Bicep Tendon Tear

Biceps Tendon Tears

The biceps muscle has two tendons that attach the muscle to the shoulder(long and short head bicep tendons) and one tendon that attaches it at the elbow.


Biceps tendon tears can be either partial or complete.

  • Partial tears. These tears do not completely sever the tendon.
  • Complete tears. A complete detachment of the tendon from the bone.


Biceps tear -shoulder

The long head of the biceps tendon is the more likely tendon of the three attachments to be injured. This is because it is vulnerable as it travels through the shoulder joint to its attachment point within the shoulder socket. Fortunately, the biceps has two attachment heads at the shoulder, and the short head of the biceps rarely tears. When this second attachment remains intact, many people can still use their biceps even after a complete tear of the long head.

Biceps Tear – Elbow

Tears of the biceps tendon at the elbow are less common. They are most often caused by a sudden injury, and tend to result in greater arm weakness than injuries to the biceps tendon at the shoulder, because there is only one attachment point. Once torn, the biceps tendon at the elbow will not attach back onto the bone and heal. Other arm muscles make it possible to bend the elbow fairly well without the biceps tendon. However, they cannot fulfill all the functions of the elbow, especially the motion of rotating the forearm from palm down to palm up. This motion is called supination. Sometimes there is only a partial tear to the tendon, which may heal to a certain extent and can be rehabilitated to a reasonable level of strength without surgery.


Underhand / Overhand Grip

In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes when lifting a heavy object. Also If you fall hard on an outstretched arm or lift something too heavy, you can tear your biceps tendon. The lower bicep head tendon tear is a reasonably common injury in powerlifters(but not in the general population) using an under and overhand grip on the bar. It is the underhand grip arm  the bicep usually tears on. Lifting with two overhand grips as in weightlifting is safer on the biceps but is seen as a weaker grip.


  • Sudden, sharp pain in the upper arm while lifting with the arm
  • Pain/Bruising of the bicep area near shoulder or elbow
  • Weakness in the shoulder and the elbow
  • Difficulty turning the arm palm up or palm down
  • Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow (“Popeye Muscle”) may appear, with a dent closer to the shoulder.

I have seen many people with bicep tears lead normal lives, after a small bit of physio. The arm will be weaker but functional. If you require close to full recovery of strength in a torn bicep,  surgery is required.


The ”I.T. Band” is not the problem

The ”I.T. Band” is not the problem

Regularly I come across  people receiving seemingly endless treatment sessions iliotibial band syndrome, with the main focus of the treatment being to try and loosen out the I.T. band. Below are a few things I believe you should consider when  treating  iliotibial band syndrome.


  1. 1. A client is told they have certain weak muscle groups which are causing the problem and are given a load of exercises to correct these weaknesses. Sometimes they are told that they need orthotics. Sometimes these treatment protocols may be necessary, but more often this is just an overuse injury that is being made way too complicated. Say you have been running for a year(or years) with no issues, why are all these ”weaknesses” just now causing you problems? Most likely they are not the cause.  Why do you suddenly need orthotics. Did you change your feet(joke)? It is more likely you are overdoing it a bit in your running.

  3. 2. All the emphasis is often placed on the I.T. band and treatment of same. The I.T. band is a long tendon and is a fairly inflexible structure, so concentrating on loosening out that is not going to give much relief in itself. Now if you shift the focus to loosening out the tightened outer quad muscles which attach to the I.T. band by fascia(connective, supportive sheet of tissue, kind of like a very strong clingfilm) and as a result pull on the I.T. band, you will generally start to recover fairly quickly. There is nearly always a section of the outer quad about a quarter of the way up from the knee which will be tight and ropey in this injury. Also don’t forget the Tensor fascia lata muscle. This is up near the hip. It is the muscle that attaches directly to the I.T. band. If this has tightened it also needs to be worked out and loosened also. The I.T band should not be totally ignored of course. Instrument assisted soft tissue release can be excellent in loosening it somewhat, as well as for loosening out tightened quad muscles and fascia.

  5. 3. Another problem with this condition is a lack of understanding as to what is causing the pain at the side of the knee. The tension and resulting friction on the I.T. band causes the bursa under it at the side of the knee to become inflamed. This is what causes the pain. Treatment options here include a combination of non steroidal anti-inflammatories, compression with ice(very effective), maybe some electro-acupuncture. You want to compress the icepack into the side of the knee to flatten the inflamed bursa and reduce inflammation. A packet of peas or one of those gel packs will not be cold enough.

  7. 4. Rest is needed. This is an overuse injury, remember, but the better and more effective the treatment, the faster the recovery.

Above is not stuff you will find in a text book but comes from knowledge of anatomy and experience in  successfully treating this condition hundreds of times over the years, often in about two treatment sessions. Injuries are often over-dramatized. Sometimes you just need a little rest, with the right physio treatment protocol to aid recovery.

Lumbar Spinal Stenosis

Lumbar Spinal Stenosis

Spinal stenosis is a narrowing of the space within the spine. This can put pressure on the nerves that travel through the spine. It occurs most often in the lower back and the neck. Some people are born with a congenital form, but most develop spinal stenosis as part of the degenerative cascade. Sometimes people do not feel effects of the narrowing, but as part of the aging process, most people will eventually notice radiating pain, weakness, and/or numbness secondary to the compression of the nerves or spinal cord. In lumbar stenosis, the spinal nerve roots in the lower back become compressed and this can produce – tingling, weakness or numbness that radiates from the low back and into the buttocks and legs, especially with activity.

Lumbar spinal stenosis often mimics the symptoms of vascular insufficiency. Both conditions can cause claudication, which means leg pain with walking. If vascular studies identify normal blood flow, and tests confirm spinal stenosis,the symptoms are then referred to as neurogenic claudication.

Tralee Physio – Three Exercises You Shouldn’t Be Doing

Tralee Physio – Three Exercises You Shouldn’t Be Doing

The internet is full of ”experts”. Unfortunately a lot of these ”experts” are not properly qualified. This is often the case when it comes to exercise and nutrition. Today we will look at three exercises I see performed regularly in the gym these days, where the risks far outweigh the benefits.

Generally speaking the best position for the spine to be in when you are lifting something is having your back straight and upright. The pressure of the lift is best dissipated through the discs,  joints,  muscles and ligaments etc. , and the back is at its strongest in this position. That is why in manual handling courses you are always told to ”keep your back straight” and ”lift with your legs”. You want to protect your back at all times because if it gets injured you will be crippled in pain.

Exercise 1.   Good Morning exercise




In this exercise the person places the bar and weights on the shoulder as shown. The person then bends forward as shown and returns to starting position, repeating this several times. This is exactly what you are told not to do in most exercises, i.e. squats, deadlifts etc. During lifting, correct form is keeping your back as straight and upright as possible. With the  ”Good Morning” you are putting your body in a very mechanically disadvantaged  position. There is maximal stress on spinal structures like the discs, vertebrae, muscles etc. because the lever is so long. This leaves them very vulnerable to injury.

Exercise 2. Hack squat facing the machine









Above is the proper way to do a hack squat. It is the way the machine is designed to be used, with your back straight and supported. However some people have come up with the idea of doing it the opposite way, where you face the machine and there is no support for your back. The machine is not designed to be used like this and your spine is no longer supported as you squat. Also you are starting with say a 30 degree bent forward angle for your back. This angle increases as you drop into the squat putting undue stress on the spine. Also the spine is often forced into a slight curvature as you reach the bottom of the lift. This does not occur when you use the machine as it was designed, with your back to the machine.

It was hard to locate a photo of the reverse hack squat most likely because it should not be done this way, but I managed to find one. See below. You can see even from the photo that the position looks unnatural.






Exercise 3 : Kneeling squat with free weights or on the smith machine

This involves squatting on your hunkers while kneeling under a smith machine or weighted bar. Why do you think tilers etc. who work on their knees wear protective knee pads.  It is because humans aren’t meant to be on their knees. Even with the pads many tilers suffer knee pain over time. Doing the kneeling squat could easily damage knee cartilage over time, more specifically the  meniscus on either side of the knee. Each of your knees has two menisci — C-shaped pieces of cartilage that act like a cushion between your shinbone and your thighbone. When these get torn or damaged it can lead to significant pain within the knee joint. Also the patella(kneecap) could be vulnerable to damage especially the cartilage over which it glides as the kneecap may start to mis-track from this exercise.






Tralee Physio Phone 086-7700191

Physiotherapists Tralee – Trigger Finger

 Physiotherapists Tralee – Trigger Finger


Trigger finger is a condition in which one of your fingers gets stuck in a bent position. Your finger may bend or straighten with a snap — like a trigger being pulled and released.

Tendons are fibrous cords that attach muscle to bone. Each tendon is surrounded by a protective sheath. Trigger finger occurs when the affected finger’s tendon sheath becomes irritated and inflamed. This interferes with the normal gliding motion of the tendon through the sheath. Prolonged irritation of the tendon sheath can produce scarring, thickening and the formation of bumps (nodules) in the tendon that impede the tendon’s motion even more.

People with work or hobbies that require repetitive gripping actions are at higher risk of developing trigger finger. The condition is also more common in women and people who suffer with diabetes.

Physiotherapists TraleeSymptoms

Signs and symptoms of trigger finger may progress from mild to severe and include:

  • Finger stiffness, particularly in the morning
  • A popping or clicking sensation as you move your finger
  • Tenderness or a bump (nodule) on palmside at the base of the affected finger
  • Finger catching or locking in a bent position, which suddenly pops straight
  • Finger locked in a bent position, which you are unable to straighten

Trigger finger can affect any finger and triggering is usually more pronounced in the morning.


Physiotherapists Tralee – Diagnosis

Diagnosis of trigger finger doesn’t require any elaborate testing. Diagnosis is based on  medical history and a physical exam. During the physical exam, your doctor/physo will ask you to open and close your hand, checking for areas of pain, smoothness of motion and evidence of locking.  He should also feel your palm to see if there is a lump present. If the lump is associated with trigger finger, the lump will move as the finger moves because the lump is an area of swelling in part of the tendon that moves the finger.

Physiotherapists Tralee – Treatment

Trigger finger treatment varies depending on the severity and duration of the condition. Nonsteroidal anti-inflammatory drugs  may relieve the pain but are unlikely to relieve the swelling constricting the tendon sheath or trapping the tendon.

Conservative non-invasive treatments may include:

  • Rest. Avoid activities that require repetitive gripping, repeated grasping or the prolonged use of vibrating hand-held machinery until your symptoms improve. If you can’t avoid these activities altogether, padded gloves may offer some protection.
  • A splint. Your doctor may have you wear a splint at night to keep the affected finger in an extended position for up to six weeks. The splint helps rest the tendon.
  • Stretching exercises. Your doctor may also suggest gentle exercises to help maintain mobility in your finger.

If conservative treatment fails here are the other options.

  • Steroid injection. Injection of a steroid medication near to or into the tendon sheath may reduce inflammation and allow the tendon to glide freely again. This is the most common treatment, and it’s usually effective for a year or more in most people treated. Sometimes it takes more than one injection. For people with diabetes, steroid injections tend to be less effective.
  • Percutaneous release. After numbing your palm/finger, your doctor inserts a sturdy needle into the tissue around your affected tendon. Moving the needle and your finger helps break apart the constriction that is blocking the smooth motion of the tendon.This treatment may be done under ultrasound control, so the doctor can see where the tip of the needle is under the skin and to be sure it opens the tendon sheath without damaging the tendon or nearby nerves.
  • Surgery. Working through a small incision near the base of your affected finger, a surgeon can cut open the constricted section of tendon sheath. This is a last resort.

Physiotherapist Tralee : Myofascial Pain Syndrome

Physiotherapist Tralee : Myofascial Pain Syndrome

Myofascial pain syndrome is where pressure on sensitive points within your muscles (trigger points) causes pain and sometimes refers pain to seemingly unrelated parts of your body. It can occur after a muscle has been contracted repetitively ie. repetitive motions used in jobs or hobbies or by stress-related muscle tension. While nearly everyone has experienced muscle tension pain at some point, the discomfort associated with myofascial pain syndrome persists or worsens. There is no laboratory, radiographic or other diagnostic tests to prove the diagnosis of myofascial pain syndrome so it is considered a “subjective” diagnosis. Myofascial trigger points do not always cause pain. Sometimes they can lie dormant or inactive within a muscle for months or even years. Trigger points can often be identified by a skilled therapist working through your muscles with deep tissue massage. They feel like little knots deep within the muscles which when pressed are extremely tender.

Fascia is the body’s connective tissue. It is a head to toe, all-encompassing and interwoven system of fibrous connective tissue found throughout the body. Your  fascia provides a framework that helps support and protect individual muscle groups, organs, and the entire body as a unit. It is the same as that cling film, elastic type structure that surrounds a joint of meat, helping hold it together when the outer skin is removed.

This fascia in itself can also contribute to ”myofascial pain” syndrome. Injury, illness, stress, aging and repetitive use, can cause the fascia to shorten, thicken and become more unyielding . All the nerves and blood vessels run through the fascia. Therefore, if this connective tissue is tight, the associated tissues will have poor nutrient exchange. This exacerbates any painful situation because toxic metabolic waste products build up which often further aggravate pain receptors. This can create a vicious cycle, leading to increased muscle tension and further thickening and hardening of the fascia, which in turn further limits mobility.

 Physiotherapist Tralee : Symptoms

Signs and symptoms of myofascial pain syndrome may include:

  • Deep, aching pain in a muscle
  • Pain that persists or worsens
  • A tender knot in a muscle
  • Difficulty sleeping due to pain
  • Spasm in the area

The most commonly affected muscle groups include those of the neck, shoulders, upper  & lower back. Generally one side of the body is more affected than the other. It is common for patients with myofascial pain syndrome to have poor sleep patterns. This is associated with feeling unrested after a nights ”sleep” and daytime tiredness . Stiffness after inactivity is also a common feature.


Physiotherapist Tralee : Treatment

Myofascial pain can often benefit greatly from ”proper skilled deep tissue massage”, and trigger point release, both manual and with dry needling techniques. The fascia can also be stretched and worked out during the massage.  This is also one of the benefits of a stretching program when incorporated into your exercise routine. It helps keep prevent the fascia from tightening up because you are continually stretching it out.

During treatment for myofascial pain it is important that the patients reduce their stress levels, if this is a contributing factor to the condition. Exercises prescribed by a physio may also help, along with improving ones sleep patterns. In severe, chronic cases, medications may be needed to aid recovery.

Often trials of different medications are used to find the best treatment for a particular patient. For example, trazodone or amitriptyline may be used at bedtime to improve sleep as well as relieve pain;  cyclobenzaprine or  orphenadrine can also be  used to relax muscles and aid sleep; and antidepressants such as sertraline, fluoxetine(prozac), duloxetine, can be used to control pain, as can lyrica and gabapentin. Medications have side effects, so are  added as a last resort in chronic cases showing little improvement with physio alone. They should only be taken under a doctors supervision.

Arthritis – Rheumatoid Arthritis vs Osteoarthritis : Physiotherapists Tralee

Arthritis – Rheumatoid vs Osteoarthritis


Rheumatoid arthritis – Physiotherapists Tralee

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. It is an autoimmune disease occurring when your immune system mistakenly attacks the  synovium , the lining of the membranes that surround your joints. The resulting inflammation causes the synovium to thicken, eventually destroying the cartilage and bone within the joint. The tendons and ligaments holding the joint together also weaken and stretch. Gradually, the joint loses its shape and alignment.

It is unknown exactly  what starts the process, although a genetic component appears likely.  Newly developed  medications have greatly improved treatment options.  However, severe rheumatoid arthritis can still cause physical disabilities.

 Symptoms – Physiotherapists Tralee

Signs and symptoms of rheumatoid arthritis may include:

  • Tender, warm, swollen joints
  • Joint stiffness that is usually worse in the mornings and after inactivity
  • Fatigue, fever and weight loss

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints of the fingers and toes. As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

Rheumatoid arthritis can also affect many non joint structures. This is the case in about 40 per cent of sufferers. These include:

  • Skin
  • Eyes
  • Lungs
  • Heart
  • Kidneys
  • Salivary glands
  • Nerve tissue
  • Bone marrow
  • Blood vessels

Rheumatoid arthritis signs and symptoms can vary in severity and may come and go. Periods of increased disease activity, called flare ups, alternate with periods of relative remission — when the swelling and pain fade or disappear.

Risk factors – Physiotherapists Tralee
  • Your sex : Women are more prone than men .
  • Age : Can occur at any age, but most common between the ages of 40 and 60.
  • Family history : Increased risk if there is a family history of the disease.
  • Smoking : Cigarette smoking increases your risk of developing rheumatoid arthritis.
  • Obesity: People who are overweight or obese appear to be at somewhat higher risk .


Diagnosis and Blood tests

People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding alone that confirms diagnosis.

Imaging tests

Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests can help your doctor judge the severity of the disease in your body.


There is no cure for rheumatoid arthritis. Recent studies indicate that remission of symptoms is more likely when treatment begins early using medications known as disease-modifying antirheumatic drugs (DMARDs).

The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you’ve had the rheumatoid arthritis. Medications used include :

  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation.
  • Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage.
  • Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).
  • Biologic agents. Also known as biologic response modifiers. These are a newer class of DMARDs(Disease-modifying antirheumatic drugs) .These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate.

All the above drugs have side effects which need to be monitored.


Medications can slow joint damage due to rheumatoid arthritis. When the damage becomes excessive surgery may need to be considered to repair the damaged joints.

Osteoarthritis– Physiotherapists Tralee

Osteoarthritis is the most common form of arthritis. It occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the smooth surface of the cartilage becomes roughed and worn. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone. The disorder most commonly affects joints of the hands, knees, hips and spine.

Osteoarthritis symptoms can usually be effectively managed, although the underlying process cannot be reversed. Staying active, maintaining a healthy weight and other treatments may slow progression of the disease and help improve pain and joint function. When joint pain and damage is severe, doctors may suggest joint replacement surgery.

 Symptoms – Physiotherapists Tralee

Osteoarthritis symptoms often develop slowly  over time. Signs and symptoms may include:

  • Pain. Your joint may hurt during or after movement.
  • Tenderness. Your joint may feel tender when you apply light pressure to it.
  • Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
  • Loss of flexibility. You may not be able to move your joint through its full range of motion.
  • Grating sensation. You may hear or feel a grating sensation when you use the joint.


Risk factors– Physiotherapists Tralee

Factors that may increase your risk of osteoarthritis include:

  • Older age. The risk of osteoarthritis increases with age as joints wear over time.
  • Sex. Women are more likely to develop osteoarthritis, though it isn’t clear why.
  • Obesity. Carrying extra body weight contributes to osteoarthritis in several ways, and the more you weigh, the greater your risk. Increased weight puts added stress on weight-bearing joints, such as your hips and knees. In addition, fat tissue produces proteins that may cause harmful inflammation in and around your joints.
  • Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
  • Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.
  • Genetics. Some people inherit a tendency to develop osteoarthritis.
  • Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.


Summary – Rheumatoid vs Osteoarthritis

Rheumatoid arthritis is an auto-immune response where your body mistakenly attacks its own joints. Osteoarthritis is more or less due solely to wear on a particular joint over time.



Sometimes MRI results or Xray results  state there is osteoarthritis present. With age most of us have some level of osteoarthritis due to wear on our joints. The important thing which your doctor will discuss with you is whether this level is normal for your age. A person can have mild osteoarthritis with no pain or symptoms and may have nothing to worry about.


More information can be found at

Ankle sprain – Physiotherapists in Tralee and Dingle

Ankle Sprain – Physiotherapists in Tralee and Dingle

Most people go over on their ankle at some stage in their lives. Usually they go over outwords and it is the outside of the ankle that gets injured. The ankle is stabilized by muscles, tendons and ligaments. Usually when you go over, it is an instantaneous thing where the muscles have failed to switch on and stabilize and the strain falls on the ligaments to protect you. The muscles also get strained as they try to correct the situation mid accident firing up too late. There are a lot of  ligaments in the ankle so the stability is quiet strong. Luckily, usually the ligaments strain rather than rupture. If they rupture  the sound will almost be like the sound of a tree branch breaking. You most likely will hear it. Luckily, because there are so many ligaments, even if one or two rupture, you can usually rehab the ankle fully. Protection such as strapping/taping or the likes of an ASO ankle brace may be needed thereafter, if some ligaments are torn fully, and you are involved in a sport where rapid twisting and turning  are part of the game and the training.


Treatment – Physiotherapists in Tralee and Dingle

Treatment of ankle sprains is pretty straight forward. One important point is that often most of the pain is due to the swelling that occurs rapidly post injury, so it is important to limit this. Immobilize the foot straight away. Start on NSAIDs(non steroid anti-inflammatories) immediately. Ice immediately(wet towel around iced, around the foot for about 10 mins every half hour or so). There are cold compression therapy machines which are excellent for this kind of injury. Obviously they are not always readily available.  They probably are a worthwhile investment for competitive clubs as they are not overly expensive.

After a few days physio can be commenced. This often includes gentle mobilization of the joints of the foot, massage to ease of strained/spasmed muscles and remove some of the swelling through the lymph nodes etc. Different grades of damage require slight modifications in approach but the basic idea is to get rid of inflammation, get movement back in the joints of the foot and relax down the strained muscles. Home rehab given to the patient involves self mobilization of the foot along with progressive strengthening exercises. Usually the condition does not require too many physio sessions but rather a progressive strengthening program prescribed by the physio and followed by the patient. Sometimes if pain lingers, the fibular head may have dropped slightly during the injury(so it is misplaced slightly) and it may need to be gently mobilized back into place using something like ”Mulligan Technique”. The movement of the fibular head can have been tiny, but the shift can cause considerable pain to linger if not rectified.  A good physio will always have done this during treatment anyway.

ASO Ankle Brace

Rehab progression will involve things like calf raises, heel to toes taps, proprioception exercises, standing on one foot, standing up on toes of one foot, hopping on one foot, walking , jogging, jumping in various directions. It is recommended that an ASO ankle brace be worn during training and playing for several months after the injury to prevent recurrence. Strengthening work and controlled  training is done without the brace to ensure continued strengthening of the ankle. The ankle will not weaken as a result of the ankle brace as the muscles still have to fire during play, but continued strengthening and a build up of controlled exercise intensity without the ankle brace should also take place for full recovery.


Sub-Acromial Bursitis. Overview by Physio in Tralee.

Sub-acromial bursitis. Overview by Physio in Tralee.

physiotherapists Tralee

Shoulder Joint – Subacromion Bursitis

Sub-acromial bursitis is a common cause of shoulder pain that is usually related to impingement of the bursa between the supraspinatus muscle tendon and the acromion bone(see diagram). Bursae(single = bursa) are fluid-filled sacs that help reduce friction wherever tendons move under or over bone. The Supraspinatus muscle runs along the top of the shoulder blade and inserts via the tendon onto the top of the arm(humerus bone). This muscle is used to lift the arm up sideways . Above the supraspinatus tendon and under the acromion there is a bursa. When this bursa gets inflamed and swollen it can become trapped under the acromium bone of the shoulder causing pain and inflammation.



Symptoms of sub-acromial bursitis can be similar to those of supraspinatus  muscle/tendon injury within the shoulder. There will be pain and weakness in the arm, particularly when it is lifted sideways from the hip to overhead.  Pain at different levels 0f this 180 degree arc can indicate different injuries. If it is the tendon that is injured rather than the bursa somebody may be able to lift your arm over your head for you, with much less pain than you would have lifting your arm by itself. If you have a sub-acromial bursitis, especially if it is severe, neither you or another person will be able to lift that arm fully over your head. As the arm is lifted, there is increased compression on the bursa due to reduction within the sub-acromial space. This limits the upward movement of the arm  due to severe pain and restriction caused to the swollen/inflamed bursa. If a supraspinatus muscle/tendon tear is the cause of the pain, another person will be able to lift your arm fully over your head for you, with significantly less pain than you doing it on your own. This is  because they take over the function of the torn or injured muscle/tendon. These are important differences, as they often allow a practitioner to differentiate between both injuries .

What Causes It?

Sometimes, an injury damages the bursa in your shoulder. Overuse of your shoulder muscle can also cause damage. People who do a lot of overhead lifting and/or forceful pulling are at risk.  Sports  involving a lot of throwing or pitching can also irritate the sub-acromial bursa. Other factors that can help cause this type of bursitis include:

Your age. Bursitis in the shoulder becomes more likely as you age.

Poor posture with the shoulders arched forwards increases the risk of this injury. It causes impingement of the supraspinatus tendon and bursa by making the sub-acromial space smaller.

Poor shoulder flexibility/mobility.

Infection, arthritis, gout, diabetes, or thyroid disease can also cause issues.


With very mild bursitis rest from aggravating activities and the use of non-steroid anti-inflammatories can be beneficial. A physio can loosen out the shoulder structure and give you exercises to improve shoulder posture, mobility and strength. In bad cases of bursitis, a cortisone injection into the area, done correctly, can bring full relief within days, especially if the condition is recent. Posture must be corrected, and aggravating activities reduced, thereafter, for long-term relief. For more troublesome recurring bursitis, a surgeon may need to remove the bursa altogether. Bursae do grow back, but now you have a new one to start afresh.

Natural Anti-inflammatories – Evidence Based – Physiotherapy

Natural Anti-inflammatories – Evidence Based

There are plenty  advertisements for supplements like glucosamine and chondroitin claiming they will reduce inflammation and even rebuild cartilage etc. Most of these supplements have absolutely no evidence to back their claims, or they promote a few poorly carried out studies sponsored by the manufacturers. Three foods with quiet an amount of published scientific studies substantiating their anti-inflammatory benefits are turmeric, ginger and cinnamon.
Turmeric is a brilliant yellow spice commonly used in Indian cuisine and found in any grocery store. It is the curcumin in turmeric that has the anti-inflammatory properties.  You need a small amount of black pepper and fat in your food also to help with its absorption. Ginger is a zesty spice used in many cuisines. You can buy it powdered or as a fresh root in most supermarkets. Cinnamon is a popular spice often used to flavor baked treats. It is  better to use ceylon cinnamon rather than cassia cinnamon as the casia version is higher in toxins. These three spices have been used as medicines for centuries .  You can use all three(ginger, turmeric, cinnamon) in powder form, preferably organic.
Here is a little recipe that I got from the internet  and it actually  tastes quiet pleasant. Turmeric can be hard to eat unless it is hidden in a curry or a soup or something like that to mask the earthy flavor, but this recipe softens its taste.

1 cup of warm whole fat milk

1 teaspoon of turmeric powder

half teaspoon of ginger powder

half teaspoon of cinnamon powder

1 to 2 dessertspoons of honey

good pinch of black pepper
Blend it all up and drink. You would need to drink this daily to reduce inflammation.
Do the research online yourself and make up your own mind. Don’t use ”Google” as this fires everything at you both true and untrue. Key in ”Google Scholar”. This brings up a sub-site of Google which is more evidence based and shows all the scientific publications on your search.


Physiotherapy in Tralee – Phone 086-7700191

Tennis Elbow Misdiagnosis – Physiotherapist Tralee

Physiotherapist in TraleeTennis Elbow Misdiagnosis- Physiotherapist Tralee

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow usually caused by overuse. Muscles, ligaments, and tendons support the functioning of the elbow joint. Your forearm extensor muscles and tendons extend the wrist and fingers. These extensor tendons attach the forearm muscles on the outside of the elbow to the lateral epicondyle. Tennis elbow is an injury to these tendons leading to pain and tenderness on the outside of the elbow. The main tendon involved in tennis elbow is usually the ”extensor carpi radialis brevis” tendon .

Overuse – cause

When the tendon is weakened from overuse or trauma , microscopic tears form in the where the tendon attaches to the lateral epicondyle. This leads to pain and inflammation. The  extensor carpi radialis brevis tendon may also be at increased risk of damage due to its position. As the elbow bends and straightens, the tendon rubs against the bone. This repetitive action can cause gradual wear and tear on the tendon over time in certain activities.

Activities – cause

Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle. Painters, plumbers, carpenters, hairdressers, barbers, butchers(boners), people cutting hedges with clippers for long periods, are all particularly prone to developing tennis elbow.

Misdiagnosis – Physiotherapist Tralee

Misdiagnosis and mismanagement of this condition is often why people fail to recover. There are two common areas of misdiagnosis. Firstly if a person has not been doing any repetitive work with their forearm and there has been no forceful trauma while using the forearm, it is unlikely that the condition is tennis elbow. Sometimes the actual issue here is  nerve pain radiating down the arm from nerve compression in the neck and/or shoulder(neuropraxia). This nerve compression can be due to tight muscles/ locked facet joints and/or misaligned structures, often due to poor posture.  In the second type of misdiagnosis there can be repetitive injury involved but the condition is being exacerbated by nerve compression in the neck and shoulders.

A cortisone injection is often used to try and treat ”tennis elbow”. This at most usually only gives short term relief and can even exacerbate the condition long-term with true tennis elbow, as it often allows the person to return to the aggravating activity thinking the injury has healed. Cortisone is an anti-inflammatory and may decrease inflammation in the area, reducing pain. It does not however stimulate tendon repair, which is what has been damaged in true ”tennis elbow” . Neither does cortisone do anything for a trapped nerve.

The above conditions are where an experienced physiotherapist/physical therapist can help greatly, usually much more so than any medication. This is their area of expertise.  However, you always need to remember accurate diagnosis and effective treatment is very practitioner dependent. Eccentric training along with soft tissue work can be very effective for true ”tennis elbow”. For the nerve compression (neuropraxia) described above, soft tissue release of neck and shoulder muscles(levator scapulae, trapezius,scalenes etc.) along with osteopathic manipulations to release any locked cervical or thoracic facet joints can be very effective. Symptoms of nerve entrapment/involvement can include neck/shoulder pain with tingling down the arms and/or into fingers. There are also manual orthopedic tests to check for nerve entrapment.

Aside : Carpal Tunnel syndrome is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. This can also be misdiagnosed similarly and be due to nerve compression in neck /shoulder or upper thoracic regions.


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

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