Friday, 30 September 2011
This month I am going to talk about myofascial headaches, what this is, how it occurs and how a sports therapist, sports massage therapist or physiotherapist can treat it.
What is a Myofascial Headache?
Myofascial headaches are caused by myofascial pain, which is defined as a regional pain syndrome, characterized by referred pain from a trigger point located in a taut band of muscle (1). This pain can manifest itself in the form of either unilateral or bilateral headache. The pain duration can vary between hours to weeks and is usually of a moderate severity. This pain can radiate into the frontal, temporal and orbital regions (2).
What is a myofascial trigger point?
The simplest way to describe a trigger point is an area of thickening or a nodule in a muscle. This will also be an area of tenderness. Trigger points develop in muscles that are either over active or in areas of weak musculature (1). There are a number of myofascial trigger points that can cause headaches. Most of these are found in the musculature of the neck and shoulders. The muscles that are particularly susceptible are the Trapezius muscle, Levator Scapulae, Temporalis, Frontalis and Occipitalis. These cause tension on the insertion points at the Occiput this in turn radiates pain across the cranium. Treatment for Myofascial Headaches
A sports therapist or physiotherapist is able to affectively treat this sort of injury with the use of vertebral mobilizations, soft tissue massage as well as stretching and possibly some strengthening work. The use of myofascial trigger pointing and dry needling are affective ways to release the triggers. This will release the tension on the insertions of the occiput.
References
1. Skootsky S.A., Jaeger B., Oye R. K: Prevalence of myofascial pain in general interal medicine practice. West J Med, Aug. 1989, 151: 157-160
2. Hooper P. D: Treatment of head pain, Williams & Wilkins, 1994, pp 333-4
Tuesday, 30 August 2011
This month the focus is lateral Epicondylitis of the elbow or its more well known name; Tennis elbow. I am seeing quite an increased number of cases of this injury recently. Over the next two months I will also look at Golfers elbow and elbow bursitis. It is important to remember that these injuries tend not to be just sports related but can be traced back to occupational related factors.
What is Tennis Elbow?Tennis elbow or lateral epicondylitis is the onset of pain on the lateral (outside) of the elbow. The pain has a gradual onset with tenderness appearing around or below the bony prominence. The injury tends to affect the suffers ability to grip, lift or carry items with the affected arm.
How does the injury occur?
The injury is caused by tiny micro tears in the tendon and fascia, which after the initial healing will tear again leading to hemorrhaging leading to the formation of granulation tissue, as well as calcium deposits around the tissue. Collagen and proteins leak from the site of injury causing inflammation. This leads to increased pressure around the joint that can cut blood supply and also impinge on the radial nerve.
What are the symptoms?
The pain is recurring around the outside of the upper forearm. This is just below the joint line of the elbow.
The pain can be aggravated by lifting, bending or grasping even lightweights, such as a coffee mug. There can also be pain when extending the forearm; this is due to the inflammation of the muscles and tendons.
How to treat this injury
The first thing to do is stop any activity that aggravates the arm. This is ok for sports related factors, but not so easy for people who are getting aggravation from working. The use of an elbow support can help to reduce the aggravating factors.
Seeking the correct treatment is the second, but equally important part of the healing process. Your Sports Therapist or physiotherapist will use a range of treatment techniques such as ice massage, standard soft tissue massage, ultrasound, kinesio taping, advise on anti inflammatory use as well as stretching and strengthening of the muscle groups. After the initial inflammation and pain subside it is key to full recovery that strengthening work is facilitated as this will help to reduce the risk of future onset of the injury.
Tuesday, 5 July 2011
With the summer now upon us, and running becoming increasingly more popular, I thought it would be a good time to discuss a common running injury. This month I am focusing on Iliotibial Band Friction Syndrome (ITBFS) also known as Runner’s Knee. This is a condition that causes an ache or pain over the lateral (outside) aspect of the knee and is aggravated by running activities. The Iliotibial Band (ITB) is a tendinous extension of the fascia (connective tissue that surrounds many structures in the body) which covers the Gluteus Maximus and Tensor Fasciae Latae muscles; and attaches to the tibia (shin bone). This injury occurs due to friction between the ITB and the lateral epicondyle of the femur (end of the outside aspect of the thigh bone) and is commonly the result of overuse. Signs and Symptoms:
Athlete’s who are experiencing ITBFS tend to have a dull ache over the lateral (outside) aspect of the knee, which becomes aggravated and turns to pain when running. During examination the athlete may have pain or tenderness approximately 2cm above the lateral joint line of the knee. There may also be swelling present over the lateral epicondyle. If you are running a consistent route, the pain tends to come on approximately around the same distance/time. Repeated flexion/extension (straightening and bending) of the knee can also reproduce the symptoms.
Causes:
There are many different factors that can predispose an individual to ITBFS. These can include excessive foot pronation (flat feet), which can lead to an increase in internal tibial rotation. This in turn places added stress on the ITB and tightens the following muscles: Gluteus maximus, Tensor Fascia Latae, hamstrings, quadriceps. Differences in leg length can also predispose an individual to ITBFS. All of these factors, in combination with running downhill, on cambered roads or for a long duration can all lead to ITBFS.
Treatment:
Treatment of ITBFS is varied and there are many different modalities, which can be used. Some of which may include activity modification to avoid all pain provoking exercise. Symptomatic relief such as ice or ultrasound therapy and soft tissue therapy, which would be aimed at correcting any excessive tightness within the ITB, combined with frequent stretches of the ITB and other tight surrounding structures. Myofascial release has been shown to be one of the most effective treatment methods to relieve ITBFS symptoms, either via a therapist or self release using a foam roller (picture below).Strengthening of the hamstrings, quadriceps, gluteus medius and gastrocnemius are also key during the rehabilitation process to prevent the injury recurring. Kinesio tape is also a beneficial treatment for ITBFS. As demonstrated during our recent Forces March (5 marathons in 5 days), where this treatment method was repeatedly used with excellent beneficial effects.
Monday, 6 June 2011
This month I am talking about cryotherapy on acute injuries. Cryotherapy is perhaps the simplest and oldest therapeutic modality in the treatment of acute injuries. It is the therapeutic application of any substance to the body that causes a decrease in body heat, resulting tissue temperature reduction.
An acute injury is an injury of rapid onset and is usually the result of a specific movement/impact or traumatic event. Acute injuries are either the result of extrinsic (outside your control) or intrinsic (within your own body/control) risk factors. These injuries can occur to muscles, tendons, ligaments, joints, bones, plus many more structures with the human body. Examples of acute injuries are fractures, dislocations, muscle/ligament/tendon strains etc.
The Effects of Cryotherapy:
Whenever an injury occurs, there will always be some form of both inflammation and pain. It has long been believed that the use of cryotherapy as a treatment modality can aid in the reduction of both swelling and pain, both immediately and during the rehabilitation process. Edema (swelling) occurs due to an increase in local blood flow, meaning that more blood is sent to the injured site. This is the body’s own self defense mechanism to prevent further damage to the area. However, too much swelling can result in an increase time to recovery, as this needs to be removed before sufficient treatment and rehabilitation can occur. This is where cryotherapy comes into play.
The application of cryotherapy causes a reduction in tissue temperature around the injured site resulting in constriction of the local blood vessels, therefore reducing blood flow and edema in the injured area. Also by minimising the amount of edema early on, this can help to reduce athlete pain as the nerve endings (which send signals to the brain indicating pain) at the injury site will not be as compressed and as a result the athlete will experience a smaller amount of pain. Therefore, following an injury, the sooner cryotherapy is started; the greater the benefit for the athlete during their recovery.
What can be used for cryotherapy?
There are many different items that can be used for cryotherapy. These can be extremely simple and cheap or complex and expensive. Below are just a few examples of each:· Reusable frozen gel packs (Cheap)
· Instant ice packs (Cheap)
· Ice cubes in a plastic bag (Cheap)
· Game Ready Machine (Expensive)
· Cryo Cuff Machine (Expensive)
When applying cryotherapy, for best results in edema and pain reduction, apply with compression and elevation.
Thursday, 5 May 2011
Kinesio taping is a technique I use in my clinic that has been given a lot of attention in the press throughout 2010.
Kinesiology taping was first made popular at the Beijing Olympics in 2008. The technique has been developed by Dr Kenzo Kase over the past 25 year, and can now be seen in most sports including football and rugby to name but a few.
Kinesio tape is applied over muscles to reduce pain and inflammation, relax over used muscles, and to support muscles in movement on a 24hr/day basis. It is a non-restrictive type of taping that allows for full range of motion. It is not a fixation tape like most traditional tapes, nor does it obstruct the flow of fluid.
Monday, 21 March 2011
This month I am concentrating on over-pronation of the foot, also known as ‘flat feet’. Normal gait cycle of the foot would see pronation of the foot. This is when the foot rolls inwards and the arch flattens. As well as the opposite of pronation, which is supination.
Problems with pronation of the foot occur when it is excessive.
This is quite a common problem and can lead to a number of
injuries such as plantar fasciitis, Achilles tendonitis and shin
splints. The picture below shows someone who overpronates.
The right foot rolls inwards, which causes the lower leg to turn inwards. This puts the knee and hip out of alignment. The left foot has been corrected with an orthotic device.
Does this cause injury?
Excessive pronation usually causes over-use type injuries, most frequently seen in runners.
How can I tell if I overpronate?
1. Look at your feet in standing; have you got a clear arch on the inside of
1. Look at your feet in standing; have you got a clear arch on the inside of
the foot? If not, you maybe an overpronator.
2. Look at your foot wear. If they are excessively worn on the inside of the sole, pronation maybe a problem for you.
3. The wet foot test, with wet feet (be careful you don’t slip over) walk along a section of paving or carpet and look at your footprints. If you overpronate your footprint will be wider. See images below.
2. Look at your foot wear. If they are excessively worn on the inside of the sole, pronation maybe a problem for you.
3. The wet foot test, with wet feet (be careful you don’t slip over) walk along a section of paving or carpet and look at your footprints. If you overpronate your footprint will be wider. See images below.
What can I do?
Speak to a professional, who can analysis your gait pattern and tell you about your gait.
For more information go to www.revolution-ukhealth.co.uk
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