Tag: Causes

Human, Injury and Rehab, Injury Management

Injuries: Overuse

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You may wonder sometimes how you sustained an injury when you didn’t have a noticeable traumatic event like a fall. Generally injuries that have no obvious event and build up over time are called overuse injuries. They are really common and can be caused by a number of things. Read on if you want to find out more.

What is an overuse injury

Overuse injuries are a build up of micro trauma to a certain area. The body goes through a process of remodelling to help adapt to stresses placed on it. Through this process we get fitter and stronger. However if this process is disrupted we can’t remodel correctly, as a result we sustain an injury if it continues. Often overuse injuries have inflammation along with the micro trauma.

Examples of overuse injuries

  • Tennis elbow
  • Golfers elbow
  • Runners knee
  • Achilles tendinopathy
  • Shin splints
  • Stress fractures
  • Patella tendon tendinopathy
  • Patella maltracking

Causes of overuse injuries

  • Increased load
  • Frequency of training
  • Not enough rest
  • Poor diet
  • Old or poorly fitting footwear
  • Incorrect equipment

If you want to reduce the risk of sustaining an overuse injury then making sure you increase your training load and frequency gradually with enough rest in between sessions will allow your body to react well to exercise, having regular massages can also help this process. Also making sure you eat a healthy balanced diet to give your body the building blocks to remodel and lastly making sure your equipment is up to the job I.e. fits you and is not worn otherwise this can change your biomechanics and loading of certain tissues.

If you find that you are suffering from an overuse injury then do consult a physio, sport therapist or doctor to help with management and rehabilitation.

Anatomy, Biomechanics, Human, Injury and Rehab

Feet the foundation of movement: Part two Injuries

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In the last blog we introduced the anatomy and function of the foot (Part one anatomy and function). With this knowledge it can be seen that the foot is quite a complex structure and with so many components you would think quite a lot can go wrong. If you think how often you walk, run or jump and the forces going through your feet it is quite immense, and yet our feet seem to tolerate this on a daily basis. However there are occasions where trauma occurs or our feet just can’t recover as they should. Below are some common injuries your feet might experience.

Plantar fasciitis

Plantar fasciitis is one of the most common forms of foot pain. It is common in runners and older adults. It is often associated with biomechanical issues due to excessive pronation or supination. It is an overuse injury and what we would term a tendinopathy. You may have experienced tennis elbow or Achilles tendinopathy. Which is a similar condition just affecting a different part of your body. Tendinopathy in short is when the tendon is not healing in the normal manner, it can fray, become thickened and be painful.

Flat feet or high arches can increase the risk of plantar fasciitis. Tightness in the calf muscle, hamstrings and gluteals can also increase the risk. Plantar fasciitis has a gradual onset of pain which is often located on the medial aspect of the heel and experienced after activity. However when it becomes more severe pain can be experienced when weight bearing and on activity. Periods of inactivity during the day can also increase the pain when commencing activity again. Stretching the foot and fascia also can cause pain.

Stress fractures

The common bones in the foot that can suffer stress fractures are the calcanous, navicular and metatarsals. Calcaneal stress fractures are common in runners, military personnel, ballet dancers and sports that involve jumping. Having poor heel cushioning, overstriding and a heavy load can all increase the risk. The onset of pain is insidious in nature and aggravated by weight bearing. There is localised tenderness to the medial or lateral border of the heel.

Navicular stress fractures are the most common stress fracture in the foot. It can occur in sprinters, jumping sports and hurdling. It is an overuse injury and is thought to be due to training errors and impingement of the bone between other tarsal bones. Decreased dorsiflexion in the ankle is thought to perhaps bring about an increase in compensatory dorsiflexion in the foot increasing the stress placed on the navicular. Individuals often experience a midfoot localised ache, radiating along the medial aspect of the medial longitudinal arch. It often gets better with rest.

Metatarsal stress fractures occur with excessive loading of the forefoot and muscle fatigue. Forefoot pain is experienced and aggravated by activity. Pain gradually worsens with activity and tenderness over the metatarsal is present. Stress fractures don’t always present themselves on x-ray straight away so can be harder to diagnose than a complete fracture. However if one is suspected then management strategies can be implemented until diagnosis is confirmed

Metatarsalgia

Metatarsalgia is an inflammatory condition of the metatarsal phalangeal joints. It is caused by excessive pressure over prolonged periods of time. It is associated with high arches, excessive pronation of the foot, clawing/hammer toe, tight extensor tendons of the toes, prominent metatarsal heads and Morton’s foot. Pain is aggravated by forefoot weight bearing and affects the mid stance and propulsive phase of walking. Pain is gradual in onset and local tenderness over joints is present. Passive flexion of the toe causes pain and a v shape between toes can also be an early sign.

Bunion (Hallucis valgus)

This is when the big toe deviates laterally, it is more common in women and older people. There are a number of factors that can lead to the development of a bunion constricting footwear like high heels, excessive pronation of the foot, long first metatarsal (big toe), trauma to the medial and plantar ligaments and trauma to the medial sesamoid bone. As the deformity develops so does the pain over the medial border of the big toe this can be relieved by removing footwear or wearing wider shoes.

Toe Clawing

Toe clawing is not necessarily a painful condition but suggests that the long flexor tendons are tight. During the propulsion phase of gait the long flexors contract to stabilise the toes, if the foot is unstable the long flexor tendons excessively contract causing the toes to claw at the ground to maintain stability. If this continues then it could affect other areas of the foot or body as they compensate.

The above are just a few examples of injuries that can develop with feet. There are many others. The majority of the above injuries can be avoided by performing exercises and taking other everyday precautions. Part three of this series will address these solutions to help you maintain happy feet.

If you have concerns about your feet then either consult your doctor or Pollyanna would be happy to answer any queries you might have where she can

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Biomechanics, Equine, Injury and Rehab, Injury Management

Case Study Part One: Complex Lameness

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Willow the complex case of lameness

This case follows the assessment and treatment of a 19 year old horse, Willow. It shows the complexity of a case that has multiple factors interacting together and that by viewing the horse as a whole all these factors can be addressed in an efficient and effective way. This first part introduces Willow’s history and the problems that were being experienced by her. The second part will discuss treatment used and the outcome.

History

Willow is an Irish cross (possibly thoroughbred with some Arad), she is 19 yrs old, 15.1hh in height and of a slight build. Willow has had hock surgery and been owned by the current owner for 9 years.

I have been giving Willow bodywork session for the last year and she also receives McTimoney chiropractic treatment from a very good practitioner. Willow has exhibited an unlevel pelvis on a number of occasions. This is potentially linked to an underlying issue within her sacroiliac joint, which could be a result of previous activities or injury. Willow had been ridden western style and potentially barrel raced in the past. With her current owner she is hacked and schooled at a low level. Willow has been barefoot for the last year.

Willows issues

Over the winter Willow lost a bit of condition and then the mud came. Willow seemed to find the mud particularly difficult to deal with. Willow developed some heat in her right fore and lameness. After a vets visit an abscess was ruled out. However it was noted that her gait was abnormal. Not just in her right fore but the hind legs as well. The vet placed Willow on restricted turnout on a firm flat surface for 4 weeks with Bute and then review her progress.

Willow’s owner asked me to come and help make Willow more comfortable. On initial assessment Willow showed a complicated lameness, by this I mean there were a number of potential issues going on. Firstly you had the forelimb lameness which was likely to be secondary refered lameness. There was also axial lameness going on, which can be harder to identify. Willow also showed left non weight bearing lameness in her hind due to the flight pattern and placing it along her midline when stepping through, this also affected her cornering to the left. She was also hesitant to place her left hind hoof down. Willow also walks on 3 tracks and has a slight head bob down suggesting a hind limb lameness. Lastly Willow’s right hind has a slight wobble when transferring weight onto it.

Willow on initial assessment

Closer look

On palpating, Willow showed a decreased tone and atrophy in her hind quarters specifically the quadriceps and gluteals bilaterally. Willow also showed decreased activation through her tensor fasciae latea and quadriceps on her right hind, this would explain the shaking through this leg when starting to weight bear. Willow was particularly uncomfortable through the lumbar and sacral area when palpated. Her neck showed tightness bilaterally but more so on the left.

Images of Willow on first assessment

The above introduces the issues that Willow has experienced. In part two we will discuss treatments and how Willow progressed. If your horse presents as lame always consult your vet before getting hold of a bodyworker. If you have any questions or concerns then please do get in contact with Pollyanna.

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Human, Injury Management

Lower Back Pain

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At some point in everyones life they will likely suffer back pain of various degrees, some people more than others. Why this is, is not fully understood. Continued research allows us to gradually develop a better understanding. For instance 15 yrs ago the advice for back pain was to lie flat with a hot water bottle, but this is seen as detrimental and that movement does help back pain.

Causes

Back pain can be caused by many things such as a direct trauma, chronic overuse or an underlying illness where the pain is being referred from elsewhere. It is really important to seek professional help to rule out any more serious health issues if the pain is constant, non-mechanical and there is unexplained weight loss.

Causes of lower back pain can include the following

  • Fractures to the vertebra can occur due to direct trauma such as a fall or stress fractures brought on by overuse
  • Nerve root compression can occur due to disc herniation
  • Spondylolysis caused by repeated hyperextension and rotation
  • Spondylolisthesis which is the slipping of one vertebra on another
  • Spinal stenosis is the narrowing of the spinal canal due to bony changes
  • Labral tears and rim lesions in the hip joint can refer into the back

The above conditions can be diagnosed with relative ease and treated accordingly however the following structures can also cause back pain and are harder to diagnose

  • Muscle
  • Fascia
  • Nerves
  • Vertebral disk
  • Ligaments
  • Joints (capsule and cartilage)

In many cases lower back pain can be caused by more than one of the above structure. Sometimes the body can over react to pain and injury by causing muscles too spasm to protect the area, which does have it benefits as it prevents further injury of that area, however this increased tension can also cause discomfort and will need treating. Due to the involvement of multiple structures and the fact that these structures are more difficult to pinpoint in assessment does mean that when being treated there is sometimes a need to try a treatment and see if it works. It may take several alternatives before something is found so don’t be disheartened if your therapist takes some time to pinpoint the best treatment method.

Treatment

There are many treatments that a qualified professional can employ and here is a list of possibilities

  • Pain medication- in the early stages anti-inflammatories can be useful in helping to reduce muscle spasm and inflammation but after sometime it is thought that they can hinder the healing process. As a result caution should be taken when taking medication. A chat to a doctor can often help to decide what would be best for you. Something that is cheap and has relatively few side affects is ice. Ice in the early stages can reduce inflammation and relieve pain. Don’t use heat in the early stages.
  • Rest- this may be advised depending on the injury. A fracture for example, may require complete rest. In other cases reduction in volume, intensity or avoiding aggravating activities may be advised during early recovery with a plan to increase activity levels gradually.
  • Massage- a deep tissue massage and trigger point work can often elevate tension, reduce pain, encourage healing and increase mobility.
  • Mobilisations- these are gentle oscillations to a joint which can help elevate pain and reduce tension, which can help decompress and loosen joints.
  • Manipulation- is a high velocity manuaver performed to a vertebral joint to achieve the same effect as a mobilisation but often at a faster rate. This should be performed by a chiropractor/osteopath.
  • Dry needling/acupuncture- Needling is thought to help reduce tension and relieve pain. Acupuncture can also help with well being and energy levels.
  • Taping- Taping is not a sole treatment but something used to complement others. It is good with helping posture and proprioception. It can help with swelling reduction and relieve some pain. However research is mixed on the effectiveness of tape. Tape should not be something a patient becomes reliant on but a part of the whole process.
  • Cupping- this is a treatment method that needs further research but has a potential to help towards decompressing soft tissue such as fasciae and muscle. Using cups with movement could potentially be the most effective way to use cups. While there is not much research don’t be put off if your therapists suggests this as an option as you might find it effective. It does leave marks that look like bruises but the skin has not experienced a trauma like a bruise so they do not hurt.
  • Stretching- a therapist can apply some passive stretches or use muscle energy techniques which require participation from you. It encourages a muscle contraction and then relaxation to encourage lengthening. Stretches may also be prescribed to you as homework.
  • Exercises- This is probably the most important element of recovering from a lower back injury. This also requires commitment from you as an individual and is probably the area that therapist find the hardest to get clients to perform. I can’t stress how important it is to get your exercises done. You will recover quicker, stronger and are less likely to have it recurring. So please do your exercises to help strengthen muscles and mobilise joints.

Exercises

Some simple back friendly exercises to mobilise and strengthen

Shoulder bridge

The shoulder bridge is a good basic exercise to start with. Below is a link to an entry level version which is a good place to start. There are many variations that are progressively harder but start basic and gradually build. https://www.youtube.com/watch?v=d2I8_VBJPGM

Key points to remember when doing a shoulder bridge

  • Engage your gluteal muscles (butt muscles) and deep core muscles before beginning the movement
  • Keep your pelvis level by pushing through your heels evenly
  • Don’t over extend through your back at the top of the movement
  • Remember to breath
  • When progressing onto leg lifts or heel lifts maintain a level pelvis and don’t let it dip

Hip twist

Is a great way to mobilise and stretch through the lower back. This exercise can be performed as a continuous movement or held at the end of your range to get a bit more of a stretch. This link shows the movement pattern https://www.youtube.com/watch?v=ONB4d84SXRc

Things to remember when doing a hip twist

  • Keep both shoulders on the floor and look the opposite direction to your knees
  • Move within your pain range.
  • Breath and take it slow, relax into the movement