Everyone’s spine has curves, from your neck down to your lower back. These curves, which create the spine’s ”S” shape, are  lordotic in shape in the neck and lower back, and  kyphotic in shape for the upper back. They help your body 1. absorb shock,  2. support the weight of the head, 3. align your head over your pelvis, 4. stabilize and maintain its structure, 5. move and bend flexibly. When these curves are exaggerated through poor posture or hereditary conditions like scoliosis, spinal pain and problems can develop over time.

 

Kyphosis

KyphosisKyphosis is an exaggerated, forward rounding of the back. It can occur at any age but is more common in older people. Age-related kyphosis is often due to weakness in the spinal bones that causes them to compress or crack. Other types of kyphosis can appear in infants or teens due to malformation of the spine or wedging of the spinal bones over time. Mild kyphosis causes few problems. Severe kyphosis can cause pain and be disfigurment. Treatment for kyphosis depends on your age, and both the cause and the effects of the curvature.

 

Lordosis

LordosisSome curvature in the lower back is normal. However, if your curve arches too far inward, it’s called lordosis, or swayback. Lordosis can affect your lower back and/or neck. The condition can lead to excess pressure on the spine, causing pain and discomfort. It can affect your ability to move if it’s severe and left untreated. Treatment of lordosis depends on how serious the curve is and how you got lordosis. There’s little medical concern if your lower back curve reverses itself when you bend forward. You can probably manage your condition with physical therapy and daily exercises.

 

 

 

Scoliosis

scoliosisScoliosis is a medical condition in which a person’s spine curves sideways, usually in an  “S” or “C” shape. In some, the degree of curvature  remains stable, while in others, it increases over time. Mild scoliosis does not typically cause problems, however severe cases can interfere with breathing. The cause of most cases is unknown, but is believed to involve a combination of genetic and environmental factors. Diagnosis is confirmed by Xray. Treatment depends on the degree of curve, location, and cause.

Minor curves may simply be watched periodically. Treatments may include bracing or surgery in more severe cases. The brace must be fitted to the person and used daily until growing stops. Evidence that chiropractic manipulation dietary supplements, or exercises can prevent the condition from worsening is non existent. However, exercise is still recommended due to its other health benefits. Scoliosis occurs in about 3% of people. It most commonly occurs between the ages of 10 and 20. Girls typically are more severely affected than boys.

 

 

 

Physiotherapists in Tralee Phone 086-7700191

Arthritis – Rheumatoid vs Osteoarthritis

 

Rheumatoid arthritis

rheumatoid arthritisRheumatoid 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

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

  • 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.

Treatment

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.

Surgery

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

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

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

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 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.

 

Aside

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.

 

 

Physiotherapist Tralee phone 086-7700191

Natural Anti-inflammatoriesNatural Anti-inflammatories

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 usefulness as natural anti-inflammatories 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

Muscle Tear or Spasm ? Which is it ?

muscle tearWhen 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.

For treatment of muscle tears or spasms phone 086-7700191. We are physiotherapists in Tralee.

 

Low Back Pain – Facet vs Disc

Two of the most  common causes of low back pain presenting in clinic are discogenic (disc) and facet joint related pain. Injury to either can cause severe discomfort, limiting a person’s ability to carry out normal daily activities. Facet joints are small articulations along each segment at the back of the spine, and help control the movement of the spine.  There are two of these joints at each vertebral level. There are intervertebral discs between each level  and these act as primary shock absorbers. They are  generally between a quarter and a half inch in height, interconnecting the bodies of the vertebral segments.  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.

Low back painOne of the primary symptoms when a  lumbar facet joint locks is an increase in pain on extension of the lower back.  Basically there is more pain when you try and straighten up your lower back or lean back on it. This position loads pressure on the locked lumbar facet joints.   Usually with 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.

Low back pain
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 can give a person an immediate 60 – 70 % relief from pain symptoms.  The person is often almost back to normal the next day. With a facet joint injury, you are simply unlocking the locked facet joint in which the 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, spinal manipulation at the right time. A rehab program involving pilates type exercises and some gentle stretching exercises etc. is paramount once a patient starts to improve. Continuous spinal manipulations several times a week 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. Sometimes unlocking a facet joint in the area, if it has locked up say due to muscle spasm etc. can help take pressure of the disc in the area.

Eddie O Grady Physiotherapy, Tralee, Co. Kerry

 

 

 

 

Levator Scupula Muscle Related Neck pain

When you wake up in the morning with neck pain, 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. It usually presents from the top inner corner of the shoulder blade up along the neck. The Levator Scapulae muscles are located on either side of the neck. They originate on the four upper vertebrae of the cervical spine (neck). They 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.

 

Neck pain
Levator Scapula Muscle Trigger points (Xs)
Neck pain
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.

Causes

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.

Treatment for Levator Scapula Muscle Spasm / Trigger points

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

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. Allow your shoulders to relax by using the arm rests of the chair. When at a computer, pull the screen close and try to get the screen up at eye level (say using books underneath it). This will mean your head won’t have to be protruding forward. The same applies when driving a car. Pull the seat in close to the steering wheel(within reason). 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. They are a disaster for thoracic and cervical posture in the long term.

For more information click to see this video

 

Physiotherapist in Tralee Phone 086-7700191

 

thoracic outlet syndromeThoracic outlet syndrome is a disorder that occurs when the blood vessels or nerves in the space between the collarbone and first rib (thoracic outlet) become compressed. This can result in any of the following symptoms ; 1. pain in your shoulders and/or neck , 2. numbness / pain / tingling down the arm and / or in a finger / fingers. Common causes include physical trauma, i.e. car crash ; repetitive injuries from job or sports related activities; anatomical defects (such as having an extra rib); poor posture( protruding neck / rounded shoulders); and pregnancy.

You may notice symptoms of thoracic outlet syndrome if your job requires you to do a repetitive movement continuously for long periods, i.e. typing on a computer; working on an assembly line; or lifting things above your head. These repetitive activities tend to tighten up neck and shoulder muscles. Athletes, such as baseball pitchers and swimmers can also develop thoracic outlet syndrome from the years of repetitive movements.

Obesity can put an undue amount of stress on your body structures and joints leading to the development of thoracic outlet syndrome. Carrying around an over sized bag or backpack or having somebody sitting on your shoulders for long periods, say at a concert can compress nerve structures etc. and lead to the condition. You may suffer symptoms during pregnancy as muscles, ligaments, tendons and joints come under strain. This is as a result of the release of the hormone relaxin around week twelve of pregnancy, and also due to the increase in bodyweight.

The two most common types of thoracic outlet syndrome are:

1. Neurogenic (neurological) : This form of thoracic outlet syndrome is characterized by compression of the brachial plexus ( nerves coming from the spinal cord (neck). This network of nerves controls muscle movements and sensations in the shoulder, arm and hand. This is the most common cause of thoracic outlet syndrome.

Signs and symptoms include:
• Numbness or tingling in your arm or fingers.
• Wasting of muscles through which the compressed nerve travels; either in the arm or fingers or both.
• Pain in the neck , shoulder or hand.
• Weakened grip in hand / loss of strength in the arm.

Treatment : Often if neurogenic thoracic outlet syndrome is caught early, deep tissue work on neck, shoulders and arm to loosen out tightened muscles; joint mobilisations / manipulation of the cervical and thoracic spine; electro acupuncture along the affected nerve pathway; postural correction exercises, can usually bring great relief within one or two treatment sessions. If the condition is chronic ( i.e. there a month or months), it may take more time for the irritated nerve to settle. You may need to lose weight if obesity is the cause of your thoracic outlet syndrome.

2.Vascular (venous or arterial): This type occurs when one or more of the veins or arteries are compressed in the area between the collarbone and first rib.
Signs and symptoms include:
• Discoloration of the hand (bluish colour).
• Arm pain and swelling, possibly due to blood clots.
• Blood clots in veins or arteries in the upper area of your body.
• Lack of colour in one or more of your fingers or your entire hand.
• Weakened or no pulse in the affected arm.
• Cold fingers, hands or arms.
• Arm fatigue after activity.
• Numbness or tingling in your fingers.
• Throbbing lump near your collar bone.
• Weakness of arm or neck.

Treatment : For vascular (venous or arterial) thoracic outlet syndrome…you need to consult with your doctor. This condition may require thrombolytic medications, anticoagulant medications or surgery.