Needling away pain: The art of dry needling in physiotherapy

Dry needling has gained popularity in the world of physiotherapy, offering a unique approach to alleviate pain, improve function, and promote healing.

In this Blog, we will dive deep into what dry needling is, what it's used for, how it differs from acupuncture, and the myriad benefits it can bring to your recovery journey.

What is Dry Needling?
Dry needling is a specialised treatment technique used by physiotherapists to address pain and movement impairments in the body. It involves inserting thin, solid needles directly into specific trigger points or tight bands of muscle tissue. Unlike acupuncture, which is rooted in traditional Chinese medicine and focuses on rebalancing the body's energy flow, dry needling is firmly grounded in Western medicine and neurophysiology.

How is Dry Needling Different from Acupuncture?
While both dry needling and acupuncture use thin needles, they have distinct differences:

Philosophy: As mentioned, dry needling is based on Western medicine and focuses on trigger points and muscular issues. In contrast, acupuncture is rooted in traditional Chinese medicine and is often used to restore the body's energy balance (Qi).

Needle Placement: Dry needling involves targeting specific myofascial trigger points, muscles, or soft tissues responsible for pain and dysfunction. Acupuncture, on the other hand, uses a broader network of meridian points.

Needle Manipulation: In dry needling, the needles may be manipulated to create a local twitch response, helping to release muscle tension. Acupuncture needles are typically inserted and left in place for a longer period.

Training: Dry needling is performed by trained physiotherapists or medical professionals who have a strong understanding of anatomy and pain mechanisms. Acupuncture practitioners follow their own specialized training and techniques.

What is Dry Needling Used For?
Dry needling can be a versatile tool for physiotherapists, with applications in various conditions, including:

Muscle Pain: It's effective for alleviating muscle knots and trigger points, relieving muscle tension, and promoting better flexibility.
Sports Injuries: Dry needling can help athletes recover from injuries like tendonitis, muscle strains, and overuse injuries.
Chronic Pain: It's a valuable addition to pain management plans for conditions like fibromyalgia and myofascial pain syndrome.
Postural Issues: Dry needling can aid in improving posture by reducing muscle imbalances and muscle tightness.
Headaches: For tension-type headaches and migraines, dry needling can provide relief by addressing trigger points in the neck and upper back.

Benefits of Dry Needling:
Some of the benefits of dry needling are:

Pain Relief: Dry needling offers quick relief from muscle pain and tightness by releasing trigger points.
Improved Range of Motion: It can enhance flexibility and mobility by relaxing tight muscles.
Accelerated Healing: Dry needling promotes blood flow to the affected area, which aids in the body's natural healing process.
Reduced Inflammation: It helps in reducing inflammation and promoting tissue repair.
Complementary to Other Treatments: Dry needling can be used alongside other physiotherapy modalities to provide comprehensive care.

Some Examples of Areas Dry needling can be used:

Low Back Pain: Dry needling can effectively treat chronic low back pain by targeting trigger points in the lower back muscles.

Rotator Cuff Injuries: For shoulder pain and rotator cuff injuries, dry needling can relieve muscle tension and improve joint mobility.

Plantar Fasciitis: Dry needling can be beneficial in alleviating the pain and tension in the foot's plantar fascia.

Conclusion:
Dry needling is an effective addition to the toolbox of modern physiotherapy. It offers a Western medicine perspective on pain management, with a focus on musculoskeletal issues and trigger points. By understanding what dry needling is, how it differs from acupuncture, and the many benefits it brings, you're one step closer to making informed decisions about your recovery journey.

Our skilled professionals are ready to guide you towards a pain-free and active lifestyle.

Yours in health

The team from Out of the Box Physiotherapy

Whiplash: On the Road to Recovery with Physiotherapy

Whiplash is a common injury that can occur in various situations, such as car accidents or sports-related incidents. In this blog, we will explore what whiplash is, the typical timeframe for recovery, and how physiotherapy can be a crucial part of the healing process.

What is Whiplash?
Whiplash is an injury to the neck that occurs when the head is suddenly and forcefully jolted backward and then forward. This rapid motion can strain or damage the neck's soft tissues, including muscles, ligaments, and tendons. While it is commonly associated with car accidents, whiplash can also result from other high-impact incidents, such as falls or contact sports.

Recovery Phases
Whiplash recovery typically unfolds in distinct phases. It's important to note that every individual's experience may vary, but understanding these phases can help you prepare for what to expect.

Acute Phase (0-72 hours): Immediately after the injury, you may experience pain, swelling, and limited neck mobility. This is the body's initial response to trauma.
Subacute Phase (2-3 days to 6 weeks): As the acute phase subsides, you may still experience pain and stiffness. Your physiotherapist will work with you to manage symptoms and prevent complications.
Recovery Phase (6 weeks to several months): This phase focuses on regaining strength, mobility, and functionality. Physiotherapy plays a significant role during this stage.
Chronic Phase (beyond several months): Some individuals may experience lingering symptoms. Continued physiotherapy and exercises can help manage and alleviate these long-term effects.

How Physiotherapy Helps
Physiotherapy is a fundamental component of the whiplash recovery process. Here's how physiotherapy can assist in your journey to healing:

Pain Management: Physiotherapists employ various techniques, such as manual therapy, soft tissue therapy and dry needling, to alleviate pain and reduce inflammation.
Restoration of Mobility: Whiplash can restrict neck movement. Physiotherapists will work with you on exercises and stretches to gradually regain your range of motion.
Strengthening Exercises: Weakness in the neck and upper back muscles is common after whiplash. Your physiotherapist will create a customized exercise program to help rebuild strength and stability.
Posture Correction: Proper posture is crucial for neck health. Physiotherapy can help you develop good posture habits to prevent further issues.
Education and Self-Management: Your physiotherapist will provide guidance on home exercises and self-care techniques to facilitate a faster and more effective recovery.
Progress Monitoring: Regular appointments with your physiotherapist allow them to assess your progress, make necessary adjustments to your treatment plan, and offer support throughout your recovery.

In summary, whiplash is a neck injury that can disrupt your life, but with the right approach, you can overcome it. Physiotherapy is an essential part of the healing process, helping you manage pain, regain mobility, and rebuild strength. If you've recently experienced whiplash or are currently dealing with its aftereffects, don't hesitate to reach out to us at Out of the Box Physiotherapy. Our team of skilled professionals is here to guide you on your journey to recovery.

What exactly is Tendinopathy?

Tendinopathy is a term that may sound complex, but it's a condition that many of us have heard of or even experienced without fully understanding what it entails. Whether you're an athlete dealing with a nagging injury or someone who occasionally experiences tendon pain, it's crucial to have a clear understanding of tendinopathy. In this blog post, we'll break down the concept of tendinopathy, exploring its causes, symptoms, and potential treatments.

What is Tendinopathy?

Tendinopathy is a broad term used to describe conditions that affect tendons, the tough, fibrous tissues that connect muscles to bones. Tendons play a crucial role in facilitating movement by transmitting the force generated by muscles to the bones they're attached to. When tendons become damaged or degenerated, it can lead to pain, reduced mobility, and functional limitations.

Types of Tendinopathy

Tendinopathy is an umbrella term that encompasses several specific conditions, including:

Tendinitis: This refers to the inflammation of a tendon. It's typically caused by overuse or repetitive stress on the tendon and often presents as acute pain and swelling. Common examples include Achilles tendinitis and tennis elbow.

Tendinosis: Unlike tendinitis, tendinosis is a chronic condition characterized by degeneration of the tendon's collagen fibers. It's often the result of long-term wear and tear, without significant inflammation. Tendinosis tends to cause pain and stiffness and can take longer to heal compared to tendinitis.

Paratenonitis: This condition involves inflammation of the paratenon, a sheath that surrounds some tendons. It's commonly seen in the Achilles tendon and can result in pain and swelling around the affected area.

Insertional Tendinopathy: Here, the inflammation or degeneration occurs at the point where the tendon attaches to the bone. It's often associated with conditions like rotator cuff tendinopathy or patellar tendinopathy.

Causes of Tendinopathy

Understanding the causes of tendinopathy is crucial for prevention and management. Common contributing factors include:

Overuse: Repetitive movements and excessive strain on a tendon, especially in sports or work-related activities, can lead to tendinopathy.

Aging: Tendons naturally degenerate as we age, making older individuals more susceptible to tendinopathy.

Poor Biomechanics: Abnormal joint mechanics or muscle imbalances can place additional stress on tendons.

Inadequate Rest and Recovery: Not giving your body enough time to heal after strenuous activities can increase the risk of tendinopathy.

Medical Conditions: Certain medical conditions, like diabetes and autoimmune disorders, can increase the likelihood of developing tendinopathy.

Symptoms of Tendinopathy

Tendinopathy can manifest with various symptoms, depending on the type and location of the affected tendon. Common signs include:

Pain: Persistent, localized pain that worsens with movement or activity.

Stiffness: Reduced range of motion and joint stiffness, particularly in the morning or after periods of inactivity.

Swelling: Swelling or tenderness around the affected area, which may be warm to the touch in cases of tendinitis.

Weakness: Reduced strength in the affected limb or joint.

Crepitus: Some individuals may experience a crackling or popping sensation when moving the affected tendon

Treatment and Management

The treatment of tendinopathy depends on its type and severity. Common approaches include:

Rest: Giving the affected tendon time to heal by reducing or modifying activities that exacerbate symptoms.

Physiotherapy: Targeted exercises and loading protocols to improve tendon strength, flexibility and energy storage and transfer capacity.

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation in cases of tendinitis.

Orthotics: Custom orthotic devices may be prescribed to improve biomechanics and reduce stress on the tendon.

Corticosteroid Injections: In some cases, corticosteroid injections may be used to reduce inflammation and pain.

Surgery: For severe cases that don't respond to conservative treatments, surgical repair or debridement may be necessary.

Tendinopathy is a common and often painful condition that can affect anyone, from athletes to office workers. Understanding its causes, symptoms, and treatment options is essential for effective management and prevention. In a majority of tendinopathy cases, the best place to start is with a physiotherapist. Whilst the condition can sound generic, the management plan is always best personalised as no two tendinopathies are the same. Remember, early intervention can lead to faster recovery and a return to pain-free movement.

Can you move your neck well?

In today's fast-paced world, where digital devices and sedentary lifestyles have become the norm, neck pain has emerged as a prevalent issue affecting countless individuals. Whether it's due to long hours spent hunched over a computer screen, excessive smartphone use, or poor posture, neck pain has become an unwelcome companion for many. One key factor that often goes overlooked in understanding and managing neck pain is the correlation between neck range of motion and the discomfort experienced. In this blog post, we'll delve into the fascinating connection between neck range of motion and neck pain, shedding light on how helping your neck to move better can help reduce (and remove) your neck pain.

Before we explore the connection, let's clarify what neck range of motion entails. In simple terms, neck range of motion refers to the degree and direction to which an individual can move their neck comfortably. It encompasses movements such as tilting the head forward and backward, turning side to side, and tilting the head from one shoulder to the other.

How Range of Motion Affects Neck Pain
1. Muscular Imbalance: Reduced neck range of motion often stems from muscular imbalances and stiffness. Muscles that are constantly strained due to poor posture or excessive stress tend to become tight and restricted. This limits the ability of the neck to move freely, leading to discomfort and pain.

2. Joint Health: The neck is composed of numerous small joints that enable its various movements. When these joints are not used through their full range, they can become stiff, leading to decreased flexibility and pain. Regular movement maintains joint health and reduces the risk of pain.

3. Postural Alignment: A significant contributor to neck pain is poor posture. When the head is constantly held in a forward position, it places undue stress on the neck muscles and ligaments. This can lead to chronic pain as well as limitations in range of motion.

4. Nerve Irritation: Limited neck mobility can sometimes result in nerve irritation. When nerves are compressed or pinched due to restricted movement, it can lead to radiating pain, tingling, or numbness in the neck and even down the arms.

Addressing the Issue: The Role of Physiotherapy
Through targeted exercises, manual therapy, and education, physiotherapists can guide individuals toward a healthier neck and improved quality of life.

Stretching and Strengthening: Physiotherapists design tailored stretching and strengthening exercises to improve muscle flexibility and balance. This promotes a wider range of motion while reducing muscular tension that contributes to pain.

Manual Therapy: Hands-on techniques like joint mobilization and soft tissue manipulation can help restore normal joint mechanics and alleviate muscular tightness. These therapies can significantly improve neck mobility and comfort.

Posture Education: Physiotherapists educate patients about proper posture during daily activities, whether sitting at a desk, using a smartphone, or lifting objects. These guidelines minimize stress on the neck and prevent pain from recurring.

Pain Management Strategies: Physiotherapists teach pain management techniques such as relaxation exercises, heat or cold therapy, and ergonomic adjustments. These strategies help individuals manage and reduce pain during their recovery.

So if you have neck pain, the good news is that physiotherapy offers effective solutions to address these issues. By working with a skilled physiotherapist and adopting recommended exercises and lifestyle changes, individuals can regain a fuller range of motion, alleviate pain, and prevent future discomfort. Remember, a pain-free neck leads to a more comfortable and productive life.

Unveiling the Connection Between Thoracic Spine Stiffness and Shoulder Pain

If you're a swimmer, cricket, AFL or rugby player (league or union), or someone engaged in employment in heavy industries or construction, you're likely no stranger to shoulder pain.

This persistent discomfort can hinder your performance and daily activities at home, work and during sporting endeavors. However, what you may not realize is that the biomechanical driver of your shoulder pain could be related to the stiffness in your thoracic spine. In this article, we'll delve into the relationship between thoracic spine stiffness and shoulder pain, shedding light on how addressing one can alleviate the other.

Understanding the Thoracic Spine
The thoracic spine, comprising the twelve vertebrae in the middle part of your back, serves as a crucial link between your upper body and lower back. Its role extends beyond providing stability; it also facilitates optimal movement of the arms, shoulders, and chest. However, prolonged repetitive movements, poor posture, or heavy workloads can lead to thoracic spine stiffness, resulting in shoulder pain.

The Impact of Thoracic Spine Stiffness
When the thoracic spine loses its mobility due to stiffness, it can have significant repercussions on the shoulders. Here's how thoracic spine stiffness can contribute to shoulder pain:

Restricted Range of Motion: Stiffness in the thoracic spine limits the shoulders ability to move into end of range flexion (arms moving in front of the body above head) and abduction (arms moving out from the side of the body above the head). Consequently, your shoulder joints suffer a reduced range of motion in these directions (flexion and abduction) leading to stiffness and impaired muscle activation patterns around the scapula and shoulder joint.
Compromised Shoulder Mechanics: A stiff thoracic spine alters the normal movement patterns of the shoulders. This disruption can cause muscle imbalances and poor biomechanics, leading to shoulder impingement, tendonitis, or rotator cuff issues.
Postural Imbalances: Thoracic spine stiffness often leads to a rounded shoulder posture, where the shoulders roll forward and the chest collapses. This postural imbalance places excessive stress on the shoulder joint, leading to pain, instability, and decreased athletic performance.

Addressing Thoracic Spine Stiffness to Relieve Shoulder Pain
To alleviate shoulder pain caused by thoracic spine stiffness, it's essential to adopt a multifaceted approach that focuses on improving thoracic mobility and optimizing shoulder mechanics. Consider the following strategies:

Thoracic Mobility Exercises: Incorporate exercises that promote thoracic spine mobility, such as thoracic extensions, foam rolling, and cat-cow stretches. These exercises can enhance flexibility and reduce stiffness in the thoracic region.
Corrective Posture Techniques: Pay attention to your posture, both during activities and throughout the day. Avoid slouching or rounding your shoulders forward, and strive to maintain an upright posture. Ergonomic adjustments in your workplace can also play a significant role in supporting proper posture.
Strengthening and Stability Exercises: Engage in exercises that target the muscles supporting the thoracic spine and shoulders, such as rows, scapular retractions, and push ups. Strengthening muscles that perform these movements can help maintain stability, improve shoulder mechanics, and alleviate pain.
Activity Modification and Rest: If your shoulder pain is aggravated by specific activities or sports, consider modifying your technique (in consultation with your physiotherapist and coach) or taking rest periods to allow for proper recovery. Overuse and repetitive motions can exacerbate shoulder pain, so it's crucial to give your shoulders adequate rest when needed.

In a lot of cases, manual therapy is needed to help address thoracic spine stiffness so it is always beneficial to seek the help of a physiotherapist to provide treatment to this area. We do often find that unlocking the stiffness in the thoracic spine assists greatly in the management of shoulder pain conditions. Often across a few visits, we are then able to progress to self-managed exercises at home or the gym to keep your pain and stiffness away.

Yours in health
Chris and the team at Out of the Box Physiotherapy

Unravelling the role of the SIJ (Sacroiliac Joint) in lower back pain

Lower back pain can be debilitating and can affect individuals from all walks of life, including (but not limited to) office workers, athletes, stay at home parents and those working in heavy industries. While there are multiple factors that can contribute to lower back pain, one often overlooked source of pain is the sacroiliac (SI) joint.

In this article, we'll delve into the sacroiliac joint and its relationship to lower back pain, shedding light on how understanding and addressing any dysfunction present at this joint can alleviate discomfort and improve quality of life.

Understanding the Sacroiliac Joint
The sacroiliac joint (SIJ) is found between the triangular bone at the base of the spine, known as the sacrum, and the ilium, which is part of the pelvis. This joint connects the spine to the pelvis and plays a crucial role in supporting and transmitting forces between the upper body and the lower extremities. It also provides stability while single limb weight bearing and allows for limited movement, primarily in the form of subtle rotations and tilting.

The Impact of Sacroiliac Joint Dysfunction on Lower Back Pain
When the sacroiliac joint becomes dysfunctional or experiences imbalances of muscular tension and weakness, it can contribute to lower back pain.

Here's how sacroiliac joint dysfunction affects lower back pain:

Altered Movement Patterns: The sacroiliac joint's role in transferring forces and facilitating efficient movement means that any dysfunction can disrupt the normal mechanics of the lower back leading to the development of altered movement patterns. This alteration in movement patterns can lead to muscle imbalances, strain on surrounding structures of the lower back, and subsequent lower back pain.
Increased Stress on Surrounding Structures: Sacroiliac joint dysfunction can result in excessive stress on the ligaments, tendons, and muscles surrounding the SI joint and lower back. Over time, this increased stress can cause inflammation, irritation, and localised pain in the lower back.
Impaired Postural Alignment: The sacroiliac joint is integral to maintaining proper posture.
Dysfunction in this joint can result in pelvic asymmetry or dynamic instability, leading to compensatory changes in posture. These postural imbalances can place additional strain on the lower back, resulting in discomfort and pain.

Addressing Sacroiliac Joint Dysfunction to Relieve Lower Back Pain:
To alleviate lower back pain associated with sacroiliac joint dysfunction, a comprehensive approach that focuses on restoring joint function, releasing and strengthening surrounding muscles, and restoring optimal movement patterns is crucial. A management plan will consider the following strategies:
1. SIJ Stabilization Exercises:
Engage in specific exercises that target the muscles supporting the sacroiliac joint, such as bridges, clamshells, bird dogs and dead bugs. These exercises can enhance stability, improve joint function, and alleviate lower back pain when done with the correct technique.

2. Manual Therapy:
Seeking the expertise of a healthcare professional, such as a physiotherapist can be beneficial. They can provide manual therapy techniques, such as joint mobilisation or manipulation, to restore proper alignment and function of the sacroiliac joint and lumbar spine.
3. Postural Awareness and Ergonomics:

Pay attention to your posture, both during daily activities and while sitting at your desk. Ensure that your workstation is ergonomically optimised to support proper posture, including using a supportive chair and maintaining a neutral spinal alignment. If you are someone whose occupation involves hazardous manual handling such as repeated lifting then making sure your technique is optimal will effectively help to prevent lower back injuries.

4. Activity Modification and Rest:
If certain activities or movements exacerbate your lower back pain, consider modifying or avoiding them temporarily. Rest periods and gentle stretching can also help alleviate symptoms and allow for healing.

The best solution is to see us for a physiotherapy assessment so that we can conduct a thorough evaluation, provide personalised advice, and administer targeted treatments to address joint dysfunction and alleviate your lower back pain effectively. We are always more than happy to help so don’t feel you have to put up with your annoying pain any longer.

What a pain in the Knee Cap!

In this blog post, we will delve into a common condition called patello-femoral pain syndrome (PFPS), exploring its causes and how physiotherapy can provide effective solutions to alleviate pain and restore function.

Patello-Femoral Pain Syndrome, also known as runner's knee, is a prevalent knee condition characterised by pain and discomfort around the front of the knee, particularly at the patella (kneecap) and femur (thigh bone) joint. It typically arises from activities involving repetitive knee motion, such as running, jumping, squatting, or climbing stairs.

Understanding the Causes:

Several factors contribute to the development of PFPS. Let's explore a few of the most common causes:

Muscular Imbalances: Weakness or imbalances in the muscles surrounding the knee, including the quadriceps, hamstrings, and hip muscles, can lead to altered tracking of the patella. This abnormal movement causes excessive pressure and irritation on the joint surfaces, resulting in pain.
Overuse and Poor Training Techniques: Engaging in high-impact activities without proper conditioning or technique can place excessive stress on the knee joint. Gradual increases in activity levels, poor running mechanics, and inadequate recovery time can all contribute to the onset of PFPS.
Biomechanical Issues: Structural abnormalities, such as flat feet, excessive foot pronation (inward rolling), or a high Q angle (angle formed between the hips and knees), can alter the alignment and mechanics of the knee joint. This misalignment can lead to imbalanced forces and increased stress on the patella.

How Physiotherapy Can Help:

Here is how we typically go about managing our patients with PFPS.

Comprehensive Assessment: Our experienced physiotherapists will conduct a thorough evaluation to identify the underlying factors contributing to your PFPS. This assessment may include analyzing your movement patterns, assessing muscle strength and flexibility, and examining your foot mechanics.

Pain Management: Through a combination of manual therapy techniques, such as soft tissue mobilization, joint mobilization, and taping, our physiotherapists can help alleviate pain and reduce inflammation in the affected knee.

Strengthening and Flexibility Exercises: A customized exercise program will be developed to address muscle imbalances, strengthen weak muscles, and improve flexibility. These exercises may include quadriceps and gluteal strengthening, core stabilization, and hip mobility drills.

Biomechanical Correction: Our physiotherapists will analyze your movement patterns and running technique to identify any abnormalities that may contribute to your PFPS. They will provide guidance on proper form, footwear selection, and orthotic prescriptions if necessary, helping you optimize your biomechanics and reduce knee stress.

Activity Modification and Education: Our physiotherapists will educate you on proper warm-up and cool-down techniques, optimal training strategies, and ways to modify activities to prevent further aggravation of your symptoms. They will guide you on appropriate exercise progression and provide advice on incorporating cross-training and rest days into your routine.

Patellofemoral pain syndrome can become a frustrating condition. It is often quite simple to diagnose but can be difficult to manage and settle down due to the multitude of factors that can be contributing.
If you have pain in the front of your knee with physical activity, walking or climbing stairs, chat to us today a get a plan for recovery.

Yours in health

Chris from Out of the Box Physiotherapy

3 Tips to manage a pinched nerve in your neck (Cervical Radiculopathy)

Cervical radiculopathy can be a challenging condition to manage, as it can cause significant discomfort and limit your ability to perform daily activities. However, physiotherapy can play an essential role in the treatment of cervical radiculopathy, helping to alleviate symptoms and improve function.

Cervical radiculopathy is a condition we see very often. All cases are different however the following three tips tend to apply across the vast majority of cases.

Maintain good posture:
Poor posture can put extra strain on the neck and spine, increasing the likelihood of compression or irritation of the cervical nerve roots. To avoid this, aim to maintain good posture throughout the day. This means keeping your shoulders back, your head upright, and your spine in a neutral position. Try to avoid slouching or leaning forward for extended periods, as this can exacerbate symptoms as does long periods of looking up, such as would occur doing jobs at home like painting, washing the windows and hedge trimming.
Be mindful of your movements:
Certain movements or activities can exacerbate symptoms of cervical radiculopathy, such as twisting and turning, looking up, or lifting heavy objects, particularly lifting above shoulder height. Be mindful of these movements and try to avoid them where possible. If you do need to lift something, use proper lifting technique by bending at the knees, keeping the object close to your body, and avoiding twisting or jerking movements.
Follow your physiotherapy program:
We will develop a personalized program to help manage your cervical radiculopathy. This program may include exercises to strengthen and stretch the neck and upper back, as well as manual therapy techniques to reduce pain and improve mobility. It's essential to follow this program as closely as possible to achieve the best possible outcomes. Be sure to attend all scheduled appointments and communicate with your physiotherapist about any changes in your symptoms. This is one condition where the spacing between appointments can make the difference between the condition resolving or in it hanging around longer than it should.

As always, we are here to help and relief is just a few appointments away.

Heel Pain in Kids

Understanding and Managing heel pain in kids: Sever’s Disease

Sever's disease, also known as calcaneal apophysitis, is a common cause of heel pain in children and adolescents, especially those who are physically active. It is a temporary condition that typically occurs during growth spurts, when the bones grow faster than the muscles and tendons, causing stress and strain on the heel.

Who gets Sever's disease?

Sever's disease is most common in children between the ages of 8 and 15, who are undergoing rapid growth and development. It is also more common in children who participate in sports that involve running, jumping, and excessive heel impact, such as soccer, basketball, gymnastics, and dance. Children with flat feet or high arches are also more prone to developing Sever's disease.

What causes Sever's disease?

Sever's disease is caused by repetitive stress on the heel's growth plate, which is a layer of hyaline cartilage that connects the heel bone (calcaneus) to the calf bone (tibia). The stress on the growth plate can cause small micro-tears in the cartilage, leading to pain and swelling in the heel. The heel's growth plate is particularly vulnerable because it is not as strong or flexible as the surrounding tissue.

How Physiotherapy can help?

Physiotherapy can play an important role in the management of Sever's disease. A physiotherapist can help to reduce pain and improve function in the affected heel in the following ways:

1. Stretching and Strengthening Exercises: Stretching the calf muscles and hamstrings, as well as strengthening the muscles in the feet and legs, can help to relieve stress on the heel and reduce pain.

2. Modification of Physical Activity: A physiotherapist can recommend modifications to physical activity, such as avoiding high-impact sports or using orthotics, to reduce stress on the heel.

3. Ice Therapy: Applying ice to the affected area can help to reduce pain and swelling.

4. Massage Therapy: Massaging the calf and foot muscles can help to improve circulation and reduce muscle tightness.

5. Taping and Bracing: A physiotherapist may recommend taping or bracing to provide support to the affected heel and reduce stress on the growth plate.

If your child is experiencing heel pain it is important to seek advice. We will help you to develop a treatment plan that is appropriate for your child's individual needs.

You can book your consultation by clicking HERE

Back to school tips from your physio

With school about to go back for 2023 we thought it a great time to put our two cents from a physio perspective to help your kids have a great year.

Back to school is a busy time with lots to think about, from lunchboxes and uniforms to books and stationary. But for us, the two most important things to think about are the type of bag that they use and what they wear on their feet.

Here are some physio tips to help find a backpack that fits well.

Choose a bag with wide straps that fit well on the shoulder
Find a bag with chest and waist straps as these help to transfer some load to the hips and pelvis where the stronger muscles are
Padded back supports allow for a nice snug fit
Don’t buy a bag that is too big for them hoping that they will grow into it (a tip here is that the back should not extend higher than the child’s shoulders when sitting)
Make sure your child avoids swinging their backpack around and only uses one strap

In terms of footwear, there are a range of options. Kids naturally want to be active at school so it is important that their footwear allows this. Here are some tips on how to choose the right set of shoes for your child (and for anyone for that matter).

A firm heel cup. This holds the foot in place. You should not be able to compress the heel cup in or down on itself
Torsional stability (twisting). Hold both ends of the shoe and twist. It should have minimal movement to help protect the foot from rolling in or out too far
Toe box bend. Press both ends on the shoe inwards on each other. The shoe should bend at the toes which is a natural flex point of the point. If it bends in the middle, it can be a problem in the arch.
Good fit - not too big or small. Either will cause rubbing and blisters.

As always, please reach out if you need any more help or advice and have a great 2023.

Chris from Out of the Box Physiotherapy

Finding the "sweet spot" in your shoulder rehabilitation

If you have persistent shoulder pain that won't go away, read on.

As physiotherapists, we see a lot of patients with painful shoulders. Usually this pain has been around for some time and is not getting any better. Often our patients have been elsewhere and tried trigger point releases, massage, and even some theraband exercises but frustratingly they are still in pain. Unfortunately, too often we hear from patients that they have been told their shoulders are just “tight”. Sure they might be, but fixing the tightness won’t offer a long term solution (you might liken it to simply putting a bucket under a leaking tap). In our clinic we often talk about how when it comes to shoulders, two shoulders with the same “diagnosis” can require two different treatment and rehabilitation plans.

Some patients have a great outcome from a cortisone injection, many do not. Some patients respond well to trigger point releases around the shoulder, some do not. But the common theme we do see is that all shoulders need some form of strengthening (and by shoulders, we mean more than just the rotator cuff). Exercises done in shoulder rehabilitation need to be more than just therabands. This is a good start in a lot of cases but we need to think more functional and think about pull, push and press movements in addition to rotation.

Where the challenge lies is that a loading protocol that works for one patient, might not work for another. But the good news is we keep adjusting until we find the sweet spot. So if you have been struggling with shoulder pain; been told that your pain is due to “tightness” and perhaps even tried cortisone injections to no avail, then we need to chat so that we can start loading the shoulder again and remember, a strong shoulder is a healthy shoulder.

Yours in health
Chris

Stress Fractures, Stress Reactions and Pars Defects of the Lumbar spine

Been told you have a pars defect? Read on

Firstly, it is important to note that when discussing lumbar spine injuries, stress fracture, spondylosis and pars defects are all terms used interchangeably to describe the same pathology. The pars interarticularis is the segment of bone bounded by the lamina, pedicle, and the superior and inferior articular processes (facet joints) of each vertebrae.

Pars defects begin as stress reactions which then progress to stress fractures (spondylosis) which can then become chronic fractures. It is possible that in some cases, pars defects can progress to being complete fractures causing a slipping forward of one vertebrae relative to the one directly below it (spondylolisthesis).

Research indicates that lumbar spine stress reactions (or stress reactions) are most common in athletic populations and we typically see these types of injuries present in our athletic teenage populations. Studies have also suggested that males are more likely to present with pars defects than females.

The main mechanism of injury that results in stress fractures / stress reactions in the pars is repetition and overload and insufficient recovery time. Sports such as diving, volleyball, tennis and cricket are considered to be higher risk sports due to stresses placed on the spine. The movements that are most problematic is repetitive hyperextension and / or rotation of the lumbar spine.

Diagnosis

The main sign of lumbar spine stress reactions (and fractures) is back pain that is worse following sport or activities involving repetitive extension of the spine. Pain can sometimes be worse at night. In the clinic, we look at the range of motion of the lumbar spine in addition to taking a good history around symptom behaviour, activities and loading. We often use a combination of lumbar extension and rotation to see if we can reproduce any signs of the issue. It is possible though that clinical examination is clear and asymptomatic. This means we may send off for imaging of the spine to confirm. X-ray can be useful however in many cases MRI is the investigation of choice. Your physio will liaise with your medical professional if this is required.

Management

Restoration of range of motion using physiotherapy is important. So too is resting from the aggravating activities / movements. Physio will aim to keep you as active as possible however we do need to find the sweet spot between continuing to train and play and allowing the spinal symptoms to settle down. This is certainly not a condition to play through as the symptoms (and degree of injury) can worsen if ignored.

Prevention

Load management is the key to preventing lumbar spine stress related injuries. Knowing which movements are likely to cause issues in our adolescent populations is vital. It is also important to measure load throughout the whole of the week, not just games. For example, in cricket, there may well be a limit on the number of overs that can be bowled in a match, however is anyone monitoring how many balls are being bowled in a net session (and also how many net sessions might be being undertaken). Load management is still an area where as physios we feel more work can be done.

Having a good range of motion in the lumbar spine, thoracic and shoulder girdle is also important in prevention. Abdominal strength is also very important as having strong muscles in this area can help to reduce stresses on the bony structures. Your physio can assess abdominal strength and provide exercises to improve this if needed.

If you have back pain that sounds like it could be stress related, then the best place to start is with a physiotherapy assessment and consultation. We can confirm the diagnosis and provide a plan that manages your symptoms and gets you back to playing. If left untreated, the outcomes are usually poor and can result in significant time away from sport and exercise.

We are here to help.

Chris and the team from Out of the Box Physio