Chantal Wingfield

Pain Triggers – Laptop Bags

laptop-bagsCarrying a heavy laptop bag can be a common cause of lots of joint issues including neck, shoulder, lower back or forearm pain. Laptops and all the paperwork that comes along with them often weigh more than we think and can cause significant postural asymmetries and abnormal joint loading – especially if we carry them for long periods and always on the same side.

Another common culprit is us females popping our heavy laptops and papers into our shoulder handbags – not only is this bad for our shoulder and neck but also bad for our bags!  

Consequently consider using a wheeled or rolling laptop bag and swapping arms regularly backpackto help keep these aches and pains at bay. A rucksack bag rather than an over the shoulder or carrying case is also better option.

So ladies for those of you going against these recommendations its a good excuse to go shopping – happy bag hunting! 

laptop-bag

 

If you suffer from shoulder pain or neck pain, it is advisable to start shoulder treatment straight away.  Your physiotherapist has numerous tricks that can help to quickly relieve your shoulder pain and muscle spasm.

If you have had shoulder pain or stiffness for a month or more, your GP may be able to refer you to a physiotherapist in Sydney as long-term shoulder stiffness can be treated effectively at any time.

If you are not sure what to do, please contact Sydney Physio Solutions for advice or to make an appointment with one of our shoulder physiotherapists.

A Physio’s Top 4 Stretches for After a Run

 

There is a lot of information out there regarding stretching for runners so we have tried to summarise a few key fact to help you with your running-stretch-strategies!

Firstly research has shown that static stretching prior to exercise can reduce power output and thus is no longer being promoted for use prior to our runs. However, static stretches are still recommended for after our runs to aid recovery and reduce DOMS (delayed-onset-of-muscle-soreness).

It is still important to warm up our joints and cardiovascular system before our runs, so a brisk walk/light-slow jog, some dynamic stretches and joint mobility exercises are a great start as part of your warm up. Please see our blog for more details on this if interested.

As for after your runs – please find four of our favourite stretches below to target the key running muscles groups. Hold each of them for a count of 40 (minimum of 30sec but we recommend 40 as we usually count too fast!) and repeat twice on each leg.

1. Quadriceps Stretch Quad-Stretch

Take your right foot in your right hand behind you. Keep your knees together and tail tucked under. Feel the stretch in the front of your thigh.

 

               

 

 

 

2. Hamstring Stretch Hamstring-Stretch

Place your right foot up onto a step and slightly bend your right knee. Tip your tail bone out and bend forwards, maintaining a straight back posture. Feel the stretch in the back of your thigh only.

 

 

       

 

 

3. Calf Stretch Calf-Stretch

Lean against a wall with your right leg bent in front of you and your left extending back behind you. Ensure your feet are facing forwards, your left knee is straight and that your left heel is down. Feel the stretch in your left calf.

 

 

 

 

 4. Gluteal (Buttock) Stretch  GluteStretch

Lying on your back take your right knee into your chest and across your body towards your left shoulder. Add a little rotation by drawing the left ankle in towards you. Feel in the buttock only. Cease if you feel this in your groin/front of hip and seek guidance from your physio for an alternative stretch.

 

With your static stretches hold a light stretch and gradually increase the intensity within comfortable limits. If you are over zealous with your stretches your body can tighten up in response to protect itself – so ‘slow and steady wins the race’ in this case folks!

Top Tips for Ankle Exercises After Injury

Top Tips for Ankle Exercises After Injury Using Small Pilates Equipment

  • Retraining balance (proprioception) after an ankle injury is vital to prevent repeat injury. The picture below demonstrates how to do this using a Pilates wobble cushion. You could also use a bosu dome up or down.

 

Ankle ex on bosu

  • Calf raises are a great rehabilitation exercise after ankle injury. Using the ball or band with them helps to retrain your ankle in its neutral position whilst also retraining your inside (medial) and outside (lateral) ankle stabilisers isometrically at the same time.

ankle ex with ball

ankle Ex with theraband

 

ankle4

  • Ankle inverters and everters are the two groups of muscles on either side of your ankle that control our rolling in and rolling out action. Therefore these muscle groups are commonly injured during an ankle sprain and are also paramount in preventing ankle injury. They need to be strong through their full range to help us recover from a small roll and bring us back to neutral. They exercises below demonstrate how you can strengthen these muscles through range using a Pilates Theraband.

ankle6ankle5

 

 

 

 

 

 

 

 

 

Exercises To Manage Shoulder Pain

This month I wanted to share with you some shoulder rehabilitation exercise options. This is tricky as there are so many potential problems which can occur with this complex joint; but here are a few of my top favs!

The rotator cuff is imperative for the stability and optimal functioning of our shoulder joint. The core role of our rotator cuff is to stabilise the ball within the socket during all movements.

 

  • Starting Position :
  • Draw the ball of the shoulder joint into the socket centrally and maintain this position throughout. Remember they are relatively quite small muscles so start with a light weight to ensure we are not compensating with other larger and more superficial muscles.
Rotator Cuff Exercise 1

Rotator Cuff Exercise 1

Rotator Cuff Exercise 2

Rotator Cuff Exercise 2

 

 

 

 

 

Serratus anterior is another key muscle whose role is to stabilise the scapular (shoulder blade) and ensure correct positioning of the joint socket.

  • Starting Position:

    Standing facing a wall and lean forwards onto forearms. Allow your body to sink between your shoulders so that your chest moves towards the wall

  • Procedure:

    Push away from the wall by rounding out your shoulders. Keep deep neck flexors on (neck lengthened). Shift body weight onto left/right arm and the lift the opposite arm out to side.

    Below Tanya is activating serratus whilst maintaining an isometric contraction of her posterior rotator cuff. Ensure you are not fixing through your chest muscle (pectorals) during this ex. If unsure have it reviewed by your physiotherapist.

Serratus Anterior

Serratus Anterior

Levator scapulae, rhomboids and pectorals are three muscle groups which commonly become tight with shoulder pain. See how to stretch these out below.

Levator Scapular

Levator Scapular

Levator scapulae

  • Starting Position: Reach the left hand over the head to hold the back of the head on the left side
  • Procedure: Turn head into slight right rotation.

Gently draw head down towards left arm-pit, feeling stretch in upper shoulder muscle on right side

                                                

Rhomboids

Rhomboids 

 

Rhomboids:

 

 

 

 

                                                        

Pectorals

Pectorals

Pectorals:  

  • Starting Position: Standing in a doorway with right arm up against door frame. Elbow bent at 90 degrees
  • Procedure: Turn body to the left while gently lifting chest.
  • Feel stretch in right side of chest wall.

Neck Pain

Screen Shot 2015-01-08 at 10.36.49 AM

Neck pain is one of the most common musculoskeletal complaints amongst desk workers. Recent studies have found that people experiencing neck pain consistently present with weakness of their deep postural neck muscles (deep cervical flexor muscles). As a result, they also found an overactivity of their more superficial neck muscles (such as sternocleidomastoid). These superficial muscles are not designed to work for long periods and as a result can become a source of pain and discomfort if they are used in this way.

So how can we correct this imbalance?

Multiple studies have identified the importance of retraining your deep cervical flexors effectively in order to correct this muscle imbalance and prevent recurrence of your neck pain symptoms. Additionally, a recent study also identified that the use of a specific biofeedback cuff during the retraining process is more effective than conventional retraining programs alone.

Screen Shot 2015-01-08 at 10.35.02 AMScreen Shot 2015-01-08 at 10.36.00 AM

Subsequently, if you are experiencing neck pain please come and see one of our Physiotherapists who are all able to assess you with the latest techniques and teach you how to retrain your deep postural stabilisers with the use of a biofeedback cuff. We may then progress you into a Pilates based neck and postural training program for ongoing progression and injury prevention if appropriate. Our Pilates classes also have a strong consideration of this muscle group, with specific exercises directed at retraining these intergrated throughout.

Please don’t hesitate to contact us should you have any questions regarding this blog or our Pilates options.

Reference: Ilsub, J. & Kyoung, k. (2013). A Comparison of the Deep Cervical Flexor Muscle Thicknesses in Subjects with and without Neck Pain during Craniocervical Flexion Exercises. Journal of Physical Therapy Science. 25(11): 1373–1375.  Iqbal, Z. A., Rajan, R., Ahmed-Khan,S. & Alghadir, A. H. (2013). Effect of Deep Cervical Flexor Muscles Training Using Pressure Biofeedback on Pain and Disability of School Teachers with Neck Pain. Journal of Physical Therapy Science. 25(6): 657–661

 

 

Tennis Elbow

Tennis Elbow or Lateral Epicondylitis

Background Information

  • Affects 1-3% of our population.
  • Risk Factors include:
    • Smoking
    • Obesity
    • Aged between 45 and 54
    • Repetitive movements for at least 2 hours daily
    • Managing physical loads over 20 kg

What is Lateral Epicondylitis?

Tennis Elbow

Tennis Elbow

  • Your Lateral Epicondyle is a bony point on the outside of your elbow.
  • Your wrist extensor muscles attach at this point. These muscles enable you to lift your wrist and assist with grip.
  • Lateral Epicondylitis is inflammation of this area when these muscles are repetitively overused.

What can cause lateral Epicondylitis?

  • Repetitive or explosive demand on the muscle-tendon is the main cause of lateral epicondylitis.
  • Performing strenuous or exaggerated movements with a known degenerative tendon.
  • Repetitive motions in which the wrist frequently deviates from a neutral position (ie not held straight).
  • The regular handling of loads over 20 kg.
  • Non conditioning or weakness of the muscles/tendons to be able to perform all of the above tasks

Treatment

  • Initially relative rest and avoidance of all aggravating activities with guided graded return of these activities when appropriate.
  • Use of Taping/support brace to offload the tendon.
Support Brace

Support Brace

  • Physiotherapy led specific strengthening exercises.
  •  Use of Non-steroidal anti-inflammatories or Gels if not contraindicated
  • Using ice wrapped in a light cloth over the painful area – 10 minutes on, 5 minutes off, 10minutes on.
  • Soft tissue release and friction massage of the wrist extensor muscles and tendon.
  • Dry needling or western medical acupuncture to aid muscle release and pain relief.
  • Joint mobilisation
  • If your symptoms persist or are significantly impeding your function/ability to work a corticosteroid injection or PRP treatment may be beneficial.
    Elbow Injection

    Elbow Injection

  • Very occasionally a surgical referral may be required if severe pain/functional restrictions continue for six months or longer despite compliance with physiotherapy.

Prognosis

  • Over 90 % of cases of epicondylitis can be managed non-operatively.
  • On average if left untreated, symptoms associated with Epicondylitis persist between 6 months and 2 years
  • With treatment symptoms usually improve within 6-12 weeks.
  • In some cases rehabilitation may take 3-6 months.
  • Longer rehabilitation is more likely with high physical strain at work, dominant side involvement, concurrent neck pain, duration of symptoms for greater than 3 months, and severe pain.

Wrist Pain

The wrist is a complex joint involving the articulation between 8 small carpal bones, the 2 bones of the forearm (ulna and radius) and your 5 key hand bones (metacarpals). The wrist has multiple ligaments to aid stability around each of these boney articulations. The complex nature of these articulations is what enables us to have such flexibility and combined movement options of the wrist, but of course this also means that this complex is prone to injury.

There are multiple tendons around this region involved in moving our wrist, fingers and thumb at differing joint levels. These tendons can become inflamed and painful with overuse use injuries or repetitive tasks – one example being DeQuirvain’s syndrome at the base of the thumb.

Our three main upper limb nerves (median, ulna and radial) run through the wrist complex under a thick ligamentous type structure called our retinaculum. As a result these can also be a source of wrist pain or tingling symptoms in the fingers/hand. The most common being carpal tunnel syndrome – compression/irritation of the median nerve.

In addition we have a wedge of triangular cartilage on the outside of the wrist, under the ulna (forearm bone) to aid our load bearing and wrist stability. This is called our TFCC (triangular fibrocartillage complex) – this too can become a source of pain or dysfunction in the wrist, leading to nonspecific pain around the outside of the wrist and hand and/or clicking. This can occur as a result of a traumatic incident or just gradual overuse.

Wrist

Wrist

Pain & Management: Wrist pain can occur as a result of direct trauma, sudden overuse or gradual wear. Treatment varies depending upon diagnosis but may include relative rest with use of a splint or taping, massage of any overused muscles and specific rehabilitative exercises.

If unsure regarding the cause of your wrist pain book an appointment with your physiotherapist to fully assess these structures and guide you regarding the correct management.

Physiotherapy for Horse Riders

 

Physiotherapy for Horse Riders

Physio for Horse Riders

 Horse riders are often so busy looking after their horses that they fail to take care of themselves. Riders need to begin to recognise themselves as sports people, and start treating their bodies accordingly. How your body is functioning has a direct impact on how your horse will perform.

Typical horse riding injuries often occur to the upper part of the body such as the neck, shoulders and arms, in particular the wrists. If a rider falls they often brace their impact with the ground by putting their arms out in front of them often injuring the wrist. Many riders may experience whiplash type injuries if their horse stops suddenly and they are thrown forward.

Many horse riding injuries can also be treated with physiotherapy. This means that you can get back to horse riding sooner and with more confidence. A physiotherapist will also be able to recommend treatments for longer term or chronic conditions that may have been the result of an injury sustained long ago. Often people who love horse riding will put up with a degree of pain and reduced mobility in order to continue riding. This need not be the case, most conditions can be treated completely or at the very least improved.

Stiffness, weakness, asymmetry and fitness of the rider all has a huge impact on how your horse performs. At Sydney Sports and Orthopaedic Physiotherapy, Chantal Wingfield is a qualified Physiotherapist with a specialist interest in horse rider’s performance. Being a keen horse rider herself and having previously competed in a wide range of horse riding disciplines she has an in-depth knowledge of the physical demands on horse-riders.

All of the below can directly impact how you and your horse perform. Here are just a few examples:

Symmetry: if you have an asymmetry in your hips (e.g one hip is tighter than the other), this can really put your horse off balance. This could in turn cause your horse to knock a fence, or make it harder for your horse to do a half pass.


Core strength: horse riders need a lot of core strength to stay upright in the saddle. If you have a weak core, it could be affecting your balance, posture, and endurance when riding. This would also make you more prone to injury, especially back pain.


Strength: If you have poor shoulder stability, you may not be able to hold your horse sufficiently. This could cause him to run at a fence uncontrolled and knocking it.


Physiotherapy for horse riders

You may not realise that your poor posture is damaging your body and cause imbalances whilst riding. You may have poor posture whilst riding but more commonly it will be due to other activities such as sitting at a desk, driving or even just sitting or standing. Incorrect posture can lead to changes in the body that will go to affect your performance whilst riding. 

Visit our website to make a booking.

Knee Pain – ITB Syndrome

The Iliotibial band is a strong connective tissue that runs down the outside of the thigh originating from tensor fascia latae and gluteus maximus muscles at the pelvis and inserting into the outside of the knee onto the lateral tibial epicondyle.

During flexion and extension of the knee the band slides forwards and backwards over the femoral condyle (bony prominence on the outside of the knee). Therefore with a sudden increase in repeated motion or altered biomechanics of the lower limb this can cause excess fiction at this junction and result in knee pain known as ITB friction syndrome.

ITB friction syndrome is a very common overuse injury and occurs as a result of repeated trauma rather than a specific injury. It accounts for approximately 22% of lower extremity injuries.

Signs and symptoms include

  • Sharp or burning pain on the outer aspect of the knee
  • Pain that worsens during activity or running
  • Occasionally swelling can occur around the outside aspect of the knee

Common Causes

  •       Sudden increase in activity especially running
  •       An increase in incline training (downhill as well as uphill)
  •       Poor or worn out footwear
  •       Altered muscle balance/biomechanics
  •          –  Often tight quadriceps (especially vastus lateralis), TFL, adductors and                    sometimes  gluteals
  •            –  Often weak gluteals, core and sometimes hamstrings, post tibialis or                       medial  quadriceps.
  •        Poor running technique
  •            –  Often running with a positive crossover, excessive pronation and/or                        poor lateral pelvic control

Management

  •        Initially relative rest and reduction in training with a graded return once   biomechanical factors have been addressed.
  •       In the short term NSAIDs may be of benefit to aid pain and inflammation
  •       If swelling is present ice therapy short term can help
  •       Proprioceptive taping
  •       Soft tissue release
  •       Dry needling
  •       Foam rolling
  •       Specific corrective stretching and strengthening exercises are essential to               address the biomechanical faults identified upon assessment
  •        Correct footwear
  •        Correction of running technique
  •        Occasionally a corticosteroid injection can be of benefit to aid pain and inflammation locally. However, the biomechanical issues must be addressed to ensure long-term resolution of symptoms and prevent recurrence once the injection benefits wear off.

 Should this sound like symptoms you are experiencing please don’t hesitate to contact our physiotherapy team, we can help to advise you appropriately and assess your biomechanics and running technique fully using our video technology.

 

The Achilles Tendon

by Chantal Wingfield

Your Achilles tendon is band of fibrous collagenous connective tissue which attaches your large calf muscles to your heel. It is situated at the back of your ankle.

Contraction of your calf muscles pulls on the Achilles tendon which in turn lifts your heel. This enables us to push up onto our toes, push off the ball of our foot during walking, running, hopping and jumping activities.

This tendon can become inflamed and irritated as a result of overuse. For example a sudden increase in running intensity/distance, an increase in high impact activities or occasionally just a change in footwear.

Symptoms of Achilles Tendinopathy

Pain at the back of the ankle, above the heel. Especially after sporting activities or high impact activities such as prolonged running, jumping, hopping or skipping.

Tenderness in the morning which resolves with gentle movement as the morning progresses.

Pain on palpation of the tendon at the back of the ankle.

Sometimes the area can also become swollen.

Initial Management

Reduce the intensity of your activity.

Reduce high impact activities short term. Swap running for the crosstrainer, cycling or swimming to reduce load through the tendon but maintain your cardiovascular fitness.

Regular ice therapy. 10-20 mins regularly throughout the day, after exercise and when sore.

A short course of Non-steroidal anti-inflamatories can also help. Please check with your pharmacist prior to taking.

Gently stretch your calf muscles for 30seconds daily. Ensure the stretch is pain free.

Key facts

The Achilles tendon is the largest tendon in the body.

It can account for approximately 11% of running injuries.

Tendons have a relatively limited blood supply and thus injuries can take longer to resolve.

Achilles tendinopathy can be an acute injury (short term) or become chronic (recurrent issue over the longer term). So it is worth managing the issue fully upon onset in order to prevent it becoming a chronic problem.

Further Management Options

Addressing your footwear is a key component of your Achilles Tendinopathy management.

Graded increase of your exercise intensity is also paramount.

Bracing/taping techniques can help to reduce symptoms by aiding load transfer through the Achilles tendon.

Research has shown that tendinopathies improve best with eccentric strengthening. This involves exercises which challenge the calf muscles whilst they are lengthening.

Research has also identified a correlation between weak gluteals (buttock muscles) and Achilles tendinopathy. A physiotherapist will be able to identify these areas of weakness and prescribe you specific exercise program to target these muscles.

Cortisone or autologous blood injections are occasionally used in the management of this condition should it not improve with conservative management.

Prevention strategies

Regular strengthening and stretching can help to prevent Achilles tendinopathy.

Specific eccentric strengthening exercises have been found to aid remodelling of a previously injured tendon.

Graded increase of activity no more than 10% each session.

Good footwear.

Good control throughout the lower limb including pelvis, gluteals, knee and ankle.