Matt Crawshaw

What is Carpal Tunnel Syndrome?

The small bones in our wrist form one side of a tunnel and a ligament (or retinaculum to more specific) forms the other side. In this tunnel, called the Carpel Tunnel sit many tendons which are used for gripping and bending the wrist into flexion. The median nerve also sits in this tunnel. There is only a certain amount of space in the tunnel. If the tendons get irritated by overuse they will naturally swell and increase the pressure within the tunnel and compress the median nerve. Other reasons why pressure within the tunnel can increase can be the effects of pregnancy.

Print

Symptoms include burning wrist pain on the palm side with numbness and pins and needles in the distribution of the Median Nerve. That is the thumb, index finger, middle finger and thumb side of the ring finger. Nocturnal pins and needles is common. Pain can radiate to the forearm, elbow and shoulder. Diagnosis is achieved through history taking and holding the wrist in prolonged flexion to reproduce symptoms. Tinsel’s sign can also help reach a diagnosis. This test comprises of repetitively tapping over the wrist on the palm side where the Median Nerve passes to reproduce symptoms.

Mild cases can be treated effectively with anti-inflammatories and physiotherapy. 1024px-Carpal_tunnel_splintA Physiotherapist will release the tension from the muscles and tendons that flex the wrist and fingers and provide stretches for a patient to do. Additionally a physiotherapist will provide a splint which keeps the wrist in a neutral position for the irritated Median Nerve to settle.  For more severe cases simple surgery to create more space in the tunnel can be done.

Don’t Sit on Your Wallet

Think about what bone you sit on. It’s called the Ischial Tuberosity. It is at the base of your pelvis which provides the base for your spine to fit in. You can imagine if one side is pushed higher the effect it has on your pelvic alignment and spinal alignment. As your pelvis and spine are deformed with activities such as sitting on a wallet, ligaments holding your pelvis and spine together stretch. Do it long enough and the laxity of these ligaments can increase permanently, leading to chronic spinal or pelvic misalignment and instability.

Symptoms caused by this could be sciatic pain, glut and or lower back pain. Additionally this can effect the ability to exercise. Leading to a truckload of problems. Sitting-on-a-wallet

With the current use of cards that you tap, thick wallets should be a thing of the past. However even a thin wallet used consistently over time will create enough disturbance in the bones and joints of your lower back and pelvis.

Clinically we see pelvic instability a lot. Wheather it be postnatally, injury related or degeneratively. It can be a real tough problem to fix with lots of work for the patient to do themselves. So the best medicine in this case is definitely prevention.

 

 

Neck Pain and breathing

The knowledge of how to breath with your diaphragm comes pre-programmed in every new baby. It is well understood and implemented by the infant with no complications.

How does breathing get messed up and lead to neck problems?

The diaphragm is your primary breathing muscle. It is a thin, wide sheet of muscle that separates the rib cage from the abdomen. It has a high domed shape which flattens out significantly when it contracts. The dome-shape is much more pronounced than most people realise, and that shape is important to understand.

breathing-hydraulics-s                Unknown

When the diaphragm contracts, that dome flattens significantly to allow space for the lungs to expand. As it flattens it pushes downwards on the viscera in your stomach. As the viscera is like liquid, which can not be compressed, the stomach must bulge out to accommodate the action  of the diaphragm. Hence, good breathing is usually described as “abdominal breathing” or “diaphragmatic breathing.” So the stomach in a person breathing correctly looks a bit like the happy buddha when they are breathing in.

The innocent infant grows into a self conscious teen and adult who responds to cues around them to keep their tummy in, in response to vanity. Smaller, less efficient muscles in the upper chest, throat and neck designed to help breathing in times of high demand (like running) are recruited to do the every second of every day task that is breathing. These are called accessory muscles e.g.. pectorals minor and scalenes. These are small muscles which quickly become overused and tight, leading to poor muscle stability around the shoulder and neck. See the connection to neck pain !

How to practice breathing your diaphragm

1. Lie on your back – put one hand on your chest and one hand on your tummy. As you breath in, allow your tummy to rise (do not push it up) while your chest does not move. To breath out, allow your tummy to flatten. Practice this in different positions. Sitting is the hardest. Practice this during different tasks and activities such as walking, gym, hanging out the washing etc.

2. To strengthen/condition your Diaphragm you can put a large heavy book on your stomach while lying on your back and practice diaphragm breathing with the extra weight of the book on your stomach. You could start by doing 20 breathes once a day and build up to more if you feel comfortable.

Ischaemic Heart Disease

We are all familiar with the cause of a heart attack (not enough blood getting to the heart) or stroke (not enough blood getting to the brain). How does this happen?

Atherosclerosis is the build up of plaque in the vessels carrying blood to the brain or heart. A good diet and lots of exercise are important to keep plaque to a minimum. The tricky bit comes when Men start to age a little, their capacity to exercise diminishes somewhat due to general aches and pains, accumulation of small injuries over many years or degeneration of joints.  This coincides with a Man’s time of life when he is more vulnerable to a heart attack or stroke. Therefore, there is an acute need to not allow these relatively innocuous ailments to reduce exercise capacity.

Strategies to improve exercise tolerance includes

1. Finding the correct type exercise for a Man’s capacity. e.g. if walking/running is too hard then try cycling or swimming

3. Finding the correct intensity of exercise to match a Man’s capacity. e.g. if walking up and down hills is too much then walk on the flat.

2. Get professional medical help to deal with musculoskeletal problems to allow better exercise capacity

Men’s Health is gathering momentum in the general community. Men have a much higher prevalence of Ischaemic Heart Disease than Women. When basic solutions can make a big difference Men need to devote enough attention to themselves to keep exercising from middle to old age.

Running and Knees

Runners knee pain 

The most common type of knee pain is pain around the knee cap (patella) and can come on as load, like increased running distance and time, is increased. A common time when this occurs is when a runner is training for a running race like a half marathon or marathon.

Why? Because if there is any problem with the biomechanics of the pelvis, hip and foot the most common site for pain to present is at the anterior knee as it attempts to transfer load from the core to the ground

.002small-file

If you start to feel any type of knee irritation during your running  training come to Sydney Physiotherapy Solutions so the biomechanics of your running can be addressed before pain stops you running for long periods of time. Better yet, before you increase load on the knee come in and get a full running assessment to get the tick for good biomechanics or a program to address any biomechanical problems.

We are the experts at running assessments and have the latest technology, including Dorsa Vi, to assess your running style.

If your underlying problem revolves around your pelvis and hip we have dedicated Physiotherapist who are Pilates Instructors to teach you superior core control specific to runners needs.

If the underlying problem is your feet we have a strong relationship with the best professional running shoe facility in Sydney.

The movement of running is beauty in motion when done correctly. The trick is knowing what is ugly and how to make it beautiful.

Pelvis Problems

Pelvis Problems……you say Potato , I say …. Chronic Pelvic Pain Syndrome, Pudendal Neuralgia, Pelvic Dysfunction, Sacro Illiac Dysfunction.

The Pelvis is so misunderstood; we as a society have difficulty even finding a consensus on how to name problems with it. Here are a few names which really mean the same thing –

  • Chronic Pelvic Pain Syndrome
  • Pudendal Neuralgia
  • Pelvic Dysfunction
  • Sacro Illiac Dysfunction

When this confusion is combined with the difficulty some patients have talking about their very personal issues, we are left with poor communication between patients and medical practitioners and often lost and depressed patients.

Patients may see a range of doctors and specialists. In fact it is important that all medical explanations be investigated. Sometimes there is no convincing diagnosis. Sometimes a patient is correctly diagnosed and then sent to a physio/chiro/osteopath who does not treat the issue completely and the results are not good enough.

To treat this problem from a musculoskeletal view the practitioner must have an excellent understanding of the relationship between the thorax, lower back and the pelvis. If this relationship is not good the patient’s core loses the ability to stabilise, and two things can happen. One side of the Pelvis can rotate and irritate the Pudendal Nerve, which goes to the perineum, or the pelvic floor muscles try too hard to create core stability. If the pelvic floor muscles are overused they become tight, develop trigger points and cause pain and dysfunction.

These conditions, or should I say this condition, has symptoms which include:

  • Pain, tingling, numbness, burning and / or sharp stabs anywhere from the anus to the head of penis or labia.
  • The patient may have associated thigh, leg, buttock or back pain.
  • The patient may have urinary problems
  • Men may have pain with ejaculation, or delayed onset of pain post sex
  • The patient may have increased symptoms with sitting

It may be a mixture of these examples

Two highly experienced senior physiotherapists are now combining their knowledge to overcome this problem. Stuart Baptist is a men’s pelvic floor physiotherapist at the forefront of his field. I am a thorax, lower back and sacro-illiac joint physiotherapist who helps both men and women with pelvic problems.

If you are suffering, chances are you can be helped. Contact the front desk, 9252 5770  for an initial consultation.