A typical calf stretching routine would involve stretching for a total of 5 or more minutes each day. For example, 30 seconds a side and then alternate for a total of 5 minutes (2.5 minutes each side). Calf stretching needs to be performed regularly (ex. daily) for a minimum of 4-6 weeks before any significant effect will be noted.

April 5th 2019

Sciatica

Nagging, burning pain radiating down the back of the leg, or dull throbbing pain in the buttocks on one side can all be signs of a very frustrating condition referred to as Sciatica, or Sciatic Nerve Pain. It is caused by pressure placed on the sciatic nerve. When a nerve is placed under pressure it sends out pain signals. It may radiate down the length of the nerve or be focused in a specific area. The muscles innervated by the nerve may or may not be directly affected.

What Causes Sciatica?

Sciatica has several possible causes. Any condition that puts pressure on the sciatic nerve can result in pain in the lower back, buttocks and back of the leg. The pressure may come from vertebral discs, bones or muscles. The causes of sciatica may be acute or chronic. A traumatic event may result in injury to the lower back or hip area causing pressure on the sciatic nerve through misplaced bones, spasm of a muscle or inflammation from the injury. Chronic causes of sciatica may be due to muscle imbalances, misaligned bones, or narrowing space in the vertebrae.

There are four conditions that most commonly cause sciatica
• Piriformis syndrome is one common cause and is the result of the piriformis muscle putting pressure on the nerve. This may be caused by misalignment of the pelvis and/or hip joint, which changes the position of the piriformis, placing pressure on the sciatic nerve. This misalignment is often caused by muscle imbalances.
• Herniated discs in the spinal column can also put pressure on the nerve. A herniation, or protrusion, of the disc can result from a traumatic event or from years of pressure from muscle imbalances.
• A third possibility is spinal stenosis, or a decrease in the space between the vertebrae. This reduced space compacts the nerve where it leaves the spinal column. The narrowing is often caused by compression on the spine due to muscle imbalances.
• The fourth cause is Isthmic Spondylolisthesis, which is a condition where the vertebrae slips or moves out of position, pinching or placing pressure on the sciatic nerve. This may be caused by a traumatic event or a chronic muscle imbalance. Muscle imbalances are a common thread through the four possible causes listed above. This makes treatment and correction of the muscle imbalances paramount in the recovery and prevention of sciatica.

What are the Signs and Symptoms of Sciatica?

Sciatica is classified as pain in the sciatic nerve. This pain may be sharp, dull or burning. It may be focused in one area or it may radiate the entire length of the nerve. It is often felt in the lower back and buttocks region, and often spreads down the back of the leg. The pain is usually only felt on one side. Coughing, sneezing, squatting or extended periods of sitting can cause an increase in pain. The muscles that are innervated by the sciatic nerve may also spasm or cramp, causing additional pain. The pain in the lower back and hamstrings can also lead to inflexibility in the back and hips. Pain and stiffness in the opposite side may also result over time.

Common signs and symptoms of sciatica include:
• Pain - This pain can vary from dull, aching pain, to sharp, burning pain anywhere along the nerve pathway.
• Numbness - This can also occur anywhere along the nerve pathway. Pain may be experienced in one area with numbness below it.
• Weakness - The muscles innervated by the sciatic nerve may become weak due to a decreased ability to send signals along the pathway.
• Tingling or “Pins and Needles” - This may be felt in the lower legs and feet.
• Cramping or Spasm - The muscles of the hamstrings or calves may spasm or
cramp as a result of incomplete signals being sent through the nerve pathway.

Exercise Provides Sciatica Pain Relief

While it may seem counter-intuitive, exercise is usually better for relieving sciatic pain than bed rest. Patients may rest for a day or two after their sciatic pain flares up, but after that time period, inactivity will usually make the pain worse. Without exercise and movement, the back muscles and spinal structures become de-conditioned and less able to support the back. The de conditioning and weakening can lead to back injury and strain, which causes additional pain. In addition, active exercise is also important for the health of the spinal discs. Movement helps exchange nutrients and fluids within the discs to keep them healthy and prevent pressure on the sciatic nerve. Typical features of any sciatica exercise program include:

Core muscle strength. Many sciatica exercises focus on strengthening the abdominal and back muscles in order to provide more support for the back. Stretching exercises for sciatica target muscles that cause pain when they are tight and inflexible. When patients engage in a regular program of gentle strengthening and stretching exercises, they can recover more quickly from a flare up of sciatica and are less likely to experience future episodes of pain.
Specific diagnosis. Most exercise programs will be tailored to address the underlying cause of the patient’s sciatic pain, such as a lumbar herniated disc or spinal stenosis. Doing the wrong type of exercise can worsen the sciatic pain, so it is important to get an accurate diagnosis from an osteopath prior to starting a program of sciatica exercises.

Hamstring stretching. Regardless of the diagnosis, most types of sciatica will benefit from a regular routine of hamstring stretching. The hamstrings are muscles located in the back of the thigh. Overly tight hamstrings increase the stress on the low back and often aggravate or even cause some of the conditions that result in sciatica.

Advanced Sciatica Exercises for Abdominal Muscles and Back Muscles

As the patient’s pain works out of the lower extremity (leg) and centralizes in the low back, the exercises typically are advanced to strengthen the low back and abdominal muscles to prevent recurrences of sciatic pain caused by a herniated disc.

Low back muscle strengthening exercises:
Upper back extension. In the prone position with hands clasped behind the lower back, raise the head and chest slightly against gravity (Figure 4) while looking at the floor (stay low). Begin by holding position for 5 seconds, and gradually work up to 20 seconds. Aim to complete 8-10 repetitions.
In the prone position with the head and chest lowered to the floor, lightly raise an arm and opposite leg slowly, with the knee locked, 2 to 3 inches from the floor (Figure 5). Begin by holding position for 5 seconds, and complete 8 to 10 repetitions. As strength builds, aim to hold position for 20 seconds.

Abdominal muscle strengthening exercises:
Curl-ups. For the upper abdominals, the patient should lie on the back with knees bent, arms folded across the chest, and the pelvis tilted to flatten the back. Then curl-up lifting the head and shoulders from the floor (Figure 6). Hold for two to four seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten curls. Do not attempt to lift the head up too high, and bring the head and chest towards the ceiling. For patients with neck pain, place the hands behind the head to support the neck.

For the lower abdominals, tighten the lower stomach muscles and slowly raise the straight leg 8 to 12 inches from the floor (Figure 7), keeping the low back held flat against the floor. Hold leg raise for eight to 10 seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten lifts.

Water exercises are also excellent to strengthen the lower abdominal muscles, and even just walking in waist-deep water can be helpful.

Degenerative Disc Disease Exercises While Lying on the Back

Examples of the dynamic lumbar stabilizing exercises done while on the back include:

Hook-lying march.
While lying on the back on the floor, with knees bent and arms at sides, tighten the stomach muscles and slowly raise alternate legs 3 to 4 inches from the floor. Aim to ‘march’ for 30 seconds, for two to three repetitions, with 30-second breaks in between repetitions.

Hook-lying march combination.
Same exercise as described above, but includes raising and lowering the opposite arm over the head.

Bridging.
Start by lying on the back with the knees bent, then slowly raise the buttocks from the floor. Hold bridge for eight to 10 seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten bridges.

These exercises should all be performed with a rigid trunk. The pelvic tilt, tightening the lower stomach muscles and buttocks to flatten the back, can be used to find the most comfortable position for the
low back.

Degenerative Disc Disease Exercises While Lying on the Stomach

This same pelvic position (tightening the lower stomach muscles to flatten the lower back) is maintained while performing stabilizing exercises from the prone position (lying flat on the stomach):
• Raise one leg behind with the knee slightly bent and no arch in the back or neck
Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg raises.
• Lying face down, with elbows straight and arms stretched above the head, raise one arm and the opposite leg 2 to 3 inches off the floor. Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of opposite side raises.

Stabilizing exercises

These can be done in the 4-point position (kneeling on hands and knees), raising the arms and legs only as high as can be controlled, maintaining a stable trunk and avoiding any twisting or sagging:
• Raise one leg behind with the knee slightly bent and no arch in the back or neck
Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg raises.
• For a slightly more advanced exercise, raise one leg with the knee slightly bent and no arch in the back or neck and also raise the opposite arm
Hold for four to six seconds, then slowly lower to starting position. As strength builds, aim to complete two sets of ten leg
raises.

April 5th 2019

Patellar Tendonitis - Jumper’s Knee

Knee pain and knee injuries, as a result of Patellar Tendonitis, can be an extremely painful and frustrating injury that puts a big strain on both the knee and hip joints. Knee injuries like patellar tendonitis are very common among runners and cyclists, however it doesn’t usually occur in an instant like a hamstring strain or groin pull, but commonly starts off as a twinge or niggle, and progresses quickly to a debilitating sports injury that can sideline the best of us.
What is Patellar Tendonitis? As with all cases of tendonitis, patella tendonitis is simply the inflammation, degeneration or rupture of the patellar ligament and the tissue that surround it, leading to pain and discomfort in the area just below the knee cap.

Anatomy of the Knee

The picture to the right is a front-on view of the bones, tendons and ligaments that make up the knee joint. In the very center of the picture is the patella, or kneecap. The blue structure that runs downward from the patella to the tibia (shinbone) is the patella ligament. On occasion you may hear of this structure being referred to as the patellar tendon, but for the purposes of anatomy and physiology this structure is a ligament, as it attaches the patella (knee cap) to the tibia (shin bone). Ligaments attach bone to bone, while tendons attach muscle to bone.

What causes Patellar Tendonitis?

Overuse is the major cause of patellar tendonitis. Activities that involve a lot of jumping or rapid change of direction are particularly stressful to the patellar ligament. Participants of basketball, volleyball, soccer, and other running related sports are particularly vulnerable to patellar tendonitis. Patellar tendonitis can also be caused by a sudden, unexpected injury like a fall. Landing heavily on your knees can damage the patellar ligament, which can lead to patellar tendonitis.

Patellar Tendonitis Prevention

Although it is important to be able to treat patellar tendonitis, prevention should be your first priority. So what are some of the things you can do to help prevent patellar tendonitis?
1. Warm up properly. A good warm up is essential in getting the body ready for any activity. A well- structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Avoid activities that cause painThis is self-explanatory, but try to be aware of activities that cause pain or discomfort, and either avoid them or modify them.

2. Rest and Recovery. Rest is very important in helping the soft tissues of the body recover from strenuous activity. Be sure to allow adequate recovery time between workouts or training sessions.

3. Balancing Exercises. Any activity that challenges your ability to balance, and keep your balance, will help what is called, proprioception: - your body’s ability to know where its limbs are at any given time.

4. Stretching. To prevent patellar tendonitis, it is important that the muscles around the knee be in top condition. Be sure to work on the flexibility of all the muscle groups in the leg.

5. Strengthening Short-arc extensions are done sitting up or lying down. Use a rolled-up towel to support your thigh while you keep your leg and foot in the air for 5 seconds. Lower your foot as you bend your knee slowly. Repeat 10 times for each leg, twice a day.Straight-leg raises are done lying down. Lift your whole lower limb at the hip with the knee extended, and keep it up in the air for 5 seconds. Then lower slowly. Repeat 10 times for each leg, twice a day.Quadriceps isometric exercises are done sitting up, with your legs extended in front of you. Tighten your quadriceps muscles by pushing the knees down onto the floor. Hold for 5 seconds. Repeat 10 times each leg, twice a day.Stationary bicycling on low tension setting improves your exercise tolerance without stressing your knee. Adjust your seat high enough so that your leg is straight on the down stroke. Start with 15 minutes a day and work up to 30 minutes a day.

6. Footwear. Be aware of the importance of good footwear. A good pair of shoes will help to keep your knees stable, provide adequate cushioning, and support your knees and lower leg during the running or walking motion.   

7. Strapping. Strapping, or taping can provide an added level of support and stability to weak or injured knees.

April 3rd 2019

Iliopsoas Tendonitis and Iliopsoas Syndrome

Iliopsoas Tendonitis and Iliopsoas Syndrome are conditions that affect the iliopsoas muscle located in the anterior region (or front) of the hip.Technically, they are two separate conditions, but it’s not uncommon to hear the term iliopsoas tendonitis or iliopsoas syndrome being used to describe the same thing. Iliopsoas tendonitis refers to inflammation of the iliopsoas muscle and can also affect the bursa located underneath the tendon of the iliopsoas muscle. Whereas iliopsoas syndrome refers to a stretch, tear or complete rupture of the iliopsoas muscle and / or tendon. The iliopsoas muscle is actually made up of two separate muscles located in the anterior (or front) of the hip area. Psoas are responsible for lifting the upper leg to the torso,or flexing the torso towards the thigh (as in a sit-up). Although the two muscles start at different points (the psoas originates from the spine, while the iliacus originates from the hip bone) they both end up at the same point; the upper portion of the thigh bone. It is at this point; the insertion, that most injury occurs.

Causes

Iliopsoas tendonitis is predominately caused by repetitive hip flexion or overuse of the hip area, resulting in inflammation. Iliopsoas syndrome, on the other hand, is caused by a sudden contraction of the iliopsoas muscle, which results in a rupture or tear of the muscle, usually at the point where the muscle and tendon connect.Athletes at risk include runners, jumpers and participants of sports that require a lot of kicking. Also at risk are those who participate in strength training and weight lifting exercises that require a lot of bending and squatting.

Symptoms

Pain and tenderness are common symptoms of both conditions; however the onset of pain associated with iliopsoas tendonitis is gradual and tends to build up over an extended period of time, whereas the pain associated with iliopsoas syndrome is sudden and very sharp.

Prevention

There are a number of preventative techniques that will help to prevent both iliopsoas tendonitis and iliopsoas syndrome, including modifying equipment or sitting positions, taking extended rests and even learning new routines for repetitive activities. However, there are four preventative measures that I feel are far more important and effective.

Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the hip area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury.

Secondly, rest and recovery are extremely important; especially for athletes or individuals whose lifestyle involves strenuous physical activity. Be sure to let your muscles rest and recover after heavy physical activity.

Thirdly, strengthening and conditioning the muscles of the hips, buttocks and lower back will also help to prevent iliopsoas tendonitis and iliopsoas syndrome.

And fourthly, (and most importantly) flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. When this happens, strains, sprains, and pulled muscles occur.

Exercises

Stretching:

Iiliopsoas stretch: Kneel on one foot and the other knee. If needed, hold onto something for balance and then push your hips forward.

The “quad stretch” with your leg held backwards like a bow offers some stretch to the iliopsoas. Another more specific stretch would be lying on your bed, and allow your leg to dangle off the side of the bed from the hip on down. This is uncomfortable, but it does stretch the area. You can do 3 sets of 20 second stretches on each side. Alternatively you can move down towards the bottom of the bed and allow both legs to dangle off the bottom of the bed. To lessen some of the pain you are having you’ll also find that when you get up from a lying (supine) position you may want to roll over onto your side first or use your elbows and hands to assist in lifting yourself up. When you are almost completely recovered, gentle lunges can help you regain more flexibility and your ability to take a full stride without pain. Don’t do this if it causes pain - focus on the other stretches in that case.

Strengthening:

The abdominal muscles need to be strengthened to aid the hip flexors. This must be approached cautiously or you will aggravate the tendonitis. While ordinarily I believe that no pain equals lots of gain, unfortunately, with this problem, there is some discomfort during the rehabilitation. The abdominals can be strengthened with crunches done on the floor or with an “ab machine” in the gym. If you are doing the ab machine, make sure you use very light weights and perform 2 sets of 25. This should cause a minimum of discomfort. Do not rush to increase the number of sets or the resistance. You will probably find you cannot perform the knee up exercise until further in your rehab program.

Alternatively you may do a 5 minute core workout: Planks 15 to 45 seconds
Bridges - 10-15
Single Legged Bridges - 8-12

Side Planks - 10 to 30 seconds each side

In running, avoid hills. Uphills will be somewhat painful when lifting the leg, and downhills may also aggravate the condition. Curtail your speedwork, and shorten your stride. Also, try a brief rest of a few weeks, while continuing your stretching and strengthening exercises.

April 2nd 2019

Ankle Sprain

An Ankle sprain is one of the most common musculoskeletal injuries. Patients typically describe an episode where they roll their ankle to the inside. Patients typically have significant pain and swelling, and usually limp. However, quite often they are able to bear weight, unlike an ankle fracture where weight bearing is extremely difficult. With the ankle swollen over the outside (lateral) aspect, there is often associated redness due to the increased blood flow to this area.

Physical Examination

Physical examination will reveal swelling over the outer aspect of the ankle and unlike ankle fractures, there is usually no major tenderness over the posterior outside aspect of the ankle. Usually there is no tenderness on the inside of the ankle (medially). It is important to assess for other areas of tenderness and potential injury, as the same mechanism that creates a ankle sprain can also lead to otherinjuries (ex. fracture of the anterior process of the calcaneus, talar osteochondral injury). 

Imaging Studies

In the emergency room, x-rays are often taken, however, they are not always indicated. In a patient with an ankle sprain, x-rays will not identify any bony abnormalities and the ankle joint will be well located. If there is no tenderness posteriorly, and the patient is able to take 4 steps, then the patient does not require x-rays.

Classifications

Ankle sprains are typically classified as mild, moderate, and severe. It is often difficult to tell exactly which category the ankle sprain is.

1. A mild ankle sprain involves partial tearing of the anterior talofibular ligament. This ligament is torn and may be even stretched, but it is intact. These ankle sprains will take 4-7 days to achieve most of the recovery.

2. A moderate ankle sprain involves a significant tearing of the anterior talofibular ligament and some tearing of the calcaneofibular ligament. This type of ankle sprain often takes 7-12 days to mostly recover.

3. A severe ankle sprain involves disruption of all of the ligaments on the lateral aspect of the ankle, specifically the anterior talofibular ligament, the calcaneofibular, and the posterior talofibular ligament. This is a major injurythatmaytake4-6weeks,or even longer,to largely recover. Furthermore, in approximately 8-10% of patients suffering a severe ankle sprain, there will be associated injuries such as an osteochondral injury to the talar dome. 

Initial Treatment

• Rest and Activity Modification: Time is usually the best treatment for a typical ankle sprain. The body just takes time to heal the injured tissue. Staying off the injured ankle by limiting activity during the healing period is helpful.

• Ice: Ice should be applied 10 minutes on and 10-15minutes off repeatedly. Ice helps limit the blood flow to the injured ankle. Normally, increasing the blood flow to an area is a good thing. However, after an ankle sprain, excessive local blood flow leads to too much swelling during the acute phase of the injury.

• Compression: Compression helps decrease the swelling. This can be achieved with a compression wrap, such as an Ace bandage.

• Anti-inflammatory medications (NSAIDs): Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen can be helpful to decrease pain by decreasing the inflammatory response to the injury. However, there is some evidence that suggest that anti-inflammatories may have an adverse effect on ligament healing.

Subacute Phase

Once the symptoms associated with the initial ankle sprain have started to improve, patients will benefit from exercises designed to improve their:

• Range of Motion (Figure of Eight Exercises)

• Strengthening: Particularly Eversion Strengthening

• Proprioception

Figure of Eight Exercises

Imagine that the tip of your big toe is a pen, then “draw” a figure of eight with your big toe. Move slowly and repeat this motion for 30-60 seconds. Take a break, and then repeat this exercise 5-10 times for a total of 5-10 minutes per day. Don’t be discouraged if your motion is limited compared to the opposite foot. It often takes time to get this motion back. Be sure not to do anything that creates excessive discomfort.

Resisted Eversion

A stretching band is attached to a fixed object such as a doorknob, and then wrapped around the outside of the foot (Figure 1). The foot is then moved in an outward direction against resistance. This motion is repeated 10-20 times. A total of 3-6 sets should be performed.

Proprioception Exercises

Perform a graduated program that works to improve proprioception until both the right and left sides have equal propriceptive ability (assuming one side is uninjured). Compare to your uninjured side (do exercises on both sides until each side is equal). Do exercises daily. Do exercises for 30 seconds and repeat for 5-10 repetitions. Gradually progress the complexity of the exercises:

• Basic Exercise. Stand on one foot on a flat surface with your eyes open (30 seconds)

• Higher difficulty. Stand on one foot on a flat surface with your eyes closed (30 seconds). Have something available to grab if you lose your balance.Even higher difficulty

• Stand on one foot on a flat surface with your eyes closed and move your head from side to side (30 seconds). Have something available to grab if you lose your balance.Highest difficulty

• Stand on one foot on a soft surface (ex. a pillow or bed) with your eyes closed, and move your head from side to side (30 seconds). Have something available to grab if you lose your balance.

April 1st 2019

ضحايا مسجد النور ومسجد لينوود

إذا كنت مصابًا في أي من الهجومين ، يمكنك الحصول على علاج مجاني من Philip Bayliss في St Albans Osteopathy. يمكنه مساعدتك في تسجيل مطالبة ACC جديدة إذا لم يكن لديك حساب مسجل بالفعل. لا يوجد ممارس أنثى هنا ، لكن يمكنك الحصول على علاج كامل الملابس ، ونرحب بك لإحضار شخص دعم و / أو مترجم شفهي.

Masjid Al Noor and Linwood Masjid Victims

If you were injured in either attacks, you can receive free treatment from Philip Bayliss at St Albans Osteopathy. He can help you register a new ACC claim if you haven’t had one registered already. There is no female practitioner here, but you can have treatment fully clothed, and you are welcome to bring a support person and/or an interpreter.

March 31st 2019

Osteitis Pubis

Osteitis Pubis is the inflammation of the pubic symphysis; the point where the left and right pubic bones meet at the front of the pelvic girdle. Individuals who are most at risk of Osteitis Pubis are those who participate in running events, especially distance runners. Weight lifters, ice skaters and dancers are also vulnerable to Osteitis Pubis, and people who have recently had prostate or bladder surgery.

Anatomy of the Pelvic Girdle.

The pubic symphysis is the point where several muscles from the abdomen and groin attach and contract quite vigorously during exercise. These excessive forces pull on the pubic symphysis and cause an inflammatory response. Osteitis Pubis results in pain in the front of the pelvic girdle due to inflammation of the pubic symphysis.

Symptoms of Osteitis Pubis

The most common symptoms of Osteitis Pubis are pain and tenderness; this pain can be sharp or dull. The onset of pain is usually gradual, and is most commonly located in the front and center of the pubic bone. However, the pain may radiate into the lower abdomen and also down into the groin and thigh.

Causes of Osteitis Pubis

Osteitis Pubis is predominantly caused by repetitive contraction of the muscles that attach to the pubic bone and the pubic symphysis, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.

Overload (or training errors): Osteitis Pubis is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. Other overload causes include:

  • Exercising on hard surfaces, like concrete;
  • Exercising on uneven ground;
  • Beginning an exercise program after a long lay-off period;
  • Increasing exercise intensity or duration too quickly; and
  • Exercising in worn out or ill-fitting shoes.

Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to Osteitis Pubis are faulty foot and body mechanics and gait disturbances. Other biomechanical causes include:

  • Poor running or walking mechanics;
  • Subluxation of the sacroiliac joints;
  • Tight, stiff muscles in the hips, groin and buttocks;
  • Muscular imbalances; and
  • Leg length differences.

Exercises for Osteitis Pubis

The following exercises are commonly prescribed to patients with osteitis pubis. You should discuss the suitability of these exercises with your osteopath prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Transversus Abdominus Retraining

Begin this exercise in lying or standing. Slowly pull your belly button in “away from your belt line” and breathe normally. Your rib cage should remain relaxed and should not elevate during this process. You should be able to feel the muscle contracting if you press deeply 2cm in from the bony process at the front of your pelvis. Practise holding this muscle at one third of a maximal contraction for as long as possible during everyday activity (e.g. when walking etc.) provided it does not increase your symptoms. Repeat 3 times daily

Adductor Stretch

Begin this exercise by standing tall with your back straight and your feet approximately twice shoulder width apart. Gently lunge to one side, keeping the other knee straight, until you feel a stretch in the groin or as far as you can go without pain (figure 3). Ensure the stretch is pain-free. Hold for 15 seconds and repeat 4 times at a mild to moderate stretch provided there is no increase in symptoms.

Bridging

Begin this exercise lying on your back in the position demonstrated (figure 4). Slowly lift your bottom pushing through your feet, until your knee, hip and shoulder are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds and repeat 10 times provided the exercise is pain free.

March 31st 2019

Sacroiliac Joint Sprain and Dysfunction

There are two Sacroiliac (SI) joints. They connect both sides of the sacrum to the iliac part of the pelvic bones, forming the ring of the pelvis. The sacrum is usually formed by five vertebrae fused together (though it can be four or six). The SI joints are big and very strong and are synovial (fluid filled) joints. They are held together by thick and strong ligaments. They are subjected to a small rocking movement in opposite directions to each other when walking. They are subjected to twisting forces when the spine twists. They are under compressive forces when standing or walking, and extreme forces when landing after a jump. The SI joints are ‘shock absorbers’, and transfer forces from the axial skeleton to the legs, and from the legs to the axial skeleton. In women, a large movement of the SI joints are needed to facilitate childbirth. No single muscle crosses the joints and moves the joints as a ‘prime mover’; instead, the joints are moved as a result of complex musculoskeletal movements such as walking.

What is Sacroiliac Joint Pain?

Sacroiliac pain is often described as pain that is focused in the lower portion of the back and the buttocks. It may radiate out to one hip. In some cases it may travel around to the front on one side, in the groin area. Some males may feel pain in the testicles as well. Pain may radiate down the back of one leg, to either the knee or the ankle, but will rarely be felt in the foot. The pain may be similar to sciatica. The pain may increase by walking or weight bearing on the affected side. Sneezing, coughing, rolling over in bed and bending may increase the pain. Stiffness in the lower back may be experienced as well. The sacroiliac joint can become strained and inflamed, with or without a subluxation (this is a partial dislocation). The bones are slightly displaced, which stretches the ligaments that hold it together and causes them to become inflamed. Subluxation of an SI joint may be caused by bending and lifting to one side, or landing heavily on one leg. Pain can come from the joint surfaces or from the synovial membrane or fibrous capsule of the joint or from the ligaments that hold the joint together. These are rich in nerve endings, and therefore any inflammation or injury to this area results in pain. A subluxed SI joint may give the appearance of a short or long leg on that side, depending on the direction that the SI joint is subluxed. The resultant tilt of the base of the sacrum them puts a twist and side-bending into the lower lumbar spine, and can cause dysfunction and symptoms in this region and sometimes above. A feeling that the leg, or hip, is rotated may accompany this condition, and the toes of one foot may turn out more than the other. One hip bone may appear higher than the other, and there may be asymmetry in the waist.

SI joint sprain may be accompanied by piriformis syndrome, though piriformis syndrome may occur without a SI sprain and be misdiagnosed as a SI sprain. Pain may radiate into one leg, either because there is pressure on some of the nerves to that leg, as some of them passes through the piriformis muscle (which crosses the SI joints); or because of a stretch of the hamstring or adductor muscles due to a shift of their origins caused by the ischial and pubic bones having moved by a subluxation of the SI joint. The hormones of pregnancy soften the sacroiliac ligaments to allow extra movement of the sacrum, to enable the baby to pass through the pelvis at childbirth. Unfortunately this also means that pregnant women are more susceptible to sacroiliac joint strains. Also it is possible for one or both joints to become subluxed and ‘jammed’, which can lead to an obstructed delivery and an emergency caesarean if it is not corrected. Fortunately strained sacroiliac joints in pregnancy are easily treated, though it is important to see an osteopath who specializes in pregnancy, as not all osteopathic colleges train their students in the most suitable techniques. Unfortunately many pregnant women with sacroiliac joint strains are told that it is ‘normal’ and they have to live with it. Sacroiliac Joint Pain may be the result of inflammatory disease processes such as ankylosing spondylitis, which can eventually lead to fusion of the SI joints. Fractures can be caused by acute trauma, such as a car accident, causing severe pain.

Conventional treatments include injections and surgery. Manipulation is best from an osteopath, who will make a complete bio-mechanical analysis of the joints and muscles of the spine and pelvic girdle; and treat where appropriate using both manipulation of the relevant joints and soft tissue work on the muscles.Osteopaths have always believed the sacroiliac joints move and can become strained, and have always treated sacroiliac joint strains and dysfunction. Until recently, medical doctors and physiotherapists didn’t believe that sacroiliac joints could move, let alone become strained. This is because of the teachings of a famous British orthopaedic surgeon called James Cyriax, who died in 1985 at the age of 80. He always maintained that SI joints couldn’t move or become strained, and that osteopaths were fraudulent for claiming that they could, which delayed the recognition of osteopaths. He taught crude and rough manipulation techniques to doctors and physiotherapists, ignoring underlying causes. Since his passing, it has become widely accepted that sacroiliac joints can move and become strained, and osteopaths are now widely recognized and regulated by statute. Unfortunately his methods are still widely practiced by doctors and physiotherapists.

Exercises

If you are looking to do exercises for sacroiliac joint pain then your first focus should be to stabilize the pelvis including the sacrum in proper alignment. DO NOT do SI joint exercises in poor pelvic alignment, you will only stabilize the faulty alignment and cause more problems! See your osteopath first!

1) Learn neutral spine:Neutral Spine is the healthiest and most stable position for the spine and pelvis taking in to account the natural curvature of the spine.

  • Standing: Back up against a wall with your buttocks and shoulder blades leaning into the wall. Notice whether your lower back is against the wall or if there is an excessive arch there. The latter is more common.To achieve neutral keep the buttocks and shoulders against the wall and then draw the middle part of your back into the wall. You should feel the abdominal muscles engage and/or the ribs drawing in.
  • Lying: Lying on a mat with your knees bent and feet hip width apart, arms at your side. Begin by releasing your tailbone down creating an arc in the lower back, move up into the mid back and draw it down without flattening the spine. The shoulder blades are down and heavy and the back of the neck is long, do this by drawing your chin down towards your chest leaving the size of a fist space there.
  • Sitting: When sitting in a chair press your bottom right up against the back of the chair then stack the rest of the spine over it. Your collarbone is over your hip bones and your breastbone is right above the pubic bone. Navel drawn in gently.Proper posture is the best way to reduce tension from sitting at work all day, on computers, driving, etc.

2) Pelvic Stabilization Exercises for Sacroiliac Joint Pain:

  • Wall squats Position: Standing in neutral against the wall with your feet the length of your thighs away from the wall.Action: Bend your knees no lower than a 90 degree angle keeping your weight in the heels evenly for both feet. Kneecaps should line up with the second toe in each foot. Repeat for 8-12 repetitions. Do 2-3 sets every other day. Cues: Place hands on hip bones and make sure they stay level as you bend and lift, also keep the buttocks, shoulder blades, and mid part of the back against the wall throughout the exercise.
  • Pelvic clocks Position: Lying on the floor with neutral spine and knees bent.Action: Imagine your pelvis as a clock. 12 o'clock is at your navel, 6 is at your pubic or tailbone, 3 and 9 are the hip bones. Now imagine there is water in that clock or bowl and you are going to empty from 12 o'clock around clockwise and then counterclockwise feeling each number on the clock working. Cues: Keep the knees still you are just mobilizing the pelvis.
  • Diaphragmatic Breathing Position: Lying in neutral spine. Action: Without changing the position of your spine inhale deeply through the nose filling up or expanding into the ribs and upper back, then exhale through your mouth expelling the air again without changing the spine. On the exhale feel all the air leave your body feeling the muscles tighten around the waist as your abdomen flattens.

3) Strengthening Exercises for Sacroiliac Joint Pain: Once you have a stable and aligned pelvis you can begin mobilizing exercises to continue strengthening.

  • Leg Circles. Position: Lying on the floor with one leg extended along the mat and the other at a 90 degree angle to the floor and a neutral spine.Action: Keeping the pelvis still circle the thigh (leg) in the hip socket 6 times each direction. Switch legs. Cues: Focus on keeping the torso and leg on the mat very still as you freely circle the leg in the air.
  • Bridges. Position: Lying in neutral with knees bent arms at your side.Action: Inhale to prepare and exhale as you press into your heels lifting the pelvis up in neutral until weight is between shoulder blades not in the neck. Inhale hold then exhale to bring the tailbone and ribs down all at one time. Cues: Focus on the navel drawn in to lift the pubic bone up to the ceiling. Weight even in the feet. Rotation and side bending exercises can be added as you are symptom free in neutral spine.

4) Stretching Exercises for Sacroiliac Joint Dysfunction.

The main objective of exercises for sciatic pain from sacroiliac joint dysfunction is to restore the range of motion in this joint which can be limited if the joint is inflamed. Performing range of motion exercises directed at the SI joint can often restore normal movement and alleviate the irritation of the sciatic nerve. Three helpful exercises are:

  • Single knee to chest stretch. Pull one knee up to the chest at a time, gently pumping the knee three to four times at the top of the range of motion. Do 10 repetitions for each leg.
  • Press-up. From the prone position, press up on the hands while the pelvis remains in contact with the floor. Keep the lower back and buttocks relaxed for a gentle stretch. Hold the press- up position initially for five seconds, and gradually work up to 30 seconds per repetition. Aim to complete 10 repetitions.
  • Lumbar rotation—non-weight bearing. Starting by lying on the back with both knees bent, keep the feet flat on the floor while rocking the knees from side to side. The thighs should rub together and the knees will not move very far. The lower spine should remain fairly still. Rock the knees for 30 seconds.
March 29th 2019

Hamstring Strain

The hamstring muscles are very susceptible to tears, strains and other common sporting injuries. Those athletes particularly vulnerable are competitors involved in sports which require a high degree of speed, power and agility. Sports such as Track & Field (especially the sprinting events) and other sports such as soccer, basketball, tennis and football seem to have more than their fair share of hamstring injuries.

Hamstring Anatomy

The hamstring group of muscles, located at the back of the upper leg, are actually a group of three separate muscles. The top of these muscles are attached to the lower part of the pelvis, and the bottom of the hamstring muscles are attached to the lower leg bone just below the knee joint. The technical or anatomical names for the three hamstring muscles are semimembranosus, semitendinosus and biceps femoris.

How is the Hamstring Strained?

During sprinting the hamstring muscles work extremely hard to decelerate the tibia (shin bone) as it swings out. It is in this phase just before the foot strikes the ground that the hamstrings, become injured as the muscles are maximally activated and are approaching their maximum length. A pulled hamstring rarely manifests as a result of contact -if you have taken an impact to the back of the leg it should be treated as a contusion until found to be otherwise.

Exercises

Dynamic Stretching. This involves gentle swings of the leg forwards and backwards gradually getting higher and higher each time. Around 10 to 15 swings on each leg should be enough. The stretches can be done early in the morning (be careful not to force it) as this will set the length of muscle spindle for the rest of the day. Do not attempt this type of stretching in the early stages of rehabilitation, or if it is painful. It works by using the properties of muscle spindles. A muscle spindle is a sensor in a muscle that senses amount of stretch and speed of stretch. By gradually taking the leg higher and higher the muscle spindle allows it to go safely and lengthen the muscle. If the muscle is forced then a stretch reflex is initiated which causes a reflex contraction (shortening) of the muscle. This is called ballistic stretching and can damage muscles. Dynamic stretching is particularly important when returning back to full fitness, especially when speed work is involved. Muscles need to be able to move throughout their full range of motion at speed - not just when stationary.

March 28th 2019

ACL Injury

ACL injury, or Anterior Cruciate Ligament injury, is another common problem that affects the knee joint. The ACL is damaged in about 70% of all serious knee injuries, which makes it the most common injury affecting the knee joint.

Exercises
• Heel slide: Sit on the floor with legs outstretched. Slowly bend the knee of you injured leg while sliding your heel/foot across the floor toward you. Slide back into the starting position and repeat 10 times.
• Isometric Contraction of the Quadriceps: Sit on the floor with your injured leg straight and your other leg bent. Contract the quadriceps of the injured knee without moving the leg. (Press down against the floor). Hold for 10 seconds. Relax. Repeat 10 times.
• Prone knee flexion: Lie on your stomach with your legs straight. Bend your knee and bring your heel toward your buttocks. Hold 5 seconds. Relax. Repeat 10 times.
Add the following exercises once knee swelling decreases and you can stand evenly on both legs without favouring the injured knee.
• Passive knee extension: Sit in a chair and place your heel on another chair of equal height. Relax your leg and allow your knee to straighten. Rest in this position 1-2 minutes several times a day to stretch out the hamstrings.
• Heel raise: While standing, place your hand on a chair/counter for balance. Raise up onto your toes and hold it for 5 seconds. Slowly lower your heel to the floor and repeat 10 times.
• Half squat: Stand holding a sturdy table with both hands. With feet shoulder’s width apart, slowly bend your knees and squat, lowering your hips into a half squat. Hold 10 seconds and then slowly return to a standing position. Repeat 10 times.
• Knee extension: Loop one end of Theraband around a table leg and the other around the ankle of your injured leg and face the table. Bend your knee about 45 degrees against the resistance of the tubing and return.
• One Legged Standing: As tolerated, try to stand unassisted on the injured leg for 10 seconds. Work up to this exercise over several weeks.

March 27th 2019

Hockey

Hockey relies heavily on both upper and lower body musculoskeletal anatomy, as well aerobic and cardiovascular endurance. Among the most critical muscles used are: abdominal muscles, oblique muscles, erector spinae muscles and associated back muscles, hip extensors including the gluteal and hamstring muscles and hip flexors and quadriceps muscles. Muscles of the core are particularly critical for hockey. Core muscles include the abdominal muscles (such as the rectus abdominus and more importantly, the transverse abdominus), and the internal and external oblique muscles. Quadriceps and gluteal muscles, particularly the gluteus maximus are relied on for power. The gluteus maximus is used to extend the leg at the hip. Quadriceps muscles in the thighs also play an important role. The inner thigh muscles are used in abduction. Among upper body muscles, the anterior and middle deltoids and biceps muscles are the most heavily used.

Most Common Hockey Injuries

Hockey players are prone to a variety of overuse injuries due to movement inherent in the game, as well as assorted acute or traumatic injuries. Back muscle strain or back ligament sprain, groin strains, hip flexor strain, adductor strain, and tendonitis of the hip, pelvis, and groin; hip, knee or shoulder injury, wrist, hand and finger injuries, head and neck injuries including concussion and assorted contusions are all commonplace. Risk of traumatic injury comes from possible impact with hockey sticks and balls. The most common injuries include:

• Contusions, which may occur in the upper or lower body

• Neck and spine injuries

• Knee injuries, particularly sprains to the medial collateral and capsular ligaments

• Shoulder injuries, including acromioclavicular, or AC joint separation, (also known as a separated shoulder) as well as shoulder dislocation

• Gamekeeper’s thumb, resulting from the tearing of the ulnar collateral ligament

• Fractures of the hand and wrist

• Concussion, ranging from mild to severe and involving brief to extended periods of unconsciousness.

Injuries to the shoulder joint occur frequently in the game. The shoulder joint is composed of the humeral head and the glenoid fossa of the scapula. This highly mobile joint is relatively exposed, making it highly vulnerable to injury. Subluxation of the shoulder occurs when the humeral head slips out of joint, occasionally causing temporary paralysis. Fractures of the clavicle are also a common affliction, requiring proper medical attention.

Injury Prevention Strategies

The following safety points should be strictly adhered to:

• Always properly warm-up (including practice skating) prior to play

• Allow an adequate cool-down period and perform after-game stretching

Three Hockey Stretches

Reaching Lateral Side Stretch: Stand with your feet shoulder width apart, then slowly bend to the side and reach over the top of your head with your hand. Do not bend forward.

Kneeling Quad Stretch: Kneel on one foot and the other knee. If needed, hold on to something to keep your balance and then push your hips forward.

Kneeling Heel-down Achilles Stretch: Kneel on one foot and place your body weight over your knee. Keep your heel on the ground and lean forward.

March 10th 2019

Yesterday I attended day 3 (the last day) of the New Zealand Pain Society Annual Scientific Meeting.

0900-0945: Bridging The Gap: How to Apply Best Evidence Practice in Community Settings

Professor Michael Nicholas, Director, Pain Education & Pain Management Programs, Pain Management Research Institute, The University of Sydney, NSW, Australia  

0945-1030: Back Pain - Don’t Take It Lying Down

Professor Rachelle Buchbinder, Senior Principal Research Fellow; Director, Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Melbourne, Australia

1100-1115 Online Mindfulness and Gratitude Intervention for Persistent Pain (#40)

Associate Professor Nicola Swain, University of Otago, Dunedin, NZ

1115-1130 Do Online Resources Foster Self-Management Support in People with Persistent Pain?

Dr Hemakumar Devan, Postdoctoral Fellow, Centre for Health, Activity & Rehabilitation Research, University of Otago, Wellington, NZ

1130-1145: ‘My Shoulder has a Brain’: Feasibility of Neuroscience- Informed Physiotherapy for Persistent Shoulder Pain

Associate Professor Nicola Swain, University of Otago, Dunedin, NZ

1145-1230: Reflections on 23 years in Acute Pain Management

Richard Craig, Nurse Leader, Acute Pain Service, Christchurch Hospital, Christchurch, NZ

1330-1400: Summary /Review of the Evidence for the Role of Gabapentinoids in Pain

Dr John Alchin, Pain Physician, Pain Management Centre, Burwood Hospital, Christchurch, NZ

1400-1430: Summary /Review of the Evidence for Addiction to / Abuse of Gabapentinoids

Dr Tony Harley, Psychiatric Registrar, Community Alcohol and Drug Services, Christchurch, NZ

1430-1500: A Discussion of the Role and Use of Gabapentinoids in Pain, in the Light of the Abuse Potential

Panel Discussion

1530-1600: Is Pain Intensity the Best Measure of Pain Treatment Outcome?

Professor Jane Ballantyne, Anesthesiology and Pain Medicine, University of Washington, Seattle, USA

1600-1630: Panel Discussion with our Keynote Speakers

Professor Jane Ballantyne, Anesthesiology and Pain Medicine, University of Washington, Seattle, USA;Professor Fiona Blyth, Public Health and Pain Medicine, Head Concord Clinical School, Faculty of Medicine and Health University of Sydney, Concord, NSW,  Australia; Professor Rachelle Buchbinder, Senior Principal Research Fellow; Director, Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Melbourne, Australia   and Professor Michael Nicholas, Director, Pain Education & Pain Management Programs, Pain Management Research Institute, The University of Sydney, NSW,

March 9th 2019

Yesterday I attended day 2 of the New Zealand Pain Society Annual Scientific Meeting.

0900-0905 Arthritis New Zealand Update

0905-0945 ACC Update – ePPOC

Janelle White, Quality Improvement, Research, Electronic Persistent Pain Outcomes Collaboration (ePPOC), Australian Health Services Research Institute (AHSRI), University of Wollongong, NSW, Australia

0945-1030 Update on Knee Arthroscopy for Pain

Professor Ian Harris, Orthopaedic Surgery, University of NSW, Sydney, Australia

1100-1145 Persistent Pain following Total Knee Arthroplasty

Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ Chair: Dr John Alchin

1145-1230 Panel Discussion on Knee Arthroscopy

Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ Professor Ian Harris, Orthopaedic Surgery, University of NSW, Sydney, Australia

1330-1415 Placebo and Outcomes

Professor Ian Harris, Orthopaedic Surgery, University of NSW, Sydney, Australia

1415-1500 How to Create a Health Scare

Professor Keith J. Petrie, Health Psychology, Department of Psychological Medicine, The University of Auckland, Auckland, NZ

1530-1615 RCT on Vertebroplasty and its Afterlife

Professor Rachelle Buchbinder, Senior Principal Research Fellow; Director, Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia

1615-1700 Panel Discussion

Professor Keith J. Petrie, Health Psychology, Department of Psychological Medicine, The University of Auckland, Auckland, NZ,Professor Rachelle Buchbinder, Senior Principal Research Fellow; Director, Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ

March 8th 2019

I have just been to the opening of the new osteopathy clinic and osteopathy technique practice rooms for the new osteopathy course at Ara Institute. They are in High Street and are very impressive. It was good to meet the second year and new first year students.

March 8th 2019

Yesterday I attended day 1 on the New Zealand Pain Society Annual Scientific Meeting.

These are the sessions I attended:

0900-0945: Chair: John Alchin

Dr Mike Butler, Retired, Consultant Rheumatologist and Pain Medicine Specialist, formally at Auckland DHB, NZ. A Senior Retired Pain Physician’s Personal Choice of Top Pain Researchers (basic and clinical) in the Latter Half of the 20th Century

1015-1100: Epidemiology of Pain

Professor Fiona Blyth, Public Health and Pain Medicine, Head Concord Clinical School, Faculty of Medicine and Health University of Sydney, Concord, NSW 2139, Australia

1100- 1200: PATRICK WALL LECTURE - Insights into the US Opioid Epidemic

Professor Jane Ballantyne, Anesthesiology and Pain Medicine, University of Washington, Seattle, USA

1300-1315: Illness Perceptions in Complex Regional Pain SyndromeB (#45) Dana Antunovich, The University of Auckland, Auckland, NZ

1315-1330: Factors Influencing Physiotherapy Rehabilitation in People with Persistent Pain from CALD Communities (#38)

Dr Hemakumar Devan, Postdoctoral Fellow, Centre for Health, Activity & Rehabilitation Research, University of Otago, Wellington, NZ

1330-1345: A Proposed Clinical Conceptual Model for the Physiotherapy Management of Complex Regional Pain Syndrome (#47)

Tracey Pons, Physiotherapy Specialist, University of Otago, Kaiapoi, NZ

1345-1400: Short Term Relief of Chronic Multi- Site Pain with Bowen Therapy (#16) Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ

1400-1500: Cannabinoids in Pain

Dr John Alchin, Pain Physician, Pain Management Centre, Burwood Hospital, Christchurch, NZ

1530-1545: The Development and Maintenance of a Well- Functioning Chronic Pain Team (#9)

Heather Griffin, Physiotherapy Team Leader, Bay of Plenty DHB, Tauranga, NZ

1545-1600: Have Our Chronic Pain Management Programmes Progressed? A Mapping Review (#18)

Associate Professor Gwyn Lewis, Neurophysiologist, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, NZ

1600-1630: Burwood Advancement Screening Education (BASE) Seminar: How Changing a Service Gateway Changed a Service

Bronny Trewin, Senior Clinical Psychologist, Pain Management Centre, Burwood Hospital, Christchurch, NZ: Dr Ian Holding, Musculoskeletal Specialist and General Practitioner, Pain Management Centre, Burwood Hospital, Christchurch, NZ

1630-1700: Interprofessional Teamwork: Working Within and Across Multidisciplinary Treatment Teams Bronny Trewin, Senior Clinical Psychologist, Pain Management Centre, Burwood Hospital, Christchurch, NZ

Dr Bronnie Lennox Thompson, Academic Coordinator, Senior Lecturer, Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, NZ

March 7th 2019

Rotator Cuff Injury and Shoulder Tendonitis

The rotator cuff is a group of four muscles that helps to lift your arm up over your head and also rotate it toward and away from your body. Unfortunately, it is also a group of muscles that is frequently injured by tears, tendonitis, impingement, bursitis, and strains. The major muscle that is usually involved is called the supraspinatus muscle. The other rotator cuff muscle are: subscapularis, infraspinatus, and teres minor

Rotator cuff problems are usually broken up into the following categories listed below. If you’re not sure which one of these you have, start with rotator cuff tendonitis.

 Rotator cuff tendonitis

This is also known as impingement syndrome or shoulder bursitis. Usually this occurs in people 30-80 years of age, and usually the weakness in the shoulder is only mild to moderate. Rotator cuff tendonitis, also known as “bursitis” or “impingement syndrome” occurs when the rotator cuff gets irritated on the under surface of the acromion. The reason this begins in the first place is a source of some debate. Some people are born with a “hooked” acromion that will predispose them to this problem. Others have rotator cuff weakness that causes the humerus to ride up and pinch the cuff. This means that the bursa — a water-balloon type structure that acts as a cushion between the rotator cuff and acromion/humerus — gets inflamed.

Common symptoms of rotator cuff tendonitis include:

  • Pain. Pain located primarily on top and in the front of your shoulder. Sometimes you can have pain at the side of your shoulder. Usually is worse with any overhead activity (reaching up above the level of your shoulder).
  • Weakness. Mild to moderate weakness, especially worse with overhead activity.
  • Popping. Sometimes bursitis that occurs with rotator cuff tendonitis can cause a mild popping or crackling sensation in the shoulder.
  • Unable to Sleep on Shoulder. Most patients complain of difficulty sleeping on the shoulder at night.

How is impingement syndrome diagnosed?

Often, the diagnosis is suggested by your symptoms. Your osteopath can have you perform various manoeuvres to detect this problem. This physical examination is designed to test your motion, strength, and certain positions of pain. In addition, plain x-rays can show a spur on the under surface of the acromion. An MRI is occasionally ordered if a rotator cuff tear is suspected.

How do we treat rotator cuff tendonitis?

  • Just about all orthopaedic surgeons agree that this problem should be initially treated conservatively (i.e., without surgery). What are the steps to healing?
  • Stop any activities that can aggravate your symptoms. For example, if you’re painting the ceiling in your garage and it’s making your shoulder feel worse, stop doing it!
  • Do not ignore your body. It is telling you (with pain) that something is wrong.
  • Take medications, if necessary, to make you comfortable and decrease your pain.
  • Consider using cryotherapy (cold therapy) to get your pain under control.
  • STRENGTHEN your rotator cuff!

Why does strengthening the rotator cuff muscles work? When you have this tendonitis you get into a “vicious cycle”:

  1. First your rotator cuff is irritated for various reasons (e.g., overuse, injury, etc.).
  2. Then it doesn’t work as well, and that causes increased pressure under the acromion bone.
  3. The only way the acromion can react to that is to make new bone (a bone spur!).
  4. That bone spur then presses on the rotator cuff.
  5. So the rotator cuff gets MORE irritated, and then more weak, and so on (go back to

Strengthening your rotator cuff is the scientifically proven way to break this vicious cycle. Osteopaths agree that exercise for the rotator cuff muscles (e.g., stretching and strengthening) is the most important first step in treating impingement syndrome/rotator cuff tendonitis/bursitis.

Rotator cuff tears

These occur usually in people who have had tendonitis for a while and are starting to experience more weakness. It can also happen in someone who tries to lift something too heavy and feels a pop in the shoulder. A rotator cuff tear occurs when the tendonitis in the rotator cuff gets so bad that it wears a hole through the rotator cuff tendon. Since the tendon is what connects the rotator cuff muscle to your humerus bone, when the tendon is torn, you have weakness in the shoulder. Usually these tears occur in people who have had shoulder pain for some time (called a “chronic rotator cuff tear”). This is, by far, the most common type of rotator cuff tear. However, tears sometimes happen in people who do not have a history of shoulder problems. These people try to lift something that is too heavy and feel a pop in their shoulder, usually with immediate pain (this is called an “acute rotator cuff tear”). Usually the diagnosis is made with an examination by your osteopath. He or she can do special tests to determine how weak your rotator cuff muscles are. In addition, the doctor can check your motion to see if stiffness has developed. X-rays can show bone spurs in people with rotator cuff tears. Often these bone spurs helped to create the tear. Sometimes an MRI is ordered. This can show the osteopath with great detail the rotator cuff tendon and where it is torn. If your osteopath suspects a partial thickness tear (the tendon is not torn all the way through, just part of the way), an MR-arthrogram may be recommended (with consultant referral). This involves an injection into your shoulder before the regular MRI.

Treating the torn rotator cuff usually involves the following:

  • Control your pain. Over-the-counter medicines or prescription medication is given to help to relieve pain. In addition, cold therapy (cryotherapy) can help to decrease the pain and local swelling. Avoid activities that can worsen your pain, particularly overhead activities, repetitive motions, and heavy lifting. Do not put your arm in one position for a long time, keep it mobile. Your physician may give you a steroid injection into your shoulder area to also help improve the pain. Most osteopaths recommend that you get no more than one or two of these a year, as they do have the potential to weaken your tendons (every person is different, however, and you should check with your osteopath).
  • Regain motion. It is critical to regain the motion lost as a consequence of having this tear of the cuff muscle/tendon. Strengthen the other muscles of the rotator cuff that are not torn. These muscles can help to compensate for the torn muscle. Because there are four muscles in the rotator cuff, and usually only one is torn, sometimes strengthening the others is all you need to return to pain-free function.
  • Sometimes, if all this fails to relieve your pain, rotator cuff repair surgery might be needed to re-attach the torn tendon. There are lots of pros and cons to surgery, and different people need surgery for different reasons; be sure to discuss this with your osteopath. The bottom line is that many people recover from a rotator cuff tear without surgery.

Instability impingement

Mainly occurs in younger patients, typically 15-30 years old. The rotator cuff is irritated because the shoulder is loose in the socket. This often happens in baseball pitchers, swimmers, and other throwing athletes. The pain of both of these types of bursitis is usually better with rest or even using some heat over the areas of pain. This is the most common type of bursitis. An infection to the bursa usually has redness associated with this swelling and the pain is constant. If you think you may have an infection, please seek medical treatment immediately.

Shoulder instability can be classified into two different types, dislocations and subluxations.

  • Dislocations. This happens when the head of the humerus completely pops out of the socket. The first few times this happens, it is usually with significant trauma (although some people can have these without any injury at all). After that, it can get easier and easier for the joint to dislocate. Most shoulder dislocations are anterior. This means that the ball pops out the front of the socket.
  • Subluxations. This is the feeling that the shoulder slips slightly out of socket, then immediately comes back in place. This often happens without any major trauma. Sometimes it happens in people who are very “loose-jointed”. Sometimes these happen in just one direction (like out the front, or anterior), and other times they happen out multiple directions (e.g., front, anterior and back, posterior). This is called “multidirectional instability”. Most often, a diagnosis of recurrent shoulder dislocations can be made by simply listening to the patient’s symptoms. These patients will come in stating that their shoulder pops out of socket, and either goes back in by itself, or has to be put back in by someone else. Sometimes, the tricky part is knowing which way the shoulder is coming out of the socket. It can come out the front (“anterior”) or the back (“posterior”) or both (“multidirectional”). Your osteopath may order x-rays, and sometimes an MRI, to get a better idea of what is causing your dislocations (e.g., a torn cartilage, loose ligaments, etc.). Diagnosing subluxations can be more tricky. There are physical examination manoeuvres that your osteopath can perform to get a better idea if your shoulder is loose. Sometimes, however, it is not always clear; people with subluxations may not know their shoulder is subluxating, they may simply experience pain. An MRI can occasionally be helpful in this diagnosis.

Shoulder Instability Treatment

Most osteopaths will agree that treatment of most shoulder dislocations and subluxations should initially be conservative, that is, without surgery. If this was your first dislocation, especially if you had an anterior shoulder dislocation, your osteopath will usually recommend that you wear a shoulder sling for up to three weeks (depending on how old you are; be sure to follow your doctor’s direction). Controlling your pain will be important. Cryotherapy can help in relieving pain and swelling. Next, you need to regain motion if you have gotten stiff. Be sure to follow your doctor’s instructions on when and how to do this. Our deluxe shoulder therapy kit is a great device to help you get your motion back. Now comes the most important step: Strengthening your shoulder to prevent recurrent dislocations or subluxations: Strengthening the rotator cuff muscles is the scientifically proven way to help reduce your chance of re-dislocating or subluxating your shoulder. Because the rotator cuff muscles surround your shoulder, by strengthening them you help to improve the stability of the shoulder. Indeed, the muscles can sense when your shoulder is about to come out of socket and activate to try to prevent it. Strengthening your shoulder is more than just going to the gym and doing military presses. Most exercises that body-builders perform do not strengthen the rotator cuff. If all this fails, then surgery to correct the dislocating shoulder may be an option.

Exercises

The major objectives of rehabilitation from a rotator cuff injury are to increase flexibility, obtain pain-free range of motion, and strengthen the muscles of the shoulders, upper back, front chest, and upper arms. In severe cases, you should avoid activity that causes shoulder pain altogether. In these cases, you can still maintain cardiovascular fitness by cycling, unless otherwise prescribed by your doctor.

Stretching and strengthening of the 4 shoulder rotator cuff muscles (subscapularis, infraspinatus, supraspinatus and teres minor - for diagram, see link I’ve given to Marc’s post. There he gives a good website outlying the basic anatomy of the shoulder musculature), as already mentioned the foundation of rehabilitation of rotator cuff injuries. Initially, soon after injury, after the pain has died down a little, it is best to start performing shoulder exercises to maintain the range of motion in the shoulder and prevent scarring from the inflammation. This is best performed initially by isolating each muscle group and selectively training that muscle (known as Isometrics) - with no weights.

Phase 1 - Isometric exercises.

The subscapularis is the anterior stabilizer of the rotator cuff and responsible for internally rotating the shoulder. It is best strengthened by holding your arm in front of the body, with the arm flexed to 90 degrees, and rotating the hand to touch the belt. The exercise can be performed while lying on your back with the elbow close to your side and flexed ninety degrees. Lift the weight until it is pointing toward the ceiling and then lower it slowly. Add small amounts of weight as you progress, making sure you are in minimal pain at all times. If it gets too painful, stop and rest.

The supraspinatus is strengthened by holding out your arm straight in front of the body, with the thumbs pointed toward the floor. Slowly elevate the weight to above the head. Stop if pain is produced in any portion of this motion, as the rotator cuff is under maximal stress in this position. As you feel better, you can slowly introduce small amounts of weight to continue strengthening of the muscles.

The infraspinatus is strengthened by holding your arm (and later on, a weight) in the position of the ski pole just prior to planting the pole. By rotating the arm from the neutral straight ahead position, to the externally rotated (out to the side) position, the infraspinatus and teres minor are strengthened. Again, this exercise can also be performed while lying on your side with the elbow close to your hip, and flexed ninety degrees. Rotate the weight until it is pointing toward the ceiling. Shoulder exercises are best performed with relatively light weights and multiple repetitions. The logic behind stretching and strengthening the inflamed rotator cuff in order to speed healing and functional performance is as follows: the inflamed tissue is characterized by increased fluid between the cells, increased numbers of new blood vessels and inflammatory type cells. As a result of this inflammatory reaction, new collagen tissue is laid down in an effort by the body to heal the injured tissue. If the shoulder is immobilized during this time, the new collagen is laid down in a disorganized fashion, creating scar. The goal of gentle stretching, strengthening and anti-inflammatory medication, is to stimulate the cells to lay down collagen along the lines of stress, forming normal strong tendons. The combination of a good warm up, gentle stretching,  strengthening below the limits of pain, icing after working out and anti-inflammatory medication has been consistently shown to speed recovery time in the strongest possible fashion. After you are comfortable with these stretches and have minimal pain and good/fair range of motion in your shoulder, you can move onto resistance exercises. These usually start with what is known as tubing exercises. The ‘tubing’ is also known as a theraband, which is just a big rubber elastic band that you tie, at one end, to something and you hold the other end and pull the band thereby stretching it and providing resistance for your shoulder.

Phase 2 - Tubing exercises

External rotation: Stand resting the hand of your injured side against your stomach. With that hand grasp tubing that is connected to a doorknob or other object at waist level. Keeping your elbow in at your side, rotate your arm outward and away from your waist. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Repeat 10 times. Build up to 3 sets of 10.

Internal rotation: Using tubing connected to a door knob or other object at waist level, keep your elbow in at your side and rotate your arm inward across your body. Make sure you keep your forearm parallel to the floor. Do 3 sets of 10.

Extension: Same principles as the other two. Keep the arm parallel. 3 sets of 10.  As you feel more confident and you find your strength increasing, you can add more resistance - either in terms of shortening the length of the theraband so you need more resistance to stretch it or by increasing hand held weights in small increments.

Overhead stretch

Lie on your back with your arms at your sides. Lift one arm straight up and over your head. Grab your elbow with your other arm and exert gentle pressure to stretch the arm as far as you can.

Cross-body reach

Stand and lift one arm straight out to the side. Keeping the arm at the same height, bring it to the front and across your body. As it passes the front of your body, grab the elbow with your other arm and exert gentle pressure to stretch the shoulder.

Towel stretch

Drape a towel over the opposite shoulder, and grab it with your hand behind your back. Gently pull the towel upward with your other hand. You should feel the stretch in your shoulder and upper arm.

Shrugs

Stand with hands at sides with no weight in either hand. Raise shoulders to the point of pain and hold for five seconds. Relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, hold dumbbells of equal weight in each hand while performing this exercise. Add weight by using hand-held dumbbells as pain permits.

Bicep curls

Stand with arms fully extended at sides while grasping 2- to 5-pound weights in each hand, held palm forward. Flex the arms at the elbow to approximately 100 degrees, or to the point of pain, whichever comes first. Hold this position for 5 to 10 seconds. Return to the start position. Rest for 5 seconds. Repeat this exercise 10 times. You can increase the weight as pain allows and strength develops.

Triceps curls

Stand with elbows directed upward over the shoulders and with arms relaxed. Extend arms at the elbow so that the hands proceed upward to the point of pain. Hold this position for five seconds. Return to the starting position and relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, add weight by using hand-held dumbbells.

Chest raises

Lie on belly with hands extended along sides of the body. Raise the upper chest from the floor to the point of pain and hold this position for 5 seconds. Return to the start position and relax for 10 seconds. Repeat this sequence 10 times, 3 times daily.

Saws

Reach out and place the unaffected side hand on a corner of a table. Bend at the waist. Flex the injured side arm at the elbow and pull the injured side arm backward and upward as if sawing wood. Slowly bring the shoulder blades as close together as pain will permit. Slowly bring the injured side arm down to its beginning position. Repeat this sequence 10 times, at least three times daily.

Pendulum swings

Stand with the hand of the unaffected arm resting on the corner of a table and supporting some of the body weight. Slightly bend the knee on the unaffected side and extend the other leg sideways. Allow the injured arm to hang loosely over the unaffected side foot. By shifting the body weight, cause the relaxed injured arm to swing in circles to the fullest extent possible as limited by pain. Perform 25 swings in a clockwise direction. Allow the injured arm to cease swinging. Perform 25 swings of the injured arm in a counter clockwise direction. Repeat this sequence at least three times daily.

Flexed elbow pull

Bend and raise the injured side elbow to shoulder height. Grasp the injured side elbow with the uninjured side hand. Gently pull the injured side elbow toward the opposite shoulder until limited by first significant pain. Hold this position for 10 seconds. Relax for 10 seconds. Repeat this sequence 10 times at least three times daily.

People often say, when can I start weight training again? Or when can I return to sport? There is no definite answer for that. It depends on the degree of your injury, how dedicated you are to your rehab and the rate at which your body heals. Some people with minor tears can return to full contact sports in as short as 4 weeks. Other with larger tears has to have surgery and can be out for a year. My advice to you is, don’t rush it. Let your body take its time to heal. Do your exercises, have osteopathy, and the results will come with time. Impatience is one of the biggest causes of re-injury. And most importantly, always consult your osteopath for advice. While I can help you on these downloads and point you in a right direction, nothing can replace a one-on-one physical examination and a good chat with your osteopath.

March 6th 2019

Osgood-Schlatters Disease

Osgood-Schlatters Disease is a common cause of knee pain in late adolescent and early teenage boys. The condition is less prevalent in females, although being active in sports increases a young female’s chances. This condition was named for the two doctors who defined the condition, simultaneously, in 1908; Dr. Robert Osgood and Dr. Carl Schlatter.

Anatomy Involved

The quadriceps tendon attaches to the patella (knee cap) and then continues down to the top of the tibia as the patellar tendon. When the quadriceps muscle flexes it shortens pulling upward on the tendon, which in turn causes the tendon to pull up on the tibia, causing the lower leg to extend. As with any attachment it is under considerable stress when forcibly extending the knee or supporting the bodyweight during dynamic activities. Repetitive forceful contractions of the quadriceps can cause tiny avulsion fractures at the tendon attachment on the tibia. The bone will attempt to repair itself by adding more calcium to the area to protect and strengthen the attachment. This causes the lump under the knee often associated with Osgood-Schlatters Disease. When an adolescent or young teen goes through a growth spurt the muscles often struggle to keep pace with the growing bones and therefore are often too short compared  with the accompanying bones. This places additional stress on the attachments and happens often with the femur and quadriceps muscle. The femur grows quickly and the quadriceps does not stretch so the muscle is tight until it has a chance to adapt to the new growth. This puts a chronic strain on the quadriceps and patellar tendon. This stress leads to those tiny fractures at the attachment site when the muscle is under stress. These lead to the calcium loading at the site and pain and inflammation result.

Causes of Osgood-Schlatters

Osgood-Schlatters may be caused by any condition that puts extra stress on the patellar tendon resulting in small breaks at the attachment site. Some of the common causes:

  • A growth spurt or rapid lengthening of the femur, causing the quadriceps to be tight.
  • Repetitive stress to the patellar tendon through knee flexion and extension, such as with kicking or landing when jumping.
  • Chronically tight quadriceps as seen with weight training without proper flexibility training as well.
  • Untreated injury to the knee causing small avulsion fractures to the patellar tendon attachment on the tibia

Signs and Symptoms

Knee pain without an apparent direct cause or pain in the knee during and after exercise may be a sign of Osgood-Schlatters Disease. Although the symptoms may be similar to other conditions, such as patellar tendonitis, in younger athletes this condition should be considered. Some of the common signs and symptoms of this disorder include:

  • Pain below the knee cap, worsens with exercise or when contracting the quadriceps.
  • Swelling and tenderness below the knee.
  • A bony prominence may be noted under the knee as the condition advances.
  • A “grinding” or stretching sensation may be noted at the tendons attachment site.

Osgood-Schlatters Prevention

Preventing Osgood-Schlatters Disease involves avoiding or changing the conditions that lead to it. Knowing that chronic stress on the tendon and attachment causes this disorder, it is important to reduce that stress. Some of the strategies for prevention include:

  • Proper warm-up techniques will help prepare the muscles and tendons for the activity and increase the flexibility of the tendon. Warmer tendons are more flexible tendons.
  • If particular activities cause pain they are probably causing stress on the area. Reducing or avoiding these activities will help prevent the development of this condition. It is important to distinguish between healthy muscle pain and pain of injury. If it is stiffness and pain in the belly of the muscle and goes away in 24 hours it is simply pain from muscle breakdown and recovery, if it does not go away in a day or two, or is focused around a joint or bone attachment it may be the result of an injury.
  • Since a lot of the stress placed on the quadriceps and patellar tendons is due to tight quadriceps muscles, stretching these muscles to relieve the tightness and to lengthen the muscle will help alleviate some of the stress. Developing a balance between the hamstrings and quadriceps is also important. If the hamstrings are proportionately weaker than the quadriceps then they will not be able to act as a counter force against the forceful quadriceps contractions, which could put additional stress on the tendon. If the quadriceps muscles are weaker than the hamstrings (very rare) they will be chronically tight from resisting the hamstrings. Strengthening the quadriceps also helps facilitate muscle lengthening and increases flexibility if done properly through a full range of motion.

Exercises for Osgood Schlatters disease

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your osteopath prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Static Quadriceps Contraction

Begin this exercise by sitting with your leg straight in front of you (figure 2). Tighten the muscle at the front of your thigh (quadriceps) by pushing your knee down into a towel. Put your fingers on your inner quadriceps to feel the muscle tighten during contraction. Hold for 5 seconds and repeat 10 times as hard as possible pain free.

Quadriceps Stretch

Begin this exercise by holding a chair or table for balance. Take your heel towards your bottom, keeping your knees together and your back straight until you feel a gentle stretch in the front of your thigh or as far as you can go without pain. Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.

March 5th 2019

Groin Strain

Depending on the severity, a groin strain can range from a slight stretching, to a complete rupture of the muscles that attach the pubic (pelvis) bone to the thigh (femur) bone. A groin strain specifically affects the “Adductor” muscles. (Adductor; meaning, moves part closer to the midline, or middle of the body) These muscles are located on the inside of the thigh, and help to bring the legs together. The adductor muscles consist of “Adductor Brevis”, “Adductor Magnus” and “Adductor Longus,” all of which are displayed in the picture to the right. Adductor Longus has been cut to display the muscles underneath.  Of these three, it is Adductor Longus that is most susceptible to injury, and the most common place of injury on Adductor Longus is the point at which the muscle and tendon attach to the femur (thigh) bone. When a muscle is strained, the muscle is stretched too far. Less severe strains pull the muscle beyond their normal excursion. More severe strains tear the muscle fibres, and can even cause a complete tear of the muscle. Most commonly, groin strains are minor tears of some muscle fibres, but the bulk of the muscle tissue remains intact.

What Causes a Groin Strain?

Competitors that participate in sports that require a lot of running or rapid change in direction are most susceptible to groin injuries. Other activities like kicking, jumping and rapid acceleration or deceleration also place a lot of strain on the groin muscles. Another activity that puts a lot of strain on the groin is any movement that results in a sudden pressure being applied. Such as a fall, landing awkwardly, twisting, or bending while stress is applied to the groin muscles.

What are the symptoms of a groin strain?

An acute groin pull can be quite painful, depending on the severity of the injury. Groin pulls are usually graded as follows:

  • Grade I Groin Strain: Mild discomfort, often no disability. Usually does not limit activity.
  • Grade II Groin Strain: Moderate discomfort, can limit ability to perform activities such as running and jumping. May have moderate swelling and bruising associated.
  • Grade III Groin Strain: Severe injury that can cause pain with walking. Often patients complain of muscle spasm, swelling, and significant.

How to Prevent a Groin Strain?

The basis of prevention comes down to two simple factors. A thorough warm-up and physical conditioning, ie: flexibility & strength. Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Secondly, flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement, which can cause strains, sprains, and pulled muscles. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.

Exercises

Athletes who sustain a groin strain will need osteopathy and incorporate a stretching program as part of their rehabilitation. Some simple stretches can help ease the symptoms of a groin strain. Furthermore, stretching can be a useful part of preventing groin injuries from occurring. As a general rule, the stretches should not hurt. There should be a gentle pulling sensation of the muscle, but this should not be painful.

The squatting adductor stretch:

  • Squat to the ground with your arms between your legs.
  • Allow your knees to move outwards.
  • Stretch your legs apart by pushing out with your elbows.

The butterfly stretch

  • This is done in a sitting position.
  • Sit with your feet together and knees bent. Grasp your feet with your hands.
  • Stretch your knees down towards the ground.
  • Do not bounce. Feel the stretch along your inner thigh.

The adductor stretch

  • This is done while standing.
  • Stretch one leg out to the side, keeping your other leg under your torso.
  • Bend the knee underneath your torso to stretch the muscles of the inner thigh of the opposite leg.
  • Your outstretched leg should have a straight knee, and you should feel the stretch on the inner thigh.

The cross-leg stretch

  • This is done while sitting.
  • While sitting in a chair, cross one leg over the other.
  • Press the knee of the crossed leg down towards the ground.
  • This stretch will emphasize the muscles of the inner thigh and front of the thigh.
March 4th 2019

Achilles Tendonitis

Achilles injuries are commonly associated with sports that require a lot of running, jumping and change of direction. Excessive twisting or turning of the ankle and foot can result in a rupture or strain. The sports that are most susceptible to Achilles injury include running, walking, cycling, football, basketball and tennis.

What is an Achilles tendon Injury?

The Achilles tendon is located at the rear (posterior) of the bottom half of the lower leg. It is a thick band of connective fibre that runs from bottom of the Gastrocnemius muscle to the heel bone. The Achilles tendon is used to plantar flex the foot, or point the foot downward. This allows a person the run, jump and stand on one’s toes. The Achilles tendon is the strongest tendon of the body, and able to withstand a 500Kg force without tearing. Despite this, the Achilles ruptures more frequently than any other tendon because of the tremendous pressures placed on it during competitive sports. There are two main types of injuries that affect the Achilles tendon; Achilles Tendonitis and Achilles Tendon Rupture. Achilles Tendonitis is simply an inflammation of the tendon, and in most cases is caused by excessive training over an extended period of time. Achilles Tendon Rupture, on the other hand, is a tear (or complete snapping) of the tendon, and usually occurs as the result of a sudden or unexpected force. In the case of a complete rupture, the only treatment available is to place the lower leg in a plaster cast for 6 to 8 weeks, or surgery.

Causes and Risk Factors

There are a number of causes and risk factors associated with Achilles Tendonitis. One of the most common causes is simply a lack of conditioning. If the tendon, and muscles that connect to the tendon, have not been trained or conditioned, this can lead to a weakness that may result in an Achilles injury. Overtraining is also associated with Achilles Tendonitis. Doing too much, too soon places excessive strain on the Achilles tendon and doesn’t allow the tendon enough time to recovery properly. Over time small tears and general degeneration result in a weakening of the tendon, which leads to inflammation and pain. Other causes of Achilles injury include a lack of warming up and stretching. Wearing inadequate footwear, running or training on uneven ground, and simply standing on, or in something you’re not meant to. Biomechanical problems such as high arched feet or flat feet can also lead to Achilles injuries.

How to prevent Achilles Tendonitis

1. Warm Up properly

A good warm up is essential in getting the body ready for any activity. A well- structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Plyometric drills include jumping, skipping, bounding, and hopping type activities. These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments in the lower leg and ankle joint.

2. Balancing Exercises

Any activity that challenges your ability to balance, and keep your balance, will help what’s called proprioception: - your body’s ability to know where it’s limbs are at any given time.

3. Stretching exercises

Towel Stretch:

This simple Achilles tendonitis exercise can be done by anyone whether you are suffering from tendonitis or not. As the name suggests you will need a towel for this exercise. Sit on a hard floor and spread one of your leg outside, but keep your other leg folded. Now loop the towel around the toes and ball of the spread leg. Then pull the towel towards you, but be careful that you do not bend your knee. You can hold this position for 20-25 seconds. Repeat this exercise 3-4 times.

Calf Stretch:

This exercise will help you release the strain on the tendon. Face a wall and place your hands on the wall at eye level. Take a deep lunge with the back leg heel touching the ground. Place the back leg as though it were slightly pigeon toed. Now slowly push your weight on the wall and feel the stretch on the back leg. Hold this stretch for 20 seconds. Change the legs and repeat the same for the other leg as well. Repeat 3-4 times on each of the legs.

Leg Lift:

This is also called ‘Side-lying leg lift’. Lie on your uninjured side. Keep your body in straight line. Place both the legs on top of one another. Now tighten the quadriceps muscle of the leg on top, then lift the leg off ground to make 45-60 degree angle with the leg below. Again do not bend either of the legs in the knee. Hold the leg in the same position till you count 20 and slowly bring it down. Repeat this exercise 3 times.

Heel Raise:

One of the easiest of the Achilles tendonitis exercises. Take support of a wall or a chair and raise your body and balance all the weight on your toes. Count for 5 counts and slowly come down. Repeat for 5 times. When the pain reduces, you can try bringing only one leg down at a time and balance all the weight on one leg.

Quadriceps Stretch:

Hold a wall or a chair. Stand on the uninjured leg. Hold the foot of the injured leg and slowly pull the heel of the injured leg towards the buttocks. Stay in this position for 15-20 seconds. The stretch is felt in the quadriceps and on the Achilles tendons. Repeat the quadriceps stretch 8-10 times.

4. Strengthening exercises

The Eccentric Knee Squat

To complete the Eccentric Knee Squat, stand facing a wall with posture erect, feet shoulder-width apart, and your toes just a few inches from the wall. Then, simply bend your legs at the knees, while keeping your upper body upright, so that your knees lightly touch the wall. You may have to adjust the distance from your feet to the wall to accomplish this effectively. Return to the starting position, and then bend your legs at the knees again, but this time point your knees to the left as you move them toward the wall. Note that this produces a dandy ‘eversion’ (outward movement) of the right heel, which is exactly what happens to your heel when you pronate during the stance phase of running. What happens is that this motion replicates the twisting forces applied to the Achilles and calves during running, helping them to fortify themselves in a rotational as well as straight- ahead plane. Return to the starting position, and then bend your legs at the knees again, but this time move your knees toward the right, giving your left heel a nice eversion. Come back to the starting position to finish the cycle (straight-ahead, left, and right). Repeat several more times, and your first experience with the Eccentric Knee Squat is over. Over time, the two-footed Eccentric Knee Squat will become easy for you. That will be the signal for you to abandon the two-footed version of this exercise and move on to the one-footed Eccentric Knee Squat. This squat is exactly like the two-footed exertion, except that now full body weight is on one foot, as it is when you run. You repeat the same pattern (straight-ahead, left, and right) which you used for two-footed eccentric squatting, carry out several reps on one foot, and then move over to the other one. The toe of the non-weight-bearing foot can be tucked neatly against the heel of the weight-bearing foot as you complete the drill. You’ll soon find that the one-footed knee squat is an absolutely dynamite activity for boosting Achilles and calf strength - in the same planes of motion (front to back, side to side, and rotational) which are present during the stance phase of running!

The Balance and Eccentric Reach with Toes

Start by standing on your right foot only as you face a wall, with your right foot about 75 cms or so from the wall (you may need to adjust this distance slightly). Your left foot should be off the ground and positioned toward the front of your body, with your left leg relatively straight.

Then, bend your right leg at the knee while maintaining your upper body in a relatively vertical position and nearly directly over your right foot. As you bend your right leg, move your left toes toward the wall until they touch, keeping the left leg relatively straight. End the movement by returning to the starting position. Then, conduct essentially the same motion, but move your left foot forward and to the left, again keeping your left leg straight and attempting to make contact with the wall. Your left foot may not quite reach the wall, since you are moving in a frontal plane (from right to left) in addition to the straight-ahead, sagittal plane. Return to the starting position, and then carry out essentially the same motion, but with your left foot crossing over the front of your body and going to the right as you attempt to touch the wall. Then return to the starting position. Do a few (4-6) reps (the straight, left, and right motions make one rep) on your right foot, and then attempt the same exercise with your body weight supported only on the left foot. Like the Eccentric Knee Squat, the Balance and Eccentric Reach with Toes forces your calf muscles to work eccentrically and in a variety of planes of motion, as they do during the stance phase of running (you will really feel it!). Both exertions also do a nice job of strengthening your knee and hip muscles and coordinating their activities with what is happening down at the Achilles and calves.

The Balance and Eccentric Reach with Knee

Stand on your right foot about an arm’s length from the wall, with your left leg flexed at the knee and your left shin roughly parallel to the floor. You should be standing with erect posture, and you may place a finger from each hand on the wall for balance. Then, simply bring your left knee forward until it touches the wall - while moving your upper body backward from the hips so that it remains roughly over the right foot. You will feel a very fine strain in your right calf and Achilles-tendon region. Finish the movement by returning to the starting position. Again, thrust the left knee forward to the wall, but this time move the knee in a frontal plane (towards the left). Return to the starting position, and then move the knee well towards the right. Finish by going back to the starting position. Continue this pattern (straight, left, and right) a few more times, and then change over to the other foot. As you move your knee to the left and right and back to the starting posture, you’ll notice that your activity is forcing the calf muscles and Achilles to withstand ankle-twisting rotational forces and side-to-side (frontal-plane) movements, not just straight-ahead pulling. That’s what you want, because improved strength in all appropriate planes of movement will make you more stable and injury-resistant when you run.

The Dynamic Achilles Stretch

This will actually be the easiest movement to carry out, since it’s somewhat similar to traditional stretching routines for the calf-Achilles complex. Begin this one by facing that familiar wall, about an arm’s length away, with your weight supported on your right foot, your right knee slightly flexed (as it would be during the stance phase of running), your left leg imitating the swing phase of the gait cycle, and your hands against the wall for support. Then, simply rock forward toward the wall, so that you feel a nice stretch in your right calf and Achilles tendon. After 20 seconds or so, pronate your right foot (roll it toward the inside), and hold the stretch for 10 more seconds. Finally, supinate the right foot (roll it toward the outside), and hold for 10 seconds. After you have stretched for a total of about 40 seconds, lean towards the left so that your right Achilles tendon and calf are now being pulled in a lateral-left direction. Hold for 20 to 30 seconds or so. Finally, lean towards the right, crossing your left leg over your right, so that the right Achilles and calf are being pulled in a lateral-right direction. Again, hold for 20 to 30 seconds. Repeat one more time, and then shift over to the left foot for the same pattern of stretching.

5. Footwear

Be aware of the importance of good footwear. A good pair of shoes will help to keep your ankles stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion.

March 3rd 2019

Swimming

Competitive swimming is primarily an aerobic exercise, involving long exercise time. Muscles must be constantly supplied with oxygen, with the exception of sprints where the muscles are worked anaerobically. Swimming, particularly in events where the stroke styles are varied between backstroke, front crawl (freestyle) and breast stroke, make use of all major muscle groups:

• Abdominals

• Biceps and triceps

• Gluteals

• Hamstrings

• Quadriceps

The basic muscles used for each stroke are: Freestyle; deltoids and legs muscles Breastroke; thighs, biceps, and gluteal muscles Butterfly; abdominals, deltoids and leg muscles Backstroke; Triceps and leg muscles. A single stroke, for example, the butterfly, requires the coordination of various muscles and muscle groups, including:

• Latissimus dorsi

• Posterior deltoids

• Rhomboid muscles

• Middle and lower trapezius

• External and internal obliques

• Transverse abdominis

• Rectus abdominis

• Longissimus

• Spinalis

• Iliocostalis

Hand force applied to the water is actually generated by the rotation of the hips, rather than the muscles of the arm. Torque generated by the larger, stronger hip muscles, allows the swimmer’s powerful arm strokes to strike the water with a rapid turn of the hips. For this reason, elite swimmers focusing on increasing the acceleration of their hips are able to double their peak hand force output.

Most Common Swimming Injuries

• Drowning can result from the inhalation of water, particularly if natural bodies of water swamp or otherwise overwhelm the swimmer

• Exhaustion or unconsciousness may result, especially in open bodies of water

• Swimmers may become incapacitated through shallow water blackout, due to heart attack, carotid sinus syncope (transient loss of consciousness) or stroke

• Secondary drowning can occur should salt water be inhaled, creating a foam in the lungs that restricts breathing, (a condition known as Salt Water Aspiration Syndrome, or SWAS)

• Thermal shock can result from jumping into icy water, which may cause the heart to stop

• An abnormal growth (or exotosis) in the ear can result, due to frequent splashing of water into the ear canal. (Commonly known as Swimmers’ ear)

• Exposure to chemicals, especially chlorine can cause skin irritations while the swallowing of chlorine can adversely affect the lungs

• Chlorine in pools can also damage the hair over time, turning blonde hair greenish and stripping brown hair of its colour

• Various infections can result from swimming as water provides an excellent environment for a variety bacteria, parasites, fungi and viruses

• Skin infections from both swimming and shower rooms are common, particularly, athlete’s foot

• Parasites including cryptosporidium can produce diarrhoea illness should they be swallowed

• Ear infections of the otitis media (or otitis externa) are not uncommon

• Serious health issues may arise from improperly chlorinated pools. These include

illnesses such as chronic bronchitis and asthma

Overuse injuries may result, including back pain, vertebral fractures or shoulder pain, (particularly from excessive butterfly strokes over time). Breaststroke swimmers may develop knee or hip pain, while freestyle and backstroke swimmers risk shoulder pain, (known as swimmer’s shoulder - a form of tendonitis). Osteopathy is essential. Finally, dangers in natural waters place swimmers at risk for a range of accidents and injuries, which include:

• Hypothermia, due to cold water, which can lead to rapid exhaustion and eventual unconsciousness

• Dangerous aquatic life including Stingrays and jellyfish, stinging corals, sea urchins, zebra mussels, sharks, eels, etc.

Injury Prevention Strategies

• Always take time to warm up and stretch, as cold muscles are more prone to injury.

• Avoid swimming alone or in unsupervised areas.

• Properly pace swimming activity avoiding situations of exhaustion, overheating or excessive cold

• Never dive into shallow water, as serious risk exists for disabling neck and back injuries

• Extreme care should be taken in open water. Be certain the water is free of undercurrents, riptides and other hazards

• Avoid swimming in lakes or rivers following a storm, when severe currents may be present

• Use of alcohol should be strictly avoided before swimming, as judgment, orientation and thermal regulation are all impaired with alcohol consumption

• Dry the body thoroughly after swimming and remove excess water from the ear canal to avoid infection

• Attention to proper swimming technique as well as strength and agility training can help avoid common overuse injuries

• Swimmers should be at least minimally knowledgeable about first aid and be prepared to administer it in the case of minor injuries including facial cuts, bruises, minor tendonitis, strains, or sprains

Three Swimming Stretches

1. Reaching-up Shoulder Stretch: Place one hand behind your back and then reach up between your shoulder blades.

2. Arm-up Rotator Stretch: Stand with your arm out and your forearm pointing upwards at 90 degrees. Place a broom stick in your hand and behind your elbow. With your other hand pull the bottom of the broom stick forward.

3. Single Heel-drop Calf Stretch: Stand on a raised object or step. Put the ball of one foot on the edge of the step and keep your leg straight. Let your heel drop towards the ground.

March 2nd 2019

Rugby

Rugby is a game with a good deal of running, and a lot of hard hitting. The minimal, if any, protective equipment worn by players makes it a very violent sport, as well. Because of this, players must be in good physical condition to compete. They must have good cardiovascular conditioning to run the field and must have good musculature to protect their bones and joints. Speed and agility are also important to outrun and out-manoeuvre other players. Rugby players require a strong base, with strong legs and hips. During a rugby scrum the leg and hip drive is important. A strong neck to protect the spine during hits is also important. A strong core is essential for balance and protection of the ribs and internal organs.

Playing rugby taxes all of the muscles, but the major muscles used in play include:

• The muscles of the upper legs and hips; the quadriceps, hamstrings, and the gluteals and the calf muscles; the gastrocnemius and soleus.

• The muscles of the neck and the trapezius.

• The core muscles; the rectus abdominus, obliques, and the spinal erectors.

• The muscles of the shoulder girdle; the deltoids, latissimus dorsi, and the pectorals.

A good strength and conditioning program is important to a rugby player to ensure protection for the bones and joints, and to make the muscles strong enough to continue to play at their optimum level.

Most Common Rugby Injuries

Studies have shown that injuries are the most common reason for players to quit playing rugby. Successive injuries over time can lead to long term effects. Injuries common to rugby include muscle strains, knee sprains, contusions, hip dislocations, and facial injury.

• Muscle Strain: When competing in rugby, or practicing for competition, the muscles are stressed and stretched repeatedly. A hard driving scrum or a move to evade a defender can place the muscles at risk of tearing. When the muscle tears it becomes weaker, pain and tenderness set in, and some slight swelling and bruising may occur. A minor strain will respond to ice, rest, and NSAIDs then osteopathy, with a return to full activity within 1 to 2 weeks. A complete rupture of the muscle will require immobilization, and possible surgical intervention, requiring a much longer recovery time.

• Knee Sprain: Any of the ligaments in the knee are subject to sprain in a hard hitting rugby game. The most common sprains include the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL.) The ACL is often torn when the foot and lower leg are planted but the upper leg rotates. The MCL is commonly sprained by contact from another player on the outside of the knee. The severity of the sprain is determined by the amount of tearing present in the ligament, with the worst being a complete rupture. Minor sprains may take 2 to 3 weeks for recovery, while a complete tear may take 8 weeks. Ice, immobilization, and NSAIDs, then osteopathy will help with recovery.

• Bruises and Contusions: As with any contact sport, bruises and contusions are very common in rugby. Players are being impacted from many directions and the hard hitting results in blood vessels under the skin rupturing and causing swelling, pain, discoloration, and tenderness. Most contusions can be treated with ice and NSAIDs. Deeper contusions in the muscle tissue may require rest and a gradual return to activity as tolerated. Repeated impact with an area that is already bruised may cause damage to the healing tissue, so protection of a contused area is important.

• Hip Dislocation: When the knee and hip are flexed and an impact from behind the knee occurs the hip joint may become dislocated. A direct blow to the hip may also result in a fracture/dislocation of the hip. When the femoral head becomes dislodged from the hip, stability is lost in the hip and the leg is unable to support weight. A hip dislocation is extremely painful and a medical emergency. The hips should be immobilized and the patient transported for medical evaluation. Recovery from a hip dislocation depends on the extent of damage. If the ligaments are torn or a fracture occurs in either hip or femur then the recovery time will be extended. Osteopathy is essential.

• Facial Injury: Facial injuries in rugby can include a broken nose, dislodged teeth, and facial fractures. Due to the lack of a full cage helmet (as used in American Football), the face is exposed to blunt force trauma during hits. This trauma can result in a separation of the cartilage of the nose (broken nose), a tooth being knocked loose, or a fracture to one or more of the bones of the face. Treatment for facial trauma includes removal from the activity, controlling of any bleeding, and ice for swelling and pain control. If a tooth is dislodged the tooth should be retrieved if possible and taken with the player for possible reattachment. Return to activity should only occur after the injury has completely healed, and protective measures should be taken to avoid future injury to that area.

Injury Prevention Strategies

A rugby player must have a lot of natural protective layering (musculature) and be strong enough to withstand the high impact of the game.

• Practicing the game to become proficient at avoiding the hardest hits and knowing how to position the body when delivering a blow, or taking one, will help the player avoid some of the injuries in rugby.

• Playing in official games with referees and officials, under sanctioned rules, will also help to keep the rugby player safe.

• Use of the minimal protective equipment allowed will help shield the body from some of the usual trauma encountered in a game or practice.

• Strength training to build protective muscle tissue over the bones and joints will help keep the body strong for games and speed recovery should an injury occur.

• Flexibility is key when the body is twisted and contorted at different angles during tackles or when avoiding a defender.

Three Rugby Stretches

1.  Reaching-up Shoulder Stretch: Place one hand behind your back and then reach up between your shoulder blades.

2.  Lying Knee Roll-over Stretch: While lying on your back, bend your knees and let them fall to one side. Keep your arms out to the side and let your back and hips rotate with your knees.

3.  Kneeling Quad Stretch: Kneel on one foot and the other knee. If needed, hold on to something to keep your balance and then push your hips forward.

March 1st 2019

Gymnastics

A balance between upper and lower body strength is important for the well rounded gymnast. The legs must be strong to jump and flip, and provide a solid base for the beam and other activities. The upper body must be strong enough to support the body during flips and rolls, and lift the body during bars, vaults, and rings activities.

Gymnastics use the following major muscles during the various events:

  • The upper torso; the deltoids, pectorals, rhomboids, and latissimus dorsi.
  • The core muscles; rectus abdominus and spinal erectors.
  • The hip muscles; the gluteus maximus, hip flexors, adductors and abductors.
  • The muscles of the legs; the quadriceps, hamstrings and the calf muscles.
  • The muscles of the arms; the biceps, triceps and the flexor and extensor muscles of the forearm.

It is important for a gymnast to follow a good strengthening and stretching program for these muscles to keep them ready for competition and practice.

Most Common Gymnastics Injuries

The most common injuries experienced by the gymnast are dislocations, ankle sprains, plantar fasciitis, joint pain, and muscle strains.

  • Dislocations: Dislocations in a gymnast often occur from a bad landing or a fall when the arm is extended. Shoulders are the most common dislocation, with elbows and wrists next, and knees occasionally. A dislocation happens when the bone in a joint is either pushed or pulled out of the normal range of motion and separates from the joint. It may return to normal on its own or it may require medical attention to reduce it. Treatment for a dislocation includes immobilization, ice, rest, NSAIDs and osteopathy. Recovery time for a dislocation depends on the involvement of the ligaments, tendons and bones of the joint and how much total damage occurred.
  • Ankle Sprains: An ankle sprain happens when the joint is rotated through an extended range of motion, causing tears to the ligaments that support the joint. It can occur from rolling of the joint, either in or out. Jumping and running put the ankles at risk of sprains. Landing from a dismount or other activity can easily result in an ankle sprain. Common treatments for ankle sprains include rest, ice, immobilization and osteopathy. Time to full recovery may be as long as 8 weeks depending on the amount of damage done to the ligaments.
  • Plantar Fasciitis: The plantar fascia is subjected to a lot of stress during gymnastics floor moves and during the landing of a dismount. The plantar fascia is a strong ligamentous band that runs along the bottom of the foot and supports the arch of the foot. This band can become inflamed when it is under constant, excessive stress. This inflammation usually occurs at the heel end of the fascia. Rest, anti-inflammatory medication and osteopathy are the best treatment for this injury.
  • Joint Pain: Gymnasts are constantly pounding their joints during jumps, tumbles, flips, and other activities. The cartilage in the joints helps cushion some of the impact; however it can only do so much. The joints, and the bones of the joints, can become inflamed and cause pain. This pain is usually the body’s first warning sign that it is time to take a little rest. With rest and NSAIDs the pain will usually subside. If it does not then there may be another, underlying, problem that must be addressed with osteopathy.
  • Muscle Strains: Muscle strains are common in gymnastics. The muscles must contract forcefully to push the body through the movements of a routine. This forceful contraction may result in excessive tearing of the muscle, a muscle strain. This causes inflammation and pain in the muscle. The tears may be minor, with tears in a small number of fibres, to major, that involve large numbers of fibres and a larger area of the muscle. Treatment usually includes rest, ice, and anti-inflammatory medication. Osteopathy may be beneficial for muscle strains, and stretching and strengthening exercises, may help speed healing.

Injury Prevention Strategies

A gymnast must be conditioned to ensure injury prevention.

  • Practicing the form of each new move to ensure proper form and correct body position will help reduce injuries.
  • Learning the proper form of each new move before trying it; and then practicing it to perfect it will help ensure proper form.
  • The use of spotters when learning a new skill will also reduce the number of injuries.
  • The use of well maintained equipment and a safe practice area is essential in injury prevention.
  • A strengthening and stretching program that covers the entire body, making sure the body is strong and flexible enough to perform the various moves will help the gymnast reach peak levels and avoid injury.

Three Gymnastics Stretches

  1. Arm-up Rotator Stretch: Stand with your arm out and your forearm pointing upwards at 90 degrees. Place a broom stick in your hand and behind your elbow. With your other hand pull the bottom of the broom stick forward.
  2. Standing High-leg Bent Knee Hamstring Stretch: Stand with one foot raised onto a table. Keep your leg bent and lean your chest into your bent knee.
  3. Squatting Leg-out Adductor Stretch: Stand with your feet wide apart. Keep one leg straight and your toes pointing forward while bending the other leg and turning your toes out to the side. Lower your groin towards the ground and rest your hands on your bent knee or the ground.
February 28th 2019

Basketball

Basketball involves muscles throughout the body. Running, pivoting and jumping employ a full range of muscles in the feet, legs and trunk, with particular concentration in the quadriceps and hamstring muscles. The vertical jump in basketball is critical and involves a range of muscles, particularly:

• Abdominals: These muscles are flexible, supporting the back through a range of motion. In particular, the abdominal muscles on the sides, which assist in turning and twisting, known as the obliques, work the hardest, especially in the execution of the jump shot.

• Calf muscles: Located at the back of the lower leg, these muscles are used intensively to achieve vertical height when jumping.

• Hamstrings: These powerful muscles run along the back of the thigh, from the lower pelvis to the back of the shin bone. Hamstrings function to extend the hip joint and flex the knee joint.

• Quadriceps: Located in the knee, the large thigh muscles known as quadriceps muscles are connected to the patella (kneecap) by the quadriceps tendon, while a separate tendon - the infrapatellar tendon - connects the patella to the top of the tibia (shin bone). Quadriceps are a focus of training for basketball players, especially for in order to improve jumping capacity.

• Gluteus Muscles: Known as glutes, these muscles, are responsible for a large portion of the upward thrust necessary in the vertical jump. The gluteus maximus originates along the crests of the pelvic bone crests and attaches to the rear of the femur. Its primary function is hip extension (as the thigh moves to the rear).

As a strong vertical jump gives the athlete considerable advantage in scoring, all five of these muscle groups should be equally targeted in basketball training.

During the free throw in basketball, numerous upper body muscles are employed, including rotator cuff muscles, deltiods, coracobrachialis, latissimus dorsi, pectoralis major, biceps brachii, brachialis, brachioradialis, triceps brachii, anconeus, pronator teres, and pronator quadratus.

A multitude of muscles in the hands and fingers come into play, including the flexor capri radialis, palmaris longus, flexor carpi ulnaris, extensor carpi ulnaris, extensor carpi radialis brevis, extensor carpi radialis longus, flexor digitorium superficialis, flexor digitorum profoundus, flexor pollicus longus, extensor digitorum, extensor indicis, extensor digiti minimi, extensor pollicus longus, extensor pollicus brevis, and the abductor pollicus longus.

Most Common Basketball Injuries

Like many athletic injuries, those occurring in basketball may be classified as overuse injuries and traumatic injuries.

Overuse injuries

Overuse injuries occur when a particular area is put under continual stress and becomes damaged in the process, causing pain, loss of movement, in many cases, swelling. One such injury common to the sport is patellar tendonitis, also known as “jumper’s knee,” which is characterized by pain in the tendon just below the kneecap.

Another typical overuse injury is Achilles tendonitis, involving the tendon connecting the muscles in the back of the calf to the heel bone. The result of this injury is pain in the back of the leg, slightly above the heel. In more severe cases, the Achilles tendon can tear, requiring osteopathy and immobilization of the injury to allow healing.

Shoulder injuries involving overuse are not uncommon and may involve the tendons in their shoulders. The rotator cuff of the shoulder is made up of four muscles, attached by tendons to the shoulder bones. Inflammation and pain can result from overhead activities, including throwing the basketball.

Traumatic injuries

Unlike repetitive or overuse injuries, traumatic injuries result from a sudden forceful event. Among the most common traumatic injuries in basketball are jammed fingers, which can range in severity from minor injury of the ligaments, to a fractured bone. Such injuries require adequate care and may need to be splinted to ensure proper healing. Muscle pulls or tears are common basketball injuries, often occurring in the large muscles of the legs.

• Ankle sprains may be the most frequent basketball injury, often occurring when one player lands on another’s foot or during a rapid change of direction. The result causes the stretching or tearing of the ligaments connecting bones and supporting the ankle. Ligaments tearing may be partial or complete.

• Knee injuries Knee injuries are potentially dangerous and debilitating. The knee may be sprained, with a tearing of ligaments or joint capsule. Twisting the knee can tear the meniscus - tissue acting as a cushion between the bones of the upper and lower leg at the knee. This injury may require surgical treatment.

Tears to ligaments supporting the knee may also be serious. A tear of the anterior cruciate ligament (ACL) is one of the more common ligament injuries. Tears in the ACL require prompt osteopathy and may require surgery.

Injury Prevention Strategies

• Proper warm-up is essential. Jumping jacks, stationary cycling or running or walking helps limber up muscles, preventing strains and other injuries.

• Be aware of the position of other players on the court, to avoid collisions.

• Proper, snug-fitting and supportive footwear can help avoid injuries. Cotton socks absorb perspiration, also providing extra support to the foot. Use of ankle supports can reduce the incidence of ankle sprains.

• Use of a mouth guard helps protect the teeth and mouth.

• Safety glasses should be used by those wearing eyeglasses.

• Basketball courts, whether indoors or out must be free of obstructions and debris

Further, players should be knowledgeable about first aid methods and familiar with first aid options for minor injuries including strains or sprains, facial cuts, bruises, or minor tendonitis.

Three Basketball Stretches

1. Standing Reach-up Quad Stretch: Stand upright and take one small step forwards. Reach up with both hands, push your hips forwards, lean back and then lean away from your back leg.

2. Rotating Stomach Stretch: Lie face down and bring your hands close to your shoulders. Keep your hips on the ground, look forward and rise up by straightening your arms. The slowly bend one arm and rotate that shoulder towards the ground.

3. Single Heel-drop Achilles Stretch: Stand on a raised object or step and place the ball of one foot on the edge of the step. Bend your knee slightly and let your heel drop towards the ground.

February 27th 2019

Badminton

Most people can easily learn to hit the shuttlecock over the net. However, at the competitive levels a great deal of cardiovascular conditioning and muscular endurance are needed. Great agility, quickness, and reaction are essential to be successful in badminton as well. Lower body strength and endurance are important to the badminton player. A strong swing requires good upper body strength, as well. Core strength and endurance help with balance which improves overall agility.

Playing badminton requires the use of the following major muscles:

• The muscles of the lower leg; the gastrocnemius, the soleus and the anterior tibialis.

• The muscles of the upper legs and hips; the gluteals, the hamstrings, and the quadriceps.

• The muscles of the hip; the gluteals, the adductors and abductors, and the hip flexor.

• The muscles of the shoulder girdle; the latissimus dorsi, the teres major, the pectorals, and the deltoids.

• The core muscles; the rectus abdominus, obliques, and the spinal erectors.

• The muscles of the forearm and upper arm; the wrist flexors and extensors, the biceps and the triceps.

A conditioning program that includes an overall cardiovascular program, a solid strength component, and good flexibility training will keep the badminton player healthy and performing at his or her peak.

Most Common Badminton Injuries

Badminton is not a contact sport, but due to the fast pace it can result in traumatic injury. Ankle sprains, Achilles tendon strains, anterior cruciate ligament sprains, and rotator cuff injuries are all common among competitive badminton players.

• Ankle Sprains: The sudden change in direction, especially once a player becomes fatigued, can easily result in the ankle “rolling.” This rolling of the ankle causes tears in the ligaments that support the ankle. This results in pain and tenderness at the injury site, swelling, and difficulty bearing weight. A popping sensation may be felt with the injury, as well. Initially ice, immobilization, and compression may help reduce the discomfort, followed by osteopathy. An x-ray should be taken to rule out a fracture. Usual recovery time is about 4 to 6 weeks for a moderate sprain.

• Achilles Tendon Strain: The Achilles tendon connects the calf muscles to the heel bone (calcaneus.) When the calf muscle contracts forcefully this tendon is under a great deal of stress. If the muscle is tight or not properly warmed up, a tear may occur in the tendon. This is called a strain. The amount of the tendon involved in the tear will determine the severity of the injury. A complete tear (or rupture) will take much longer to heal and may require surgical intervention. Minor tears can be treated with osteopathy, rest, ice and NSAIDs. The low blood flow to tendons complicates the recovery and lengthens the process.

• Anterior Cruciate Ligament (ACL) Sprain: The anterior cruciate ligament is the main stabilizing ligament in the knee. When the foot is planted and the upper leg begins to rotate the ACL is put under tremendous stretch, and may result in a tear. This reduces the structural integrity of the knee and results in a great deal of pain. Immobilization, ice, and rest are keys to treating an ACL injury. In cases of complete rupture of the ligament, surgical intervention may be needed to reattach the ligament. This, of course, increases overall recovery time. The knee may be loose and lose some structural strength, requiring both osteopathy and exercises to get it back to pre-injury condition.

• Rotator Cuff Injuries: The swinging motion places the shoulder in an exposed position and if the arm rotates out of the natural path of movement the shoulder may be injured. The rotator cuff muscles are designed to stabilize the shoulder and if they are stretched or torn due to an acute, unnatural movement, they will not be able to provide that support. Acute injury to the rotator cuff can be minor, a simple strain of the muscles, to severe, with a complete rupture of the muscular structure. Chronic injury to the rotator cuff muscles and tendons may also occur if improper body mechanics are used in the swing repetitively. Rest, ice and NSAIDs is needed for acute conditions, while osteopathy will be needed to help heal both acute and chronic injuries.

Injury Prevention Strategies

Overall conditioning is essential to the badminton player to help reduce injuries on the court.

• Playing on well-manicured outdoor courts or indoor courts with well-maintained surfaces will reduce lower extremity injuries.

• Strong muscles, especially in the lower extremities, will prevent many injuries caused by the constant change in direction and explosive movements.

• Good endurance will help delay the onset of fatigue, which contributes to a high percentage of sports injuries.

• Quality equipment and body mechanics training will help prevent chronic injuries that develop due to misalignment issues.

• Proper warm-up and a good flexibility program will reduce injuries from tight and inflexible muscles.

Three Badminton Stretches

1. Rotating Wrist Stretch: Place one arm straight out in front and parallel to the ground. Rotate your wrist down and outwards and then use your other hand to further rotate your hand upwards.

2. Elbow-out Rotator Stretch: Stand with your hand behind the middle of your back and your elbow pointing out. Reach over with your other hand and gently pull your elbow forward.

3. Standing Toe-up Achilles Stretch: Stand upright and place the ball of your foot onto a step or raised object. Bend your knee and lean forward.

February 26th 2019

ACC

You don’t need to have a GP referral to see an osteopath on ACC. Philip can help you can make a new ACC claim if you have an injury that is the result of an accident which happened within the last year. ACC contributes to the cost of osteopathic treatment of everyone, of any age, both working and not working, for all injuries that result from an accident that occurred at work, at home, playing sports or driving. The accident must involve an external force or resistance. This can include road traffic accidents, sports injuries, carrying something, lifting, pushing or pulling something, or falling and hitting something or something hitting you. ACC does not cover bending or twisting if no external force or resistance is involved, even if the injury occurred at work. ACC does not fully fund osteopathy, so a top-up payment is payable by the patient. You must start your osteopathic treatment within one year of the accident date, and can initially have up to 16 treatments within 52 weeks of your accident date. In some circumstances it may be possible to make an ACC32 application for additional treatments. If you have not seen Philip recently you will need to have a consultation so Philip can get current information to complete the application. Any additional treatments approved must be given by the osteopath who makes the application. For a standard ACC32 request, there is no application fee. Standard requests must meet the following criteria.

• it’s for an accepted ACC claim

• you are within 12 months of the injury

• this is the first additional treatment request for the claim

• it’s for the original diagnosis and listed on the standard Read Code list

 A non-standard request is a long and complicated procedure, and there is a fee of $30. Non- standard requests are often declined. If ACC declines your claim, declines your application for additional treatment, or declines to pay for treatment on an existing claim for any reason, you will then be liable to pay the difference between the ACC top-up payment and the private fee of any osteopath treatments that you have had. If you are making a new ACC claim or applying for additional treatment, you may wish to wait until you have heard from ACC before you have further treatment.

 If your injury is work related, please let your osteopath know whether your employer is an ‘accredited employer’ in the ACC Partnership Programme (these are all large companies). This means that they take responsibility for their employees’ work injury claims. If you don’t know, please ask your employer. If they are, you will need to provide your osteopath with contact details for both treatment approvals and invoicing. Accredited employers (or their insurance companies) usually allow fewer treatments than ACC does, for similar injuries. It is a Worksafe New Zealand (formerly OSH) requirement that if you have an injury at work, that you should complete an incident report at your work place.

ACC will be able to help you with travel expenses if, within 14 days of your injury, you need to travel more than 20 kilometres (one way per trip), or you travel more than 80 kilometres within any calendar month, or within any calendar month you spend more than $46 on bus, train or ferry (or, with prior approval from ACC, you spend more more than $46 within any calendar month for other transport such as taxis, hire-cars or shuttles). ACC will then pay your return fare, provided you return to where you started from. If you use a private vehicle they’ll pay 29 cents per kilometre (inclusive of GST). ACC can help pay the travel costs for someone to travel with you if you qualify for travel costs and you’re under 18 years, or your medical condition requires that you travel with an escort, or the transport provider requires you to have an escort. If you share private transport ACC will pay the private transport rate for one person only. You will need to keep your tickets or receipts and give the form to Philip to stamp and sign. To obtain an ACC250 Request for Travel Costs form call ACC on 0800 101 996 then press 4, drop into your nearest ACC office or simply Google: “ACC250”, and download it. Under New Zealand legislation an osteopath is unable to certify anyone as unable to work. Please see your GP if you need such certification for your employer, ACC or WINZ.

February 25th 2019

If you have an injury: RICE

R = Rest
I = Ice
C = Compression
E = Elevation

You should apply the RICE method in the 24 hours immediately following injury in order to relieve pain and reduce the extent of swelling (inflammation). The RICE method should not be used if you have Raynaud ’s disease, diabetes or peripheral vascular disease.

REST
Stop activity. With an injury to the leg, this may mean having to use crutches.

ICE
Apply ice for 10-15 minutes every 1-2 hours initially and then gradually reduce the frequency of application over the next 24 hours.
Methods of applying ice:
• Ice bucket.
• Instant ice packs.
• Crushed ice wrapped in wet towel.
• Packet of frozen peas wrapped in wet towel.

COMPRESSION
Compression, by the use a compression bandage around the injured area, helps to prevent or reduce swelling. The bandage should be applied firmly but not so tight that the blood is cut off. If applied to a limb, the fingers or toes should remain pink and not become ‘tingly’. Ice can be used over the bandage. Remove the bandage every 3-4 hours and reapply.

ELEVATION
Raise the leg above the level of your hip e.g. lie down with your leg propped up on a chair and/or pillows, or the arm in a sling or with the hand on the opposite shoulder.

February 24th 2019

The Kirksville Declaration

The basic concept of osteopathy was described in the introduction to the Kirksville consensus declaration written in 1953: “Osteopathy is a philosophy, a science and an art. Its philosophy embraces the concept of the unity of the body structure and function in health and disease. Its science includes the chemical, physical and biological sciences related to the maintenance of health and the prevention, cure and alleviation of disease. Its art is the application of the philosophy and the science to the practice of osteopathy. Health is based on the natural capacity of the human organism to resist and combat noxious influences in the environment and to compensate for their effects; to meet, with adequate reserve, the usual stresses of daily life and the occasional severe stresses imposed by extremes of environment and activity. Disease begins when this natural capacity is reduced, or when it is exceeded or overcome by noxious influences. Osteopaths recognise that many factors impair this capacity for resistance and recovery, thus reaffirming the validity of the ancient observation that the physician deals with a patient as well as a disease.”

February 23rd 2019

The Principals of Osteopathy

The following set of principals are based on those offered in 2002 by Felix Rogers DO, Gilbert D'Alonzo Jnr DO, John Glover DO, Irvin Korr PhD, Gerald Osborn DO, Michael Patterson PhD, Michael Seffinger DO, Terrie Taylor DO, and Frank Willard PhD.

1. A person is the product of dynamic interaction between bio, psycho, social and environmental factors.

The human body functions as a unit, with structure and function being reciprocally interrelated between all systems and levels of organisational complexity. Alterations in the structure or function of any one area of the body influences the integrated function of the body as a whole.

2. An inherent property of this dynamic interaction is the capacity of the individual for the maintenance of health and recovery from disease.

Osteopaths view health as the natural state of the body. The health of the individual is determined by complex, self-regulating homeostatic systems that are strongly influenced by the structure of the individual. These regulatory systems are capable of compensatory alterations in the face of disease, yet can be self-healing and restorative when their function is optimised.

3. Many forces, both intrinsic and extrinsic to the person, can challenge this inherent capacity and contribute to the onset of illness.

A realistic view of health focuses on wholeness, understanding and accepting of the person in his or her full ecologic context, and appreciating his or her efforts to maximise health status and cope with disease or disability. Osteopaths recognise that each individual is uniquely vulnerable to stressors that place him or her at risk for loss of health. Illness is thought to represent the body’s inadequate, self-regulatory responses to challenges from the internal and external environment.

4. The neuromusculoskeletal system significantly influences the individual’s ability to restore this inherent capacity and therefore to resist disease processes.

Historically, orthodox medicine has emphasised internal organs and their disturbances; diagnostic and therapeutic methods have been largely directed at the manifestations of these disturbances. The neuromusculoskeletal system has been relegated to a secondary role, as an organ system that is primarily related to locomotion. Osteopaths consider the neuromusculoskeletal system to play a primary role in health and disease. Metabolically, it can be the most demanding body system, and its requirements vary widely and often rapidly from moment to moment according to individual activities and responses to the environment. Derangements in the neuromusculoskeletal system are common and represent significant public health concerns. Abnormalities in the structural system affect its function and that of related circulatory and neural elements. The interventions directed to the neuromusculoskeletal system include osteopathic palpatory diagnosis and manual treatment, therapeutic and recreational exercise, and physical therapy modalities.

5. The patient is the focus for healthcare.

Osteopaths are trained to focus on the individual patient and resist reducing the focus to the abstractions of presenting symptoms, body parts and named disease entities. The relationship between clinician and patient is a partnership in which both parties are actively engaged. The osteopath is an advocate for the patient, supporting his or her efforts to optimise the circumstances to maintain, improve, or restore health and well-being.

6. The patient has the primary responsibility for his or her health.

Although the patient-osteopath relationship is a partnership, and the osteopath as a healthcare professional has obligations to the patient, ultimately the patient has primary responsibility for his or her health. The patient has inherent healing powers and must nurture these through diet and exercise, as well as adherence to appropriate advice in regard to stress, sleep, weight control, and avoidance of substance misuse.

An effective osteopathic treatment program is founded on these principals and:

  • incorporates available evidenced-based and best-practice guidelines as appropriate to the patient’s needs  
  • optimises the patient’s natural healing capacity
  • addresses the primary cause of disease
  • emphasises health maintenance and disease prevention

The emphasis on the neuromusculoskeletal system as an integral part of patient care is one of the defining characteristics of osteopathy. When applied as part of a coherent philosophy of the practice, these principals represent a distinct and necessary approach to healthcare.  

February 22nd 2019

Archery


Archery does not require a great deal of cardiovascular conditioning, but it does require muscular endurance. The continuous drawing back of the bow string requires strength and endurance in the upper body. A strong core and lower body is essential for balance and control. Strong forearms will ensure proper aiming and a steady grip. The major muscles used by the archer include:

• The muscles of the shoulder girdle; the latissimus dorsi, the teres major, and the deltoids.

• The muscles of the neck; the levator scapula and trapezius muscles.

• The core muscles; the rectus abdominus, obliques, and the spinal erectors. 


• The muscles of the upper legs and hips; the gluteals, the hamstrings, and the quadriceps. 


A good overall strengthening program to keep the muscles strong and flexible will keep the archer on target for a long time. 

Most Common Archery Injuries 

Archery is a non contact sport that does not subject the body to a lot of violent impact. With the exception of an errant bolt, there are very few dangers of traumatic injury for the archer. The repetitive motion involved in practice and competition does, however, put the archer at risk for repetitive strain injuries. Although archery has a low reported incidence of injury associated with it, there is some risk. The archer may fall victim to rotator cuff injuries, tendonitis in the elbow, wrist, or shoulder, contusions, and impalement (although very rare.)

• Rotator Cuff Injuries: Due to the constant draw on the bow string, especially at high draw weights, the rotator cuff muscles are under constant strain. The action of holding the string back as the arrow is sited puts additional stress on these muscles. The muscles may become fatigued leading to the potential for strains. Pain in the shoulder, especially during the drawing action may be evident. Weakness and inability to lift and rotate the arm may also occur. This may be treated with osteopathy, rest, ice and the use on non-steroidal anti-inflammatory medication. In severe cases, or complete tears or resistance to treatment, surgical remediation may be required.

• Tendonitis: Tendonitis is caused by unusual or repetitive strain on the tendon. The constant strain placed on the tendons during archery can lead to tendonitis in the joints of the upper extremities, specifically the wrist, elbow, and shoulder. Pain in the attachment of the muscle, especially when the muscle flexes before warming up, may indicate tendonitis. The joint may be stiff and sore and the muscles may be weaker than usual. Osteopathy, rest and NSAIDs may be all that is required to treat tendonitis. Recovery time will vary depending on the severity of the condition, with an average three to six weeks.


• Muscle Strains: The muscles of the back, neck and shoulder are subjected to constant tension during archery and overtime, or when using a different bow, could be subject to a strain. The muscle fibres tear slightly during normal use, but when subjected to a load that is greater than their capacity more fibres may tear, causing pain and inflammation. The muscle will also be unable to handle large loads until it repairs. Pain within the muscle, inflammation, and stiffness may be evident with a strain. Osteopathy, rest, ice (for the first 72 hours), and anti-inflammatory medication will help manage the strain. Limited activity can be attempted as it is tolerated.

• Contusion: When the bow string is released it may slap along the forearm on the way back, this is called “String Slap.” This can cause bruising where the string hits. The blood vessels under the string are broken due to the force of the string hitting the area and this causing bleeding under the skin. Slight swelling and discoloration will be present. Sharp pain will be felt immediately, then the pain becomes dull and usually only occurs with pressure on the area. Ice and protection will speed the recovery of the contusion.

Injury Prevention Strategies

• The use of proper equipment and an overall conditioning program to prepare the muscles for repetitive use is essential for the archer.

• Proper use of arm guards and release devices will prevent “String Slap” and other potential injuries.

• Gradual increases in draw weight and repetitions during practice will ensure that the body is ready for the next step without shocking the muscles, helping to prevent strains.

• A good strengthening program for the upper body will prepare the muscles for the repetitive strain of drawing back the string and holding the position.

• Flexibility is essential to aid in recovery and keeps the muscles ready each time they are called into play. A good overall stretching routine will also help prevent imbalances caused by constantly pulling the same way.

Three Archery Stretches

1. Arm-up Rotator Stretch: Stand with your arm out and your forearm pointing upwards at 90 degrees. Place a broom stick in your hand and behind your elbow. With your other hand pull the bottom of the broom stick forward.

2. Rotating Stomach Stretch: Lie face down and bring your hands close to your shoulders. Keep your hips on the ground, look forward and rise up by straightening your arms. The slowly bend one arm and rotate that shoulder towards the ground.

3. Assisted Reverse Chest Stretch: Stand upright with your back towards a table or bench and place your hands on the edge. Bend your arms and slowly lower your entire body. 

February 3rd 2019

Osteopathy in the Rest of the World

Dr John Martin Littlejohn, a Scotsman, was the first professor of physiology at the ASO and also dean of the ASO. He established the Chicago College of Osteopathy in 1900. Teaching in theoretical subjects was extended and physiology was established as a central subject. The school flourished and developed into one of the most important scientific sources of early osteopathy. In 1913 Littlejohn returned to the UK and and in 1917 established the British School of Osteopathy where he taught until he passed away in 1947. He developed a theory of spinal mechanics, published many papers, and wrote two textbooks.

Until the 1960’s, all osteopathy schools worldwide taught osteopathic diagnosis based primarily on structural alignment and theories of spinal mechanics formulated by pioneers such as Littlejohn and Fryette. In the 1960’s Hugh Middleton of the BSO started a new approach based primarily on assessing the function of all joints and tissues of the musculo-skeletal system and correcting any dysfunction. Normal mechanical function leads to normal physiology and hence helps eliminate pathology (disease). It also became standard practice to identify the tissues causing symptoms, the pathology of those tissues, the pre-disposing factors, precipitating factors and maintaining factors. These factors include not only neurological, muscular and skeletal factors, but also the patients home, work and social environment, psychology, old injuries etc. This more holistic approach is very effective and is also more acceptable to regulators and other health professionals. In the 1970’s Laurie Hartman of the BSO developed a way of performing high velocity thrust manipulations with minimal leverages. Since the 1980’s he has taught his techniques and the functional approach to other UK osteopathic colleges. These are now taught at all British, New Zealand and Australian schools of osteopathy except for one small UK school.

Over time more osteopathic schools were started in the UK, Australia and New Zealand, and more recently in other countries. Osteopathy courses in New Zealand, Australia and the UK are rigorously science based and teach a non-surgical, non-pharmaceutical approach based on the updated principals of osteopathy. Their graduates are primary care practitioners who see themselves as manual medicine or neuromusculoskeletal (NMS) specialists, complementary to all systems of medicine. They spend considerably more time training in osteopathic diagnosis and technique than their US counterparts, in addition to the study of anatomy, physiology, pathology, embryology, neurology, paediatrics, orthopaedics, rheumatology and psychology to a similar standard as medical schools. Some medical doctors undertake a postgraduate training in osteopathy.

Courses in osteopathy are currently offered by ten universities and colleges in Britain, eight in Canada, seven in France, five in Germany, three in Belgium, Russia, Spain and Australia (RMIT, Victoria University and Southern Cross University) and two in Finland, the Netherlands, Switzerland, Argentina, Austria, Chile, Ireland, Italy, Norway, Poland, Sweden, South Korea and New Zealand (one at UNITEC in Auckland which has stopped taking new students, and a new course that started at the ARA institute in Christchurch in 2018). The qualifications conferred vary widely, and include: certificates, diplomas, bachelors’ degrees, masters’ degrees and Doctor of Philosophy (PhD).

February 2nd 2019

Osteopathy in the USA after Still

In the early 20th century, osteopathy in the United States moved closer to mainstream medicine. The first state to pass laws giving those with a D.O. degree the same legal privilege to practice medicine as those with an M.D. degree was California in 1901, the last was Nebraska in 1989. In 1962, in California, the AMA tried to eliminate the practice of osteopathic medicine in the state. In 1974, the California Supreme Court ruled that licensing of DOs in that state must be resumed, and as of 2012, there were 6,368 D.O.s practicing in California. Osteopathic physicians are licensed to perform surgery and prescribe medications, and are taught to practice medicine with a patient-centered, holistic approach, emphasising the role of the primary care physician within the health care system plus osteopathic manipulative therapy (OMT) as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. There are currently 29 osteopathic medical schools in the United States, offering education at 37 locations. As of 2011, there are approximately 78,000 osteopathic physicians in the U.S., but only about 2,000 of those practice OMT as their sole modality. (90% of manipulative therapy in the US is administered by chiropractors, of which there are 49,000). A 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey indicates that osteopathic physicians have become more like M.D. physicians in every respect —few perform OMT, and most prescribe drugs or suggest surgery as a first line of treatment. Osteopathic physicians are unevenly distributed in the United States. The states with the highest concentration are Oklahoma, Iowa, and Michigan where osteopathic physicians comprise 17-20% of physicians, and the lowest concentrations of DO’s are Louisiana, Massachusetts and Vermont where only 1–3% of physicians have an osteopathic medical degree. Public awareness of osteopathic medicine likewise varies widely in different regions. U.S. trained DOs are currently able to practice in 45 countries with full medical rights, including New Zealand and the United Kingdom, but not in Australia or the Republic of Ireland. The United States does not have any colleges training non-physician osteopaths, and osteopaths trained in other countries are not permitted to practice in the U.S.

February 1st 2019

Some of the Major Influences on Andrew Taylor Still

Still was influenced by the intellectual and philosophical movements making their way across America during his life time such as transcendentalism, phrenology, natural hygiene, homoeopathy, magnetic healing, spiritualism and mesmerism and also by Hippocrates’s doctrine where all illness was seen as the result of an imbalance in the body of four humours. The therapeutic approach was based on “the healing power of nature” (“vis medicatrix naturae”), the body containing within itself the power to rebalance the four humours and heal itself. He studied the English philosopher Herbert Spencer, who developed a theory of evolution before Darwin and wrote about a wide range of subjects, including ethics, religion, anthropology, economics, political theory, philosophy, biology, sociology, and psychology. In later years Still was a Freemason.

Still, was fascinated with machines, and was an amateur inventor. He assembled and operated a steam-powered saw mill when he helped build Baker University. He invented a wheat harvesting machine, but his idea was stolen by a visiting sales representative, who put it into production. In 1871 he invented and marketed a centrifugal butter churn. Some of his inventions were related to the practice of osteopathy, such as the patient brace, a simple device designed to keep patients from falling off the narrow treatment table during vigorous manipulations. In 1910 he patented a smokeless coal furnace, though he had difficulty producing a full-sized working model. Heartbroken by Mary Elvira’s death in May 1910 he did not pursue the matter further. He was fascinated by human mechanics and had an excellent knowledge of anatomy. Still said: “An osteopath is only a human engineer, who should understand all the laws governing his engine and thereby master disease.” Still, as a boy, scrutinised the muscles, nerves and bones of the animals he hunted. Later, as a young doctor he dug up Indian graves to study the skeletons. For years he carried one or two bones in each of his pockets and often a whole sackful over his shoulder. He wondered about their mechanics and how they influenced health and disease. He saw that the nerves that control the body branched off from the spinal column through small holes between the vertebrae. He became convinced the minor dislocations or subluxations, which he called “osteopathic lesions” could cause disease. He said: “all diseases are mere effects, the cause being a partial or complete failure of the nerves to properly conduct the fluids of life”.

Still was an intuitive thinker who spoke in florid allegories, was dogmatic, evangelical, kind, humorous and generous. He was venerated by his early followers as an infallible font of truth. He continued to dress as a ‘tramp doctor’, even as principal of the ASO. Many of his ideas were years ahead of their time. Still never believed that drugs apart from anaesthetics and antiseptics had any value. At the time that Still learned medicine form his father, Louis Pasteur had yet to discover, in 1861, that micro-organisms cause infectious diseases, and it wasn’t until 1865 that Joseph Lister invented anti-sepsis. Common medical treatments at that time included vomiting, purging, blood-letting and heroic doses of opium, morphine, arsenic, and calomel (a mercury based drug which rotted the teeth, gums, and cheeks of the patient), and often did more harm than good and didn’t prevent three of his children dying from meningitis. He correctly recognised that the muscular and skeletal systems are important to the body’s health. His belief in the self-healing powers of the body is similar to modern theories. His idea of the “osteopathic lesion” (now called “somatic dysfunction”) has been supported by research by Korr and Denslow on how a facilitated segment can act as a neurological lens contributing to disease. Osteopaths today do not believe that “somatic dysfunction” can be the sole cause of disease, but that it can be a contributing factor, and that treatment of “somatic dysfunction” can be an adjunct to conventional medical treatment to hasten recovery.

January 31st 2019

The Story of Osteopathy Part Seven

On 1st November 1892 Andrew opened the American School of Osteopathy (later renamed the Kirksville College of Osteopathic Medicine, and now part of the AT Still University) in a two roomed timber framed building. Bill Smith taught anatomy and some chemistry and physiology. This first class consisted of five women and sixteen men, including former patients, family friends, three of Andrew’s children and his brother. At the time women were barred from US medical schools. The first graduation was in 1894. Andrew wished his graduates to be general practitioners, caring for patients with a wide variety of health problems, able to perform surgery, and deliver babies. The state of Missouri was willing to grant him a charter for awarding the MD degree, but he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree. An infirmary was opened in January 1896 and in that year Andrew and his students had performed thirty thousand osteopathic treatments. Andrew sanctioned the use of anaesthetics and antiseptics. By the late 1890’s his school, infirmary and new surgical hospital were increasingly successful both academically and financially. In 1897 two wings were added to the infirmary that more than tripled the size of the original building. The Wabash Railroad Company had to increase the number of passenger trains running to Kirksville to four a day to accommodate the 400 people traveling to the ASO every day for treatment. By 1902 the ASO was graduating 300 students a year. Andrew Taylor Still died on 12th December 1917 from the effects of a stroke he had sustained three years earlier.

January 30th 2019

The Story of Osteopathy Part Six

Andrew had an epiphany on 22nd June 1874 - he saw the body as an intricate machine which if free from displacements, derangements and contractures, nourished and cared for, will perform the functions for which it was intended, having within itself the power to manufacture and prepare all chemicals, materials and forces needed to regain its normal equilibrium and run smoothly to a useful old age. In September 1874 Andrew performed what he later called his first osteopathic treatment (although he wouldn’t call it that until 1885), treating for no fee a poor boy he saw in the street with his lower body covered with blood. In Andrews’ own words: “My first case was of bloody flux (haemorrhagic gastroenteritis) in a little boy of about four summers. I didn’t know what caused the flux, except that it affected young and old alike and was common in summer. I knew that a person had a spinal cord, but really I knew little, if anything, of its use. I had read in anatomy that the upper portion of the body was supplied with motor nerves from the front side of the spinal cord, and that the back side of the cord gave off the sensory nerves, but that gave no very great clue to what to do for flux. I placed my hand on the back of the little fellow, in the region of the lumbar, which was very warm, even hot, while the abdomen was cold. I began work at the base of the brain, and thought by pressure and rubbing I could push some of the hot to the cold places. While so doing I found rigid and loose places in the muscles and ligaments of the whole spine, while the lumbar was in a very congested condition. I worked for a few minutes on that philosophy, and told the mother to report to me the next day, and if I could do anything more for her boy I would cheerfully do so. She came early next morning with the news that her child was well. Flux was in a large percent of the families of Macon. My home at that time was still in Baldwin, Kansas, and I was only visiting in Macon. The lady whose child I had cured brought many people with their sick children to me for treatment. As nearly as I can remember, I had seventeen severe cases of flux in a few days, and cured them all without drugs.”

 Soon after, Andrew was publicly “read out” (or formally removed) from the Methodist Church by the minister in Baldwin, Kansas. Because of his “laying on of hands”, Andrew was accused of trying to emulate Jesus Christ and was labelled an agent of the devil. His practice dropped off rapidly. He was socially and professionally ostracized, became financially destitute, and was ultimately forced to move his family to Macon, Missouri. From that time he called himself a “magnetic healer”. Shortly after he moved alone to Kirksville, Missouri and after three months sent for his family to join him. Kirksville at that time had a population of 6000. In 1876, he was stricken with typhoid and for six months was confined to bed. From 1880 until 1885 Andrew called himself a “Lightning Bone Setter” traveling from town to town in rural Missouri. He used to treat people in the street for all manor of diseases solely using lightening bone setting, and was known as the “tramp doctor”, sleeping wherever he could find a bed. He was away from his wife and children for months at a time. In 1885, on the advice of his friend, the Scottish doctor William (Bob) Smith, Andrew changed the name of his healing art from lightening bone setter to osteopathy, from the Greek “osteon” for bone and “pathos” for suffering. In 1886 Bob Smith helped Andrew set up his first clinic in Kirksville and Andrew stopped travelling. Andrew continued to refine osteopathy. He described the principals of osteopathy as: structure governs function, the medicine chest within, the rule of the artery reigns supreme and the body is a unit. Although he and others doubted whether osteopathy could be taught, he made several attempts to train others. Andrew hoped that his two sons would carry on his work through the establishment of a school of osteopathy, so he waited for their return from service in the army. During this time patients flocked from all over America for his treatment. Hotels were built in the town of Kirksville to house the many patients who arrived daily for help.

January 29th 2019

The Story of Osteopathy Part Five

After he returned from the war, Andrew and his wife Mary Elvira repeatedly petitioned the US government for Andrew to receive a pension based upon the injury (the hernia) he received in the Civil War, which made him unable to do hard physical work, such as farming. However, because the Kansas Militia was not officially sworn in to the Union Army, their requests were denied. Andrews earnings were very low, and the family suffered many hardships. Andrews’ faith in medicine was shaken when, within two weeks, three of his children from his first marriage died of meningitis, and two weeks later a child from his second marriage died of pneumonia. Andrew with his medical knowledge could do nothing to help them. In 1867 Abram died at age 71 of pneumonia. Andrew was very close to his father and his death was a great loss. Three children were then born in close succession. In 1870 Andrew enrolled for a short course in medicine at the College of Physicians and Surgeons in Kansas City, though there is no record of his graduation. Some believe that he had extensive arguments with the faculty and dropped out. In 1873 Andrew was seriously ill with a lung infection for three months. After his recovery another child was born.

January 28th 2019

The Story of Osteopathy Part Four

From 1861-1864 Andrew fought in the Civil War on the side of the Union Army. He served his entire military career in Kansas, in several different militia units. Andrew was refused a commission as a surgeon due to his lack of formal training, so he enlisted as a hospital steward with the rank of sergeant. Normally hospital stewards were selected for training from the enlisted men in the hospital corps. They were given a basic training in sanitation, pharmacy, medicine and surgery and their duties included being in charge of hospital stores, dispensing medicines and having general charge of the sick in the absence of the medical officers. Andrew was exempt from this training because of his prior medical training from his father, and his medical experience. A hospital steward could expect to be promoted to an officer and surgeon with experience. Andrew stated in his autobiography that whilst he was nominally a hospital steward was in reality a de-facto surgeon. After his first militia unit was disbanded Andrew wished to be an infantry officer. He organised a new militia, was promoted to the rank of Captain and ultimately achieved the rank of Major. Andrew fought in the Battle of Westport, during which he suffered an inguinal hernia.

January 27th 2019

 

Philip Bayliss, Registered Osteopath, 43 Thames Street, St Albans, Christchurch, NZ. ☎️03 356 1353