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back pain

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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Medial tibial stress syndrome

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Medial tibial stress syndrome

What is medial tibial stress syndrome?

Medial tibial stress syndrome (MTSS) is a common condition mostly affecting runners and recreational sports players. It is an overuse injury resulting from repetitive stress to the bone in the lower leg, the tibia. Stress reactions occur on the tibia and the surrounding muscles when the body is unable to heal properly, and with repetitive stress and inadequate healing, this creates an overuse condition. Tibialis posterior, a muscle in the back of the calf has been the main muscle responsible for this condition. However recent studies have identified that several muscles are involved, including flexor digitorum longus and the soleus, which are two muscles in the calf as well.

 

What are the symptoms?

The symptoms of MTSS include:

  • Vague diffuse pain in the lower leg near the shin bone
  • Pain that gets worse at the beginning of exercise but eventually subsides
  • Pain the following morning
  • As the condition worsens the pain may persist during activity

 

What are the risk factors?

The risk factors for MTSS is influenced by your individual biomechanics of movement, and the type of training you are performing. This means that the way your body moves and its positioning during walking and running can make you more susceptible to this condition. Some of these risk factors include:

  • Flat feet (excessive pronation)
  • Training errors
  • Sudden changes in physical activity e.g. sudden increase in intensity or duration
  • Shoe design
  • Surface type
  • Fatigue
  • Decreased flexibility
  • Muscle dysfunction

 

How do we treat it?

The foundation of treatment for medial tibial stress syndrome is based on identifying the risk factors involved, and treating the underlying pathology. This will ensure that we are treating the cause of the problem so it will not return in the future. Treatment begins with providing relief through rest and ice. In order to keep you active and still exercising you are able to completed pain free activities such as swimming or cycling.

Your physiotherapist will then begin a careful assessment of how your foot, knee and hip alignment are affecting your running and walking. Taping may be used to control your foot pronation (flat foot), and other techniques including strengthening and stretching of muscle imbalances, mobility exercises, motor control and stability exercises. Your physiotherapist will tailor these treatment options to your specific biomechanics which will reduce the stress placed on the tibia.

 

If you have any questions regarding shin 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. Galbraith, M. Lavallee, M. 2009. Medial tibial Stress syndrome: conservative treatment options. Current Rev in Musculo Med. 2(3) 127-133.
  2. Batt, M. 2011. Medial Tibial Stress Syndrome. British Journal of Sports Medicine. 45(2)1-8.
  3. Franklyn, M. Oakes, B. 2015. Aetiology and mechanisms of injury in medial tibial stress syndrome: current and future development. World J of Ortho. 6(8) 577-589.

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Gua Sha

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Gua Sha

What is gua sha?

Gua sha is commonly known to be a traditional eastern medicine technique where a blunt tool, such as a ceramic soup spoon, is used to scrape the skin to improve blood circulation and oxygen supply to the soft tissue. A modern take on this technique is often referred to as instrument-assisted soft tissue mobilisation (IASTM).

 

What happens during tissue injury?

Inflammation usually occurs following an injury to generate new cells. The formation of scar tissue reduces elasticity of the injured tissue and results in adhesion. The scar tissue may also limit oxygen and nutrient supply and thus affect tissue regeneration. If left untreated, chronic inflammation may lead to tissue degeneration and contribute to chronic pain. These areas may also be more susceptible to re-injury.

 

How does gua sha work for injured tissue?

Adequate pressure and shear force applied during soft tissue mobilisation create micro-trauma in the affected area. This can facilitate the inflammatory response during the healing phase of the tissue. By using an instrument to assist, the clinician is able to deliver a greater force and stimulate adhesive points deeper within the tissue. Removing scar tissue and releasing adhesions help collagen synthesis and realignment. These in turn improve soft tissue function, range of motion, decrease pain and speed up healing.

 

Do I need gua sha?

Gua sha can be beneficial for conditions including but not limited to:

  • Tennis elbow
  • Patella tendon injury
  • Hamstring tendinopathy
  • Achilles tendinopathy
  • Partial muscle tears
  • Plantar fasciitis
  • Chronic neck pain
  • Chronic low back pain

 

What should I expect when receiving gua sha?

The clinician will typically start by rubbing lubricant such as cream to the skin before applying the instrument at a tolerable pressure onto the affected area. The clinician will perform smooth firm strokes over the affected area while feeling for restrictions or soft tissue irregularities. This process may take about 5-15 minutes depending on the affected area and condition.

In physiotherapy, gua sha may be used in conjunction with stretching and strengthening exercises depending on the type of injury and the stage of recovery. These exercises help restoration of function and prevent re-injury.

 

Are there any side effects with gua sha ?

Gua sha should not be painful during treatment. The rubbing and scraping may cause small blood capillaries near the surface of the skin to burst and result in redness, light bruising or soreness. These symptoms should resolve in a few days and can be managed with ice if necessary.

 

If you have any questions regarding whether gua sha can help, 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. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exerc Rehabil. 2017;13(1):12-22.
  2. Lambert M, Hitchcock R, Lavallee K, et al. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Physical Therapy Reviews. 2017;22(1-2):76-85.

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What does your pillow do to you?

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What does your pillow do to you?

With approximately one third of our lives spent sleeping, it is essential to have good quality sleep in order for the body to maintain normal physiological function and biological processes [1,2]. However for many of us, a good night’s rest is interrupted by uncomfortable neck pains that most likely will wake us during the night and persist throughout the day. Studies have shown that problems sleeping and in sufficient time of rest can also be indirectly linked with increased risk of diseases, hormonal changes, sleeping disorders and associated stress [3]. So you may ask, what can be done to ensure you get a more comfortable nights’ rest and reduced neck pain?

Studies have concluded that the proper selection of pillow can significantly reduce neck muscular tension and pain, improving an individual’s overall quality of sleep [1]. Poor neck support increases the work of neck and upper back muscles during sleep, causing increased biomechanical stress and morning pain [2]. Therefore the posture we adopt during a night’s rest can be related to musculoskeletal injuries of the neck and upper back, with muscular tension found to be a contributing factor to constant headaches [2].

 

What can be done?

Muscular tension and neck pain can therefore benefit from an appropriate pillow type as an adjunct management strategy to neck exercise training [1,4]. There are many various pillows on the market designed to help create the most relaxed position for the neck joints and surrounding muscles. How do you know what pillow to choose?

Here are some tips:

  • A pillow that has firm support to cervical lordosis (neck contour) which holds the head and neck region sufficiently in a neutral alignment to the upper back, reducing the biomechanical load to these regions [2] 
  • A neck pillow with the appropriate shape and consistency [5] 
  • A pillow of the correct height that will correctly support the cervical lordosis [5]
  • A one size fits all approach does not exist.

 

What has studies shown?

Studies have found that after 18 months of use of a supportive pillow, 84% of users achieved clinically important relief from neck pain [1] Compared to conventional pillows cervical pillows were shown to be effective in reducing neck pain and discomfort [1]

Another study found that muscle activity was higher in those with shoulder and neck pain, with a change of pillow height to a more suitable height significantly lowering the amount of muscle activity [2]. This study also showed that a pillow height of 10 cm not only had the lowest muscle activity but also resulted in similar muscle activity on both side when in side lying positions. They concluded that the best perception of comfort was associated with better head and shoulder alignment which produced the lowest amount of muscular activation [2]. A study that compared the comfort of certain material types of pillows found that memory foam pillows performed best with reduced waking pain and improved sleep quality, whilst the feather pillow performed the worst [6].

However, changing a pillow may be beneficial in improving a night rest and reduce pain, but for those who experience acute and chronic neck pain clinical treatment is most advantageous in conjunction with a suitable pillow.

 

How can Physiotherapy help?

  • Provide suitable tailored maintenance strategies to decrease muscular tension, pain and headache symptoms
  • Create a personalised exercise and stretching program to increase neck and upper back muscle strength
  • Undertake a postural and movement assessment of neck and upper back and provide recommendations on adjustment of seating posture
  • Help assist you with selecting the correct pillow for you through analysing posture and upper back and neck biomechanics
  • Provide education to encourage self-management strategies.

 

If you have any questions regarding neck pain and sleeping posture please give us a call at (02) 8411 2050. Here 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. Erfania P, Tenzif S, Guerriero RC. Assessing effects of a semi-customized experimental cervical pillow on symptomatic adults with chronic neck pain with and without headache. Journal of the Canadian Chiropractic Association. 2004;48(1):20-28.
  2. Sacco ICN, Pereira ILR, Dinato RC, Silva VC, Friso B, Viterbo SF. The effect of pillow height on muscle activity of the neck and mid-upper back and patient perception of comfort. Journal Of Manipulative And Physiological Therapeutics. 2015;38(6):375-381.
  3. Lavin RA, Pappagallo M, Kuhlemeier KV. Cervical pain: A comparison of three pillows. Archives of Physical Medicine and Rehabilitation. 1997;78(2):193-198.
  4. Helewa A, Goldsmith CH, Smythe HA, Lee P, Obright K, Stitt L. Effect of therapeutic exercise and sleeping neck support on patients with chronic neck pain: a randomized clinical trial. The Journal of Rheumatology. 2007;34(1):151-158.
  5. Persson L, Moritz U. Neck support pillows: a comparative study. Journal Of Manipulative And Physiological Therapeutics. 1998;21(4):237-240.
  6. Gordon SJ, Grimmer-Somers K, Trott P. Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy. 2009;14(6):671-678.

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Middle back pain and left arm pain

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Middle back pain and left arm pain

Question

A 50 years old female, Mrs L., presents with middle back pain and left arm pain gradually developed over the weekend without clear mechanism of injury. The only potential reason that she could think of was gardening. She had ongoing back stiffness; otherwise she is normally healthy and active. What could be the cause of her problem?

 

Clinical examination

Mrs L’s left arm pain is provoked when she is reaching forward. Her left shoulder range of movement is normal. She has reduced neck and middle back range of movement, specifically cervical retraction and thoracic extension.

In neurological examination, Mrs L’s biceps and triceps jerk reflex are normal. Her strength and sensation were also normal. On palpation, her left mid thoracic area is stiff and her arm pain is also provoked.

It appears that Mrs L’s left arm symptom is related to her left thoracic spine.

 

Management

Mrs L’s left arm symptoms and thoracic spine stiffness are reduced after some thoracic spine joint mobilisation. She was then given some cervical and thoracic mobility exercises to restore her loss of range of movement. Her symptom is almost completely abolished in two weeks.

It is not uncommon that sometimes the arm pain that patient experienced come from a different body part, typically cervical or thoracic spine. A systematic examination procedure will help identifying the source of the symptoms, and aid an appropriate management approach.

 

If you have any questions regarding suspicious arm pain and need and assessment, 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.

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ACL Tear

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ACL Tear

History

A 15 years old female Miss K who is a netballer presents with a right ACL reconstruction surgery one week ago. Her surgeon has referred her to do physiotherapy. What does she need to do in rehab?

 

Clinical examination

The patient is walking with two crutches. Her knee is moderately swollen. Her wound is covered by wound dressings. Her knee extension range is -5 degrees (meaning it’s in a slightly bended position) and her flexion range is about 20 degrees, both motions are limited by pain and stiffness.

 

Management

It is expected that ACL reconstruction rehabilitation to be a lengthy process. It generally takes at least six months to twelve months to return to sports. Most surgeons would provide the patient and the physiotherapist a rehabilitation protocol, but it is common to have variations which depend on the graft choice and individual factors.

Initial stage of ACL-recon for Miss K focuses on swelling control and restoring her loss of knee extension range. This is critical as it allows her to walk with normal gait as soon as possible and avoid the development of compensation strategies. Her treatment includes manual therapy, compression therapy, and inner range closed chain quadriceps exercises. 

In six weeks times, Miss K has recovered full knee extension and ninety per cent flexion range of motion.

Depends on the sports type, most patients can return to sports after six to twelve months. In between this six to twelve months, there is a variety of exercises need to be covered to allow successful return to sports. That includes improvement on proprioception, strength, balance, flexibility, agility, functional strength, plyometric ability and sports-specific skills.

As Miss K is very compliance to her rehabilitation program and keen to return to sports. She performs her exercises well and on schedule. She is able to return to low level netball in nine months.

 

If you have any questions regarding your post operative rehabilitation or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here 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.

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Low Back Pain in the Office

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Low Back Pain in the Office

In this case review, we take a look at an office worker struggling with back pain.  She was treated efficiently and was back to full function much quicker than she anticipated.  We take pride in utilizing the most effective methods using the least number of sessions to get you back to 100%!

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