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Shin Splints

Posted on 11/03/2022

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Overview

Shin splints is a generic term used to describe several conditions of the lower leg such as:
– Medial tibial stress syndrome (MTSS)
– Stress Fractures
– Compartment Syndrome

Throughout this article will we discuss the signs & symptoms for each condition.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”false” padding_left=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” spacing_right=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Shin Splint Anatomy

The function of the tibialis anterior muscle is to dorsiflex the foot (bringing your toes towards the shin). Not a lot of strength is required to perform this movement and as a result the TA tends to be quite small. As the muscle contracts to perform dorsiflexion, the plantarflexors relax to allow the foot to raise. Plantarflexors are muscles that create the opposing movement of the foot, meaning they bring your toes down towards the ground. If the plantarflexors fail to relax, then the TA needs to overcome both the weight of the foot and the intrinsic resistance of these antagonistic muscles. This extra effort causes overload on the TA, resulting pain and discomfort.

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Medial tibial stress syndrome (MTSS)

MTSS is inflammation of the periosteum, usually occurring on the posterior and medial surfaces of
the tibia. The inflammation results in scar tissue which can stick or ‘splint’ the affected muscles
(gastrocnemius and soleus) to the bone, making it difficult for them to lengthen, which would allow
the tibialis anterior (TA) muscle to function.

Symptoms

– Pain and discomfort in the front and medial side of the shin, especially when walking or running
uphill since the ROM required increases.
– inflammation along tibia
– persistent discomfort during activity, increases with walking or uphill running
– limited dorsiflexion (tight calf musculature)
– pain on palpation of medial tibial border
– pain on full contraction or stretch
– foot in a pronated position

Causes

– Muscle imbalance
– Impact
– Change of stress (e.g: shoes, surfaces, intensity)
– Over pronation of the foot[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Stress Fractures

Continued microtrauma caused by repetitive impact can lead to small cracks developing in the tibia. The fractures often occur on the anterior tibia where the impact force is focussed.

Symptoms

– Pain felt on anterior and posterior tibia
– Increased pain with activity (particularly impact)
– Pain on palpation on anterior tibia
– Nodules along anterior tibia may be felt in more chronic stages

Causes

– Muscle imbalance
– Poor posture
– Over pronation during walking, jogging or running gait
– Overuse and excessive repetition
– Too much too soon

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Compartment Syndrome

Compartment syndrome results in an increase in pressure in any of the four compartments of the lower leg

Symptoms

Symptoms are similar to those of deep vein thrombosis (DVT), so the healthcare professional should be confident that DVT is not a possibility before progressing with any treatment.

– Pain and swelling of lower limb
– Pain and discomfort increasing with activity
– Symptoms relieved shortly after activity stops
– Pain on palpation of affected compartment
– Pain on contraction of affected muscles
– Reduced ROM relating to movements of the muscles in the affected compartment
– Neurological symptoms distal to the compartment (numbness, tingling)
– Reduced pulse quality of the affected foot

Causes

– Post-impact bleeding
– Rapid hypertrophy of compartment muscles
– Inflammation of tendons from repetitive movement or impact
– Reduced flexibility in an adjacent compartment[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Diagnosis

Shin splints are usually diagnosed from the patients’ medical history and a physical exam. In some cases, an X-ray or other imaging studies can help identify stress fractures.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Treatment

Rest – Avoid activities that cause pain or discomfort but don’t give up all physical activity. While you’re healing, perform low-impact exercises, such as swimming, bicycling or water running.

Ice – Apply ice packs to the affected shin for 15 to 20 minutes at a time, every 2-3 hours for several days. To protect your skin, wrap the ice packs in a thin towel.

Take an over-the-counter pain reliever. Try ibuprofen to reduce pain.

Resume usual activities gradually after your pain is gone.

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Exercises

Standing Gastrocnemius Stretch

Stand facing a wall with your palms flat against it, place your left foot behind you ensuring your toes are facing forward. While keeping your left heel on the ground & your leg straight lean forward to create the stretch in the lower leg. If the stretch isn’t felt move your heel further back. Hold the stretch for 30 seconds before returning back to the starting position. Repeat a minimum of 3 times before changing legs.

Soleus Stretch

Start in the same position as the Gastroc stretch however this time the back leg needs to be bent. Making sure to keep the heel on the ground, the stretch should be felt in the lower as you bend the knee. Hold the stretch for 30 seconds before returning back to the starting position. Repeat a minimum of 3 times before changing legs.

Tibialis Anterior Stretch

Kneel down on the ground, once in this position slowly sit onto your heels. You can place your hands on the ground behind you for balance and you should be able to feel the stretch in the front of your lower leg. To get more of a stretch push down into your heels and slowly lift your knees up off the ground. Make sure to hold the stretch for 30 seconds, repeat 3 times.

Calf Raises

Resisted Dorsiflexion

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Prevention

– Lessen the impact involved with the types of activity you’re doing- e.g: change from road running to softer ground running
– More support, wear more supportive shoes, arch supports
– Avoid too much overload on the shins e.g: too much high impact activity

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Temporomandibular Disorders (TMD)

Posted on 15/04/2021

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Overview

Temporomandibular disorders (TMD) are conditions which affect the movement of the jaw. They are sometimes referred to as TMJ disorder or TMJD. It can cause facial pain, tenderness and difficulty moving the joint. TMD is believed to affect up to 15% of adults, with peak incidence at 20 to 40 years of age, more commonly found in women. TMD is treatable, but can have many different causes which can make diagnosis a challenge. Once diagnosed most patients can be successfully treated at home using methods such as reducing stress and changing posture.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”false” padding_left=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” spacing_right=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Anatomy

TMD refers to a group of disorders affecting the Temporomandibular Joint (TMJ).

This joint connects your lower jaw (mandible) to your skull. It is located bilaterally (on both sides of your head) just in front of your ears. The function of this joint is to open and close your mouth, allowing you to eat and speak.

The TMJ is a hinge joint which allows for precise and complex movements of the jaw.

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Symptoms

The symptoms typically present, either on one or both sides of the face:

Pain in the face or neck
Limited jaw range of motion and/or locking of the joint
Stiffness in the jaw muscles
Clicking or popping from the TMJ area
Malocclusion (a shift in jaw position)

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Causes

There is no single specific cause for TMD, but some conditions are believed to contribute to developing a disorder. These include arthritis, joint erosion, clenching or grinding of the teeth, congenital structural jaw problems and trauma to the jaw. It is also thought that prolonged stress and poor posture which puts extra strain on the muscles of the face and neck are associated to the development of TMD.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Diagnosis

There is no standard test for TMD, you may be referred to an ENT specialist for a diagnosis. They may physically examine your jaw for swelling or tenderness and possibly carry out and X ray, CT scan or MRI to assess the structure of your jaw.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Treatment

Most TMD patients are treated conservatively, using pain medication, ice to reduce pain and swelling and reducing jaw movements by eating soft foods and avoiding chewing gum.

Many find that physiotherapy or sports massage therapy can support treatment for TMD. Your therapist can manipulate the muscles surrounding your jaw and neck, thereby relieving the tension in your TMJ. They can also provide you with exercises the stretch the muscles around your jaw, optimising joint movement. As stress and upper body posture is believed to be a contributing factor in TMD you may find that regular massage treatments can help you to manage your condition.

In extreme cases your GP or ENT specialist may advise corrective dental treatment if this bite alignment is an issue or arthrocentesis if fluid and debris needs to be cleared from the joint.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”false” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” spacing_right=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Exercises

There are many different exercises which can be used to help TMD. Your Physiotherapist or Sports Massage Therapist will be in a better position to advise which are best for you, but here are a few examples that they may ask you to carry out.

Goldfish Exercise:

Press your tongue to the roof of your mouth. Then place one index finger on your left TMJ and the other index finger on your chin. Apply light pressure on each finger, drop your chin so that your mouth opens, but tongue stays in contact with the roof of your mouth. Repeat with the right TMJ.

Chin Tucks:

Stand or sit tall then bring your head backwards, tucking your chin in towards your chest. Keep your head straight, it might help to focus on a point or object straight in front of you.

Jaw Stabilisation:

Keep your jaw in a neutral position and then partially open it, about the width of the top of your thumb. Apply gentle pressure with your hand, first on the left then right then at the bottom of your jaw. Resist the pressure to keep your jaw stationary.

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Prevention

As TMD have no specific cause it can be difficult to prevent their occurrence. You may find it helpful to use a mouth guard at night or use muscle relaxants (under the supervision of your GP) if you are prone to teeth grinding. Physio or sports massage therapy can help to optimise your posture and avoid excess pressure on your TMJ. It is also advisable to reduce, or manage, stress levels and anxiety. This can be achieved through regular exercise, massage treatments, diet and counselling.[/fusion_text][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

Lumbar Disc Herniation

Posted on 11/04/2021

Overview

A herniated disc, also known as a slipped or bulging disc, is a relatively common pathology often occurring in people aged 30 to 50. The intervertebral discs play a crucial role in the spine acting as a shock absorber between the vertebrae, as well as allowing for a wide range of movement. Disc herniation refers to a condition in which the spinal discs become damaged & encroach on the nerve roots branching off the spinal cord. This can happen anywhere along the spinal column but often occurs in the cervical or lumbar region, due to the wide range of movement in these areas causing more wear & tear on the discs. For most people a slipped disc is extremely painful due to the nerve compression, however some people don’t even feel that it has happened.

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Anatomy

The Spinal column is made up of 24 individual interlocking bones known as vertebrae. These vertebrae are split into 3 different sections consisting of 7 Cervical, 12 Thoracic & 5 Lumbar, followed by the Sacrum & Coccyx. Even though the vertebrae in each section look different they all have the same functional components; the body for load bearing, the vertebral foramen to protect the spinal cord & the transverse processes for ligament attachment. In between these vertebrae the intervertebral discs are found, protecting the bones by absorbing shock from body weight, trauma & daily activities such as walking, lifting or twisting.

Spinal discs are made up of 2 parts, a soft gel-like inner portion called the nucleus pulposus & a tough outer ring known as the annulus fibrosus. The nucleus pulposus, mainly consisting of water plus loose networks of collagen fibers, is where shock absorption primarily takes place. Surrounding this inner core, the annulus fibrosus is composed of tough ligamentous fibers which protect the nucleus pulposus, as well as securely connecting the vertebrae above and below the intervertebral disc.

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Causes

A herniated disc occurs when excess pressure is placed on the disc causing the annulus fibrosus to become weak. This weakness can then cause bulging, cracking or ruptures within the annulus fibrosus allowing the nucleus pulposus being able to “leak” through & compress against the nearby nerve roots. The result, intense pain in the lower back followed by shooting pains into the buttock & down the leg.

The main factors that can increase the risk of a herniated disc are:

Age – Over time the intervertebral discs naturally start to lose the fluid which normally allows them to stay pliable and spongy between the vertebrae, this is known as disc degeneration. This dehydration of the discs causes them to become stiff and unable to withstand strenuous compression, leaving the annulus fibrosus more susceptible to bulging or rupturing even from the slightest of movements.

Lifting heavy objects repetitively or incorrectly – Lifting heavy objects can place excessive strain on the lower back which can cause a herniated disc. Especially when they are lifted without correct technique, predominantly using your back muscles instead of your legs to lift combined with a twisting motion overstress the discs increasing risk of herniation. If you have a physically demanding job, the repetitive nature of the role can also increase the risk and your placing this strain on the disc over and over.

Obesity – Excess weight increases the stress on the lumbar spine making individuals who are overweight more likely to herniate a disc.

Smoking – Experts suggest that putting nicotine into your system limits the blood flow to the discs causing them to break down quicker, speeding up degeneration therefore increasing the risk of herniation.

Trauma – The least common cause of disc herniation is trauma, a serious fall or accident can lead to this pathology but is less common than the other factors.

While all these factors can increase the risk of lumbar disc herniation anyone at any time could herniate a disc.

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Symptoms

Signs & Symptoms tend to vary depending on where the herniated disc is situated & the level of herniation. Typically only affecting one side of the body, symptoms can range from moderate lower back pain to extreme pain & numbness going all the way down the leg.

Lower back pain
Pain often down one leg from the buttock into the thigh & calf.
Numbness, tingling or burning sensations due to nerve compression
Pain that worsens at night
Pain that worsens with certain movements such bending or sitting
Muscle weakness
Sciatic pain
Difficulty lifting the foot (Foot Drop)
Pain when standing from a seated position

Pain normally eases within six weeks, but during this short duration pain can be severe making daily activities difficult to participate in. However not all herniated discs can cause symptoms, as the herniation may not be compressing on a nerve & therefore not radiating any pain. [/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” margin_bottom=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Diagnosis

If you believe this is a pathology you may be suffering with you should consult with a healthcare professional so they can conduct a thorough assessment. They will ask about your symptoms, medical history & when/how the pain started. After this a physical exam would be performed to find the source of the pain and discomfort. They will also assess your muscular strength and discover what movements trigger the pain. A herniated disc may be suspected if pain starts in the lower back and is then accompanied by radiating pain down the leg. In order to confirm this more tests can be performed, these include:

Straight Leg Raise Test – While lying on your back & keeping your legs straight, your healthcare professional will slowly raise your affected leg until symptoms occur. If pain is felt during 30 to 70 degrees of hip flexion this indicates lumbar disc herniation. If you have a herniated disc compressing on a nerve, this particular movement recreates symptoms by increasing this compression therefore resulting in a positive test. You will also be asked if any numbness or tingling is felt down the leg while completing this movement.

MRI (Magnetic Resonance Imaging) – This type of scan usually provides the most accurate imaging of a herniated disc, as it shows the disc, surrounding soft tissue & nerve roots. This allows your healthcare professional to actually see where the herniation has occurred & which nerves are being impinged.

X-Ray – These aren’t often used to diagnose herniated discs as the soft tissues structures of the discs & nerves are hard to capture. However, X-Rays are used to rule out any other causes of the pain such as a fracture or bone spur, a tumor or spinal alignment issues.

Your healthcare professional can then put all this information together to diagnose the cause of your pain & discomfort. However, during the initial assessment, if no serious signs of a herniated disc are found then imaging scans may not be provided at this point. As some professionals prefer to wait & see if symptoms ease on their own within the six weeks.

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Treatment

Treatment for a herniated disc can range from minimal pain management to surgical treatment. In most cases lumbar disc herniation often resolves from minimal treatment within six weeks. Your GP may prescribe painkillers or muscle relaxants to relieve short term pain and also refer you to a Physiotherapist/Sports Therapist. Your therapist will then provide you with stretches and exercises for the back and surrounding areas.

When slipping a disc, or with any injury in fact, initial response is to decrease the pain that you are in, ways to do this include:

Rest – Bed rest is ok at first when pain is severe, however this should be limited to a couple of days as any longer than this can cause muscles to become stiff and weak. Heavy lifting & intense exercise however should be avoided for the first six weeks.

Ice – Applying ice after initial injury can help to ease pain by reducing inflammation & muscle spasms associated with disc herniation.

Pain Medications – Over the counter painkillers can help to treat pain & inflammation. Also your GP may prescribe muscle relaxants if spasms get particularly bad.

Heat Therapy – Applying heat to the area after the first 48 hours, with a hot water bottle or by having a nice bath, can help to relax the muscles surrounding the injured area & reduce muscle pain & spasms.

Hot & Cold Therapy – Some individuals find maximum relief from using a mixture of hot and cold treatment. For example, applying ice for 10 minutes, immediately followed by a heat pack or hot water bottle for 10 & repeat.

After this you can start to consider more long term solutions for the pathology, this options include:

Strengthening Exercises

Spinal Manipulations

Epidural Injections

Acupuncture

Massage Therapy

If symptoms do not improve after these treatments & persist longer than six weeks, surgery is then sometimes considered.

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Exercises

Provided are some exercises that can help lumbar disc herniation:

Back Extension – Lie on your front with your forearms and palms flat on the floor. Slowly lift your upper body up off the floor and hold for up to 30 seconds, aim for 10 reps.
Glute Max Stretch – Lie on your back with your knees bent, life one leg off the ground and place the outside of the ankle joint over the opposite knee. Hold the knee of the lifted leg and pull the leg in towards the body and hopefully you should be able to feel the stretch in the buttock region. Hold stretch for up to 30 seconds and try to treat 3 times on each leg.
Pelvic Tilts – While lying on your back, place your hands on your hips & roll your pelvis back & forth along the ground. Aim for 10 sets of 3 reps
Superman – On your hands and knees slowly lift and straighten your opposite arm and leg. Aim to complete 10 sets of 3 reps.

While completing exercises if any pain or discomfort is felt then stop immediately and rest instead.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ align_self=”auto” content_layout=”column” align_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” order_medium=”0″ order_small=”0″ hover_type=”none” border_color=”” border_style=”solid” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”false” last=”true” border_position=”all” padding_top=”127px”][fusion_youtube id=”www.youtube.com/watch?v=HtYiLQM4EVE” alignment=”center” autoplay=”false” api_params=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” css_id=”” /][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Prevention

It isn’t always possible to prevent herniating a disc but here are some steps you can take to reduce your risk.

Strengthening exercises – Increasing your core strength can help to stabilise and support the spine, decreasing the stress placed on your discs.

Maintain good posture – Sitting up straight and keeping your back aligned reduces the pressure placed on the discs.

Lose weight – If you are classed as overweight losing excess weight can help to reduce wear and tear on your discs as the load being placed on them will be less.

Correct lifting techniques – Make sure when you are lifting heavy objects that you are doing it correctly, bend and lift from your legs not your waist.

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Rotator Cuff Strain

Posted on 11/04/2021

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Overview

In the rotator cuff region there are four muscles, tendons and ligaments, surrounding the shoulder which provide added stability to the shoulder joint. This structure helps to keep the bone securely placed into the socket. Injury to the rotator cuffs can cause an ache like pain in the shoulder. This may lead to a feeling of muscle weakness and inability to lift the shoulder above the head.

Rotator cuff injuries are most commonly presented in people regularly exposed to overhead movements, such as painters, carpenters and builders. Individuals who suffer from this injury can usually manage their symptoms, through sports massage and specific exercises focusing on the rotator cuff muscle region. However, if not treated correctly, further injury to the area may occur such as a complete tear, which may result in surgery.

Anatomy

The rotator cuffs are made up by four muscles, these are the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles aid in keeping the upper arm and shoulder into the socket with stability. They also each allow specific movements at the shoulder joint. The group of four muscles all originate within the shoulder blade, but all insert into different portions of the upper arm bone.

Supraspinatus: This muscle originates at the supraspinous fossa; the muscle belly passes laterally over the acromion process and inserts into the greater tubercle of the humerus bone. This muscle allows the first 15 degree’s movement of abduction, after this the deltoid and trapezius muscles will then allow further motion.

Infraspinatus: The origin of the infraspinatus is the infraspinatus fossa, and the insertion is also the greater tubercle of the humerus. The motion created by this muscle is lateral rotation of the shoulder, moving the arm away from the centreline of the body.

Teres Minor: A small narrow muscle on the back of the shoulder blade which sits underneath the infraspinatus. The origin is the lateral boarder of the scapula. This muscle contributes to external rotation of the arm of the body.

Subscapularis: This rotator cuff is the strongest and largest out of the three listed above. This muscle originates at the subscapularis fossa and inserts into the lesser tubercle of the humerus. The subscapularis allows greater motion at the shoulder and mainly aids in allowing medial rotation of the arm.

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Symptoms

Common symptoms of possible rotator cuff strain include:

Dull ache
Difficulty lifting arm over head
Weakness around the shoulder
Disturbed sleep
The constant need to use self-myofascial techniques

Causes

There are a few common risk factors of why rotator strain may occur:

Family History: There may be family history of rotator cuff injuries which may make certain family members more prone to having the injury than others.
The type of job you do: Individuals who work in construction or manual labour who have repetitive overhead movement of the shoulder could damage the rotator cuff overtime.
Age: As you get older joints and muscles become weaker, meaning you may be more prone to injury overtime.

Diagnosis

To diagnose a rotator cuff strain a physical examination will be carried out by a doctor or a physiotherapist. Firstly, they may ask about your day-to-day activities which may determine the seriousness of the injury. The doctor will test the range of movement at the shoulder by getting you to perform movements such as flexion, extension, abduction, adduction and medial and lateral rotation. This will allow the doctor to determine if it is actually rotator cuff strain or whether it may be other conditions such as impingement or tendinitis.

Imaging scans such as X-Ray’s may also be used to see if there is any abnormal bone growth within the joint, which may be causing the pain.

Treatment

Treatments for rotator cuff injuries can be non-surgical or surgical. Tendinitis may occur over time from the repetitive strain placed around the joint, so it is important to treat the affected area.

Apply a cold compress/ ice to the effected area to reduce swelling
Heat packs can be used to reduce swelling
Resting the affected area
Inflammatory medication such as ibuprofen and naproxen
Reduce the amount of repetitive movement to the joint
Don’t lift the arm overhead

Exercises

Doorway Stretch
External rotation with weight
High to low rows with resistance band
Reverse fly’s
Lawn mower pull with resistance band
Isometric internal rotation
Isometric external rotation

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Hip Labrum Impingement

Posted on 05/03/2021

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Overview

Hip labrum impingement may occur when the ball and socket joint is unable to move smoothly within the joint. It is more frequently known as Femoral acetabular impingement (FAI). The ball and socket joint are lined with a layer of cartilage that assists in cushioning the femur bone into the socket, which allows free movement no grinding or rubbing within the joint, resulting in no pain. It is also lined with a ridge of cartilage called the labrum, this will keep the femoral head in its place inside the hip socket enabling extra stability.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”false” padding_left=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px” spacing_right=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Anatomy

The hip is a synovial joint more so known as a ball and socket joint. The ball of the joint is the femoral head (the upper part of the femur) more commonly known as the thigh bone. Within the socket is the acetabulum which is surrounded by the pelvis, this makes up the joint.

The surface of the ball and socket is protected by articular cartilage. This enables the bones in and around the joint to glide easily when performing everyday movements such as walking. The cartilage also helps prevent any friction around the surface of the joint avoiding any sort of impingement. Another feature around the joint is the hip labrum. This fibrocartilage labrum is found within the acetabulum, this enables stability to the joint as the hip has a large range of motion in movements such as flexion, extension, abduction, adduction and rotation.

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Causes

Common causes of hip impingement are triggered by the femoral head being covered too much by the hip socket. Repetitive grinding at this joint leads to cartilage and labral damage, causing the feeling of impingement.

Other factors that may affect an individual to suffer with labrum impingement could be that individual may have been born with a structurally abnormal ball and socket joint. Also, movements that involve repetition of the leg moving into excessive range of motion may aid in the injury of hip labrum impingement.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” element_content=”” padding_top=”1%” padding_right=”2″ padding_bottom=”” padding_left=”” border_sizes_top=”0px” border_sizes_bottom=”0px” border_sizes_left=”0px” border_sizes_right=”0px”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Symptoms

Some common Hip Labrum impingement symptoms are as follows:

Stiffness in the hip or groin region
Reduced flexibility
Pain when performing exercise such as running, jumping movements and walking
Groin area pain, especially after the hip is placed into flexion
Pain in surrounding areas such as lower back and the groin
Pain in the hip even when resting

Causes

When you go to visit your doctor/ health care professional about hip complications they may talk about two main types of hip impingement:

Cam impingement
Pincer impingement

Cam impingement “occurs because the ball-shaped end of the femur (femoral head) is not perfectly rounded. This interferes with the femoral head’s ability to move smoothly within the hip socket”.

Pincer impingement “involves excessive coverage of the femoral head by the acetabulum. With hip flexion motion, the neck of the femur bone “bumps” or impinges on the rim of the deep socket. This results in cartilage and labral damage”.

Unfortunately, both these two types can happen at the same time, more so known as combined impingement. Which may cause an individual to experience a lot of pain and discomfort.

Diagnosis

The diagnosis of hip impingement will be given by a doctor based on how you describe your symptoms and after performing a physical examination of the hip. Some imagining tests may also be performed such as:

X-Ray – The X-Ray screening may show an irregular shape of the femur bone at the top of the thigh or too much bone around the rim of the hip socket, thus causing the impingement
MRI Scans – This may pick up wear and tear of the cartilage which runs along the hip labrum
CT scans may also be performed

Treatment

A passive motion special test that is commonly used for hip impingement is called the FADIR (flexion, adduction and internal rotation). This is where the patient will lie in supine position (on their back) with the legs relaxed, then the doctor will carry out the test:

The affected leg will be raised so that the knee and hip are at a 90-degree angle
The doctor will support the knee and ankle and gently push the entire leg across the midline portion of the patient’s body moving into adduction
Then whilst keeping the knee in position, the doctor would move the foot and lower calf away from the body into abduction

People who are suffering with hip impingement would feel pain during stage 3 of the test, however it may be hard to differentiate between each injury as someone not suffering with impingement may still feel pain, so it is always important to test the unfaceted side for a comparison.

Exercises

Hip flexor stretches
Piriformis stretches
Isometric hip raises in abduction
Glute bridge
Single leg bridge
Straight leg raises (can also use resistance band)

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Prevention

When exercising avoid placing full body weight onto your hip when the legs are positioned in excessive range of motion
Do daily stretches morning and night
Always rest when needed
Perform rehabilitation exercises given by a physiotherapist

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Winging Scapula

Posted on 05/03/2021

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Overview

Scapula winging is a condition that affects the shoulder blades, the shoulder blade bones should usually lay flat against the back of the body. Scapula winging occurs when a person suffers with shoulder problems, causing the shoulder blades to stick out abnormally. The condition of scapula winging is quite rare but some individuals may suffer really bad from the condition and need effective treatment.

The main muscle involved in the cause of scapula winging is the serratus anterior. This muscle originates from the ribs 1-8 and attaches to the anterior surface of the scapula, which pulls the muscle against the ribcage. The long thoracic nerve is stimulated by the serratus anterior, when or if this nerve becomes injured the scapula will be affected as it jolts back adding more force onto the arm. Injuries to the shoulder may affect this nerve causing inflammation and added pressure onto the nerve, consequently triggering the onset of scapula winging.

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Anatomy

The scapula more commonly known as the shoulder blade articulates with the humerus at the glenohumeral joint. The scapula has three surfaces: the costal, lateral and posterior.

Costal Surface

The anterior surface of the scapula faces the ribcage. This is where the subscapularis originates (one of the rotator cuff muscles). The coracoid process also originates here which lies underneath the clavicle allowing the pectoralis minor, coracobrachialis and bicep brachii to attach at this region.

Lateral Surface

The lateral surface faces the humerus bone. This is where the glenohumeral joint is situated, the main bones around this area are the glenoid fossa, supraglenoid tubercle and infraglenoid tubercle.

Posterior Surface

The posterior surface of the scapula is the site of the majority of the rotator cuff muscles. These include the Infraspinous fossa and the Supraspinous fossa.

All 3 surfaces of the scapula are important to know to locate the site of pain/ discomfort and understand what is causing the winging.

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Symptoms

Scapula winging symptoms may differ as it depends where the location of the muscle or nerve damage is situated. Scapula winging is commonly presented by the shoulder blade sticking out from the back uncharacteristically. This may affect a person from even doing everyday things such as sitting down on a chair that has a hard back or even carrying bags that have straps.

Common symptoms of scapula winging are shown as:

Shoulder blades sticking out
Pain into the neck, shoulders and arms
Weakened muscles surrounding the shoulder blade
Tiredness and exhaustion when performing simple tasks
Pain and discomfort around the area
Inability to lift arms over the head
Sagging of the scapula

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Causes

Scapula winging Is triggered by an individual sustaining a severe injury to any muscles that control the scapula. The serratus anterior is one of the main muscles that enables a person to lift the arm above shoulder level, therefore when this is injured it can cause many problems within the shoulder region.

The main causes of scapula winging are:

Nerve damage to the long thoracic nerve
Serratus anterior weakness
Weakness in the rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis)
Compression on the dorsal scapula nerve (controls the Rhomboid muscles)
Weakness in the trapezius

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Diagnosis

Firstly, for the diagnosis of scapula winging your doctor will look at the shoulder blades for any clear obvious signs of winging. Some patient’s scapula bone may be more visible than others and have distinct scapula winging. The doctor may also ask you to perform arm/ shoulder movements to examine the range of movement and stability at the joint.

One of the main tests that are used to aid in the diagnosis of scapula winging is the serratus anterior test. This is where the patient is asked to face a wall, standing about two feet from the wall and then push against the wall with flat palms at waist level. This test is carried out to identify if any damage is done to the thoracic nerve causing the scapula to wing.

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Treatment

Treatment for winging scapula is dependent on which muscles or nerve is causing the issue. There are two types of treatment surgical and non-surgical.

Non-surgical treatment (Scapula Winging)

Physical therapy/ Rehabilitation
Stretching exercises
Strengthening exercises given by a physiotherapist
Wearing a brace/ sling to support the arm and shoulder
Sports massage therapy
Muscle relaxants/ anti-inflammatory drugs

Surgical treatment (Scapula Winging)

One surgical treatment for scapula winging is nerve and muscle transfers. This is a process which involves moving a part of the nerve and muscle to a different portion of the body, this mainly focuses on the neck, shoulder, back and chest areas.

Static stabilization is another form of treatment used to prevent scapula winging, however there is a risk with this treatment that it may return. This procedure uses a sling to attach the scapula to the ribs to add extra stability to the shoulder blade.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”false”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Exercises

When performing these exercises aim to do 3 rounds of 15 sets for each exercise. Make sure they are slow and controlled so that it is solely focusing on strengthening the weakened muscles:

Scapula retraction
External Rotation
Horizontal Row
Standard press ups
Press up on knees (easier version)
Angel wings exercise

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Prevention

Prevention for scapula winging may not always be possible, however there are procedures you can complete to reduce the risk:

Perform exercises to help with posture
Try and maintain correct posture positioning
Don’t carry anything to heavy on the shoulders and back
Do not lift heavy weights at the gym that could cause more damage to the shoulder
Strengthen the muscles in the neck and shoulders
Perform rehabilitation exercises given by a physiotherapist or doctor
Avoid constant repetitive shoulder/ arm movements
Rest when needed

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Achilles Tendinitis

Posted on 26/02/2021

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Overview

Achilles tendinitis may occur when overuse or to much strain is placed onto the tendon in the ankle region. The Achilles tendon is situated at the heel of the foot and connects the lower leg muscles of the calf to the heel bone of the ankle.

This pathology is mainly sustained by people who do a lot of running and high intensity exercises. Individuals who may have amplified the time and intensity of their runs, thus potentially leading to Achilles tendinitis. This injury could also occur with a lot of people who play sports such as tennis, netball or basketball, due to the fast pace and explosive movements, causing added pressure onto the ankle joint. If not treated correctly Achilles tendinitis could lead to further complications such as tendon tears or ruptures, which may require surgical repair.

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Anatomy

The Achilles tendon, also known as the calcaneal tendon is situated at the back of the ankle. It is a hard band of fibrous tissue that attaches the calf muscles to the calcaneus (heel bone of the ankle). The Achilles tendon is also the largest and strongest in the body.

The two calf muscles; the gastrocnemius and soleus form into one band of tissue, which becomes the Achilles tendon at the lowest point of the calf. A bursa (small sac of fluid) covers the Achilles tendon to help support and protect the area.

When we flex the calf muscles the Achilles tendon pulls onto the heel. This enables us to perform day to day movements such as walking, running and standing on our tip toes. So, it is important to be safe when exercising ensuring the area is protected. The tendon has a limited amount of blood supply, so when we place the tendon under strain or tension it can be more susceptible to injury.

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Causes

The main causes for Achilles tendinitis are from repetitive stress and tension placed onto the tendon, it is not usually related to one specific injury cause. Too much pressure on our bodies sometimes can be harmful and extra care should be taken whenever performing any sporting event or exercise activities. Here are some causes of Achilles tendinitis:

Tightness in calf muscles
Sudden increase in intensity of exercise
Longer duration of exercise
Unexpected bone growth

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Symptoms

Common signs and symptoms of Achilles tendinitis are as follows:

Stiffness at the back of the ankle first thing when you wake up
Pain along the back of the tendon
Sharp pain along the back of the foot
Feels different e.g., thicker or tighter
Lack of range of movement
Severe pain after exercising
Swelling around the tendon

When exercising or walking and you feel or hear a loud popping noise, you should see your doctor immediately. As it is highly likely that you may have torn/ ruptured the tendon and will need medical attention.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Diagnosis

If you feel you are suffering with Achilles tendinitis, then it is best you go and see your doctor. The health care professional will palpate (feel) the area to determine the site of pain tenderness and swelling. The doctor will also complete a physical examination assessing flexibility, alignment, reflexes and range of movement around the effected area.

Special imaging test may also be used such as:

X-Rays
Magnetic Resonance imagining (MRI)
Ultrasound

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Treatment

Now days there are many treatment theories available for Achilles tendinitis. These could be home treatments, anti-inflammatory medication or surgery.

Use the RICE acronym- Rest, Ice, Compress and Elevate the area of injury
Reduce physical activity until swelling and pain has reduced
Ice the area after exercising when pain has occurred
Anti- inflammatory drugs such as aspirin or ibuprofen (however this may just mask the pain)
See a sports/ physiotherapist for rehabilitation exercises and stretches
Wear protective equipment such as a brace to prevent heel movement

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Exercises

Here are a few exercises which may aid in preventing Achilles tendinitis:

Calf raises on floor
Single leg calf raises
Calf raises on elevated bench
Lunge calf stretch
Resistance band calf stretch
Resisted plantarflexion
Walking on tip toes

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Prevention

It may not be possible to full prevent Achilles tendinitis from occurring, however you can incorporate certain measures to reduce the risk factors:

Don’t over do exercise, make sure to have rest days and include full warm ups before exercising
Increase intensity levels of exercise progressively
Make sure you are wearing the correct footwear
Stretch daily, and even more importantly before and after exercising
Perform specific exercises to strengthen the calf muscles
Complete non weight bearing exercise such as swimming to reduce pressure onto the Achilles tendon.

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Lateral Ankle Sprain

Posted on 12/02/2021

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Overview

A lateral ligament sprain within the ankle complex is one of the most frequently injured area within the body, being encountered at 83% in sports such as football and many athletic events.

The main mechanism of this occurring is when an individual will be placed in excessive inversion and internal rotation of the foot whilst the leg is forced into external rotation. The anterior talo-fibula ligament is thought to be the most susceptible within this Injury.

As soon as athlete or personnel have sustained a lateral ankle injury, mechanical limitations and neuromuscular control of the joint becomes effected, for example; ligamentous tear, reduced strength and loss of balance. Due to these influences effecting the ankle joint, it leads to a 73% chance of recurrent damage and injury within one year, especially if correct and safe rehabilitation is not carried out.

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Anatomy

The ankle complex consists of three key joints; these are the talocrural, subtalar and distal tibiofibular. The talocrural joint is known as a hinge joint, movements such as plantarflexion, dorsiflexion, inversion and eversion can be experienced. However due to the fibula being protracted superiorly towards the lateral malleolus compared to the tibia with medial malleolus, eversion movements become restricted. Therefore, implying why inversion injuries may be more frequent in the lateral ankle complex. [/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”yes” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”false” last=”true” padding_bottom=”0px” margin_bottom=”0px” padding_left=”0px” element_content=””][fusion_imageframe image_id=”4801|full” max_width=”400PX” style_type=”” blur=”” stylecolor=”” hover_type=”none” bordersize=”” bordercolor=”” borderradius=”” align=”center” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”” link=”” linktarget=”_self” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://store.livewellhealth.co.uk/wp-content/uploads/2021/02/Lateral-Ankle-Sprain-Birmingham-Manchester-Liverpool-London-Bournemouth-Plymouth-Leicester-Nottingham-Derby-Leeds.jpg[/fusion_imageframe][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” element_content=”” padding_top=”1%” padding_right=”2″ padding_bottom=”” padding_left=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Symptoms

A few symptoms of a lateral ankle sprain are as follows:

Tenderness and swelling
Bruising around the ankle joint
Tenderness on palpation around the joint
Unable to place full body weight onto the joint
Restricted range of movement
General pain and discomfort

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Causes

A lateral ankle sprain may occur when the ankle joint is forced out of its natural position, causing an overstretch within the ligaments around the joint, therefore resulting in a possible partial tear or complete tear. Some causes may consist of wrongly falling on the ankle causing it to twist. Awkwardly landing from a jump or pivoting. Walking or running on an uneven surface resulting in loss of balance, or another person unintentionally landing onto the ankle during a sporting event.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Diagnosis

An injury to the ankle complex is classified by grades I to III to distinguish the severity of ligamentous damage and indisposition of the sprain. Lateral ankle injuries consist of two types of dysfunction, one being mechanical instability and the other being functional instability.

Both of these elements influence the acute injury, implying that once an individual has sustained a lateral ankle injury, a development of chronic ankle instability may transpire in the near future. The incidence of CAI may be present due to mechanical instability from where ligaments have not healed properly in the ankle region and joint laxity becomes effected.

Specific Tests can also be used to help with the diagnosis of a lateral ankle sprain:

The Anterior Draw test: Tests the ATFL
Talar tilt test: Tests the CFL
Posterior Draw test: Tests the PTFL

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Treatment

Treatment for a lateral ankle sprain can vary as it will be dependant on the severity of the injury.

The first step that should be taken 24-72 hours after the injury is sustained would be to reduce the amount of swelling around the joint. An individual should follow the RICE model. Rest, Ice Compress and Elevate. This would include using a cold compress on the ankle and making sure no weight is placed onto the joint.
Soft tissue massage therapy may also be used to assist with the removal of oedema and aid in mild stretching. However, this technique should only be performed once swelling and bruising has reduced around the joint.
Once the ankle can handle some weight being placed onto it, rehabilitation exercises given by a Physiotherapist or doctor should be performed. This will help decrease stiffness around the joint, increase ankle strength and prevent any further complications such as long-term chronic ankle instability issues. These exercises may consist of proprioceptive, strengthening and early motion specific training exercises.

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Exercises

Here is a list of exercises specifically for lateral ankle sprain injuries:

Single leg squat (use chair to hold onto if needed)
Single leg squat (use chair to hold onto if needed)
Single leg hip abduction
Wobble board balance on one leg
Standing single leg balance
Star excursion balance test

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Prevention

To assist in the prevention of a lateral ankle sprain from reoccurring you should:

Ensure a full warm up and cool down is performed before and after taking part in Sporting events or exercise activities.
Wear the correct footwear that is made for your activity e.g., suitable running trainers when going for a run.
If suffered with an ankle sprain before then use protective equipment such as a brace or tape to add extra support to the ankle.
Perform some form of stability training and balance exercises regularly.
Use strengthening exercises for the ankle joint.
Make sure any rehabilitation strategies are executed and performed daily.

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Piriformis Syndrome

Posted on 30/01/2021

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Overview

Piriformis Syndrome is a condition where the small Piriformis Muscle, located in the buttock region, can press on or irritate the Sciatic Nerve. Many Doctors and other professionals mistake this condition for “True Sciatica” which is where the Lumbar Spine degenerates and pinches the Sciatic Nerve. Usually Piriformis Syndrome will be incorrectly diagnosed as “Sciatica” just because it affects the Sciatic Nerve. The piriformis muscle, as it irritates the sciatic nerve, will cause pain, numbness and a tingling feeling along the leg and into the foot.

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Anatomy

The piriformis muscle is one of 6 muscles known as the “Deep 6” and form the wider gluteal muscles or glutes in the buttock region. The Piriformis muscle alongside the other 5 muscles work together to bring the femur bone into external rotation in the hip socket. The other muscles that form the Deep 6 are the gemellus superior, gemellus inferior, obturator externus, obturator internus, and the quadratus femoris. The piriformis muscle sits over the Sciatic Canal where the sciatic nerve runs through and thus why Piriformis Syndrome gives you sciatic pain.

[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”yes” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”false” last=”true” padding_bottom=”0px” margin_bottom=”0px” padding_left=”0px” element_content=””][fusion_imageframe image_id=”4757|full” max_width=”400PX” style_type=”” blur=”” stylecolor=”” hover_type=”none” bordersize=”” bordercolor=”” borderradius=”” align=”center” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”” link=”” linktarget=”_self” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://store.livewellhealth.co.uk/wp-content/uploads/2021/01/Piriformis-Syndrome-birmingham-manchester-london-liverpool-nottingham-derby-leeds-leicester-gloucester-worcester.jpg[/fusion_imageframe][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” element_content=”” padding_top=”1%” padding_right=”2″ padding_bottom=”” padding_left=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Symptoms

Piriformis syndrome is quite literally a pain in the ass! The symptoms will typically start with either pain in your bum, lower back, numbness or tingling down from the bglutes and down the leg. This usually only presents in one side but in extreme cases can be in both legs depending on various factors. If you do suffer with pain this can range from a minor irritant to extreme pain which can run down the length of the sciatic nerve which runs down into the toes. This pain is known as Sciatica because it affects the nerve but is not as serious as true sciatica which is to do with issues in the lumber vertebrae. The pain is caused from the piriformis muscle compressing or irritating the sciatic nerve.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Causes

The exact causes of piriformis syndrome are unknown, hence the “syndrome” terminology. However there are suggestions and suspected causes such as:

Tightness in the Piriformis muscle or a spasm. This can be because of over training, incorrect footwear, sitting for long periods of time or even tightness in the quad muscles that can affect the tilt of your pelvic bone.
Injury or Swelling of the piriformis muscle.
Bleeding in the area of the piriformis muscle.

One or a multiple array of the above issues can cause Piriformis Syndrome of the above problems can affect the piriformis muscle.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Diagnosis

There is no definitive test for piriformis syndrome. In most cases just using questioning and getting a history of when the pain started, where the pain / tingling is etc the practitioner can usually have a good idea whether it is Piriformis Syndrome or Sciatica. In some cases, a contracted or tender piriformis muscle can be found on palpation / physical exam.

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Treatment

There are a number of ways you can treat Piriformis Syndrome most will involve finding ways to strtetch or loosen off the muscle itself. Starting with the lease invasive and least painful:

Take a hot bath and use hot water bottles on and around the glute / bum muscles as often as you can, at least twice a day. This will help relax the muscles if there has been a tightening or spasm.
Trigger Pointing the piriformis muscle. If you have an good understanding of the glute anatomy, you can use a foam roller or trigger pointing ball (or a golf ball etc) to apply pressure to the piriformis in order to force it to relax and length.
Stretching the Glute muscles, Hamstring Muscles, Lower Back (Quadratus Lumborum) and Quad (front muscles). Some may argue the anterior leg muscles however if they are tight they could be giving your pelvis an anterior tilt which by lengthening the Piriformis muscle too much can cause it to press against the sciatic nerve.
Massage therapy. A good qualified sports therapist can provide a high level massage therapy / sports massage which can include things such as soft tissue release, neuromuscular therapy and general lengthening and loosing techniques to manipulate the muscle to relax.

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Exercises

Glute Max Stretch

Piriformis Stretch

Hamstring Stretch

Quadricep Stretch

Trigger Point the Piriformis Muscle

Please see some exercises and stretch examples in our video.

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Prevention

As this is a syndrome and the direct cause of this condition is unknown we would recommend if you are in a seated job to get up and stretch the hamstrings and glutes from time to time or adjust your sitting position so your legs do not continually get placed under the chair shortening the hamstrings for example.

Walking can also help as this will use antagonist muscles to help relax the posterior chain.

Reducing any sporting activity that you feel is increasing the symptoms.

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Morton’s Neuroma

Posted on 28/01/2021

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Overview

Morton’s Neuroma is a condition in your foot that affects one of the plantar digital nerves that are located between the metatarsals. A neuroma is a non-cancerous tumour that grows from a nerve; however, a Morton’s neuroma is not like this and instead it leads to the thickening of the nerve. This condition usually only affects one foot at a time and is mostly found to affect the nerve in between the third and fourth toes. Morton’s Neuroma usually occurs in women 75% of the time and commonly affects people over the age of 35. The reason for this happening is unknown but Morton’s Neuroma is believed to be a chronic condition that may have occurred as a result of the nerve being compressed or stretched.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”false” padding_left=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Anatomy

Morton’s neuroma usually affects your foot between your 3rd and 4th toes.

It is sometimes referred to as an intermetatarsal neuroma. Intermetatarsal describes its location in the foot between the metatarsal bones. Neuromas can occur in other locations in the foot.

The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”yes” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”false” last=”true” padding_bottom=”0px” margin_bottom=”0px” padding_left=”0px” element_content=””][fusion_imageframe image_id=”4774|full” max_width=”” style_type=”” blur=”” stylecolor=”” hover_type=”none” bordersize=”” bordercolor=”” borderradius=”” align=”center” lightbox=”no” gallery_id=”” lightbox_image=”” lightbox_image_id=”” alt=”” link=”” linktarget=”_self” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″]https://store.livewellhealth.co.uk/wp-content/uploads/2021/02/MORTONS-NEUROMA-LABELS.jpg[/fusion_imageframe][/fusion_builder_column][fusion_builder_column type=”1_1″ type=”1_1″ layout=”1_1″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”true” element_content=”” padding_top=”1%” padding_right=”2″ padding_bottom=”” padding_left=””][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Symptoms

The symptoms of Morton’s Neuroma will be aggravated by wearing tight or high heeled shoes and the symptoms will get worse over time. The symptoms will include but may not be limited to:

A shooting or stabbing pain in either the ball of the foot or the toes
Feeling like there is a small stone stuck under your foot
Tingling of the toes
May be difficulty walking

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Causes

Morton’s neuroma is the directly caused by an irritated or damaged nerve, which sits between the toe bones.

It’s can often be a cause and linked to:

wearing shoes that are too tight.
Wearing pointy or high-heeled shoes.
Doing a lot of sports such as running, tennis, squash or other sports/activities that place pressure through the feet.
Having other foot related issues. These can be things such as high arches, flat feet, bunions or hammer toes.

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Diagnosis

During your visit to your local GP or Sports Therapist / Physiotherapist, they will press on your foot to feel for a mass or tender spot. There may also be a feeling of “clicking” between the bones of your foot.

Imaging tests
You can have various imaging tests which come with varying levels of success.

X-rays – Your doctor is likely to go down the route of X-Ray’s first to look at your foot, this will be to rule out other issues / causes for your pain.
Ultrasound – Ultrasound is beneficial when looking at soft tissue abnormalities
MRI (Magnetic resonance imaging) – This is an expensive but detailed scan of the area and often indicates neuromas in people who have no symptoms.

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Treatment

The pain can sometimes be unbearable but whether it is or is not does not affect the fact that the immediate aim is to decrease the pain level.

There are many ways that you can decrease the pain that you are feeling but the most effect way for immediate relief would be to rest the area and then combine this with either heat or cold therapy. This should help to remove the pain or at least reduce the intensity; however, this will only act as a short-term pain relief so if the pain became persistent you would have to do this regularly.

For long term relief and hopefully a complete elimination of the pain there are further ways to treat the area.

By having a deep tissue massage in the area this would help to relieve the pain by focusing the massage on the metatarsal heads whilst being cautious to aggravate the neuroma.

Mobilisation techniques of the metatarsal heads would also be a viable option to try and relieve the pressure in the nerve. In addition to this stretching the toe extensors, calf muscles and the plantar fascia regularly should help to strengthen your feet and improve foot stability.[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_2″ type=”1_2″ layout=”1_2″ spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=”” hover_type=”none” border_size=”0″ border_color=”” border_style=”solid” border_position=”all” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ first=”true” last=”false”][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””]

Exercises

The best way to treat Morton’s neuroma is firstly to rest. If pain allows, some stretching and strengthening exercises can help improve symptom’s and alleviate some pain.

You can stretch the calf muscles and Achilles tendon.
Stretch the plantar fascia along the underneath of the foot, this can be done using a hard ball also.

If you are going to exercise, make sure you build these up slowly so that you don’t irritate the nerve and start the inflammation process again.

Firstly, try a gentle walk to start, maybe start with a mile or 2 depending on your level of fitness.

Once you have done this for a week or two and feel comfortable, then try some HIIT walk/running with 4 minutes of walk followed by 2 minutes light jogging, repeating four to six times. The following day complete rest then try again the next day and as time goes on, pain allows and symptoms reduce, increase the length and intensity.

Please see some exercises and stretch examples in our video.

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Prevention

There are a number of things you can do to prevent Morton’s neuroma:

Try to limit the time you are wearing tight or high-heeled shoes.
Try to wear shoes or trainers that are wider at the front to stop your toes being pushed together.
If you are training such as Running or Walking, try to wear shoes or trainers that have a good amount of cushioning especially around the balls or your feet.
Keep a Healthy Lifestyle and your Weight under control as excess weight can put undue stress on the foot.
For athletes, discuss alternative training plans with your coaching team.

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