Posts Tagged ‘sciatica’

Physiotherapy and Early Shoulder Management

Help for shoulder pain

Physiotherapists and orthopaedic surgeons spend significant amounts of time and effort treating shoulder injuries and conditions, of which there are many. The shoulder, an unstable joint with a very large range of movement, the greatest in the body, is vulnerable in many situations to injury or mechanical stresses. Its instability means it can be relatively easily dislocated in a fall or activity at end range. We use the arm to save ourselves if we fall, making fractures common and heavy or overhead work over time leads to rotator cuff tears.Physiotherapists pay close attention to the shoulder as there are many different operations, fractures and degenerative conditions which can affect this area and have an important role in the management of shoulder conditions after elective surgery or trauma, ensuring adherence to the surgical and rehabilitation protocols. On initially seeing the patient a useful strategy is to quickly go over the presenting problem from the beginning as this can indicate errors or misunderstandings which can then be corrected. Physiotherapists should also give the patients an opening so that they can feel they have told their story.After operation or injury the weight of the arm hanging from the shoulder may need to be supported in a sling to reduce pain and allow damaged tissues to rest. The broad arm, triangular bandages are cheap but not comfortable around the neck and difficult to customise to the patient’s specific needs. Putting some foam round the strap at the neck may help slightly but a better solution is to use a Velcro based sling such as the Seton sling. Seton slings are greatly preferred by patients, are more comfortable and are easier to adjust to the specific requirements of the shoulder condition.When fitting the Seton sling the elbow should fit right back into the gutter with the sleeve folded back slightly if necessary to allow the hand to be clear of the sling. There may be a small Velcro strap to place across the upper forearm to keep the gutter closed but this should not be tight or it can cut in to the tissues, especially if there is a lot of thick swelling such as after humeral fracture. The long strap is then taken from the elbow side of the sling over the opposite shoulder and down to the wrist. Tightening this up is where it gets trickier.Due to the materials from which the slings are made there is a degree both of elasticity and friction against surfaces when they are adjusted. As the sling is adjusted and tightened up the elbow is often not well supported by the sling at all and patients are usually aware that the support is not that good. The physiotherapist can easily feel that the sling is not giving the correct support and if they just tighten up the strap it solely tightens up at the front but does not improve the support of the arm. This needs another strategy.Two people are needed to adjust the sling in co-operation, a helper and the patient. The patient is asked to relax the arm as much as they can while the helper lifts the weight of the arm at the elbow, holding it there as they pull the strap from its attachment at the back of the gutter up and over the shoulder, then fixing it there with one hand. Continuing to hold onto the strap which has been pulled forwards the helper unstraps the Velcro fastening of the main strap and tightens it up. Checking the support of the elbow now will show it to be much better supported.Sling management advice is useful for washing and dressing, for which the sling can come off. Putting clothes on should be using the affected arm first and the arm needs to be kept in by the body during the process with no active lifting of the shoulder. For washing if the patient keeps the arm bent by the tummy and bends forward they can get access to wash their armpit easily.

Use ice to decrease pain

Easy Sciatica Exercises

Help for shoulder pain

Sciatica exercises come in many different forms, but the last thing you need when you’re in pain is to have to learn a complicated exercise routine. But using exercise to alleviate sciatica doesn’t have to be difficult. Getting relief can be as simple as doing just one exercise and doing it frequently until such time as the pain is gone or at least much improved.

To figure out what exercise will be of most benefit, it is important to try to distinguish whether you have sciatica from a lumbar disc bulge /herniation, or whether you have a condition called “piriformis syndrome”, which produces symptoms very similar to disc-related sciatica but is caused by contraction of the piriformis muscle in the buttock area.

An easy method to help you determine what the problem is can be done by doing a couple of tests while sitting in a firm chair. In the sitting position, try straightening your knee on the painful side, so that your leg is parallel to the floor. If this increases your symptoms, chances are you have true sciatica related to a disc problem.

The second test is to bend your leg to pull the knee toward your chest. Begin by first bringing the knee on the painful side toward the shoulder on the same side. Then release the leg slightly and pull the knee toward the opposite shoulder. If pulling the knee toward the opposite shoulder increases the pain significantly more than pulling it toward the same side shoulder, chance are you have piriformis syndrome. It should be noted that it is possible to have both true sciatica and piriformis syndrome at the same time.

Once you determine whether you have true sciatica or piriformis syndrome, or both, you can usually get considerable relief from just a single exercise for either condition (two exercises if you have both).

For true sciatica, most people will find relief through the basic McKenzie extension exercise (named for physical thearapist Robin McKenzie). This exercise is performed by lying face down on a firm surface and then propping yourself up on your elbows, creating an increase in the curve of the lower back. Getting into this position may be painful at first, but within about 30 seconds, most people will notice a decrease in the severity or the range of the sciatica, or both. A positive sign is when the symptoms furthest from the spine decrease.

As long as the symptoms are decreasing furthest from the spine, the exercise described is beneficial, even if the symptoms closer to the spine seem to increase at first (they’ll usually improve with repetition of the exercise over time). I suggest you remain in this position for a couple of minutes and then take a break by either just lying flat, or by getting up and walking for at least a few minutes in between the exercise repetitions in order to avoid developing a lot of tightness in the low back muscles.

For piriformis syndrome, you can do a simple stretch of the piriformis muscle. I recommend you do this by lying on your back, pulling your knee on the painful side toward the same side shoulder for a few seconds, then partially releasing the leg and then pulling your knee toward the opposite shoulder. Hold this stretch for about 10 seconds at a time, then carefully release your leg for a a few seconds before repeating the stretch.

Whether you need the McKenzie extension exercise, or the piriformis stretch, or both, the sciatica exercises work best when repeated frequently – up to several times per day while you are having signficant symptoms.

When the symptoms have subsided, it is extremely important to learn what sciatica exercises you can do to prevent the symptoms from returning in the future. Don’t be fooled! Just because the symptoms go away, it doesn’t mean that everything is back to normal. All too often, sciatica sufferers go from one episode of pain to the next, with episodes becoming more severe and more frequent over time, because they fail to manage the problem correctly so you can avoid the common problem of developing chronic pain and disability.

Use ice to decrease pain

Shoulder Fracture? Try Physiotherapy

Help for shoulder pain

Fractures of the humerus are common and make up about 5% of all fractures, with 80% of them either undisplaced or just minimally displaced. More common in people suffering from osteoporosis, it is common to have a forearm fracture on the same side. Damage to the nerves or circulatory system is possible from these fractures but not often seen. Common areas of fracture are the neck of humerus at the top of the arm(fractured shoulder) and the mid shaft of the arm bone. A fall onto the outstretched hand, onto the elbow or onto the shoulder itself is the most common cause of a fractured arm. Since many of the arm muscles insert onto the humeral head, when the injury occurs the muscular action involved can displace the fragments and complicate the management. 65 years old is the peak incidence for this kind of fractured humerus and if younger patients suffer this fracture the likely cause will involve high forces such as traffic accidents or sports injury. If the fracture occurred without significant force then a pathological cause such as cancer must be suspected. On physio examination pain will occur on movement of the shoulder or the elbow, there may be extensive bruising and swelling, the arm may appear short if the fracture is displaced in shaft fractures and there is very restricted shoulder movement. Radial nerve damage is rare in upper humeral fractures but more common in fractures of the shaft, leading to “wrist drop”, weakness of the wrist and finger extensors and some thumb movements.Shoulder Fracture ManagementInitial management is to restrict the patient’s movement and give them enough painkillers to make them comfortable. Upper humeral fractures can be managed conservatively if not displaced but if the greater tuberosity is fractured then an injury to the rotator cuff must be considered, more common in older people, injuries with high forces involved and where there is a lot of displacement. The typical treatment is a collar and cuff sling, allowing the elbow to hang in mid air and keep the humerus in line. Shaft fractures may be managed by humeral bracing. Fractures with three or four parts plus displacement often need surgical treatment, with open reduction surgical fixation (ORIF) more often required in younger patients. In older people the humeral head may be replaced as the fracture may not heal or give an acceptable pain or movement result. Shaft fractures usually heal without surgery (plating or nailing) and are managed in a functional brace.  Complications include frozen shoulder, avascular necrosis of the humeral head in multi-part fractures and nerve injury in shaft fractures. Six to eight weeks is typical healing time with older people often suffering a permanent reduction in shoulder movement. Physiotherapy Management of Shoulder FracturesInitially the physio assesses the arm, asking the patient about their pain level as this varies greatly, examining the swelling and bruising of the arm. The physiotherapist then checks the available range of movement of the shoulder, elbow, forearm and hand. Any muscle weakness and sensory loss is noted as this may denote nerve damage. If not operated on, a sling is continued with and if the fracture is not too painful or severe, early exercises are started by the physiotherapist. Pendular exercises, with the patient bending over at the waist, are important in the early stages as they allow movement of the shoulder joint without much force.Once the three week stage is reached the fracture will have begun to heal and auto-assisted exercises can be started, where the patient helps the affected arm with the uninjured one. This is progressed to unassisted exercises, moving the arm up above the head, behind the back and behind the neck. As the six week point approaches, when the bone has effectively healed, the physiotherapist will start the patient doing more forceful exercises involving gentle stretches at the end of range to improve mobility. Mobilisation techniques to the shoulder joint and strengthening exercises using Theraband are progressed to increase muscle power and joint range.

Use ice to decrease pain

Treating Lumbar Spinal Pain by Physiotherapy

Help for shoulder pain

Low back pain is very common and most people have some experience of a back pain episode at some time of life. Attendances at physiotherapy clinics for low back pain are very high so physios have a variety of assessment and treatment techniques to manage spinal pain and improve patients’ function.

A serious medical condition such as cancer or infection is a very uncommon cause of back pain, but several medical problems can present this way and physiotherapists need to be aware of this so they can refer the patient on to the appropriate doctor. The physio will ask about past medical history (cancer, arthritis, diabetes, epilepsy), any loss of weight or appetite, bladder and bowel control, feeling unwell, sleep disturbance and worse pain when lying down to sleep.

The physio is looking for the patient to react as if they have mechanical spinal pain, a condition where normal physical stresses such as sitting or walking have a worsening or easing affect on the pain. The examination starts by observing the posture and movement of the patient during the questioning and the physio follows this by examining the spinal posture and ranges of movement. Abnormalities of posture are common and not always important, with leg length differences, a reduction or increase in the back curves and a scoliosis being common findings.

Next the physiotherapy examination moves on to active movements. Lumbar flexion is bending over forwards as if the hands are to touch the toes, and the range of movement and any pain is noted. This is repeated for extension and perhaps side flexions and side gliding, all adding to the picture forming in the physio’s mind. The physio may test the hip joints, the sacro-iliac joints, the sensibility, the reflexes and muscle power. Palpation of the spinal joints can tell a skilled physiotherapist about the stiffness and reaction of individual spinal segments, thus localising a problem to a specific level.

With all the information from the subjective and objective examinations the physiotherapist will use their diagnosis to form the goals and plan of treatment. A pain problem will need to be approached with respect, using gentle mobilisations, TENS, stabilising exercises and painkillers. A stiff spinal segment can be mobilised more vigorously with direct manipulations and stronger exercises.

One of the most common therapies for athletes, gym attenders and those undergoing rehabilitation after injury or illness is to perform core stability work. Many Pilates classes are available using this approach to holding a mid-range spinal posture while performing activities. Initial technique is taught on a plinth until the patient has good control then progressed to keeping their stability control whilst performing harder and harder activities, finishing off with relevant functional work.

Spinal joints do not appreciate being at end of their range for too long such as remaining slumped in sitting for a long period. This stretches the ligaments and can cause and maintain a pain problem. Physios teach patients to understand the new strange posture they are being asked to perform is the norm and that they need to perform it regularly until they do it naturally.

Many back pain physios use the McKenzie technique which uses repetitive movement to change the forces which the disc nucleus exerts on the walls of the disc, the annulus fibrosus. An increase in pressure against the posterior disc wall can worsen symptoms while a decrease can improve pain. Repeated movements in one plane establish a “directional preference”, a direction of movement which improves the presenting symptom. McKenzie therapists treat patients depending on whether they have postural syndrome, dysfunction syndrome or derangement syndrome. McKenzie therapy is a popular technique, based on the idea that the disc nucleus exerts a force on the walls of the disc and can cause pain problems.

The treatment from the physio is backed up by advice to the patient to reduce the aggravating stresses on their back by pacing their activity to avoid overdoing. This gives the problem an opportunity to settle and allows the person to get themselves fitter with weight training and aerobic exercise such as swimming or cycling. Many therapies have no supporting evidence, but increasing our fitness has been shown to reduce both the severity and impact of low back pain.

Use ice to decrease pain

Alternative Treatment for Neck Pain; Osteopathy

Help for shoulder pain

Osteopathic Treatment of Neck Painby Andrew MitchellInstead of looking at each symptom of an illness separately, osteopathic medicine is a kind of medicine that looks at your entire body to figure out the best method of treatment.  Osteopathic medicine has become quite popular, especially for people who have problems with muscle and joint pain.  A lot of people insist that when you suffer from neck pain, an osteopath is one of your best resources.  It is understandable, however, that if you haven’t ever visited an osteopath, that doing so might feel scary.  Don’t worry-you have nothing to be scared of.  Here is what you can expect to experience when you visit an osteopath for neck pain treatment:The first part of your visit will be an exam that feels more like a visit to a “traditional” doctor.  You’ll most likely give your complete medical history and also receive a physical examination. In many cases, your osteopath might order extra tests to help narrow down exactly why your neck is in pain.  You might have an X-Ray taken to see if there is any physical damage to the vertebrae in your neck, but don’t be surprised if your osteopath pays attention to other parts of your body as well!  It is important to know that your appointment will involve a lot of physical contact between you and your osteopath.  Osteopathic treatment is very “hands on.”Your Osteopath might use any of the following methods to treat your neck pain:Counterstrain technique:  this technique involves moving you into a position that will help your body restore motion to any of your muscles that might have been strained or restrained.Muscle Energy technique:  In this technique, your osteopath will prescribe specific exercises.  These exercises will start you in specific poses and move your muscles in specific ways.Soft Tissue technique:  this technique involves your osteopath putting pressure on the muscles that are near and around your spine.  Sometimes the pressure is deep, other times it involves traction or rhythmic stretching.Thrust technique:  Your osteopath will use a high velocity force to reintroduce movement to your joints and muscles.  Thrust is used to correct any asymmetry in your muscles. This method should also take care of any restricted movements, tissue changes or muscle tenderness you might have been experiencing.   Your osteopath might also use a low level laser or acupuncture techniques to help treat your neck pain.This might sound very scary but don’t worry-most people don’t experience any pain when they visit their osteopath for neck pain treatment.  In fact, most people who visit osteopaths find their treatments to be relaxing and pleasant! A number of people often confuse osteopaths with chiropractors, but it is important to understand that the two professionals, while seemingly similar, are actually quite

Use ice to decrease pain