Did you know amongst other things, chiropractors frequently also treat the hips, knees and feet?
Amazingly in an average lifetime, our feet carry us an equivalent of five times around the Earth and in addition to this, the feet must take the strain of supporting the body’s weight even when just standing still. Given how often we use our feet, and the demands we make upon them on a day to day basis, it’s so important to look after them properly.
In each foot there is a total of 26 bones, and damage to any one of them, or even related muscles, ligaments or cartilage can result in problems with the foot that may need attention from a trained professional in order to prevent longer term damage.
Here are some simple tips for you to follow to keep your feet in good condition:
Pay good attention to your feet; changes and/or pain in the feet and ankles could indicate a more serious foot ailment or circulatory problem, so if in doubt, check it out! If you think you might need support for your feet/arches then check out our biomechanics and orthotics service
While fun and efficient, our much-loved technological devices could be the cause of bad posture and resulting back and neck pain…
Technology has become part of our everyday life. Everywhere you look people are surfing the net on their computers, writing a text message on their mobile phone or using a tablet to watch a video, which means a considerable amount of our time is being spent hunched over looking at a screen.
It goes without saying that our techno devices bring a lot of fun and efficiency into our lives, but they can also, unfortunately bring a multitude of problems for our backs and necks, which is why correct posture when you are spending a lot time in front of a screen is extremely important.
Central Bath Chiropractic and Physio
Our bodies are very robust to general postural stress but to reduce repetitive loads follow these simple Do's and Don’t's:
Many people cringe at the sound of knuckles, elbows and other joints cracking. For years, experts have debated whether or not this common cracking could cause joint problems.
It has recently been confirmed that this ‘popping’ is due to a small bubble forming between your joints. The bubble forms when your joints move apart, forming a kind of vacuum in the synovial fluid, a slippery substance that lubricates your joints.
People who can deliberately make joints like knuckles pop usually do so by pushing or pulling the joint in such a way as to make an air bubble appear with a sudden pop. This is called joint cavitation. Once the bubble is there the joint will not pop again until all the air has been reabsorbed.
However, there are other cracking noises and sensations that may of concern. Snapping and cracking noises can be caused by osteoarthritis as a consequence of the natural ageing process, or following a trauma or disease in the joint. In this case the cartilage, which eases friction in the joint breaks down, so that movement causes painful friction and crunching noises.
Snapping noises and sensations, on the other hand, are likely to be caused by muscle or tendon moving across a bone. This happens when a tendon is slightly loose, and occurs most often in the hip, knee, ankle, wrist and shoulder. This could eventually lead to bursitis, or inflammation of the fluid-filled sac that allows muscle to move smoothly over bone.
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So why do we as chiropractors and physiotherapists sometimes cause joints to crack? Chiropractic manipulation takes advantage of the phenomenon of cavitation to induce movement in stiff and painful joints and offload looseness in the neighbouring joints. This reduces the likelihood of accidental popping. In other words, popping joints in the correct way can help relieve stiffness and makes neighbouring joints more stable.
Are you a joint cracker or know someone that is? Be sure to share this article with them!
AC is a condition in which the shoulder is completely or partially unmovable (stiff). Along with often intense shoulder pain, AC presents with progressive limitations in both active range of motion (joint movement you can achieve alone) and passive range of motion (movement achieved when someone else moves the joint).
The cause of this debilitating condition is not fully understood. It is believed that the shoulder (glenohumeral) joint capsule, a band of connective tissue surrounding to head of the humerus, along with shoulder ligaments, become red, swollen and inflamed, leading to shortening and stiffness (contracture) and a loss of the capsules normal elastic quality.
For some time it was believed by many that AC followed a natural history theory. If initially ‘frozen’ it would suggest it could thaw. The theory was that the condition moved from painful (freezing), stiff (frozen), through to (thawing) recovery / complete resolution. Furthermore, it was believed that the condition would improve over time (usually 2 – 3.5 years) without any intervention.
We can now confidently say that these theories have largely been disproven. No longitudinal evidence supports the natural history theory and there is moderate evidence stating that most improvement occurs early, not late; therefore, the key in AC is early diagnosis and early treatment. A delay in treatment may in fact lead to worse outcomes.
The team here at PhysioImpulse can help identify many causes of shoulder pain and stiffness and support in the management of these debilitating conditions.
Treatment of AC is focused on restoring normal range of movement and returning the joint back to its previous function. Shoulder joint injections are commonly used for AC and these injections aim to reduce inflammation and also act as pain relief. However, there is no ‘gold standard’ treatment regime; your physiotherapist will work with you to create a plan tailored to you.
Early mobilisation with physiotherapy is generally recommended as first-line treatment; a variety of techniques may be used. One of these is ‘hands-on’ physiotherapy using joint mobilisation techniques. These aim to gently stretch the joint capsule by performing passive mobilisations at varying points throughout the shoulder range. Your physiotherapist will support this with appropriate exercise therapy and activity management advice.
For Further information on Adhesive capsulitis or any other condition just call the number below or email firstname.lastname@example.org
Central Bath Physiotherapy
Achilles Tendon Injury
- The Achilles is the tendon found at the bottom of the calf and joins the calf muscles (Gastrocnemius and Soleus) to the heel bone. The Achilles tendon has to tolerate the highest loads in the body – up to 10 times your body weight during running and jumping.
- Achilles heel pain is now called Achilles tendinopathy. There are cellular changes to the tendon and to the arrangement of collagen fibres, as well as its supporting system, the matrix. With Achilles tendinopathy the tendon does not become weak, but it does make it difficult for the Achilles to tolerate loads. Correcting this that is at the heart of treatment.
- Classic features of Achilles tendinopathy are the gradual onset of morning stiffness, which may resolve within 5-10 minutes, and stiffness when walking after sitting for long periods. The morning stiffness is often worse on days after a run.
- You may also notice some swelling.
- Your Achilles tendon might feel tender when you touch it. There may be a grating noise or creaking feeling (crepitus) when you move your ankle.
- Sudden pain in your heel or calf, which quickly becomes swollen, bruised and sore, can mean you’ve torn the tendon. You may actually hear it snap. This is called an Achilles tendon rupture. You should get urgent medical attention if this happens.
- The pain/stiffness will typically “warm-up” during the first 5-10 minutes of a run. This often means people don’t seek help as they can initially run through the pain. But the earlier you seek help, the more likely you will be able to get away with adjusting your load rather than stopping running altogether.
What causes Achilles Tendinopathy?
There are certain risk factors that may lead some people to developing Achilles tendinopathy, many of which relate to changes in load through the tendon rather than to a person’s biomechanics.
- More men are affected than women
- It is more common in your 30s or 40s.
- Some individuals also have a genetic predisposition to developing tendon pain.
- Other risk factors can include changes to your exercise regime.
There are three questions that should be considered:
- What – Have I changed in my training/exercise in some way e.g. more hilly terrain for running/cycling, increased distance/speed?
- Where – Have I changed where I train e.g. cross country to road running?
- With – Have I changed what I train with e.g new footwear, altered bike set up etc?
- Diagnosis can occur at different points: the onset of pain may be quite sudden and a reaction to overload – referred to as a reactive tendinopathy and may be severely painful. Or it might be more chronic (longstanding as opposed to severe) – referred to as tendon disarray or degeneration. The treatment will therefore depend on the individual, but ultimately it involves improving the tendons tolerance to load.
The key areas that physiotherapy focuses on are as follows:
- Improving how well the tendon tolerates load
- Biomechanical correction read here about orthotics/insoles
- Manual therapy (Soft tissue and joint mobilisation to relax tight areas within the calf muscles and reduce any stiffness in surrounding joints)
- Strength training and correcting training errors
There is good evidence that slow, heavy load-strength training can improve a tendon’s tolerance to load and this is one of the gold standards for treatment. It is important, though, to avoid overload through other aspects of training while strength training, otherwise it may fail.
While there may also be specific biomechanical factors feeding into the tendinopathy.
Your Physiotherapist will consider the whole chain when assessing, including looking at the hips and knees any spinal involvement.
More common than biomechanical problems are training errors. Most people we see present with Achilles tendon problems when they have radically changed their training load. All the evidence points towards load management as the best way to treat Achilles tendinopathy. And it is important to give it time before considering other options – we suggest three to six months.
A Myofascial Trigger Point (MTrP) is a discrete, hard, hyper-irritable nodule or ‘knot’ in a taut band of muscle, which is exquisitely tender on palpation. The inclusion of “myofascial” in the name has developed from the view that both muscle and fascia (connective tissue) are likely to be involved in the symptoms. MTrP are often seen as part of Myofascial Pain Syndrome, which is a term used to describe a pain condition that involves the muscle and it’s surrounding fascia. This can be acute or chronic.
Active trigger points are associated with spontaneous pain in the immediate surrounding tissue and/or to distant sites in specific referred pain patterns. Strong palpation of the active trigger point can exacerbate a person’s pain complaint and mimics their familiar pain experience. MTrPs can also be classified as latent, in which case the MTrP is physically present but not associated with a spontaneous pain complaint. However, pressure on the latent MTrP elicits local pain at the site of the nodule. Both latent and active MTrPs can be associated with muscle dysfunction, muscle weakness, increased tension and a limited range of motion/reduced flexibility.
Muscle pain disorders were first written about in the 1500s. In the 1900s, researchers injected hypertonic saline into various anatomical structures such as fascia, tendon, and muscle in healthy volunteers in order to chart zones of referred pain in local and distant tissue.
In the 1950s, Janet Travell and Shannon Rinzler coined the term “myofascial trigger point”, reflecting their finding that the nodules can be present and refer pain to both muscle and overlying fascia. Myofascial Pain and Dysfunction: The Trigger Point Manual is the most comprehensive collection of information on trigger point referral patterns and is used by a wide range of clinicians. However, research is still on-going in this area with the view to further develop our understanding of MPS and the true mechanisms behind MTrP development.
There is general agreement that any kind of muscle overuse or direct trauma/injury to the muscle can lead to the development of MTrPs due to changes in blood flow and the release of chemicals in the body. Muscle overload is thought to be the result of sustained or repetitive low-level muscle contractions, eccentric muscle contractions, and maximal or submaximal concentric muscle contractions, hence causes of MTrP can range from sports training injuries to muscle weakness from lack of exercise; slips/trips/falls/accidents to general muscle strains; and sustained poor postures, including computer use.
Generally, myofascial pain resolves in a few weeks with or without treatment. In some cases, however, muscle pain persists long after resolution of the injury; it may even refer to other parts of the body. This heralds the ‘sensitised state’, which is one of the features of a chronic pain disorder, in which the pain itself is the pathology and requires medical intervention for its resolution. I find this fascinating and it is certainly something we see a lot of in clinic, especially given that chronic pain is defined as ‘a pain lasting more than 12 weeks’, which for a lot of people is just a mere drop in the ocean compared to how long they have had their pain.
Because of this, MPS has also been associated with other pain conditions such as referred pain from spinal discs and nerves, joint dysfunction like arthritis, tendonitis, migraines, tension headaches, carpal tunnel syndrome, whiplash-associated disorders, pelvic pain and back/neck pain. Interestingly, low mood and sleep disruptions have also been associated with MPS.
Trigger points may be relieved through non-invasive measures, such as manual therapies, which include post-isometric relaxation, trigger point compression, muscle energy techniques, myofascial release, massage, heat and cold, and stretching. Invasive treatments in our clinics would include dry needling and acupuncture. Invasive medical interventions include injections with local anesthetics, corticosteroids, or botulism toxin.
Postural re-training (including pilates), stretching and strengthening exercises, stress management, and mindfulness can also help to address the underlying causes of a person’s MTrPs. This is particularly important in chronic conditions where the chance of recurrence might be more likely due to on-going aggravating factors. Self-myofascial release techniques using a foam roller or spiky ball can be a beneficial part of this self-management.
A point regarding referred pain:
Referred pain is where a person perceives pain at a location that is different from the site of where the pain originates. Spinal nerves, joints and organs are example of parts of our anatomy that can refer pain. MTrP have specific patterns of pain referral. These charts are easily accessible on the internet and can prove very useful in self-diagnosis. If your pain persists beyond self-help, then it is important to seek professional advice as either not enough is being done to address the underlying aggravating factors that are perpetuating your symptoms, or you may require ‘hands-on specialist treatment’, or it may be that your pain may not be myofascial in origin.
If you feel this is something you would like to discuss further, then please get in touch or book in for an assessment with one of our clinicians.
Costco-vertebral joint irritation
Costco-vertebral joint irritation is pain originating from where your ribs attach on to the spine in the centre of your back. It’s a common place to suffer with pain, in particular for desk workers who are hunched forward for the majority of the day. It will be the area which you can never reach, between the shoulder and the neck but slightly too far down to show someone the exact point which is causing the pain.
Bath Chiropractor 01225 683007
By assessing and detecting the painful region, Chiropractic treatment including spinal manipulation can relieve the symptoms and increase the movement to the affected joint and the surrounding area, relieving the pin-point tenderness and any associated head, neck or shoulder symptoms. By addressing the primary cause, the muscles sitting on top or surrounding the irritable joint will overtime desensitise and stop tensing to protect the injured area. Like with most injuries, icing the area will reduce excess inflammation to a muscle, and specific exercises can help prevent future recurrences. If this sounds like something you suffer with, don’t hesitate to contact us and book in with our Chiropractor Mike
For people with hip and knee osteoarthritis (OA), high-quality research shows that exercise therapy is very helpful in decreasing pain and improving movement in these joints. The phrase, Exercise as Medicine, has been used for some time – but not just for OA, for some twenty five other long term health conditions too.
OA is the most common cause of arthritis and a major public health problem. It was first thought of as simply ‘wear and tear’ affecting cartilage within joints. Common misbeliefs focused solely on mechanical (load-related) or occupation-related reasons for these joint changes. However, our knowledge of this condition has advanced considerably.
Many risk factors come into play when considering the cause of OA, as outlined in the Arthritis Research UK information leaflet.
Exercise as Medicine
It is widely known that exercise should be an integral part of standard care for people with knee and hip OA. Raising your physical activity levels is effective in achieving good outcomes.
Exercise should consist of:
- Cardiovascular (aerobic) components
- For example, swimming or cycling
- Flexibility components
- For example, stretching exercises for your thigh or groin muscles
- Strength training components
- For example, resistance exercises for your back, hips and knees
There are also many other important non-surgical treatment options available to those who suffer with OA.
At Physioimpulse we have a Gait analysis and Biomechanic assessment service which enables us to assess your foot mechanics and create custom made insoles to reduce the pain of OA affected joints and enable more effective rehabilitation.
Some people struggle to exercise efficiently due to high pain levels so we also provide Ostenil injections which"lubricate" the joint and can provide up to 9 months of pain relief.
Other Non-Surgical Treatment Options
- Patient education
- Activity modification
- Weight loss
- Knee bracing
Here at PhysioImpulse, we want to support you to keep active and manage your OA as best able.
Stay active and exercise!
Bath Physiotherapy 01225 683007
Arthritis Research UK (2018) https://www.arthritisresearchuk.org/arthritis-information/conditions/osteoarthritis.aspx [Accessed online 2nd September 2018]
Exercise Is Essential for Osteoarthritis: The Many Benefits of Physical Activity Journal of Orthopaedic & Sports Physical Therapy, 2018 Volume:48 Issue:6 Pages:448–448.
Liu-Bryan, R. and Terkeltaub, R., 2015. Emerging regulators of the inflammatory process in osteoarthritis. Nature Reviews Rheumatology, 11(1), p.35.
Osthoff, A.K.R., Niedermann, K., Braun, J., Adams, J., Brodin, N., Dagfinrud, H., Duruoz, T., Esbensen, B.A., Günther, K.P., Hurkmans, E. and Juhl, C.B., 2018. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the rheumatic diseases, 77(9), pp.1251-1260.
Pedersen, B.K. and Saltin, B., 2015. Exercise as medicine–evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian journal of medicine & science in sports, 25, pp.1-72.
Recently updated NICE (National Institute for Clinical Excellence) guidelines have suggested that individuals with a diagnosis of Parkinson’s should have an assessment from a specialist neurological physiotherapist and on-going access to physiotherapy. NICE advocates that physiotherapy can help to manage symptoms and maintain an independent lifestyle. It can also reduce the number of admissions into hospital.
NICE quality statement (updated February 2018)
Adults with Parkinson's disease are referred to physiotherapy, occupational therapy or speech and language therapy if they have problems with balance, motor function, activities of daily living, communication, swallowing or saliva.
NICE also advises early input after a diagnosis of Parkinson’s from a specialist physiotherapist in this field. This can help people to keep in control of their condition and symptoms and allow them to live well and independently with Parkinson’s. This recommendation was updated in 2017 and highlights the benefit that physiotherapy can contribute to in the management of Parkinson’s short and long-term.
Parkinson’s is a progressive neurological condition, which affects an area of the brain known as the substantia nigra. This area normally produces a chemical known as dopamine, which helps to control the coordination of movement. In Parkinson’s, the nerve cells in the substantia nigra become damaged meaning that dopamine production is reduced. This can cause symptoms such as tremors (shaky movements), slowness of walking and rigidity (stiffness in muscles and joints). Other common symptoms are freezing (feet feel ‘stuck’ to the ground), falls, speech and swallowing difficulties and pain.
Bath Neuro Physio 01225 683007
There are many different treatment options for people with Parkinson’s depending on the specific symptoms and goals of the individual. These include:
- Gait (walking) analysis
- Advice on walking aids
- Strengthening exercise programmes
- Looking at daily activities and ways to make these easier and safer
- Strategies to manage some of the symptoms in Parkinson’s such as freezing, difficulty turning and stiffness
- Respiratory physiotherapy if you have difficulty with secretions and breathing
- ‘Hands on’ (manual) therapy to help with joint and muscle stiffness
- Strategies to reduce and manage falls
- Pain education
- Advice and teaching for carers and family members
Physioimpulse Chartered Physiotherapists