Morton's Foot
Morton’s Foot

Morton’s foot and pyridoxal 5′-phosphate deficiency: genetically linked traits.

I came across an extremely interesting article lately regarding Morton’s foot and vitamin B6 deficiency. A lot of what I say in the article comes from scientifically published research referenced at the end of the article. Apologies if some of it is a bit technical. I have tried to simplify it while keeping the content intact.

What is Morton’s foot?

A Morton’s foot  also  called Morton’s toe, is a condition characterized by a longer second toe.

Pathophysiology

Morton’s Toe will cause an individual to have abnormal or over pronation.  It is this pronation that is the ultimate cause or contributing factor to most of the problems not only of the foot but also of the whole body.

Normal Pronation is a series of motions the foot must have, so that it can absorb the shock of meeting the ground. It must be able to do this, in order to adapt and adjust to the new walking surfaces it has just met. This adjustment should only last a fraction of a second to allow the foot to slow down; absorb the shock of your body weight in order to adjust and adapt to the walking surface. If this adjustments last longer, the foot will then begin to abnormally pronate and to correct itself. This is the start of a “chain reaction” that puts the foot under a lot of abnormal stress and strain, causing  Bunions, Heel Spurs, plantar fasciitis, Corns, Callouses, ingrown toenails and numerous other foot problems.

 

Vitamin B6 deficiency

Vitamin B6 is an essential vitamin needed for many chemical reactions in the human body. It exists as several active forms but pyridoxal 5′-phosphate (PLP) is the phosphorylated form needed for transamination, deamination, and decarboxylation. PLP is important in the production of neurotransmitters, acts as a Schiff base and is essential in the metabolism of homocysteine, a toxic amino acid involved in cardiovascular disease, stroke, thrombotic and Alzheimer’s disease. Nichols and Gaiteri(2014) showed the connection between a deficit of pyridoxal 5′-phosphate and the physical foot deformity known as the Morton’s foot. Morton’s foot has been associated with fibromyalgia/myofascial pain syndrome. PLP deficiency also plays a role in impaired glucose tolerance and may play a much bigger role in the obesity, diabetes, fatty liver and metabolic syndrome. Without the Schiff-base of PLP acting as an electron sink, storing electrons and dispensing them in the mitochondria, free radical damage occurs.

 

Summary

To put this all very simply : Vitamin B6 is an essential vitamin needed for many chemical reactions that take place within the human body. This vitamin is obtained from your diet. The genetically linked condition of ”Morton’s toe” has been linked to the inability to convert Vitamin B6 into the active form pyridoxal 5′-phosphate needed for cetain chemical processes in the human body. This in turn can lead to conditions seen with vitamin B6 deficiency. Some of these conditions include:

  • Anemia
  • Skin/Hair/Nail problems
  • Depression/Anxiety
  • Nerve damage
  • Pain syndrome development
  • Systemic Inflammation
  • Circulation problems, including oxygen transport
  • Hormone Issues
  • Seizures

Do not take a B6 supplement, or “b-vitamin complex” and expect it to help. It won’t.
You need the activated form of B6 called P5P. This is the only form that your body can use.

 

Reference:

Supplementation with PLP, L5-MTHF, B12 and trimethylglycine should be used in those patients with hyperhomocysteinemia and/or MTHFR gene mutation.(Trent W. Nichols, Christopher Gaiteri ,Published in Medical hypotheses 2014, DOI:10.1016/j.mehy.2014.09.003).

 

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

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

Gout ?

GoutGout is a form of arthritis which starts as a result of excess uric acid build-up in the blood, also called hyperuricemia. It is an extremely painful condition. Uric acid is produced in the body during the breakdown of purines – chemical compounds that are found in certain foods such as meat, poultry, and seafood. Normally, uric acid is dissolved in the blood and is excreted from the body in the urine via the kidneys. If too much uric acid is produced, it can build up and form needle-like crystals that trigger inflammation and pain in the joints and surrounding tissue. The condition often starts by affecting the joint at the base of the big toe. Attacks often occur without warning and in the middle of the night. They can come on quickly and keep returning over time, slowly damaging tissues in the region of the inflammation.

Tests and diagnosis

Gout can be tricky to diagnose, as it’s symptoms can be similar to those of other conditions, i.e. bunion on the big toe. While hyperuricemia occurs in the majority of people that develop gout, it may not be present during a flare. There is one very subtle, important difference between gout and other foot conditions, that helps the health practitioner differentiate between them. When you very gently stroke the skin of a gout affected area, it will cause a lot of pain in the sufferer. This does not occur with other conditions. The gout makes the skin super sensitive. This test is not 100% accurate, but I have found it to be a reasonably good indicator that one should look in the direction of gout, and refer the patient onto a doctor. This is especially true, if during examination and history take, the patient meets other criteria that would make them more prone to gout, and there has been no specific injury to the area affected. Often with tests you are more trying to rule out other conditions and narrow your possibilities down to that of gout..

One diagnostic test that doctors can carry out is the joint fluid test, where fluid is extracted from the affected joint with a needle. The fluid is then examined to see if any urate crystals are present. As joint infections can also cause similar symptoms to gout, a doctor can also look for bacteria when carrying out a joint fluid test in order to rule out a bacterial cause. Doctors can also do a blood test to measure the levels of uric acid in the blood. However, people with high uric acid levels do not always experience gout. Equally, some people can develop the symptoms without having increased levels of uric acid in the blood. Finally, doctors can search for urate crystals around joints or within a tophus(deposit of uric acid crystals) using ultrasound or CT scans.  X-rays cannot detect gout, but may be used to rule out other causes.

Treatment

Treatment and control of the condition requires certain dietary modifications such as reducing the intake of foods high in purines ie. red meat, shellfish, and beer to name but a few. Other factors that contribute to gout include being overweight, certain medications, high blood pressure, drinking too many sugary sodas, and being regularly dehydrated. These all need to be monitored and corrected.

Treatments for acute attacks include:

  1. NSAIDs – Non-Steroidal Anti-Inflammatory Drugs
  2. Colchicine
  3. Steroids
  4. Urate-Lowering Therapy (ULT)

 

For more see video

 

Overview by physiotherapists in Tralee, Co. Kerry

 

Lumbar Spinal Stenosis

spinal stenosisSpinal 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 it 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.

 

Trigger Finger

trigger fingerTrigger 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.

Symptoms

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.

 

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.

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.

 

Update

Here is a video of exercises to get rid of trigger finger, I came across by the internet famous physical therapists Bob and Brad. These exercises have actually proved to be extremely effective  …….See video

 

Physio in Tralee phone 086-7700191

myofascial-pain-syndromeMyofascial 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.

 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.

 

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.

 

Physiotherapists Tralee : Phone 0867700191

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

Ankle Sprains

Most people go over on their ankle( ankle sprains) at some stage in their lives. Usually they go over outwards 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

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.

A few days after ankle sprains 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.

ankle sprains
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.

Physiotherapists in Tralee phone 086-7700191

 

Sub-acromial bursitis. Overview by Physio in Tralee.

 

sub-acromial 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

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.

Treatment

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.

Physical Therapist in Tralee phone 086-7700191

Tennis Elbow Misdiagnosis

Tennis Elbow Misdiagnosis

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 . Tennis elbow misdiagnosis is relatively common.

Tennis Elbow

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

Tennis elbow 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 tennis elbow misdiagnosis there can be repetitive injury involved but the condition is being exacerbated by nerve compression in the neck and shoulders, so both all areas need to be looked at for full resolution.

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 and be due to nerve compression in neck /shoulder or upper thoracic regions.

Physiotherapists in Tralee  phone 086-7700191