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What the Cup?

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What the Cup?

What is cupping?

Cupping has been used since 3000 BCE, it originated in ancient Egypt where it was used to remove toxins from the body [1]. Since then cupping has spread throughout the world and been used in many cultures as a treatment for a variety diseases. Today cupping is mostly seen in traditional eastern medicine, where it is used to correct blockages and help the flow of Qi throughout the body [2]. It involves suctioning special cups to the skin of a patient, in the form of wet cupping or dry cupping. Wet Cupping is invasive and involves suctioning small amounts of blood through minor incisions made in the skin, this means it is usually not performed by physiotherapists in western practices [3].

What is dry cupping?

Dry cupping is non-invasive, as it doesn’t involve exposure to blood. It is mostly used to treat musculoskeletal pain in the chest, stomach, back and buttocks [4]. Smaller cups can also be used to treat regions on the arms and legs.

Cups vary from 38-50mm in diameter and are generally made of plastic or glass [3].

The cup is suctioned and held in place by heating the air in the cup then placing the rim of the cup on the skin so it is air tight, or by suctioning air out of the cup using an air pump after placing it on the skin [3]. This negative pressure inside the cup suctions the skin and feels like your skin and soft tissue underneath is being pulled or stretched. Then it is generally left in place for 5-20 minutes or can be moved around to cover a larger area using lubricant so that it can slide without interrupting the vacuum seal made between the skin and the cup [5].

 

How does dry cupping work?

The vacuum inside the cup creates a tensile force that stretches the skin, subcutaneous tissue and fascia lying beneath [2]. This also causes the small blood vessels in that area to expand. The larger the cup and more suction created the stronger it stretches the soft body tissues underneath, and the longer it is left in place the more blood that is drawn to that area [2].  

This means dry cupping has the potential to be used for a number of benefits such as:

  1.  Relieving muscle and surrounding fascia tightness [3]

  2. Aiding muscle and soft tissue healing [6]

  3. Increase blood circulation and aid removal of toxins from muscles [4]

  4. Improve immune function by aiding flow of lymph [6]

  5. Provide pain relief through stimulating pain inhibiting nerves [7]

  6. Promoting deep relaxation [7]

 

Is it safe?

Yes, provided it is performed by a suitably trained therapist. Patients may feel warmer and may sweat during a cupping treatment, this is just a result of blood vessels expanding and drawing more blood and heat to the skin [3]. Patients may also experience redness, swelling and bruising of areas of skin that have been cupped after a treatment, this is normal and should go away within a few days or weeks [4]. You should not having cupping therapy if you are pregnant, menstruating, have metastatic cancer or have cupping therapy over an area with a bone fracture, deep vein thrombosis, palpable pulse or skin irritation [8]. 

Complications to cupping are very rare and usually due to a lack of therapist training and incorrect practice, which have lead to only a few reports of skin burns, contamination and pressure wounds [9].

 

What does research say about the effectiveness of dry cupping?

There have been several studies investigating the treatment effects of dry cupping on a variety of musculoskeletal conditions. The findings of these studies are:

  • 2 weeks of cupping treatment significantly reduced chronic neck pain [10]

  • 2 weeks of pulsating cupping effectively relieved pain, improved function and quality of life in patients with chronic neck pain [11]

  • Cupping and exercise together is effective in improving neck pain and neck function, and better at improving pain than using a heating pack [12]

  • Patients with sub acute and chronic lower back pain felt less pain and improved flexibility in their lower back after 1 treatment [13]

  • Pulsating dry cupping is effective at relieving symptoms of knee osteoarthritis [14]

There is however a need for future studies to focus on confirming comparing these effects to standard treatments as well as understanding long lasting effects of dry cupping.

 

If you have any questions regarding treating your aches and pains or cupping therapy, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Nickel, J.C., Management of urinary tract infections: historical perspective and current strategies: part 1—before antibiotics. The Journal of urology, 2005. 173(1): p. 21-26.

  2. Tham, L., H. Lee, and C. Lu, Cupping: from a biomechanical perspective. Journal of biomechanics, 2006. 39(12): p. 2183-2193.

  3. Rozenfeld, E. and L. Kalichman, New is the well-forgotten old: The use of dry cupping in musculoskeletal medicine. Journal of bodywork and movement therapies, 2016. 20(1): p. 173-178.

  4. Yoo, S.S. and F. Tausk, Cupping: east meets west. International journal of dermatology, 2004. 43(9): p. 664-665.

  5. Turk, J. and E. Allen, Bleeding and cupping. Annals of the Royal College of Surgeons of England, 1983. 65(2): p. 128.

  6. Ahmadi, A., D.C. Schwebel, and M. Rezaei, The efficacy of wet-cupping in the treatment of tension and migraine headache. The American journal of Chinese medicine, 2008. 36(01): p. 37-44.

  7. Musial, F., D. Spohn, and R. Rolke, Naturopathic reflex therapies for the treatment of chronic back and neck pain-part 1: neurobiological foundations. Complementary Medicine Research, 2013. 20(3): p. 219-224.

  8. Chirali, I.Z., Traditional Chinese medicine: cupping therapy. 1999: Elsevier Health Sciences.

  9. Cao, H., X. Li, and J. Liu, An updated review of the efficacy of cupping therapy. PloS one, 2012. 7(2): p. e31793.

  10. Lauche, R., et al., The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain-a randomised controlled pilot study. BMC complementary and alternative medicine, 2011. 11(1): p. 63.

  11. Cramer, H., et al., Randomized controlled trial of pulsating cupping (pneumatic pulsation therapy) for chronic neck pain. Complementary Medicine Research, 2011. 18(6): p. 327-334.

  12. Kim, T.-H., et al., Cupping for treating neck pain in video display terminal (VDT) users: a randomized controlled pilot trial. Journal of occupational health, 2012. 54(6): p. 416-426.

  13. Markowski, A., et al., A pilot study analyzing the effects of Chinese cupping as an adjunct treatment for patients with subacute low back pain on relieving pain, improving range of motion, and improving function. The Journal of Alternative and Complementary Medicine, 2014. 20(2): p. 113-117.

  14. Teut, M., et al., Pulsatile dry cupping in patients with osteoarthritis of the knee–a randomized controlled exploratory trial. BMC complementary and alternative medicine, 2012. 12(1): p. 184.

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Don’t run from the P.O.L.I.C.E.

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Don’t run from the P.O.L.I.C.E.

So, you rolled your ankle, you're thinking it will be fine, I’ll just walk it off. Little did you know as you continued to play the last 10 minutes of the game, the phases of healing have already begun. As you continue to run, your ankle throbs and feels unstable beneath your body. You feel sick as the pain won’t go away but continues to get worse. Thoughts race through your mind, what have I done? Should I see someone? Finally, you make the decision to come off the court, but what do you do now?

In the past, the process to assist with recovery was known as R.I.C.E.R. (Rest, Ice, Compression, Elevation and Referral). This has been proven to be effective, however, methods of management have changed to the P.O.L.I.C.E. protocol [1] :

P – Protection: this reminds individuals that a little bit of pain is okay but if the injury causes severe pain then the ankle should be protected using bandages, taping or crutches to off-load the ankle.

O – Optimal: the right amount of pain/discomfort (not too much but tolerable).

L – Loading: placing weight on the ankle (optimal-loading is advised).

I – Ice*: applied for 8-10 minutes at a time [2,3] alternating between 10 minutes on then 10 minutes off. This should be done as often as possible in the first 48 hours.

C – Compression: apply a compression bandage around the ankle, ensuring it is firm enough without cutting off circulation to the foot (Pinch test: squeeze toe, it should turn white then red again).

E – Elevation: raise leg above heart height to prevent pool of blood around the ankle due to gravity.

* Warning: any burning sensations in the region REMOVE the ice. Do not place ice directly on skin (apply a 1-2 cm cloth in between ice and skin). Never place ankle on top of the ice but rather the ice on top of the ankle.

 

Why this protocol?

Recent studies have shown that protecting the joint should be only as required as resting or offloading the joint could be detrimental causing changes as to how the tissue recovers [1, 4, 5]. These studies therefore promote optimal loading, where an individual can start placing body weight onto the ankle, as tolerable. This encourages correct fiber type and alignment to develop, early mobilisation and can facilitate accelerated recovery times [1, 4]. Further benefits of optimal loading are positive as changes to mechanical properties regarding load alter sensory feedback. This informs the brain that this painful feedback, which it was experiencing earlier on, is no long dangerous thus de-sensitizing the injury and reducing pain levels [4]. Previously the R.I.C.E. [6] method did not consider optimal loading and referral but rather focused on resting and went straight into management. Though icing is effective, studies have shown this has a limited effect depending on the duration and severity of the injury and should only be utilised in the acute phases [3]. Benefits of using ice should still be utilised as icing reduces the analgesic (pain) response and facilitates optimal healing by reducing swelling that would otherwise delay an individual’s rehabilitation process [7, 8].

So, when in doubt, don’t run, follow the P.O.L.I.C.E. protocol. If pain persists or worsens or you are unable to weight bare, contact your local physiotherapist and book an appointment.

 

What would a Physiotherapist do to help?

  • Perform a thorough movement examination of the lower body to provide education and understanding of the condition.
  • Provide tailored strategies and modifications to correct improper biomechanics of the ankle, i.e., taping, ergonomic assessment.
  • Design a personalised exercise program tailored to resolving muscle imbalances that would otherwise cause ankle instability.
  • Assist with improving range of movement and pain management strategies.
  • Provide education on self-management techniques.
  • Improve balance and retrain an individual back to pre-injury status.

 

If you have any questions regarding your acute injury, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE?. British Journal of Sports Medicine. 2011 Sep 7:bjsports-2011.
  2. Adie, Naylor, & Harris. (2010). Cryotherapy After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of Arthroplasty,25(5), 709-715.
  3. Prins, J., Stubbe, J., Van Meeteren, N., Scheffers, F., & Van Dongen, M. (2011). Feasibility and preliminary effectiveness of ice therapy in patients with an acute tear in the gastrocnemius muscle: A pilot randomized controlled trial. Clinical Rehabilitation, 25(5), 433-41.
  4. Glasgow, P., Phillips, N., & Bleakley, C. (2015). Optimal loading: Key variables and mechanisms. British Journal of Sports Medicine, 49(5), 278-279.
  5. Bleakley, C., Dischiavi, S., Taylor, J., Doherty, C., & Delahunt, E. (2017). Rehabilitation reduces re-injury risk post ankle sprain, but there is no consensus on optimal exercise dose or content: A systematic review and meta-analysis. British Journal of Sports Medicine, 51(20), British Journal of Sports Medicine, Oct 15, 2017, Vol.51(20).
  6. Hing, Wayne, Lopes, Justin, Hume, Patria A., & Reid, Duncan A. (2011). Comparison of multimodal physiotherapy and "R.I.C.E." self-treatment for early management of ankle sprains. (RESEARCH REPORT)(Report). New Zealand Journal of Physiotherapy, 39(1), 13-19.
  7. MacAuley, D. (2010). Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ. British Medical Journal (Clinical Research Ed.), 340(10), 1122.
  8. Bleakley CM, O'Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010; 340:1964.

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Patello-Femoral Pain Syndrome

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Patello-Femoral Pain Syndrome

What is PFPS?

Patellofemoral pain syndrome (PFPS) is prevalent in approximately 25% of the athletic population and most commonly affects young adult females [1].  PFPS is characterised by anterior knee pain in and around the patella [2,3]. When bending at the knee joint, the patella should normally track in a lateral to medial direction before moving laterally again at full knee flexion. This motion is controlled by the quadriceps muscle group, particularly the vastus medialis oblique and vastus lateralis components. Poor coordination or weakness of these muscles can lead to inflammation of soft tissues (lateral retinaculum, infrapatellar synovium and fat pad) in addition to stress on cartilage and bone causing pain [3].

Presentation

  • Acute or gradual onset
  • Aggravated by increased on unaccustomed loads on the patellofemoral joint (e.g. higher training volume, increased running speed, hill/stair running and bounding)
  • Varied presentations including achy/sharp pain, poorly localised under or around the patella
  • Knee/s may feel like it is gives way or buckles [2,3]
  • Pain during squatting [4]
patellofemoral-pain-syndrome.jpg

Aetiology

  • Inadequate neuromuscular control or weakness of quadriceps muscles
  • Patella position (tilt/rotation)
  • Pronated foot type [1,2]
  • Increased knee valgus or femoral internal rotation
  • Reduced strength, coordination or range of motion of hip abductors causing increased stress on frontal and transverse forced around the knee [3]

Complications

May predispose to the development of patellofemoral osteoarthritis.

How can Physiotherapy help?

  • Provide education and advice about your condition and promote strategies to reduce your pain and symptoms
  • Provide an accurate and comprehensive assessment of your condition and address any underlying biomechanical factors contributing to your pain
  • Provide condition specific treatment including manual therapy, massage and stretches
  • Create an individualised exercise program to target muscular imbalances in the hip and/or knee and improve coordination of quadriceps muscles
  • Taping to correct abnormal positioning of the patella [2,5]

 

If you have any questions regarding your knee pain, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Nunes, G. S., Stapait, E. L., Kirsten, M. H., De Noronha, M., & Santos, G. M. (2013). Clinical test for diagnosis of patellofemoral pain syndrome: Systematic review with meta-analysis. Physical Therapy in Sport, 14(1), 54-59.
  2. Brukner, P. (2012). Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill. 4th Edition, 87. 725-726.
  3. Panken, A., Heymans, M., Van Oort, L., & Verhagen, A. (2015). Clinical prognostic factors for atients with aterior knee pain in physical therapy: A systematic review. International journal of sports physical therapy, 10(7), 929.
  4. Collado, H., & Fredericson, M. (2010). Patellofemoral pain syndrome. Clinics in sports medicine, 29(3), 379-398.
  5. Collins, N. J., Bisset, L. M., Crossley, K. M., & Vicenzino, B. (2012). Efficacy of nonsurgical interventions for anterior knee pain. Sports medicine, 42(1), 31-49.

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Stress & Pain

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Stress & Pain

Do you often feel more pain during times of increased stress?

Pain is regulated by inputs from the brain, spinal cord and the environment and is influenced by multiple factors such as mood, thoughts, activity, sleep and stress [1]. These factors can influence the severity of pain and affect your prognosis. Often when the pressures of family, work and everyday life are weighing on you, not only do you experience an emotional impact but this can also increase your pain intensity and duration. Additionally, experiencing physical pain also makes people feel more stressed, thus creating a vicious cycle that may even lead to chronic injury. Therefore, managing stress is a significant factor to reduce pain and improve quality of life [1,2].

 

Effects of stress on the body

Psychological factors can contribute to increases in muscular tension and postural abnormalities that can accentuate the severity of physical injuries. These changes in muscle and posture can prevent muscles from functioning appropriately resulting in increased pain [1, 3].

For example, in patients following neck injuries, especially if the mechanism of injury was traumatic, they may experience increased muscle tension in the head, neck or upper limbs in addition to adapting abnormal postures that can heighten physical findings in the neck. The body’s response to stress and pain also varies widely among individuals, and these psychological factors could drive pain and take longer to resolve. Due to this variability, it is important to identify factors that may influence a patient’s recovery to potentially prevent re-occurrence [1].

Other effects of stress on your body and behaviour:

  • Fatigue
  • Sleep disturbances
  • Anxiety and/or depression
  • Lack of motivation or focus
  • Changes in mood/irritability
  • Social withdrawal
  • Reduced physical activity

 

What has research shown?

People suffering from psychological distress were shown to be five times more likely to suffer from chronic pain [4]. Current evidence supports the use of pain education for chronic musculoskeletal disorders in reducing pain, improving function, encouraging movement, lowering disability, and minimizing healthcare utilisation [5].

Research also demonstrated the effects of participating in regular exercise as an effective strategy for managing stress. Studies showed that post-exercise there was a significant impact on blood pressure responses to stress that may have implications for cardiovascular health [6,7].

Studies also recommended relaxation techniques such as deep breathing, yoga or meditation. These techniques encourage abdominal breathing which has been shown to promote stress reduction [3].

Overall, multidisciplinary biopsychosocial rehabilitation programs are recommended especially to those who suffer from chronic pain. These programs typically included pain education, pacing physical activities, and psychological treatment to address mood problems, sleep disturbances, unhelpful thoughts and behaviours in addition to medical management [2].

 

Coping strategies

Here are some tips to manage your stress:

  • Practice relaxation techniques such as deep breathing, yoga or meditation
  • Participate in regular exercise (at least twice a week for approximately 150-300 minutes of moderate intensity physical activity)
  • Ensure you have good quality sleep (between 7-9 hours)

 

How can physiotherapy help?

  • Complete a thorough assessment and physical examination of the individual and provide suitable recommendations on ways to improve posture and pain
  • Provide appropriate interventions to reduce muscle tension and pain with manual therapy techniques including massage
  • Create a individually tailored exercise program to increase physical activity and encourage self management
  • Provide education about your condition and help assist you locating appropriate resources to prevent re-occurrence

If you have any questions regarding whether we can help you manage your stress and pain better, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

 

References

  1. Brukner, P. (2012). Brukner & Khan's clinical sports medicine. North Ryde: McGraw-Hill.41-52, 332-333.
  2. Kamper, S. J., Apeldoorn, A. T., Chiarotto, A., Smeets, R. J. E. M., Ostelo, R. W. J. G., Guzman, J., & van Tulder, M. W. (2015). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. Bmj, 350, h444.
  3. Berger, B. G., & Owen, D. R. (1988). Stress reduction and mood enhancement in four exercise modes: Swimming, body conditioning, hatha yoga, and fencing. Research quarterly for exercise and sport, 59(2), 148-159.
  4. ABo, S. (2007). National survey of mental health and wellbeing 2007 (Cat. no. 4326.0). Canberra2007.
  5. Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy theory and practice, 32(5), 332-355.
  6. Hamer, M., Taylor, A., & Steptoe, A. (2006). The effect of acute aerobic exercise on stress related blood pressure responses: a systematic review and meta-analysis. Biological psychology, 71(2), 183-190.
  7. Hobson, M. L., & Rejeski, W. J. (1993). Does the dose of acute exercise mediate psychophysiological responses to mental stress?. Journal of Sport and Exercise Psychology, 15(1), 77-87

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