Beating Tendon Pain

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Have you ever had tendon pain? These disorders can occur in many tendons around our body including the Achilles, knee, hip, shoulder and elbow (golfers or tennis elbow). They can be very painful and disabling, but how do we treat them?


WHAT DOESN’T WORK?
Anti-inflammatories may be beneficial in the early stages to settle pain and bursitis but long term use of anti-inflammatories including cortisone injection has very limited evidence. Because tendon pain, also known as tendinopathy is not an inflammatory process it is hard to justify use of anti-inflammatories and in fact repeated cortisone injections may weaken the integrity of the tendon.
Stretching used to be a common treatment for tendon pain but in actual fact may be counterproductive in the natural healing process of the tendon and may cause more pain.


WHAT DOES WORK?
Exercise!! As usual exercise comes to the rescue. The most important thing you can do for your painful tendon is to use appropriate exercise. This might mean temporarily pausing irritable exercise and instead doing specific rehabilitation to improve the integrity and natural healing of the tendon. It may also be necessary to address biomechanical factors that are putting additional load or compressive load through the tendon.
For more information about tendons book in to talk with one of our friendly and experienced physiotherapists. 

Surgery or Exercise?

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About a million orthopaedic surgeries are performed each year in Australia and these numbers are continuing to rise. A recent study marked a significant increase in shoulder surgery in Western Australia including a 473% rise in public funded rotator cuff surgeries. These numbers are reflected similarly for other joint surgeries such as knee and hip replacements.
A recent news story on SBS Insight shined a light on this data and asked the question; how many of these surgeries are necessary? The evidence for surgery in many of these cases has little scientific evidence when compared with conservative treatments such as exercise. So when considering a surgical management do your research and talk to as many experts as possible before deciding if you can get just as good or better outcomes from options such as physiotherapy, exercise rehabilitation or Pilates. 

Three Simple Steps to Minimise Pain when Sitting at Work

1.       Get up and move!

The more often the better. This is the absolute best thing you can do to minimise your chances of getting pain from sitting.

Getting up and moving is the most important thing that you can do when you have been sitting down all day. We recommend getting up every 20 minutes while at work. This might be to do a quick stretch and then sit back down or to go for a walk down the hall to make a tea, as long as you are moving outside the posture that you sit in. Using a “stand up reminder” app on your phone can be a good way of ensuring that you get up more often.
Also consider how much you’re moving before and after work. If you sit in the car to and from work, then sit to eat dinner and sit on the couch watching TV then work isn’t your only problem. Get out and exercise! The health department recommends between 2.5 and 5 hours of moderate intensity exercise per week.
Remember your body needs movement. If you sit all day at work then your body needs it even more!

2.       Optimise your sitting posture

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You should be supported into good posture so that you can relax your back into your chair. Maintain the natural curves in your spine and avoid leaning on the desk.

 “The best posture is your next posture” is a saying going around the health community at the moment. It alludes to the fact that posture isn’t everything and the best thing you can do is move as much as possible. This is true but sitting with appropriate posture and support will minimise the stress on your muscles and joints thereby decreasing your risk of overuse pain.
The best position to be in is a position where you are leaning back and are supported by the back of the seat into a neutral position. If you sit up away from the back of the chair you will be unnecessarily using the muscles in your back which may cause them to fatigue. The back of the chair is there for a reason – use it!
It is also important to try to maintain your spines natural curves when you’re sitting so try to sit right into the back of your chair so you don’t slouch, sit up tall and try to avoid leaning on the desk.
For more information see one of our physiotherapists or get your workstation assessed and setup by your workplaces occupational safety and health employee.

3.       Reverse your posture

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Your body will natural crave this after sitting. You will feel like you need to stretch into the opposite position to what you have been sitting in. A good example of this after a long car trip you will naturally want to stand and stretch backwards into extension.  

When you have been sitting all day the muscles in the front of your hips and back of your thighs are in a shortened position so will start to feel tight. There can also be a tendency to slouch and therefor have your spine in a flexed posture. The opposite position of this is standing with hips and knees straight arching your spine backwards. The best stretching position for you might be different than this. If you have a tendency to roll your shoulders forwards you might want to stretch them backwards.

Stretch the muscles that feel like they need it and do it often! This is a great way to minimise the long term postural loading on muscles and joints.

If you get any pain from sitting or require more information, see one of our friendly physiotherapists.

What's Causing my Back Pain?

Did you know that only 5-10% of cases of low back pain are associated with a specific pathology. The remaining 90% of low back pain is a result of multiple contributing factors both mechanical and non-mechanical. We know many modifiable lifestyle or mechanical factors can load your lower back in a maladaptive manner. However, other non-mechanical factors including feeling anxious about your lower back pain can not only reinforce maladaptive movements but also impact your pain experience. If you are in a low mood or feeling stressed it can put you on high alert for any incoming signals and also impact how you interpret them. In other words, your mood can turn the volume up on your ‘pain channels’.

When treating low back pain it is important to provide you with the tools to create positive adaptation and pain coping strategies. There is no recipe to treating low back pain and your treating health professional should take into consideration all the factors which could be contributing to your symptoms.

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Dance Injury Prevention & Conditioning

Dance may appear graceful and effortless, however achieving this actually requires a high degree of athleticism and long hours of dedicated training.  Dancers therefore need to be athletes as well as artists.  Dancers are therefore vulnerable to injury, just as athletes in other sports are prone to sports injuries.  The types of injury dancers sustain will depend on many factors, especially the style of dance (ballet, jazz, contemporary, tap, acrobatics, ballroom, Irish, hip-hop, and many more); the number of hours spent training or performing; and the specific choreography they are rehearsing. For example if a ballet dancer is doing hours of pointe work each day (ie. on the tips of their toes in pointe shoes), they will be more prone to foot and ankle problems.  If a theatrical dancer is performing repeated layout kicks or arabesques (repetitive low back extension), they may be more prone to low back pain or injury.  These factors (called “extrinsic factors” as they are ‘outside’ the individual) are not so easy to control, as they depend largely on the needs of the school or company the dancer belongs to, and their examination, rehearsal and production processes. 

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However there are also a large number of “intrinsic factors” (within the individual), more of which are in the dancer’s control. These include:

  •  Structural factors, or the dancer’s anatomy or alignment. Eg. Lordosis, kyphosis, scoliosis (spinal curvatures); genu varum/valgum (bow-legs or knock-knees), femoral and acetabular version (anatomy of the hip joints) and many more.
  • Joint mobility & soft tissue flexibility.  This will affect the dancer’s “facility” with turn-out, splits, arabesque, etc.
  • Muscle strength, endurance & neuromuscular control. These affect the dancer’s “biomechanics” (control of alignment), joint stability, posture, “lines” of movement, and their overall performance qualities.
  • Cardiovascular fitness (“anaerobic” and “aerobic”).  This will affect their stamina, in terms of performance ability as well as coping with long hours of training.
  • Psychology, or mind-set. This obviously affects many aspects of a dancer’s life, including their attitude towards performance, dedication to training, and their ability to cope with injuries or other set-backs.

Most of these issues can be helped by programmes targeted at each dancer’s strengths and weaknesses.  Weaknesses can be identified through a comprehensive dance physiotherapy assessment. They can then be addressed with specific exercises, ranging from home exercises with no or minimal equipment, through to Pilates studio sessions, fitness training and cross-training.  Although we can’t change our anatomy (our body’s structure), most other posture, flexibility and control issues can be corrected (or at least improved) by an individualised physiotherapy “conditioning” programme. 

Physio-Dance becomes a regular part of the dancer’s warm-up and conditioning routine.  This will go a long way towards coping with the high demands of dance training, competition and performance. It can prevent injuries from occurring in the first place; or, if an injury does occur, can ensure recovery is as quick and effective as possible. 

Sitting Posture at School/Home

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Studies have shown that a large proportion of adolescents will sit with poor posture. Sitting for long periods of time in poor postures will increase the stress on your back neck and shoulders and can lead to pain. It is important to optimise these postures at a young age so that they don’t continue into adulthood.

An optimal posture while sitting should have your spine in a “neutral” position which is a position where it maintains its natural curves. This is why a chair with lumbar support is important to maintain the natural inward curve of your lower back.

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Your shoulders should be relaxed and not rolled forward with your elbows at your sides. Your cheekbones should then sit naturally above your collar bones. 

For those students who are studying at home on computers it is important to setup your home workstation properly. Using laptops or tablets should only be for short periods of time unless you are using a separate keyboard and raising the screen to an ideal height.

The other way to minimise the effect of sitting is to get up from your chair as often as possible and stretch.

 

 

These two stretches can be helpful when you are spending extended times sitting throughout the day.

  Doorway Pectoral Stretch   1.             Stand in the doorway with arms on the sides of the door frame  2.             Push the trunk forward stretching through the chest and fronts of the shoulders  3.             Be mindful of not letting your ribs flare  4.             If you are tighter on one side focus on just that arm to allow for more postural symmetry

Doorway Pectoral Stretch

  1. Stand in the doorway with arms on the sides of the door frame
  2. Push the trunk forward stretching through the chest and fronts of the shoulders
  3. Be mindful of not letting your ribs flare
  4. If you are tighter on one side focus on just that arm to allow for more postural symmetry
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Trunk Rotations

  1. Sit up in your chair, rotating around to the side
  2. Pull around on the back of the chair to get a deeper stretch
  3. Hold for one breath then slowly repeat to the opposite side
  4. Repeat 5 times to each side

Looking to improve your Golf?

Are you a keen golfer looking to improve your game? Or are you currently injured looking to get back to full function and return to golf?

Improving your game is not just about improving your swing. A thorough assessment will be the key factor to identifying any physical limitations that may be impacting your game.

From this assessment, your physiotherapist at Horizon will design a program to target your specific needs. These may include but are not limited to reduced hip mobility and stability, Pelvic/Core stability, spinal rotation and disassociation, scapula-thoracic disassociation, shoulder mobility and stability, spinal extension and balance.

Common golfing limitations we work with are reduced hip rotation causing additional loads on the spine and inconsistencies with the swing, limited drive from the pelvis causing your swing to lack power, limited spinal rotation leading to overuse of the shoulders and upper limbs to name but a few. 

Our programmes are designed to optimise your physical function to ensure you can play at your highest, most efficient level and prevent injury.

At Horizon we have specifically designed sports programmes for golf, tennis, running, cycling, swimming and rowing. If you are interested to improve your sport, please contact the clinic on 9245 7007 to book in your assessment today!

Tennis Elbow

Tennis Elbow

Tennis Elbow can affect anyone from sports people and labourers to desk workers. Pain is localised to the outside elbow and is usually felt with lifting and gripping. Occasional pain can also be experienced when straightening the arm. Symptoms are usually at their worst in the mornings.

  • What Causes Tennis Elbow?
  • Sudden increase in activity
  • Sudden change in activity such as commencement of a new sport or new job
  • Poor posture
  • Previous neck injuries such as whiplash
  • Poor upper limb bio-mechanics can lead to increased forces through the elbow
 Proper assessment of all possible causes is imperative if Tennis Elbow is to be treated successfully. Once the cause is identified, a proper treatment plan can be established. Manual and exercise therapy along with the use of braces have been successfully used to treat the painful symptoms of tennis elbow.

Proper assessment of all possible causes is imperative if Tennis Elbow is to be treated successfully. Once the cause is identified, a proper treatment plan can be established. Manual and exercise therapy along with the use of braces have been successfully used to treat the painful symptoms of tennis elbow.

Australian Institute of Sport Physiotherapists Jill Cook and Craig Purdam have developed effective treatment protocols based on their tendon model. The exercise program is designed to reduce pain and then progressively load the muscle and tendon around the elbow. This will strengthen the attachment and make it more able to take load. This has proven to be a very effective way of treating tennis elbow.

At Horizon we take a holistic approach to Tennis elbow, strengthening the muscle and tendon on the elbow as well as the stabilising muscles around the shoulder and neck.
 

Laser

Laser has long been offered as a treatment option overseas, however is now becoming more widespread in Australia and is popping up in mainstream media with athletes in cricket and AFL using laser as part of their injury rehabilitation.

Conditions Treated with Laser

What is Laser?

Put simply, laser is a device which emits light. Low level laser therapy has a bio-stimulatory effect at a cellular level and it is widely used to assist in tissue healing and rehabilitation, and pain management.

Tendon conditions in particular are showing some good outcomes with laser treatment, such as tennis elbow and Achilles tendon problems, In vitro research studies have shown laser therapy for tendons can increase collagen production and suppress inflammation essentially speeding up the healing process.

Over the past twenty years, there has been further research showing laser can improve tissue healing in other areas of the body, including ligaments, tendons and joints. It can be used in acute and chronic stages, and there have been some microscopic studies showing significant increase in cell metabolism and collagen production, essentially speeding up the healing process.

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Laser for nipples?

Historically, laser has been used with post natal women to heal cracked or damaged nipples. A pilot study at King Edward Hospital showed lower reported pain levels and increase length of time to be able to continue breastfeeding. On average, women had pain relief and improvement after two or three sessions.

In Australia, laser   treatment can only be provided by those who have undertaken further specialist    training and qualifications. At Horizon, all of our Physiotherapists have completed the laser   requirements to safely administer laser therapy. Please feel free to discuss with us whether laser may be appropriate for you

What is Gluteal Tendinopathy

The Gluteus Medius tendon is the most commonly affected tendon, and is generally a result of overusing the muscle, or a sudden and rapid increase in walking or exercise. Pain is normally felt on the outside aspect of the hip, and can lead to walking with a limp or hip pain at night as the tendinopathy worsens.

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People with gluteal tendinopathies generally complain of:

-          pain when lying on their side with the hip adducted

-          lying on the affected side

-          sitting with hips greater than 90 degrees

-          sitting with the legs crossed

-          single leg standing

-          carrying children (generally new mums or grandmothers)

 The tendinopathy can be classified along a continuum proposed by Cook & Purdam (2008) as above.

The tendinopathy can be classified along a continuum proposed by Cook & Purdam (2008) as above.

Your Horizon physiotherapist will be able to help you identify and provide you a program to help aid in the recovery of your tendon. This may include and is not limited to clinical pilates, dry needling, soft tissue manipulation, hip mobility exercises.