Instrument Assisted Soft Tissue Mobilization – Physio Tralee

Instrument Assisted Soft Tissue Mobilization – Physio Tralee

Physio TraleeInstrument Assisted Soft Tissue Mobilization (IASTM) is a process in which the clinician uses a set of ergonomically designed hand held instruments to break down the scar tissue and fascial restrictions in soft tissue (muscles, ligaments, tendons, and fascia ). The instruments you see in the photo are made of surgical grade stainless steel. Hypoallergenic aqueous cream or massage oil is used to facilitate gliding of the instrument along the muscle, tendon etc. during treatment.  The technique itself is said to have evolved from a form of Traditional Chinese Medicine called Gua Sha.  IASTM is a is a procedure that is growing  rapidly in popularity due to both the effectiveness and efficiency 0f the technique.

Physio TraleeOnce the damaged areas are detected, the instruments are used to deliver controlled microtrauma to the affected area. The purpose of the microtrauma is to stimulate a local inflammatory response, which initiates reabsorption of excessive scar tissue and facilitates a cascade of healing activities. Adhesions within the soft tissue that may have developed as a result of surgery, immobilization, muscle tears, or repetitive strain etc., are broken down, allowing the patient to regain function and range of movement. This treatment is a little intense, but it is extremely effective. It is somewhat similar to ”deep tissue massage” and/or ”rolfing”, but I always feel more is achieved in a shorter time-frame with IASTM technique . As in any Manual therapy treatment, it is usually not the only modality used. Supplementation with  stretching/strengthening exercises  etc. designed to correct biomechanical deficiencies by readdressing musculo-skeletal strength and imbalances  may also be prescribed  in conjunction with IASTM. I have used this form treatment both on myself and clients to great effect.

Physiotherapists and Physical Therapists in Tralee. Open 7am – 10pm weekdays and 8am – 2pm Saturdays. Phone 086-7700191





Maybe it’s not Plantarfasciitis but Heel Fat Pad Syndrome

Physiotherapist TraleeInflammation Of The Fat Pad

One common  cause of heel pain is inflammation of the fat pads. This typically occurs after repeated, forceful or prolonged activity. Examples include continuous jumping(gymnasts), chronically excessive heel strike(runners), jumping from high lading on heel. Decreased elasticity of the fat pad can also be a contributory factor.  Other contributory factors include increased age,  weight, poor footwear.


Fat Pad Displaced Or Thinned

Sometimes the cause can be that the fat pad has become displaced or thinned. In this type of injury, the heel pain will feel like a deep ache or a bruise. And you will find it extremely difficult to walk barefoot or on hard surfaces.

Fat Pad Pain Differs From Plantar Fasciitis

While both heel pad injuries and plantar fasciitis cause heel pain, the injuries differ. Plantar fasciitis sufferers usually experience a sharper pain in a specific spot on the inner heel. Fat pad pain is usually felt around the outside of the heel. It can sometimes be felt closer to the instep area, but  is less specific than where the plantar fascia attaches to the heel.  Keep in mind that the fat pad is the fat that covers the heel bone(calcaneous) of the foot acting as a shock absorber and cushion, so often the pain is more general and less severe than plantar fasciitis pain, which follows a fairly specific pain pattern. Also there is usually pain on the arch of the foot with plantar fasciitis and the first steps in the morning or after rest are often very painful. Plantar fasciitis is much more common than fat pad pain. If in doubt, an MRI will differentiate between both. This can be important because treatment protocols are slightly different for each as are the orthotics for the different conditions.

Treating Fat Pad Pain

There are a variety of different options to help treat fad pad pain. Staying off your feet as much as possible initially is always recommended. A cushioned orthotic which in itself acts like a fat pad, but also spreads the load under the foot is usually highly effective.


Physiotherapists in Tralee,  Phone 086-7700191, Open early until late and Saturday mornings until 2pm.





Sore Feet in Kids

Physio TraleeSore Feet in Kids – Physio in Tralee

Sometimes I get a phone-call along the lines of this.


Customer  :  Hello, I am ringing about my daughter. She has sore feet and I think she might need orthotics.

Me : What age is your daughter?

Customer  :  She is aged four. She is always complaining of pains in her feet when we go walking.

Me : How long are the walks ?

Customer  : About 5 miles a day.

Most likely the problem here is that 5 miles a day is too much walking for a kid of that age. It is not because they need orthotics.  Sometimes  also with older kids, somebody  tells the parent their kid has flat feet. Parents want the best for their kids. They look at the kids feet and now for the first time notice they are flat and start to worry(for no reason). Many kids feet are pretty flat because they are just developing and growing. Feet can change and develop as kids go through adolescence and their bodies develop.

Even in itself flat feet, or the opposite, high arches, are not necessarily a problem. Many people go their whole lives with either flat feet or high arches, without problems. Do you want to be buying new orthotics every six months as kids grow. Buy them decent supportive shoes, get them to tie their laces properly and don’t miss out on obvious things like the over-walking in infants, growing pains as a child develops, and unfortunately these days over-training in teens.

Also social media etc. has us driven crazy thinking everything should be perfect, perfect bodies, perfect looks, perfect feet, perfect gait. In reality most of the photos on the internet are photo-shopped. The body has an amazing ability to adapt, so often imperfect bodies can achieve great things. I have never heard of a doctor recommending orthotics for young kids unless they have a very unusual condition. It is mostly people who stand to make a financial gain that are pushing them for kids.

Because I prescribe orthotics myself for very specific conditions, 99 % in adults, I used to look at my own young daughter growing up, her feet going all over the place as she walked. She hadn’t the perfect gait by any means, yet she was quiet good at sports. I used to think ”should I give her orthotics ?”, because like all parents I wanted the best for her. I never did give her orthotics and she developed a perfectly normal gait and foot arch as she entered her teens.

Physio in Tralee and Dingle, Co.Kerry ……. Phone 086-7700191

See Website




Muscle twitches – Physio Tralee

Muscle twitches – Physio Tralee

Severs diseaseMuscles are made up of fibers that your nerves control. Muscle twitching is caused by minor muscle contraction in the area, or uncontrollable twitching of a muscle group that is served by a single motor nerve fiber. Stimulation or damage to a nerve may cause your muscle fibers to twitch. Most muscle twitches are minor and aren’t usually a cause for concern. Some are common and normal. Others are signs of a nervous system disorder.


Causes – Physio Tralee

These may include:

  • Autoimmune disorders such as Isaac syndrome.
  • Drug overdose (caffeine, amphetamines, or other stimulants).
  • Lack of sleep.
  • Drug side effect (such as from diuretics, corticosteroids, or estrogens).
  • Exercise (twitching is seen after exercise).
  • Lack of nutrients in the diet (deficiency).
  • Stress.
  • Medical conditions that cause metabolic disorders, including low potassium, and kidney disease, and uremia.
  • Twitches not caused by disease or disorders (benign twitches), often affecting the eyelids, calf, or thumb. These twitches are normal and quite common, and are often triggered by stress or anxiety . These twitches can come and go, and usually do not last for more than a few days.

Nervous system conditions that can cause muscle twitching include:

  • Amyotrophic lateral sclerosis (Lou Gehrig disease)
  • Neuropathy or damage to the nerve that leads to a muscle
  • Spinal muscular atrophy
  • Weak muscles (myopathy)


When to Contact a Medical Professional – Physio Tralee

Call your health care provider if you have long-term or persistent muscle twitches or if twitching occurs with weakness or loss of muscle.

Physiotherapist in Tralee : Exercise Induced Arterial Endofibrosis

Physiotherapist in Tralee : Exercise Induced Arterial Endofibrosis

This is an unusual condition, but an important one to keep in mind as a differential diagnosis, especially in the case of cyclists. When an athlete  bends forward and exercises(say like cyclists), it can put pressure on and/or cause a kink in the arteries supplying the working muscles of the leg with oxygen, sugars and so forth.  The artery affected  is usually one of the external iliac arteries which supply the majority of blood to each leg, from the heart.

The theory is that the longer time spent bending forward and exercising, the more the artery can be kinked and irritated. Over time, the body responds to this irritation by making the artery harder, thereby reducing the irritation to the artery (a good outcome), but this hardening also reduces the blood supply to the leg when exercising (a bad outcome for bike racers).

Typically the patient complains of weakness and cramping, ‘bursting’ or aching pain of a single leg only during heavy efforts on the bike.  They can’t ride through it, and in fact, the the harder they try, the worse it gets.  The onset is usually slow, over months, but extremely consistent. Always with increasing intensity comes decreasing strength.

The patient may get treated by a number of therapists often misdiagnosing the condition, and diagnosing some other exotic sounding condition instead. One thing remains constant though; the symptoms persist. A simple, but not always conclusive test that doctors perform is to exercise the patient, then take their blood pressure at their arm and at their ankle.  In a normal patient these two measurements will be the same or similar.  In a patient with the problem, the blood pressure in the ankle of the effected leg will be lower (because it is getting less blood).

More invasive tests may follow.   Treatment to correct the condition involves surgery. Often it is difficult to confirm the condition with absolute certainty.  This is important because the surgery carries risk, so you really want to be as sure as possible.  Surgery involves cutting out the kinked bit and sewing in another bit of vein from your leg instead, referred to as a ”patch”. Because a vein is a bit ‘flimsier’ than an artery, it bends a bit better. An artery has a muscular wall – which is why it pulses, making a patch using a piece of artery less suitable. Also you can ‘spare’ a bit of vein more than you can spare artery, and as a rule arteries run deep and are harder to harvest.

Return to cycling needs to be managed carefully post surgery, and has to be done under close medical supervision. However, the cyclist can eventually resume normal training/competition etc.

Physiotherapist in Tralee. Open early until late. Phone 086-7700191.

Carpal Tunnel Syndrome – Physiotherapist Tralee Overview

Physiotherapy Tralee – Carpal Tunnel Syndrome

Physiotherapist in Kerry Carpal tunnel syndrome is a condition that causes numbness, tingling and weakness in the hand and arm. The condition is caused by  compression of the median nerve within the carpal tunnel, a narrow passageway on the palm side of your wrist. The median nerve runs from your neck  down along the arm and through the carpal tunnel to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb .  Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. The anatomy of your wrist, health problems and possibly repetitive hand motions may also contribute to carpal tunnel syndrome.   A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.

Proper treatment usually relieves the tingling and numbness and restores wrist and hand function. It is worth noting that carpal tunnel syndrome is often misdiagnosed and the main site of median nerve compression can be occurring up at neck and shoulder level. Often by freeing up neck and shoulders muscles and surrounding joints with physio as well as working out muscles down along the arm through which the median nerve penetrates, and loosening and stretching the wrist structures, much relief, often total relief can often be achieved.


Symptoms – Physiotherapy Tralee

Carpal tunnel syndrome symptoms usually start gradually.

Numbness: The first symptoms are usually tingling or numbness usually in the thumb, index and middle or ring fingers, but not your little finger. The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from your sleep.

Weakness: You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.


Risk factors – Physiotherapy Tralee

A number of risk factors have been associated with carpal tunnel syndrome.  Although they may not directly cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include:

Anatomic factors. wrist fracture, dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.

Sex. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.

Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage.

Inflammatory conditions. Illnesses that are characterized by inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in your wrist and put pressure on your median nerve.

Obesity. Being obese is a significant risk factor for carpal tunnel syndrome.
Alterations in the balance of body fluids. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after pregnancy.


Diagnosis – Physiotherapy Tralee

History of symptoms, Physical examination. Nerve tension tests.

X-ray. Some doctors recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture.

Electromyogram. This test measures the tiny electrical discharges produced in muscles. During this test, your doctor inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify muscle damage and also may rule out other conditions.

Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions.

Treatment – Physiotherapy Tralee

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. Physical Therapy by a practitioner experienced in this area can be very effective. This would most like involve deep tissue work, joint manipulations, electroacupuncture and postural correction exercises, maybe nerve glide exercises as the condition improves. Other treatment options include wrist splinting, taking more frequent breaks to rest your hands, avoiding activities that worsen symptoms, medications(Nonsteroidal anti-inflammatory drugs) icing, rest etc. Surgery is also an option but is a last resort.


Physiotherapists and Physical Therapists covering Tralee and Dingl, Co. Kerry – Phone 086-7700191 ….For more details see website



Physiotherapists Tralee – Muscle Tear or Spasm ? Which is it ?

Physiotherapists Tralee

Physiotherapists Tralee – Difference Between a Torn Muscle and a Muscle Spasm

When somebody first presents in clinic with a muscle injury, it is important to first determine whether it is a muscle spasm or a tear. A spasm/cramp can often be worked out in a session with deep tissue massage and maybe some dry needling and stretching, allowing almost immediate turn to training. A muscle tear takes much longer to recover from, the length of time greatly depending on the degree of tearing. Treatment takes longer and a rehabilitation program is also essential.  A muscle spasm is caused by an involuntary contraction of that muscle. It is usually sudden, can cause significant pain and can limit the use of the muscle for a short period of time.

What is a Spasm?

 A muscle spasm is an involuntary contraction of that muscle. It is usually sudden, can cause significant pain and can limit the use of the muscle for a short period of time.

Spasm Causes

Spasms are usually caused by problems such as overworking a muscle, poor hydration, electrolyte imbalances, insufficient blood flow to the muscle or nerve compression. A pulled muscle is actually a tear in the muscle tissue. This occurs when the muscle is strained to the point where the muscle is damaged. The more significant the strain, the more the muscle can be torn.

What is a Muscle pull/Tear?

A pulled muscle is actually a tear in the muscle tissue. This occurs when the muscle is strained to the point where the muscle is damaged. The more significant the strain, the more the muscle can be torn.Pulled muscles are usually the result of not preparing the muscle for work through proper stretching, placing too much tension on the muscle or over-using the muscle. Soreness in the affected muscle is usually the first symptom. Using the muscle will be painful and difficult. In severe pulls, bruising may be present. The affected muscle will become very tender to the touch and some swelling may occur.

Pulled Muscle Causes

Pulled muscles are usually the result of one or a combination of (1) not preparing the muscle for work because of insufficient warmup,(2) lack of a proper stretching program after training to help the muscle recover,(3) placing too much tension on the muscle all of a sudden, (4) or over-using the muscle. Sharp pain in the affected muscle is usually the first symptom. Using the muscle will be painful and difficult. In severe pulls, bruising may be present. The affected muscle will become very tender to the touch and some swelling may occur.

The use of anabolic steroids is frequently linked to severe muscle tears as the body hasn’t had time to adapt to the increased workload . All training needs gradual progression and enough recovery time after training. The higher the intensity in training , the more time needed to recover. So for an athlete, periods of maximal performance require more recovery time.


Physiotherapist Tralee – Low Back Pain – Facet vs Disc

Physiotherapist Tralee – Low Back Pain – Facet vs Disc

Two of the most  common causes of low back pain presenting in clinic are discogenic (disc) or facet joint related pain. Injury to either can cause severe discomfort, limiting a person’s movement and ability to carry out normal daily activities. The facet articulations are small joints along each segment at the back of the spine, controlling the movement of the spine.  There are two of these joints at each vertebral level.  The intervertebral discs are the primary shock absorbers,  generally between a quarter and a half inch in height, interconnecting the bodies of the vertebral segments.  Therefore, it can be considered that the discs and the facets create joint complexes that allow for both shock absorption and movement at each segment of the spine.

Physiotherapist KerryOne of the primary symptoms with lumbar facet joint locking is an increase in pain on extension of the lower back, that is basically more pain when you try and straighten up your lower back or lean back on it. This position loads pressure on the locked, and now most likely inflamed lumbar facet joints.   Usually in this type of injury there is pain relief to a certain extent when a person bends forward.  The reason for this is that forward flexion decompresses the facet joint articulations, releasing some of the pressure on the joints and hence the associated pain. There can be nerve irritation with this injury but it is usually more general and not as severe as with discogenic pain.

Physiotherapist Kerry

Disc disorders

When we start talking about disc injury, we are usually referring to a small tear in the outer annular fibers of a disc that has either resulted in a bulge, a protrusion, or an extrusion of the disc particle(see diagram).  Pain occurs when a disc touches off a nerve due to one of these injuries, triggering a series of reactions, some of which include muscle spasm, inflammation and pain.   Often the nerve root irritation sends pain signals down either the front or back of the leg depending on which disc level is affected. In contrast to facet joint injuries, with disc injuries, bending forward causes a significant increase in pain, as it usually increases compression of the disc against the nerve.  So again to generalize, disc injuries are usually more sensitive to forward flexion,  whereby facet injuries are very sensitive to backward extension. A classic and very telling sign of a disc injury is where the spine becomes visibly curved off to one side as the disc tries to get away from the nerve it is touching. You will visibly see the person’s spine twisted off to one side.

With a locked facet joint, a simple osteopathic manipulation and a person can get off a treatment couch and have an immediate 60 – 70 % relief of symptoms, the person often being almost back to normal the next day. Disc injuries generally benefit more from medication, although proper physio can also play its part. With a facet joint injury, you are simply unlocking the locked facet joint which limited movement and was causing the problem. With a disc injury, you are trying to take pressure off the disc in the hope that it stops pressing against the nerve. Once off lumbar facet joint manipulation can play it’s part in recovery from disc disorders, if used at the right time by an experienced practitioner. Again this is used to mobilize the area and try and take pressure off the disc.

Often with a suspected disc injury a physio etc. may need to refer a patient to a doctor for a second opinion and most possibly medication( NSAIDs, muscle relaxant, nerve blocker), depending on the level of pain and discomfort. The doctor may also refer the patient for an MRI if they need more information on the level of damage. Physio generally involves deep tissue massage, dry needling, manipulation at the right time, but not endless sessions of this for weeks. A rehab program involving pilates type exercises etc. is paramount once a patient improves. Continuous spinal manipulations several times weekly for extended periods pushed by certain professions could do more harm than good, causing sheering of the disc and slowing healing.

”Putting back in a slipped disc” by manipulation is a myth. When somebody gets a manipulation done, the little crack you hear is when the facet joint gaps or unlocks. It is not the disc going back into place. That is the reason one person gets massive relief from ”the crack” during a manipulation and another person doesn’t. To generalize it is because one person had a locked facet joint, the other had a disc injury. If you look at the diagram of disc disorders above, you will see that the disc is more bulging, protruding or breaking down rather than being out of place.

Physiotherapist Tralee Phone : 086-7700191


Eccentric Training – The Best Bodybuilding Workout Ever – Physiotherapists Kerry

Physiotherapists Kerry – Overview of Eccentric Weight Training

When I was younger I used to concentrate on how much weight I could lift. I reached some decent levels with a 300kg squat, 180kg bench press and 320kg deadlift at a pretty young age. As I have grown older(and wiser), my goals have changed and I am more concerned Physiotherapists Kerrywith health, longevity, minimizing injury risk, holding a decent level of strength and muscle mass while keeping in shape. I have as a result totally changed my training. I still go close to failure but at a much higher rep range, no singles. I train less, warm up more and make sure to incorporate stretching and mobilization exercises , especially for my spine.

The biggest change I have made to my training in an attempt to keep the intensity but lower the risk of injury, is that I do exercises much slower, especially the eccentric part. This is where you lower the weight in free weights movements or on a pulley type machine where you release the weight. It is generally the easier part of the movement. The eccentric phase of a lift occurs when a muscle contracts while lengthening. This is the down motion of the bench press, biceps curl, or squat. The concentric phase of a lift occurs when a muscle contracts and shortens, as in the up motion of the bench press, biceps curl, or squat. Just to explain things even simpler.  Concentric is where you are lifting the weight. For example say on a bench press concentric is where you are pushing up a weight off your chest, eccentric is where you are lowering the weight to your chest. It is a great pity I didn’t discover the benefits of eccentric weight training when I was younger, because it is such an effective, underutilised method of building muscle and strength.

What I want you to think about first is why would you cheat on an exercise in the gym, concentric or eccentric….why swing or bounce through a range of motion where the muscle does not engage…Isn’t the idea of  training to stimulate the muscle. Do you really think doing a quarter rep with the leg press loaded up is working all your muscles. The only thing it is working is your ego. The idea is to build balance in your physique and this can only be done with full movements. Say you do a quarter squat, you are mainly just working vasti muscles (lower quad) to the detriment of hamstrings, glutes and upper quads etc. which all get worked in the full squat.

Below is a set of upper body exercises that will work almost the entire upper body in a single session. I have keep the list to a minimum because this workout is meant to be minimalist while working the muscles maximally. If you do too many exercises, you will spoil the intensity and slow recovery. I want you to concentrate more on the muscles you are working in each exercise than the amount of weight lifted. The weight does not matter. If you want to make the exercise harder, do it slower. After warming up for each exercise I want you to take a weight, about 70 % of what you can do comfortably for ten reps. I want you to slow everything down especially the eccentric part(lowering part) of the exercise. I want you to perform the eccentric part of each exercise at least three times as slow as the concentric part. Movements in both directions should be slow, controlled and deliberate focusing and isolating the muscles you are working. Do each exercise for one set of as many slow reps as you can. If you have done things properly the muscles you are working should be pumped to the max. You will also begin to understand the effectiveness of this type of training.

Each exercise below is done after warmup and all exercises are done to failure (probably 15 to 20 reps). I keep the rep range higher because it is easier to maintain strict control during each rep as you tire.

  1. Flat bench press with a 2 second pause on the chest at each rep.
  2. Straight barbell curls(no swinging at any stage).
  3. Flat dumbell  bench press – go deep.
  4. Barbell rows (low and slow – pull to below belly button/ touch lower stomach with bar and let the bar down fully – remember you are trying to work your lats and back, not the biceps as such).
  5. Incline dumbell bench press – again go deep.
  6. Wide lat pulldown to front – stay up as straight as you can and flare out lats keeping elbows and shoulders back.
  7. Press behind neck (right down to base of neck) – use a smith machine if you have no spotter.
  8. Narrow grip lat pulldown to front – as above letting the lats stretch out fully on top
  9. Straight arm dumbell pullovers lying sideways across a bench..get a good deep stretch. Keep hips low. Remember our priority here is to stretch that ribcage for a big chest.
  10. Reverse dumbell flies. Lie face down on a 30 % incline bench. These hit the rear deltoid as well as the middle and lower traps, rhomboids etc.

There should be a maximum of 2 minutes rest between each set. This entire program should be done in about 30 minutes. If you have done it properly, every muscle in your upper body should be pumped to the max. This program is more for a novice to intermediate trainer. More seasoned trainers could add a few extra exercises. I cannot over-emphasize that you must slow down and control the weight movement especially during the eccentric phase of each exercise, and focus on working the muscles to the maximum. This is paramount to the success of this program. The strength will always be there and most likely you will have more when you return to looser form.

Bottom line: Eccentric exercise puts muscles under tension for longer, stimulating more muscle growth.


Physiotherapists Kerry – Phone 086-7700191

Meniscus injuries in the knee – Knee Pain

Knee Pain – Meniscal Tears

Cartilage within the knee joint provides cushioning between the bones at this joint to protect them from the stresses of walking, jumping, running etc. There is articular cartilage which is the smooth, white tissue that covers the ends of bones(Femur, tibia) where they come together to form the knee joint. Healthy cartilage in our joints makes it easier to move. It allows the bones to glide over each other with very little friction. Articular knee paincartilage can be damaged by injury or normal wear and tear. Within the knee you also have fibrocartilage in the form of the medial and lateral menisci. These are two thick wedge-shaped pads of cartilage attached to top of the tibia (tibial plateau) and under the femur bone,  allowing the femur to glide when the knee joint moves. Each meniscus is curved in a C-shape, with the front part of the cartilage called the anterior horn and the back part called the posterior horn. Meniscal tears are usually described by where they are located anatomically in the C shape and by their appearance (for example, “bucket handle” tear, longitudinal, parrot beak, and transverse).

Because the blood supply is different to each part of the meniscus, knowing where the tear is located may help decide how easily an injury might heal (with or without surgery). The better the blood supply, the better the potential for recovery. The outside rim of cartilage has better blood supply than the central part of the “C.” Blood supply to knee cartilage also decreases with age, with up to 20% of normal blood supply  lost by age 40.

What causes a meniscus to tear?

A forceful twist or sudden stop can cause the end of the femur to grind into the top of the tibia, pinching and potentially tearing the cartilage of the meniscus. This injury can also occur with deep squatting or kneeling, especially when lifting a heavy weight. Meniscus tear injuries often occur during athletic activities, especially in contact sports like football and hockey. Motions that require pivoting and sudden stops, in sports like tennis, basketball, and golf, can also cause meniscus damage.

The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear out, losing its blood supply and its resilience. Increasing body weight also puts more stress on the meniscus meaning that routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing. It is estimated that six out of 10 patients older than 65 years have a degenerative meniscus tear. Many of these tears may never cause problems.

Because some of the fibers of the cartilage are interconnected with those of the ligaments that surround the knee, meniscus injuries may be associated with tears of the collateral and cruciate ligaments, depending upon the mechanism of injury.

Symptoms of a meniscus injury can include some or all of the following:

  • Pain with running or walking longer distances
  • Intermittent swelling of the knee joint: Many times, the knee with a torn meniscus feels “tight.”
  • Popping, especially when climbing up or down stairs
  • Giving way or buckling (the sensation that the knee is unstable and the feeling that the knee will give way): Less commonly, the knee actually will give way and cause the patient to fall.
  • Locking (a mechanical block where the knee cannot be fully extended or straightened): This occurs when a piece of torn meniscus folds on itself and blocks full range of motion of the knee joint. The knee gets “stuck,” usually flexed between 15 and 30 degrees and cannot bend or straighten from that position.  

The diagnosis of a knee injury begins with a history of the injury etc. and physical examination. There have been many tests described to assess the internal structures of the knee. The McMurray test one long used orthopedic test . The health-care professional flexes the knee and rotates the tibia while feeling along the joint. The test is positive for a potential tear if a click is felt or noticeable pain is felt while circumducting the knee in full flexion.

(MRI) is the test of choice to confirm the diagnosis of a torn meniscus. It also allows a radiographer to visualize the inner structures of the knee, including the cartilage and ligaments, the surface of the bones, and the muscles and tendons that surround the knee joint. Plain X-rays cannot be used to identify meniscal tears but may be helpful in looking for bony changes, including fractures, arthritis, and loose bony fragments within the joint. In older patients, X-rays may be taken of both knees while the patient is standing. This allows the joint spaces to be compared to assess the degree of cartilage wear. Cartilage takes up space within the joint and if the joint space is narrowed, it may be an indicator that there is less cartilage present, likely from degenerative disease.

Treatment of Meniscal Tears

Sometimes conservative measures such as physical therapy, NSAIDs and rest can be enough to settle the condition, if it is not too serious. When conservative measures are ineffective the next step may be surgery to repair or remove the damaged cartilage.

Physical Therapists and Physiotherapists in Tralee. Phone 086-7700191

Levator Scapula Muscle Related Neck pain. Physiotherapists and Physical Therapists in Tralee.

Levator Scupula Muscle Related Neck Pain.

The Levator Scapulae muscles are located on either side of the neck. They originate on the four upper vertebrae of the cervical spine (neck) and insert, or attach, to the scapula, also known as the shoulder blade at the superior, medial border. These two muscles are involved in elevation, downward rotation and abduction of the scapulae. They are also involved in flexion and extension of the cervical spine(neck), turning of the neck slightly left and right, along with side bending of the neck left and right.

When you wake up in the morning with a crick in your neck, feel a burning pain on the top inner corner of your shoulder blade, or have trouble turning your head to look behind you while driving etc., the culprit may be a Levator Scapula muscle in spasm. The pain can be described as a throbbing, ache, or tightness, and usually presents from the top inner corner of the shoulder blade up along the neck.

Physiotherapists in Tralee









Levator Scapula Muscle  Trigger points                 Levator Scapula Muscle


What Causes Levator Scapula Spasm / Trigger Points?

A trigger point is a tight area within muscle tissue that causes pain in that area and/or other parts of the body. The trigger points are shown above as two dark red circles, with the pain referral area also shaded in. Muscle spasm is a tightening of a muscle usually, due to overuse or overstress. It  can in itself cause pain and loss of mobility. The following events and activities are likely to activate, or reactivate, tension / pain and trigger points in the levator scapulae.

  • whiplash from an automobile accident
  • sleeping on the stomach with the head turned/or sleeping in an odd position
  • chilling of the muscle during sleep from an air conditioner or draft from an open window
  • working at a computer with the head turned for long periods
  • holding a phone between the shoulder and ear
  • carrying a heavy bag with a shoulder strap
  • use of crutches that are too tall and elevate the shoulder
  • emotional and mental stress
  • Working with your arms raised above your head for prolonged periods of time can also irritate the Levator Scapula. To help reduce neck pain, stabilize your shoulder blade when you raise your arm.
  • poor posture with a forward head position puts this muscle under continuous strain causing overuse.


Usually the condition settles after a few days if it is only a once off. Proper hands-on deep tissue massage and dry needling, when used together, can be great to settle the condition either in the short term, or if the condition has become more chronic. Also for the long term, correcting posture, stretching and strengthening of the upper back(particularly middle / lower traps, serratus posterior, rhomboids etc.) and the neck muscles(specifically the posterior neck muscles) can help prevent the condition from returning.

Posture is key to a healthy neck and spine. Try and sit up straight on a comfortable supportive chair, when at work or at home,  allowing the shoulders to relax by using the arm rests of the chair. When at a computer, pull the screen close and try to get it up to eye level (say using books underneath it), so your head doesn’t have to be coming forward. The same applies when driving a car. Pull the seat in close to the steering wheel(within reason),and try to position yourself so the shoulders are relaxed and the head isn’t jutting forward. Activities like reading in bed, playing computer games for hours etc. can really tighten up the levator muscles and are a disaster for thoracic and cervical posture in the long term.

Why the Levator Scupula muscle can be a pain in the neck. Physiotherapists and Physical Therapists in Tralee… Phone 086-7700191

Restless Leg Syndrome. Physical Therapists and Physiotherapists, Tralee & Kerry

Restless Legs Syndrome 

Restless legs syndrome(RLS) is a nervous system resulting in an urge to move the legs. Because it usually interferes with sleep, it also is considered a sleep disorder. The condition causes an uncomfortable, “itchy,” “pins and needles,” or “creepy crawly” type feeling in the legs. The sensations are usually worse at rest, especially when lying or sitting. The symptoms are generally worse in the evening and at night. The severity of RLS symptoms varies from mild to intolerable. Symptoms can come and go and vary in severity. For some people, symptoms may lead to severe sleep disturbance at night, which can significantly impair their quality of life.


Who Gets Restless Legs Syndrome?

Restless legs syndrome (RLS) may affect up to 10% of the population. It affects both sexes, but is more common in women. It may begin at any age, but most people affected are middle-aged or older.  RLS is often unrecognized or misdiagnosed. This is especially true if the symptoms are intermittent or mild.


Causes of Restless Legs Syndrome

In most cases, doctors do not know the cause of restless legs syndrome; however, they suspect that genetics plays a role. Nearly half of people with RLS also have a family member with the condition. Factors other than genetic associated with the development of restless legs syndrome can include  certain chronic diseases and medical conditions. These include iron deficiency, Parkinson’s disease, kidney failure, diabetes, and peripheral neuropathy. Treating these conditions often gives some relief from RLS symptoms.

Some types of medications including anti-nausea drugs, antipsychotic drugs, some antidepressants, and cold and allergy medications containing sedating antihistamines , may exacerbate symptoms.  Some women experience RLS during pregnancy, especially in the last trimester. These symptoms usually go away within a month after delivery. Other factors, including alcohol use and sleep deprivation, may trigger symptoms or make them worse.


Diagnosis of Restless Legs Syndrome by Physiotherapists/ Doctor

There is no medical test to diagnose RLS; however, doctors may use blood tests or other diagnostic tests to rule out other conditions. The diagnosis of RLS by a doctor or physiotherapist in Tralee is mainly based on a patient’s symptoms and answers to questions concerning family history of the condition, the presence of other symptoms/  medical conditions, use of medications, sleeplessness.


Treatment for Restless Legs Syndrome

Treatment of RLS is targeted at easing the symptoms. In people with mild to moderate restless legs syndrome, lifestyle changes, such as beginning a regular exercise program , establishing regular sleep patterns, and eliminating or decreasing the use of caffeine , alcohol, and tobacco, may be helpful.

Non-drug RLS treatments may include:

Leg massages

Hot baths or heating pads or ice packs applied to the legs

Good sleep habits

A vibrating pad called Relaxis

Medications may sometimes be helpful in treatment of RLS but results vary among individuals. Drugs used to treat RLS include:

Dopaminergic drugs, which act on the neurotransmitter dopamine in the brain; Mirapex, Neupro, and Requip, levodopa.

Benzodiazepines, a class of sedative medications, may be used to help with sleep, but they can cause daytime drowsiness.

Narcotic pain relievers may be used for severe pain.

Anticonvulsant drugs  such as Tegretol, Lyrica, Neurontin,  and Horizant.


Although there is no cure for restless legs syndrome, current treatments can help control the condition, decrease symptoms, and improve sleep.


Physical Therapists and Physiotherapists in Tralee and Dingle, Co. Kerry. Phone Eddie on 086-7700191. Click for Website

Longterm Effects of Poor posture / physiotherapists Tralee

The Long Term Effects Of Poor Posture – Physiotherapists and Physical Therapists in Tralee

Kyphosis is curvature of the spine that causes the top of the back to appear more rounded than normal. Everyone has some degree of curvature in their spine. However, a curve of more than 45 degrees is considered excessive. Poor posture (postural kyphosis) can be caused by over an extended period of time by slouching, carrying heavy bags, reading in bed, hours of forward head posture at a computor, hours playing xbox etc. The resulting continuous stretching of the supporting muscles and ligaments of the spine can lead to an increase in spinal curvature.

Postural kyphosis mainly occurs in the thoracic region(upper spine). It is often accompanied by “hyperlordosis” of the lumbar (lower) spine. The lumbar spine has a natural “lordosis” ie. a backward “C”-shape. Hyperlordosis means the lumbar spine compensates for the excessive thoracic kyphosis with an excessive C-shaped lordosis.

Different types of posture


Effects of forward head posture

Increased weight of head on the neck with forward head posture

Sometimes kyphosis causes no symptoms other than the back appearing abnormally curved or hunched. However it may cause:

• back pain and stiffness
• tenderness of the spine
• tiredness
• difficulty breathing

These issues usually become more likely as somebody with this condition(kyphosis) ages.

Postural neck pain / Physiotherapists Tralee

The most common condition that contributes to neck pain is forward head and shoulder posture. Forward head posture is when the neck juts forward placing the head in front of the shoulders. This head position leads to several problems. The forward pull from the weight of the head puts undue stress on the vertebrae of the lower neck, contributing to the chances of developing degenerative disc disease and other degenerative neck problems. Similarly, this posture causes the muscles of the upper back to be continually overworked counterbalancing the pull of gravity from the forward head position. Forward shoulder posture can also lead to impingement/injury of the supraspinatus muscle causing shoulder pain/disfunction. The more time spent with a forward head posture, the more likely it is that one will develop neck and shoulder problems.
The part of the neck most vulnerable to forward head posture is the lower part of the neck (C5 and C6 ), just above the shoulders. These cervical vertebrae may slide or shear slightly forward relative to one another as a result of the persistent pull of gravity from a forward head posture. This can sometimes be seen as a little step in these vertebrae at this area. Prolonged shearing of the vertebrae from forward head posture often irritates the small facet joints in the neck as well as the ligaments and soft tissues.
This irritation can result in neck pain that radiates down to the shoulder blades and upper back, due to the following conditions:
• Trigger points in the muscles. These are points of exquisite tenderness that are painful to touch, also leading to reduced range of motion in the neck.
• Disc degeneration problems, which may potentially lead to cervical degenerative disc disease, cervical osteoarthritis, cervical herniated disc etc.
• Neuropraxia ; Nerve pain due to nerve compression by tight muscles of the neck, locked cervical/thoracic facet joints, and/or compression of nerves due to discogenic disorders.
Muscular neck pain can be caused by the following neck/ shoulder muscles becoming tight due to being overworked:
• Scalene muscles (three pairs of muscles that help rotate the neck)
• Suboccipital muscles (four pairs of muscles used to rotate the head)
• Pectoralis minor muscles (a pair of thin triangular muscles at the upper part of the chest)
• Subscapularis muscles (a pair of large triangular muscles that attach from behind your scapulae up to the shoulders )
• Levator scapulae muscles (a pair of muscles located at the back and side of the neck).
• Trapezius

Physiotherapists Tralee

Physiotherapists Tralee / Correct Desk Posture


Foot Pronation and Supination Explained

Foot Pronation and Supination Explained

Pronation SupinationPronation
and supination are  movements that occur at the subtalar joint of the foot. The normal biomechanics of the foot are designed to absorb and direct the forces occurring throughout the gait cycle. As the foot is loaded, eversion of the subtalar joint, dorsiflextion of the ankle, and abduction of the forefoot occur. This is the pronation part of the gait cycle. Pronation should not continue past the latter stages of midstance during the gait cycle. At this stage the foot should then supinate in preparation for toe-off. Approximately four degrees of pronation and supination are necessary to enable the foot to propel forward properly. Any increase on this four degrees brings a foot into over-supination or over-pronation.



Pronation of the foot is where the heel rotates away, and the little toe moves away, from the centre of the body. The foot also dorsiflexes up slightly, the ankle rolling inwards. Pronation is part of the natural movement of the human body, but certain injuries can occur with excessive pronation.  Runners with flat feet often overpronate. Over-pronation can contribute to injuries such as shin splints, anterior compartment syndrome, patello-femoral pain syndrome, plantar fasciitis. tarsal tunnel syndrome. bunions (hallux valgus), Achilles tendonopathies. The running shoes of over-pronators often show extra wear on the inside of the heel and the ball of the foot extending to the big toe.



With supination the heel rotates towards the centre of the body, the big toe turns towards the centre of the body, the foot flexes down and the ankle rolls out. It is the opposite of pronation. A natural amount of supination occurs during the push-off phase of the running gait as the heel lifts off the ground and the forefoot and toes are used to propel the body forward. However, excessive supination  places a large strain on the muscles and tendons that stabilize the ankle, and this can make the oversupinator more prone to ankle sprain or ankle ligament rupture.

With over-supination the forces of impact on the foot are concentrated on a smaller area of the foot (the outside part), and are not distributed as efficiently. In the push-off phase, most of the work is done by the smaller toes on the outside of the foot, rather than the big toe, which is what should happen. This places extra stress on the foot, which can lead to conditions such as iliotibial band syndrome, Achilles tendinitis, or plantar fasciitis. Over-supination causes the outer edge of running shoes to wear sooner. In extreme cases, there will also be holes in the uppers where the runner’s foot has broken through. Runners with high arches and tight Achilles tendons/calves tend to be over-supinators.



Properly prescribed foot orthotics can be beneficial in the treatment of over-pronation or over-supination where these conditions are leading to injury during training etc. We supply both off the shelf and custom made orthotics. We only prescribe them when we really feel they are necessary. Often the much cheaper off the shelf orthotic does the trick once it is a quality and prescribed by an experienced practitioner. Sometimes you just have an injury that needs treatment. Just because you have a high arch or a flat foot does not mean in itself you need orthotics, especially if you are not in pain.



What causes a bone spur? Physiotherapist Tralee

What causes  a bone spur? Review by Physiotherapist Tralee

A bone spur(also called an osteophyte) is an outgrowth of bone occurring along the edge of a bone. Bone spurs are most commonly found in joints, where two bones come together. They also occur close to where muscles, ligaments, or tendons attached to bone. Some Physiotherapist Traleecommon parts of the body affected include the neck (cervical spine), shoulders, hips, hands and heel bone. Bone spurs typically occur because of continued stress or rubbing on a bone over a prolonged period of time. This can occur due to inflammatory conditions  such as osteoarthritis , tendinitis or tenosynovitis. Normally there is a smooth layer of cartilage on the edges of bones where they come together to form a joint. With osteoarthritis this cartilage layer becomes worn away, causing the exposed bones to rub against each other. New bone forms in response to this stress and the resulting inflammation. Bone spurs usually develop in areas near tendons and ligaments due to chronic inflammation in these areas, from friction between these tissues and bone, or from overuse. This is the bodies way of trying to protect itself.

Signs and Symptoms of a Bone Spur(Physiotherapist Tralee)

Bone spurs may or may not cause symptoms. Symptoms are location dependent. If bone spurs rub against other bones at joints they can cause pain and/or more limited movement in these joints. Bone spurs can also be associated with pain, numbness, tenderness, and /or weakness in areas where  they irritate adjacent tissue structures(muscles, ligaments, bones, nerves etc.). If the bone spur rubs against tendons or ligaments, they can sometimes cause a tear in these tissues over time. This is a common cause of tears in certain rotator cuff tendons .

If bone spurs occur in the spine  they can sometimes pinch the nerves (radiculopathy) or spinal cord(myelopathy). A radiculopathy can cause pain, numbness, tingling, or weakness in the arms or legs depending on the area affected. With a myelopathy there can be pain and problems with balance along with weakness.

How Do Health-Care Professionals Diagnose Bone Spurs?

Generally X-Rays, MRIs or CT scans are used to confirm suspected bone spurs. Sometimes an experienced practitioner can feel the spur with their finger depending on the area(i.e. heel spur).

When Is Surgery Appropriate for Bone Spurs?

In some cases, if symptoms cannot be controlled with more conservative treatment, surgery could be an option. The goal is to remove the bone spur, allowing a return to normal joint motion, or to remove the pressure on muscles, tendons, ligaments, or nerves.


Physiotherapist Tralee   Phone 086-7700191

Posterior Impingement Syndrome(Ankle). Review by Physical Therapist & Physiotherapist in Tralee

Posterior  Impingement  Syndrome(Ankle)

Physiotherapist in TraleePosterior ankle impingement is a condition characterised by tissue damage at the back of the ankle joint due to compression of these structures. This occurs when the foot and ankle are pointed maximally away from the body (plantarflexion ). It may occur when compressive forces are too repetitive and/or too forceful. This can occurs in the presence of ankle swelling or bony anomalies, such as additional bone, a condition known as an “os trigonum”. Posterior ankle impingement is most commonly found in gymnasts, ballet dancers, and footballers, because they regularly maximally plantarflex their ankles during their activities. The condition can also occur due to inadequate rehabilitation of an acute ankle injury (ie. ankle sprain).


Mechanism of Injury

Posterior ankle impingement may develop due to an acute traumatic plantar hyperflexion event, such as an ankle sprain. It may also occur as a result of repetitive low-grade trauma associated with plantar hyperflexion, say like in case of a female ballet dancer. It is important to differentiate between these two, because the latter, that is posterior impingement from overuse, has a better prognosis.

The anatomy of the posterior ankle is a key factor in the occurrence of posterior impingement syndrome . The more common causes of the condition are osseous in nature, such as the os trigonum, an elongated posterolateral tubercle of the talus (known as Stieda’s process), a downward sloping posterior lip of the tibia, an osteophyte from the posterior distal tibia , or a prominent posterior process of the calcaneus. However, posterior impingement can also be soft tissue related, as with a thickened posterior joint capsule , post-traumatic scar tissue, post-traumatic calcifications of the posterior joint capsule, or loose bodies in the posterior part of the ankle joint. Symptoms for all of these conditions relate to physical impingement of osseous or soft tissue structures, resulting in painful limitation of the full range of ankle movement.

The most common cause ”os trigonum” is an extra (accessory) bone that sometimes develops behind the ankle bone (talus). The mineralized os trigonum appears between the ages of 7 and 13 years and usually fuses with the talus within 1 year, forming the trigonal (Stieda) process. It may remain as a separate ossicle in 7-14% of patients, and is often bilateral(in both ankles). An os trigonum can be a focus of osseous abutment against other structures. Pain can also be caused by disruption of the cartilaginous synchondrosis between the os trigonum and the lateral talar tubercle as a result of repetitive microtrauma and chronic inflammation.

In the case of soft tissue impingement it usually results from scarring and fibrosis associated with synovial, capsular, or ligamentous injury ie. bad ankle sprain.  It is thought that this type of manifestation usually usually occurs when a significant soft-tissue component forms. The soft-tissue component can consist of synovial thickening throughout the posterior capsule or be more focal, involving the posterior intermalleolar or talofibular ligament. The flexor hallucis longus tendon runs in the groove between the lateral and medial processes of the talus and can also be injured in posterior impingement, resulting in tenosynovitis.


Signs and symptoms of posterior ankle impingement

Patients who have posterior impingement complain of chronic deep posterior ankle pain worsened by forced plantar flexion or push-off forces as occur during activities such as ballet dancing, jumping, or running downhill. In some patients, forced dorsiflexion(opposite to plantarflexion) is also painful.

Physical examination reveals pain on palpation over the posterolateral  talar process, which is located along the posterolateral aspect of the ankle between the Achilles and peroneal tendons (Fig. 3. ankle). Passive forced plantar flexion results in pain and often a grinding sensation as the posterolateral talar process is entrapped between the posterior tibia and calcaneus.(Fig. 4. ankle)


Diagnosis of posterior ankle impingement

A thorough examination by an experienced practitioner  may be all that is necessary to diagnose posterior ankle impingement. Further investigations such as an X-ray, MRI, CT scan or Ultrasound may help confirm diagnosis.



Initial treatment of posterior impingement consists of rest, ice, and non-steroidal anti-inflammatory medications. Injection of steroids, perhaps under ultrasound guidance, is also effective for symptom relief and for reduction of swelling. If conservative measures fail, operative treatment may be recommended. Areas of soft-tissue impingement are debrided. Bone spurs or an os trigonum are removed, typically in an open procedure in light of the proximity of the sural nerve, tibial nerve, and flexor hallucis longus tendon. In general, operative results are excellent, as the offending structures that caused the mechanical impingement have been removed. Many athletes are able to resume running four to six weeks after surgery.

Shin Splints – Which Type Have You?

”Shin Splints” – Which Type Have You ?

shin splints”Shin splints” is a catch-all term for shin pain either on the front outside part of the lower leg (anterior shin splints) or on the inside of the lower leg (medial shin splints). It is the curse of many athletes including runners, tennis players, dancers etc. Frequently the condition plagues novice runners who do not build their mileage gradually enough. It also affects seasoned runners who abruptly change their workout regimen, suddenly adding too much mileage, or switching from running on the flat to hills. The term mainly refers mainly to the following three conditions 1. mini stress fractures within the tibia bone, 2. chronic exertional compartment syndrome, 3. medial tibial stress syndrome.  It is important to differentiate between the three for treatment.

1. Real ”shin splints” are mini stress fractures (splint-ers) within the tibia bone. With this condition pain is gradual in onset, getting worse with activity, and there is usually a history of an increase in training intensity. Pain may occur with walking, at rest, or even at night in bed. Treatment for this condition involves rest for about eight weeks from running to allow the little stress fractures to heal. You should be able to keep up fitness levels by cycling, swimming etc., as these exercises are low impact. You may need to look at lower limb biomechanics, running style, training practices etc. to prevent recurrence of the shin splints .

2. Chronic exertional compartment syndrome is defined as increased pressure within a closed fibro-osseous space(like the space the tibia and fibula), causing reduced blood flow and tissue perfusion(perfusion is the process of a body delivering blood to a capillary bed in its biological tissue), which subsequently leads to ischemic pain(pain due to restriction of blood supply, and thus oxygen and nutrients to tissue) and possible permanent damage to tissues of the compartment. The syndrome is frequently bilateral (both legs). Typical features of the condition are absence of pain at rest, with increasingly achy pain and a sensation of tightness in the shins upon exertion. Symptoms usually resolve or significantly dissipate within several minutes of resting. Anyone can develop the condition, but it is more common in athletes who participate in activities that involve repetitive impact, such as running. Sometimes Chronic exertional compartment syndrome may respond to deep tissue work and myofascial release of the structures involved. Changing your chosen activity to one involving less impact may also help. Surgery may be used as a last resort to relieve the pressure. It involves operating on the inelastic tissue encasing each muscle compartment (fascia). Methods include either cutting open the fascia of each affected compartment (fasciotomy) or actually removing part of the fascia (fasciectomy).

3. Medial tibial stress syndrome is an inflammation of the muscles, tendons, and bone tissue around your tibia. A common cause of Medial Tibial Stress Syndrome is pes planus (flat feet) or over-pronation of the foot during running. This puts increased strain on the Tibialis Posterior and soleus muscles leading to chronic traction at their insertions onto the periosteum on the posterior inner border of the tibia, producing pain in this area. Mild swelling in the area may also occur. The pain may be sharp and razor-like or dull and throbbing, occurring both during and after exercise, and aggravated by touching the sore spot. Initial treatment involves rest, ice, analgesics. Again switching to low impact activities such as swimming or cycling can keep a sports person active during recovery. For treatment, the entire calf should be assessed. The use of myofascial release techniques along with proper hands-on deep tissue work concentrating on thickened muscle fibres of the soleus, flexor digitorum longus and tibialis posterior adjacent to their bony attachments can prove effective. Dry needling and electro-acupuncture can also benefit recovery. Arch supporting orthotic insoles designed to reduce impact forces, correct flat-footedness and overpronation during running can help prevent recurrence and facilitate recovery by offloading affected structures. For some more information click here.

Dead leg injury ; Diagnosis, treatment and management.

Dead leg

A ”dead leg”, also known as ”charley horse” or ”quadriceps contusion”, is essentially an injury due to a traumatic blow, crushing the quadriceps muscle against the femur bone. The quadriceps is the muscle at the front of your thigh. The injury can be either intermuscular or intramuscular. Treatment depends on the type of contusion and grade in Dead legseverity of the injury. An Intramuscular contusion occurs when the muscle gets torn within the sheath surrounding it. This causes the initial bleeding to cease within hours due to increased pressure within the muscle. However, the fluid and blood is not able to escape from the muscle sheath surrounding it resulting in considerable loss of function and a lot of pain. This can take days or weeks for a full  recovery. You are unlikely to see any bruising with this type of contusion, especially in the early stages. In the case of intermuscular contusions, the muscle as well as part of the sheath surrounding it gets torn. This results in a longer bleeding time initially, especially if there is no use of ice therapy. The patient usually recovers faster from this type of dead leg, as the blood and fluids can easily flow away from the injury site. Bruising is often present in this type of contusion.


  • Grade 1: Quadriceps pain, tightness in the thigh and a limp while walking. The swelling is very mild and so is the pain. The patient has almost complete range of motion upon stretching.
  • Grade 2: The patient is not able to walk properly and limps when walking. There is some swelling present and the patient will experience bouts of pain upon activity. There is pain upon extending the leg against resistance. Pressure on the site also produces pain and the patient is unable to completely flex the knee.
  • Grade 3:The patient has severe pain with obvious swelling, and is unable to walk without the help of crutches. Muscle contraction produces an obvious gap or bulge. This type of dead leg needs at least a month or two to completely heal.

Treatment for dead leg

  • I.C.E (Rest, Ice, Compression, Elevation).
  • Rest is very important and the limb should be kept elevated as much as possible.
  • Compression and ice therapy should be applied for 15 to 20 minutes every hour for the first 24 to 48 hours. Ice should be wrapped in a wet towel to prevent ice burns. A compression bandage should be worn 24/7 to reduce swelling and to give support until the pain has subsided.
  • Crutches should be used if required.
  • Never apply heat therapy(that includes having a hot bath…Do not) or perform deep tissue massage in the initial acute stage (24 to 48 hours) of a dead leg injury. This can aggravate the injury or lead to myositis ossificans later. Sports massage to help recovery should be started once the acute phase (24 to 48 hours) of the injury has passed, provided it’s not an intramuscular contusion(This may need more time to settle and sometimes requires medical intervention).
  • Gentle stretching of the area should be done after the acute stage (24 to 48 hours) has passed, but not before, provided it does not cause too much pain. The stretch should be held for 30 seconds and should be repeated 4 to 5 times in a day. With severe (grade 3) intermuscular contusion there should be no overpressure with passive stretching for 7-10 days.


When Can Exercises Be Started For Dead Leg?

  • For dead leg of grade 1 contusion of quadriceps, strengthening exercises can be started as soon as the pain has subsided. Patient should start with mild exercises and should move on to difficult ones as the dead leg pain.
  • For dead leg of grade 2 contusions of quadriceps, strengthening exercises should be started after a week or so. Patient should start with gentle warm up exercises and finish with good stretching exercises. Strengthening exercises should be continued for several weeks. Strengthening exercises should be started more than a week later and for grade 3 contusions of the quadriceps.
  • Gentle exercises such as cycling or swimming are nice gentle strengthening exercises to start with.


Myositis Ossificans

The more severe a contusion, the greater the risk of development of Myositis Ossificans, especially with poor treatment and management. In this condition calcification occurs within the healing hematoma(swelling of clotted blood within the muscle). The healing hematoma forms bone within the layers of affected muscle. Symptoms include overnight and morning pain, as well as pain on muscle contraction. It may be possible to feel a hard bump or ‘woody’ lump within the affected muscle tissue.  Stiffness and loss of knee range of movement are also common.  Sometimes surgery is required to remove the calcified tissue.

Physio – Why early referral is important

Physio and the importance of early referral

PhysioYou have been getting treatment for back pain twice a week for the past four weeks. Each time you lie there for the first fifteen minutes with a hot pack while somebody else is being treated at the same time. The therapist pops in, has a brief chat, does a quick manipulation, reassures you of your improvement, then books you in for your next appointment. You leave wondering if you are really getting any better, but console yourself with the fact that the practitioner told you that you are.
Recently a client told me a story of where they endured a situation like the above for six months. Finally they decided to go to a doctor, who referred them for an MRI. The results showed a stress fracture to one of the lumbar vertebrae of the spine. In this case the treatments had been exacerbating the condition, and what was needed was rest and immobilisation. Also manipulations, generally speaking, need to be done only once. They are used mainly to open a locked joint. A decent amount of soft tissue and myofascial work should be done by a physio beforehand to open up and relax the area. Otherwise the joint may revert to its locked position again shortly after the physio has manipulated it. Also as a general rule there should be a noticeable improvement in a clients condition from physio treatment to physio treatment.
To illustrate the importance of early recognition and referral by your physio, let us look at a few more sinister conditions that present as back pain, requiring referral to a doctor or specialist.
Spondylitis; Ankylosing spondylitis is a condition where there is chronic inflammation of the spine and sacroiliac joints. This causes pain and stiffness in and around the spine, including the neck and back. Over time this condition can lead to a complete cementing together (fusion) of the vertebrae, a process referred to as ankylosis . Ankylosis causes loss of mobility of the spine.
Spondylolysis; A common cause of low back pain in adolescent athletes. It can be seen on X-ray and is a stress fracture in one of the bones (vertebrae) that make up the spinal column. It usually affects the fifth lumbar vertebra in the lower back, and less commonly the fourth. If the stress fracture weakens the bone too much the vertebra can start to shift out of place. This condition is called spondylolisthesis.
Spondylolysthesis; Spondylolisthesis is a condition whereby one of the vertebra of the spine slips forward or backward on the next vertebra. Spondylolisthesis can lead to deformity of the spine as well as a narrowing of the spinal canal (central spinal stenosis) and compression of the exiting nerve roots (foraminal stenosis). Spondylolisthesis is more common in the lower back but can also occur in thoracic and cervical spine.

Arthritis ; various types including spondylitis, reactive arthritis, osteoarthritis, juvenile onset spondyloarthritis, enteropathic arthritis, rheumatoid arthritis, polymyalgia rheumatica etc. can all present as back pain.
kidney stones ; can cause back pain.
Osteoporosis ; Osteoporosis means porous bones. It is a silent disease that usually goes undiagnosed until a bone fracture occurs. Bone is a living tissue that is constantly being turned over. Bones need normal sex hormones, calcium, vitamin D, adequate calories, proteins and weight bearing/strengthening exercise to keep them healthy. As we get older, more bone is lost than is replaced, but people with Osteoporosis lose more bone than people who do not have the disease. This causes bones to become more fragile and break or fracture more easily.
Various cancers ; pancreatic, liver cancers etc. can cause back pain.
ovarian cysts ; Ovarian cysts are fluid-filled sacs or pockets within or on the surface the female ovary. A large ovarian cyst can cause abdominal discomfort and a dull ache that radiates into the lower back and thighs.
Spinal stenosis ; This is a narrowing of spaces in the spine causing pressure on the spinal cord and nerves. About 75% of cases of spinal stenosis occur in the low back. In most cases, the narrowing of the spine associated with stenosis compresses a nerve root, which can cause pain down the leg.

physio in Tralee
Basically what I am saying in this article is that if your condition is not improving from physio session to physio session you may need to go back to your doctor for further investigation. Just keep it in mind. A good physio will probably have already referred you.

Foot Orthotics – A few things to think about

Foot Orthotics – The Truth

Foot OrthoticsThe science behind foot orthotics is relatively new and continually evolving. To date some of the evidence regarding the benefits foot orthotics for athletes etc. has been a little conflicting. Reasons for this may include 1. differences in the experience and training of prescribing practitioners; 2. differences between foot orthotics suppliers and materials used 3. the temptation of monetary gain from prescribing foot orthotics unnecessarily.

From my experience foot orthotics do work for certain conditions the majority of the time but I feel they are way overprescribed for monetary gain. They mainly seem to benefit conditions from the knee down to and including the foot.  I cannot  really see how they would prevent hip or back pain(unless maybe there is a leg length discrepancy),neck pain etc. as some suppliers suggest. A lot of people are under the illusion that foot orthotics are some kind of amazing item especially the more expensive ones. If you have a pair, take a good look at them. They are basically a very fancy supportive insole, not much more.

Foot Orthotics – How they work

Let’s look at how they work, i.e. in the case of a lower limb tendinopathy. This condition usually occurs when the tendon has been under strain for long periods. The idea is that you put in a strategically located lift in the orthotic to take the pressure off the tendon and thus give it a chance to heal. For example with an achilles tendinopathy, you put in a little heel lift thus taking the pressure off the tightened achilles tendon. You are trying to reduce the tension on the tendon or give it slack, hoping as a result it gets a chance to heal. Looking at it from a different angle though, maybe you just had tightened calves from wearing high heels or from overdoing it in training. By loosening out the calves with massage and stretching you can reduce the pull and strain on the achilles tendon to which they are attached….maybe there is no need for orthotics? However other tendinopathies like tibialis posterior or peroneal can be more difficult to treat and may benefit from foot orthotic.

Say you have medial knee pain from running, it may be due to flat feet causing an inward force on the knee. You put in a foot orthotic with an arch support, it corrects the fallen arch, lessening the inward stress on the knee and  taking the pressure of the medial knee. As you can see there is nothing amazing going on here and the theory is pretty good. You can even use different types of materials when manufacturing foot orthotics, some which give more spring in your step reducing the load on shins (shin splints) etc.

In the case of plantar fasciitis which can be due to torsion on the plantar fascia as a result of rotational movement between the heel and forefoot. Here a heel lock in the foot orthotic coupled with an arch support can stabilise the heel and forefoot, reducing torsion on the plantar fascia and allowing it to heal.

However, here are a few things I want you to consider. 1. If you have been running for several years injury free, why would you suddenly need orthotics, could you not just have an injury that needs rest or treatment. 2. You have a young child and somebody says they need foot orthotics because they have flat feet even though they are not in any discomfort. The child is growing and developing, do you want to alter and interfere with that natural process. sometimes even if there is mild pain, maybe it is just ”growing pains” . 3. if you have flat feet or high arches and are in no pain or discomfort, why let somebody convince you that you need foot orthotics. I know plenty of runners and athletes with one of those conditions(high arches or flat feet) that never wear foot orthotics and have no problems.  4. The ”one leg an inch shorter than the other trick” to sell you foot orthotics. I can easily make it appear like one of your legs is shorter than the other when measuring you. A tiny percentage of the population 1/1000, have leg length differences of greater than 20mm or 3/4 inch(Guichet et al.; Clin Orthop. Rel. Res. 1991, 272:235). It is at this level that leg length discrepancy becomes significant. Wearing orthotics to correct a difference when there is no difference could quiet possibly cause you problems down the line. However if there is a definite actual leg length discrepancy a little heel lift in an orthotic can correct this and provide considerable relief. I regularly see people told they have a one inch discrepancy in leg length and sold foot orthotics for several hundred euro. Upon testing them I frequently see little or no difference whatsoever in their leg lengths. Here is an interesting article on leg length discrepancies Also the only way to reliably determine anatomical leg length discrepancies is to take x-rays of the lower extremities and actually measure the length of the femur, tibia, talus and calcaneus, since these are the primary weight bearing bones.   5. Lower back pain is often either disc or muscular related. I cannot in any way see how orthotics could benefit these conditions. As for neck pain, not a hope.

As for gait analysis in running stores, this is my advice; If you have been using a specific runner and having no problems, stick with it, brand and all. So often I have seen people measured up for runners and told for example they are over-pronating.  Then they are  given a runner to correct for this. Next thing two months later they have a tendon injury because they have been used to running a certain way in specific running shoes and now this altered runner is changing that suddenly, with no chance for the body to adapt.  Stick with the footwear you are used to. Make sure it is comfortable, supportive and laced up well. Replace worn out foot wear.

Also for people new to running, give your body time to adapt. Take it slowly, this is the best way to prevent injury. In terms of price, you should be able to get a quality off the shelf foot orthotic for around 60 euro. These often do the trick for many conditions. They usually include little stick on attachments to correct for various conditions so your practitioner can customise them to the injury. Custom foot orthotics shouldn’t really set you back more than 300 euro. Paying more does not mean you have a better product. Many are way overpriced for what you are getting. What seems to be major factor in whether orthotics will work or not is how comfortable the feel when worn. If you have been overtraining resulting in a lower limb tendinopathy, don’t think you can just stick on a pair of foot orthotics and keep going. Often it is rest along with eccentric rehabilitation exercises that is needed, not foot orthotics as such. I hope the above article gives you a few things to think on.


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