Sprained Ankle

An ankle sprain occurs when the medial or lateral ligaments of the ankle are overstretched when the ankle unexpectedly ‘twists' during normal walking or sport. The unexpected force of the body weight through the ligament is too much for the ligament to bear and it tears. These tears can be complete or partial. Sometimes rather than tearing the ligament pulls on the bone so hard that it pulls a piece of bone off! This is called an avulsion fracture. In the case of complete tears of the ligament and avulsion fractures the ligament cannot heal. Good muscle control is important for future stability of the ankle. Partially torn ligaments take 6-8 weeks to heal.

The ligaments pictured (below) are commonly sprained:

Ankle sprains are more complicated than just a damaged ligament. Muscle weakness, joint stiffness, and poor proprioception (your body's sense of where various limbs are at all times) decreases quickly. This is because the leg and foot are not used normally during the period in which the ligament is healing. If these complications are not prevented recurring ankle pain and sprains can result.

WHAT YOU CAN DO TO HELP

Many people delay the healing of the ligaments by attempting to go back to normal activities too early. Remember, with sprained ankles, pain means STOP.

You should:

• Rest. Decrease the amount of time on your feet. If the swelling increases you have been up on it too much.

• Elevate the foot intermittently throughout the day.

• Ice 20-30 minutes 2-3x a day with a damp cloth around the ice pak, in elevation

• Wear low heeled or flat shoes.

• Perform the exercises prescribed by your Bodymoves Physiotherapist.

Long term: Depending on the severity of the sprain you may benefit from an ankle brace or preventative ankle taping each time you play sport.

HOW PHYSIO HELPS

Many people have ankle sprains and never undergo proper rehabilitation. Without this the chance of recurring pain and sprains is high.

Your Bodymoves Physiotherapist will:

• Help reduce swelling and pain though application of ultrasound, electrotherapy, and compression bandaging.

• Instruct on balance and proprioceptive exercises.

• Teach strengthening exercises.

• Instruct on use of crutches if needed.

• Strap the ankle to make walking easier.

• Advise you on when to return to sport.

• Recommend ankle braces for sport.

Exercises

• Theraband - inversion and aversion

• Calf strengthening

• Calf stretches

• Proprioception - toes, heels, balance on one leg

• Later - hop and stop, throw ball, trampoline, fig 8's, running

• ROM - avoid pain when exercising.

• Move foot up and down and in and out.

• General - keep ball of foot supported when long sitting to avoid your ligament healing in a lengthened position.

**Disclaimer - This article is intended to be used in conjunction with the advice of a physiotherapist. Please see your doctor or physio if you think you have ANKLE problems.

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Acute Back Pain

Severe back pain can come on quite suddenly with a seemingly harmless movement. This is because poor posture, incorrect lifting techniques, and aging cause the discs, ligaments and muscles in the back to weaken. There are not many pain receptors in the deep tissues of the back so there are often no warning signs that the back is being irritated.

The source of the back pain can be a strained facet joint (see diagram), a tear in the disc, a pulled muscle, or irritation of a nerve. The pain is often felt below the area that is actually injured - buttocks, pelvis, and down the legs. Pins and needles, weakness, and numbness can indicate that some nerve compression is present.
WHAT CAN I DO?

Most people try and continue with their normal activities, pushing through the pain, hoping it will go away. This can make it worse. If your pain hasn't improved significantly in the first 2-3 days it probably won't unless you have some treatment. You can help yourself a little however by:

• Relative rest. Avoid all lifting and bending activites, including sustained slight forward bending. This means no gardening, mowing, vacuuming, etc.

• Lie down in a comfortable position several times a day. In the horizontal position the back can relax.

• Sit ALWAYS with a low back support (rolled towel, or cushion)

• Try an ice pack with a wet towel for 20-30 mins over the lower back in the first few days. Sometimes heat for 20 minutes is preferred.

• Don't sit for too long (>30minutes) Mainly stand, walk, or lie down. Avoid staying in one position for too long.

HOW PHYSIO HELPS

Back pain needs to be treated seriously. Mild twinges can be a warning that a severe injury is looming. If your back is left untreated recurring back pain can occur. Your Bodymoves Physiotherapist will:

• Diagnose the likely source of you pain.

• Relieve your pain and inflammation with massage, ultrasound, and electrotherapy.

• Use manual techniques such as joint mobilization and manipulation and muscle energy techniques to help restore normal joint position and relieve muscle spasm.

• Educate re correct posture and body mechanics to avoid recurrence.

• Prescribe exercise to correct muscle weakness or tightness that my have contributed to the injury.

• Advise re: return to work and sport

**Disclaimer: This article is intended to be used in conjunction with the advice of a physiotherapist. Please see your doctor or physio if you think you have BACK PAIN.

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Pregnancy - Exercise safely during and after pregnancy

Exercise during Pregnancy

Many expectant mothers are often unsure when it comes to exercise during pregnancy. Questions about the type of exercise, effects on the baby and activities to avoid are often raised. This information sheet aims to answer these questions and also provide important information to expectant mothers regarding safe and effective exercise during pregnancy.

So why exercise? Exercise during pregnancy can help you feel physically and mentally prepared for pregnancy, labour and the period after birth. There is also evidence that suggests that the baby of an exercising mother may tolerate labour better than non-exercising mothers1.

However, exercise during pregnancy needs to be conducted in a way that ensures the safety of both mother and baby. The following are some hints and tips to guide safe exercise during pregnancy.

• Exercise regularly, for short periods at a moderate level. By exercising three to five times a week for 30 minutes to an hour your body will feel the benefits of exercise without causing fatigue or undue stress on your pregnant body. During exercise you need to monitor how hard you are working. As an easy guide, during aerobic exercise (walking, swimming and cycling) you should be able to hold a conversation without getting breathless. Also, your heart rate should not exceed 140 beats per minute.

• Take care not to overheat by;

• Avoiding exercise in hot and humid conditions

• Wearing loose, comfortable and lightweight clothing

• Drinking plenty of water before, during and after exercise

• Positioning yourself near a fan or air-conditioner if possible
• Avoiding saunas, spas and hot baths or overheated pools

• Ensure you include a warm up and long cool down in your exercise session. The cool down will stop blood pooling in the legs and prevent leg cramps. If you do stop exercising too suddenly you may experience a drop in blood pressure which can cause you to feel light-headed and faint.

• To maintain your blood sugar levels during exercise, eat some carbohydrates (slice of bread, fruit) 1-2 hours before exercise. Also, carry some fruit juice with you during exercise to keep your sugar levels topped up.

General Guidelines;

These are to be used only as a guide, if you are unsure about your exercise regime during pregnancy contact your physiotherapist for advice.
- Continuing with contact sports during pregnancy is not advisable
- Non-contact sports can be continued as long as comfortable
- Avoid exercise when you are unwell
- Avoid long periods on your back after 16 weeks

The following is a general guideline of safe exercise during the trimesters of pregnancy

0-3 months

- Expectant mothers that have attained a high level of fitness before pregnancy can continue regular activity at a reduced intensity. They should also expect a decrease in their activity and fitness levels as pregnancy continues.
- For expectant mothers starting a new exercise routine, a low impact exercise program is recommended. This includes walking, swimming, gym programs, cycling, low impact aerobics and aqua aerobics. Start with 15 minutes of continuous exercise 3 times a week and gradually build up to 30 minutes 4 times a week.
- Abdominal crunches and sit-ups should be avoided.
- Commence deep abdominal and pelvic floor exercises

3-6 months

- Low-impact exercise can be continued. However, modify the intensity, weights and type of exercise to ensure you feel comfortable.
- Pregnancy back stretches
- Continue deep abdominal and pelvic floor strengthening
- Squatting, flexibility and stretching exercises can be added to prepare for birth

6-9 months

- Continue as above according to comfort levels

Exercise should be stopped immediately and medical attention sought if any of the following occurs;
- Dizziness, headaches, blurred vision, nausea, vomiting
- Pins and needles or numbness in the body
- Discomfort or excess fatigue after exercise
- Vaginal bleeding, contraction, leaking of amniotic fluid or decreased movement of your baby.

1. Paisley TS, Joy EA, Price RJ. Exercise During Pregnancy: A practical approach. Curr Sports Med Rep 2003;2:325-30.

 

Exercise after Pregnancy

Just as exercise is important during pregnancy, exercise is essential after the birth of your new child. A specific exercise program after birth will help you return to normal function quickly and will ensure you have the energy to keep up with the lifestyle changes that come with the new addition to the family.

Benefits of exercise after birth include;
- Improved fitness
- Weight loss
- Improved mood and energy
- Decreased anxiety and depression
- Reduced stress incontinence

However, a safe approach to exercise after pregnancy is of utmost importance. During pregnancy the body undergoes a number of changes, and after pregnancy the changes are slowly reversed. This means that activity also needs to be added gradually to allow the body to return to normal without any undue stresses. Did you know it can take up to 6 months after birth for the ligaments in your body to return to normal? So, remember to take it slowly!

So, when can you start exercising again?

As a guide, if your pregnancy and delivery was uncomplicated, a mild exercise program of walking and pelvic floor exercises can begin in the first few weeks as you feel comfortable1.

If pregnancy and labour was complicated or delivery was by a caesarean section, a physiotherapist should be consulted before starting an exercise program1.

General Guidelines

-Initially concentrate on the pelvic floor and deep abdominal exercises given to you by your physiotherapist in hospital which will help protect your back and joints and improve your posture
-Have your abdominal muscles assessed by a physiotherapist as the exercises given to you in hospital may need to be modified
-Get advice from a physiotherapist to design a specific exercise program for you
-Avoid jumping and jarring exercises (eg. high impact aerobics) for the first 4 months.

General Post Pregnancy Exercise Guide

0-3 weeks
- Walking
- Deep abdominal and pelvic floor exercises

3-8 weeks
- Walking
- Swimming
- Gym Program with light weights
- Continue deep abdominal and pelvic floor exercises

8-12 weeks
- Increase weights and intensity of exercise
- Increase difficulty of deep abdominal and pelvic floor exercises (eg. add arm, leg movements)

12-16 weeks
- Have abdominal and pelvic floor strength assessed before returning to high impact exercise/running/sport
- Continue a regular abdominal exercise program

16 weeks+
- Return to previous level of activity if pelvic floor and abdominal strength is normal

Precautions
Exercise needs to be stopped if you experience;
- back pain
- vaginal or pelvic heaviness
- urine loss
If the problems persist seek further advice from your Dr or physiotherapist.

1. Kochan-Vintinner A. Active Living During Pregnancy: Physical Activity Guidelines for Mother and Baby. Ottawa: Canadian Society for Exercise Physiology and Health;1999.

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Knee Injuries - Cartilage

Does your knee click, pop, or make other interesting noises? Does your knee hurt when you turn on it when walking/running? Does it swell up slightly after activity? Do you get sharp catches of pain, or occasions in which the knee locks? You could have a cartilage injury. The cartilage in medical terminology is called the MENISCUS.

The meniscus is a C-shaped structure inside the knee joint. There are 2 in each knee. They serve very important functions:

• They provide STABILITY - in conjunction with the ligaments

• They provide SHOCK ABSOPRTION - without the meniscus the bones of the knee joint are more likely to develop arthritis

• They provide LUBRICATION and NUTRITION to the knee joint

Front view:

Internal view from front:

HOW DOES IT GET TORN?

There are two types of tears - degenerative and traumatic, and a combination of the two:

• Degenerative - The meniscus deteriorates in all people with age and can tear with normal activity. If you've done a lot of squatting on your heels in your life (eg. plumber), you are more likely to experience degenerative tears.

• Traumatic - These occur when twisting forces are experienced by the knee, such as twisting the leg and body on a fixed foot. eg. stepping and turning in a game of football/soccer. Twisting forces through the knee can cause tears and are often associated with ligament damage. The knee is a hinge joint and does not like twisting movements.

Combination - A middle aged woman experiences knee pain after packing up and moving house. This is probably due to a slightly age degenerated meniscus tearing whilst she repeatedly squats to pack up.

WHAT YOU CAN DO TO HELP

Once diagnosed with a meniscal injury you need to do the following:

• Relative rest - decrease the amount of time you spend on your feet, particularly any jarring activities such as jogging. Some people need to use crutches in the acute stage.

• Avoid twisting your body while keeping you feet fixed. Eg. Cooking in the kitchen and turning between the bench top and fridge.

• Ice : Apply with a wet towel for 20-30 minutes. The back of the knee and the inner side of the knee are often swollen.

• Supportive strap - an elasticized strap from a pharmacy can be helpful in relieving pain as it relieves the load on associated ligament damage.

• Exercise - as shown by your Bodymoves Physiotherapist to prevent muscle weakness.

HOW DOES PHYSIO HELP?

Your Bodymoves Physiotherapist will:

• Determine what structures you have damaged.

• Instruct on strengthening exercises and balance exercises.

• Use ultrasound and electrotherapy to encourage healing and decrease inflammation in the meniscus.

• Recommend referral to a GP or specialist if needed.

• Advise re return to sport.

• Identify and treat muscle imbalances/tightness.

In CHRONIC meniscal problems, or those who suffer repeated tears, co-contraction exercise for the quadriceps and hamstrings improves your knee control and decreases ongoing pain and flare-ups.

SURGERY

Surgery on mensical tears is done via an arthroscopy, (through tiny incisions with a miniature camera). It is usually done on large tears, or on smaller tears if other treatment has failed. It can involve stitching up of the torn meniscus, or removing a flap of meniscal tissue. The aim is to save as much of the meniscus as possible. Physiotherapy is required after surgery.

**Disclaimer - This article is intended to be used in conjunction with the advice of a physiotherapist. Please see your doctor or physio if you think you have MENISCAL problems.

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SORE KNEECAPS /PATELLA PROBLEMS (KNEE PAIN)

The patella (or kneecap) is a common cause of knee pain. The patella rests on the front of the femur (the thigh bone) forming a joint called the patellofemoral joint. It is this joint that causes problems.

WHY DOES IT HURT?

The primary cause of patella pain is poor tracking (or movement) of the patella. Like a train running on railroad tracks, the patella needs to run smoothly over a track in the femur. When it runs off track it hurts.

The patella experiences forces from four directions. If one of these forces becomes too strong or too weak, the knee cap is pulled off track. Maltracking problems can be caused by:

• A weak VMO (vastus medialis muscle - the inner thigh portion of the quadriceps. See Diagram 2)

• Tightness in the muscles on the outside of the thigh.

• Arthritis.

• Traumatic injury, such as a patella dislocation.

• Flat feet.

• Deficits in the bony groove that the patella sits in.

• Knocked knees.

• Tight quadriceps

A side view of the knee:

Diagram 1:

The leg on the right has a flat foot, which causes the entire leg to rotate inwards in order to get the foot on the ground. This causes irritation of the patella and patella tendon.

Diagram 2:

Vastus medialis

Closely related to patella pain is pain of the patella tendon. (See Diagram 2 above) This experiences abnormal loads when there are tracking problems, or a tight quadriceps muscle. There is a fat pad under the patella tendon, which can also become irritated.

Muscle tightness occurs commonly in those that participate in land based sports such as tennis, jogging, soccer. The more frequently you play sport, the more likely you are to get tight muscles and have patella problems.

WHAT YOU CAN DO TO HELP

• Relative rest. Many people experience their pain after or during sport. If this is the case you need to rest from sport for a few days.

• Ice. Apply ice in a wet towel for 20-30 mins to the painful area of the patella. When you first return to sport, it is a good idea to ice immediately afterwards.

• Stretch before and after sport, particularly the quadriceps and calf muscles.

• If you are a RUNNER be aware of the following poor training habits:

• Avoid running on the side of the road as this slopes towards the gutter, increasing strain on the patella.

• Avoid running on slippery surfaces.

• Change your running shoes every year or 6 months, depending on how much you run.

• Avoid sudden increases in your training distance, and its frequency.

• Be wary of route changes that may involve increased hill running.

HOW PHYSIO HELPS

Your physiotherapist will:

• Examine your lower limbs to identify muscle imbalances and abnormalities in the bony alignment. Particularly of interest is the positioning of the feet. If you have flat feet, you may need orthotics. Your physio can supply and fit these to you. (See Diagram 2 above)

• Identify what structures are causing the pain. Is it the patella tendon, the fat pad, or the patellofemoral joint itself?

• Discuss with you what has caused YOUR pain to come about.

• Apply ultrasound and electrotherapy to decrease your inflammation.

• Perform deep tissue massage to tight muscles.

• Instruct you on specific exercise to strengthen the VMO muscle.

• Instruct you on correct stretching techniques.

Most patella pain resolves quickly once the cause is identified. Many people need only 2-3 treatments. Rest on its own generally isn't enough, as once sport is re-commenced the problem will return as the causative factors have not been addressed.

**Disclaimer - This article is intended to be used in conjunction with the advice of a physiotherapist. Please see your doctor or physio if you think you have PATELLO-FEMORAL problems.

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PAINFUL ARCHES - /PLANTAR FASCIITIS (SORE FEET)

Do you have pain in your arches or the bottom of your heel? You could be suffering from the common condition known as plantar fasciitis. The plantar fascia is the connective tissue that supports the bones of the foot and maintains the arch. When this becomes inflamed you have plantar fasciitis. The inflammation most commonly occurs at the fascia's attachment to the heel bone.

Plantar fasciitis is an overuse injury. It may build up over a period of weeks or months. This is because when you walk or run your fascia absorbs load every time your foot lands on the ground. If you increase the amount of walking or running you do, the fascia needs to absorb stress more often and may get inflamed. People who pronate (flat feet) are more likely to have problems, as their fascia is required to absorb more force.

WHAT YOU CAN DO TO HELP

• Rest: You MUST decrease or stop exercising. Don't exercise until you can do so without pain.

• Ice: In the acute stage, apply ice wrapped in a wet towel for 20-30 minutes to the arch of the foot, 1-2x a day. Push firmly into the arch with your fingers to locate the most painful spot. Make sure you also check the bottom of the heel bone. Icing after activity is a good idea also. Some find that sitting while rolling their arch on a frozen bottle of water is a good way to apply ice.

• Appropriate shoes: You MUST have good footwear if you walk or run regularly. Visit a sports shoe store, and be prepared to spend $100 plus.

• Stretch: Ensure you stretch your calves before you walk. Tight calves can increase pronation.

• You can also stretch you plantar fascia as shown in the diagram below:

HOW PHYSIO HELPS

Your physiotherapist will:

• Check the bony alignment of your lower limbs to identify if you pronate and if you need orthotics to correct this. Your physiotherapist can fit you with orthotics specially molded to you, or refer you to a podiatrist if needed.

• Identify heel spurs: Sometimes plantar fasciitis can lead to heel spurs on the heel bone. A spur is excessive bone growth. These are extremely painful whenever weight-bearing. Heel spurs occur due to tight plantar fascia pulling on the bone where the fascia inserts. This results in inflammation at this site and excessive bone growth results leading to the spur. The spurs can spontaneously reabsorb if the foot is rested and the plantar fascia stretched. Sometimes surgery is needed to remove the spur.

• Tape the arch: Taping of the arch is very important as it absorbs load when walking so the fascia can rest. Taping can result in an instant reduction in symptoms. Sometimes taping and rest for a few days is all that is needed to resolve the problem.

• Ultrasound and electrotherapy: These help decrease the inflammation in the fascia.

• Massage: Deep tissue massage helps relieve tight plantar fascia. This is usually a little painful when done. Your therapist can teach you how to massage the fascia at home.

• Correct muscle imbalances: Muscle tightness in the lower limbs, particularly the calves, can increase pressure on the fascia as you exercise. Your physio will show you what needs to be stretched and how.

**Disclaimer: This article is intended to be used in conjunction with the advice of a physiotherapist. Please see your doctor or physio if you think you have PLANTAR FASCIITIS.

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Whiplash - Neck Pain

Whiplash occurs when the head whips forward and backwards during a car accident (most commonly), a sporting game, or from a blow to the head. X-ray results are generally normal, leaving people wondering why they experience so much pain.

The pain occurs as a result of soft tissue injuries. Soft tissues include muscles, ligaments, discs, and other connective tissue that support the spine. These all experience incredibly high forces in a car accident and experience tears, and even ruptures. This results in widespread injuries around the neck with resultant inflammation and often severe pain.

The pain is often felt in the front, sides, and back of the neck. It frequently spreads across the top of the shoulders and even down the arms. Some people experience tingling and numbness and headaches. It is extremely difficult to find a comfortable position.

The pain is frequently worse when traveling in a car and when upright for more than 20-30 minutes. It can stop one going to work, playing sport, and doing household tasks. Severe pain can be present for up to two weeks. Symptoms of varying intensity can last for 6-12 months.
extreme movement during whiplash

During a rear end collision, the head and neck first swings quickly backwards and then forwards. These movements are fast and extreme, which causes damage to the front and back of the neck.

 

  

   

 

 

 

 

 

There are numerous muscles at the front of the neck, as well as the back, which can be damaged during whiplash. See how they are on stretch when the head tilts back.

 

WHAT YOU CAN DO TO HELP

• Ice: Ice is very helpful in the first few days and sometimes needs to be used for a couple of weeks. Ice will help decrease the inflammation and swelling in the soft tissues. This decreases your pain. Do not use heat. Heat may feel good while it is on, but generally provides no lasting relief.

• Rest: Try and lie down regularly, as only in this position does the neck get to rest. When sitting up, rest your head against the head rest of the couch and support the curve at the back of the head with a folded hand towel, in much the same way that you use a cushion to support your back in sitting.

• Another useful tip is using a bath towel around the neck like a brace. Fold the bath towel in thirds lengthways and then wrap it around your neck and secure with a safety pin. Make sure your chin can rest on the towel. This rests the muscles, and is particularly helpful when traveling in a car. DON'T use a soft neck brace. Studies have shown that the overuse of neck braces leads to slower recovery after whiplash. Using a towel intermittently the first 3-4 days for pain relief post whiplash is okay, but prolonged immobilization is undesirable.

• Use of a travel pillow to support the neck

• Gentle exercise: Your neck needs to be gently exercised to prevent joint stiffness. 3-4 times a day, move the neck forward and backwards slowly 3 times, and turn left and right slowly 3 times. DON'T keep moving the neck past that point where pain increases. You will make it worse.

• When sleeping: You may find the following helpful: Take a hand towel and roll it lengthways so it is about 3 cm thick. Place this along your pillow where the arch of your neck rests when sleeping. This towel supports the arch of the neck and lessens pain. If it increases your pain don't use it. If you already have a contoured pillow the towel is probably unnecessary.

HOW PHYSIO HELPS

Physiotherapy is extremely important following a whiplash injury. During the acute stage your physio:

• Provides gentle massage

• Corrects spinal alignment

• Instructs you regarding exercises

• Applies ultrasound and electrotherapy to reduce inflammation and pain

• Provides you with tips to help you return to work and sport as quickly as possible.

• Teaches you specific neck strengthening exercises in the first few days to prevent muscle weakness which can cause more pain in the long term.

• Applies ice

As your symptoms settle, heat may be used rather than ice, and the treatment focus will shift from decreasing pain and inflammation, to restoring normal neck range of movement and strength.

**Disclaimer: This article is intended to be used in conjunction with the advice of a physiotherapist. Please see your doctor or physio if you think you have WHIPLASH.

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Shoulder Pain

Pain of the shoulder experienced when moving the arm is a common problem for young and old alike. Sports people and those involved in repititve work are particularly at risk. While the causes of the problem is somewhat different in each group, the origin of pain is essentially the same - pressure (impingement) on the tendons of the rotator cuff.

The rotator cuff are four muscles which control movement of the shoulder. Two muscles are particularly prone to impingement - the biceps (long head) and supraspinatous. The tendons becvome irritated if the sub-acromial space through which they glide is narrowed. (see diagram) When this irritation occurs day after day, the tendons become inflammed, thickened and painful. In the elderly, they degenerate and fray. In some cases they disintegrate.

Narrowing can be caused by swelling, inflammation, osteoarthritis, bony spurs, and posture. Posture is a key cause of impingement and can be corrected by developing new habits and strengthening and stretching the appropriate muscles. Sports people and factory workers performing repititive arm work often get muscle imbalances. These muscles imbalances cause the humerus to jam up under the acromium when the arm is lifted, rather than rotating nicely.

In general younger people are more likely to have impingement from poor posture, an older person may have impingement from osteoarthritis of the acromio-clavicular joint. Impingement results in inflammation of the tendon and pain as one lifts their arm. People commonly experience this pain in the upper arm rather than just at the point of the shoulder.

Incidents that result in inflammation of the tendon, such as catching oneself when falling, catching a falling object, a car accident (the arm on the steering wheel) results in thickening and swelling of the tendon which restricts its movement through the sub acromial space. These problems if caught early respond quickly to treatment.

WHAT CAN I DO?

This type of shoulder pain should not be ingored as the longer it exists muscle weakness and tightness develops which worsens the problem. You should:

• Avoid the painful activities. Forcing the arm to lift will only make the tendon more inflammed and increase the impingement.

• Apply ice wrapped in a wet cloth for 20-30 minutes to the painful area. Press gently around the tip of the shoulder and you should find a tender spot.

• Avoid activities where the elbow is above shoulder height. Eg. painting walls/ceilings, stacking high cupboards, hanging out washing.

HOW DOES PHYSIO HELP?

Physiotherapy involves a two-pronged approach to:

1. Decrease inflammation and thickening of the tendon.
2. Eliminate factors that caused the narrowing.

Thus your Bodymoves Physiotherapist will:

• Apply ultrasound, ice and electrogherapy to the inflammed tendon.

• Massage the tendon and tight muscles to loosen them.

• Teach correct posture and the tips to maintain it. Eg. postural taping.

• Mobilise stiff joints, for instance, in arthritis.

• Teach appropriate stretching and strengthening exercises.

• Re-educate arm movements for sport and work.

EXERCISES

Three types of exercises are given:

1. to maintain joint range of motion.
2. to strengthen the muscles.
3. to stretch tight muscles.

Maintain joint range

• 4x a day, pendular exercises for 1-2 minutes

• 3x a day lie on your back and with the good arm assisting stretch your sore arm overhead 5 - 10x

**Disclaimer: This article is intended to be used in conjunction with the advice of a physiotherapist. Please see your doctor or physio if you think you have SHOULDER PAIN.

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INCONTINENCE

Are you a confirmed toilet hopper?  

 

Weak pelvic floor muscles put you at risk of stress incontinence – this is when you leak urine when coughing laughing sneezing or exercising.  Weak pelvic floor muscles can also affect bowel control, as well as letting you down in the bedroom.

 

There is a one-in-three chance that a woman will suffer from either bladder or bowel control problems at some stage in her life 

This is don’t be fooled into thinking this is a topic only for older women. “Young women are affected too,” says Ms Edmonds. “So take action now and learn to strengthen your pelvic muscles to help avoid developing continence problem later on. And if you’re already doing exercises, make sure you’re working those muscles correctly.”

   

The important thing for women to know is that problems with their waterworks can be prevented. Getting good guidance on pinpointing the specific muscles is very helpful, because it can be tricky to know exactly which area to concentrate on. 

Physiotherapists can teach you exercises to help strengthen your waterworks so there are no leakages or frequent dashes to the toilet in future.

 

 

 

 

Pelvic Floor exercises:

 

Why see a physio?

Because pelvic floor rehabilitation and incontinence management is much more than just exercises!  In a physio session we:     

1. Discuss your diet             
2. Have you complete a bladder diary
3. Manage constipation if present.
4. Look at your general fitness and exercise levels.
5. Strengthen your deep abdominal muscles.
6. Review your medication.
7. Determine what type of incontinence you have - Urge? Stress? Combination?
8. Give you practical tips how to manage your incontinence. (Eg. Deferment techniques for urge incontinence.  Avoiding 'just in case' toileting. The effects of caffeine)
9. Perform an internal vaginal examination to assess your muscle strength and if you have a prolapse.

Other Questions?

Does physio really help? 

YES!!  Exercises can help you regain control.  Over 84% of women with a 'weak bladder' experience improvement with pelvic floor muscle strengthening exercises under the supervision of a phyiotherapist. Most women require 5 visits, and this is significantly cheaper than the cost of surgery! (> $6000!)

I've heard about vaginal weights, do you use those?

We do not use weights routinely for our clients, as simply doing the exercises is very effective.

Do you use electrical stimulation?

Yes if your muscles are extremely weak.  Electrical stimulation can also be effective if you have an unstable bladder, or some nerve damage.

1. To improve long term outcomes after gynaecological surgery. - To avoid the downward spiral that occurs with further pregnancies and increasing body weight.- Decrease chance of nursing home admissions in the elderly.- Who to refer – some suggestions

• Multiparous
• Forceps delivery
• The very weak pelvic floor eg. 2 sec hold
• Symptoms of stress or urge incontinence
• Prolonged second stage
• Overweight
• Constipated

  (1) Bo K, Talseth T, Holme I, single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, carinal cones and no treatment in the management of genuine stress incontinence in females. Br Med J 1999 : 318 ; 487 – 493.)  

(2) Richardson, Hodges, Hides. 2004. Therapeutic exercise for lumbopelvic stabilisation. Churchill Livingstone, Edinburgh. Pp125 references.

 (3) Aditya, B and J Sharma, Predictors of a nursing home placement from a non – acute geriatric hospital. Clinical rehabilitation, 2003. 17 : p. 108 – 11. Most women consider their toilet habits “normal”. But are they? If you answer YES to any of the following questions you may need your waterworks reviewed by your Bodymoves physiotherapist. 1) Do you go to the toilet more than four to six times each day?2) Do you get up more than once during the night?3) Are your pants wet at times?4) Do you pass less than 300-400mls each time? (one coffee mug holds 250mls)5) Do you stop and start when you pass water?6) Is urinating painful? If you have answered “yes” to any of these questions book in with Katrina Coleman for assessment and management.  Sometimes only a few changes need to be made to your exercise habits, bladder habits, and diet for a big improvement to occur.  Don’t be shy, take back your bladder control!(Media Release Australian Physiotherapy Assoc, Aug 2006)

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