Understanding Frozen Shoulder: Causes, Symptoms, and Treatment

Frozen shoulder, also known as adhesive capsulitis, is a painful and debilitating condition that affects the shoulder joint. It occurs when the capsule surrounding the joint becomes thickened and inflamed, limiting its range of motion.

Causes and Risk Factors

The exact cause of frozen shoulder remains unclear, but several factors have been identified as increasing the risk:

Age: People over the age of 40 are more likely to develop frozen shoulder.
Gender: Women are more prone to the condition than men.
Diabetes: Individuals with diabetes have a higher incidence of frozen shoulder.
Immobility: Prolonged periods of shoulder immobility, such as after an injury or surgery, can contribute to the condition.
Systemic diseases: Certain autoimmune diseases or thyroid disorders may increase the risk.

Symptoms

The primary symptoms of frozen shoulder are pain and stiffness in the shoulder joint. The pain can vary in intensity, from a mild ache to a sharp, throbbing sensation. It may be worse at night or when resting.

As the condition progresses, stiffness becomes more noticeable. It can be difficult to move the shoulder in any direction, making simple tasks like reaching behind your back or dressing challenging.

Other symptoms may include:

A feeling of "locking" in the shoulder joint
Weakness in the shoulder
Limited range of motion

Diagnosis

Diagnosing frozen shoulder typically involves a combination of medical history and physical examination. Your physiotherapist will ask about your symptoms, duration, and any recent injuries or illnesses.

During the physical exam, your physiotherapist will assess your shoulder's range of motion and look for signs of tenderness or inflammation. In some cases, imaging studies like X-rays, MRIs, or ultrasounds may be ordered to rule out other conditions.

It's important to note that there is not one definitive test to help with the diagnosis of frozen shoulder. Diagnosis usually involves excluding other pathology and observing the progression of range of motion reduction across several weeks. Sometimes capsular and or ligament thickening can be seen on medical imaging.

Treatment Options

The goal of treatment for frozen shoulder is to reduce pain, improve range of motion, and restore normal shoulder function. A variety of approaches may be considered, depending on the severity of the condition and individual factors.

Non-surgical treatments often include:

Physiotherapy: This is typically the first line of treatment and involves exercises, stretching, and mobilization techniques to gradually improve range of motion.
Medication: Over-the-counter pain relievers and anti-inflammatory drugs can help manage pain and inflammation. In some cases, corticosteroid injections may be used to reduce inflammation within the shoulder joint.
Heat and cold therapy: Applying heat or cold to the affected area can provide temporary relief from pain and stiffness.

In severe cases of frozen shoulder, surgical intervention may be considered. This typically involves arthroscopic release, a minimally invasive procedure that involves releasing the thickened capsule surrounding the shoulder joint. In recent times, the appropriateness of this procedure has been questioned and as such it is not a commonly used option here in Australia

Timeline for Recovery

The recovery process for frozen shoulder can vary from person to person, but it typically involves three stages:

Freezing stage: This is the most painful stage, and it can last for several months. During this stage, the shoulder becomes increasingly stiff and painful.
Frozen stage: The pain may begin to subside, but the shoulder remains very stiff. This stage can also last for several months.
Thawing stage: As the shoulder capsule begins to loosen, pain and stiffness gradually improve. This stage can take several more months.

It's important to note that the overall recovery time can vary depending on factors such as the severity of the condition, individual health, and adherence to treatment.

Exercise Advice

Physical therapy plays a crucial role in recovering from frozen shoulder. Your physiotherapist will design a personalized exercise program to help improve your range of motion and reduce pain.

Here are some common exercises that may be included in your treatment plan:

Pendulum exercises: Gently swing your arm back and forth while leaning forward.
Internal and external rotation: Rotate your shoulder inward and outward while keeping your elbow close to your side.
Arm circles: Slowly make small circles with your arm.
Stretching exercises: Gentle stretches can help improve flexibility.
Active assisted range of motion exercises: Using a stick or pulley can provide support and assistance while gradually increasing your range of motion.

Exercises should be largely pain-free or only done to slight pain. There is no point in pushing too hard, as this can worsen the condition. It's important to perform these exercises under the guidance of a healthcare professional to ensure proper technique and avoid further injury.

Frozen shoulder can be a frustrating and painful condition, but with the right approach, it can be effectively managed. By understanding the causes, symptoms, and treatment options, you can take steps to improve your quality of life.

If you're experiencing shoulder pain or stiffness, don't hesitate to seek help from a physiotherapist. A qualified physiotherapist can accurately diagnose your condition and recommend appropriate treatment.

Remember, you don't have to live with frozen shoulder. With the right care and guidance, you can thaw the ice and regain full range of motion in your shoulder.

Book an appointment today and start your journey toward a pain-free shoulder.

Physiotherapy and Exercise: Your Keys to Managing Knee Osteoarthritis

In one of our earlier blogs, we discussed the symptoms and causes of knee osteoarthritis. Now, let's focus on effective management strategies. While medication can provide temporary relief, physiotherapy and exercise are often considered the cornerstones of long-term knee osteoarthritis management.

The Role of Physiotherapy

Physiotherapy is a crucial component in managing knee osteoarthritis. A qualified physiotherapist can assess your specific condition, provide pain relief, improve mobility, and strengthen the muscles supporting your knee joint.

Benefits of physiotherapy include:

Pain management: Physiotherapists use various techniques, such as manual therapy and heat or cold therapy, to reduce pain and inflammation.
Improved mobility: Exercises and stretches prescribed by a physiotherapist can help maintain or improve your knee's range of motion.
Muscle strengthening: Building the muscles around your knee provides support and reduces stress on the joint.
Education and advice: Physiotherapists can teach you about knee osteoarthritis, provide self-management strategies, and offer guidance on activities and load management.

The Power of Exercise

Regular exercise might seem counterintuitive when you have knee pain, but it's actually essential for managing osteoarthritis. The right type of exercise can help reduce pain, improve function, and slow down the progression of the condition.

Key types of exercises for knee osteoarthritis:

Low-impact aerobic exercise: Activities like swimming, cycling, and water aerobics are gentle on the knees.
Strength training: Building the muscles around your knee can help support the joint.
Balance exercises: Improving balance can reduce your risk of falls and injuries.

Remember: It's crucial to consult with a physiotherapist before starting any new exercise program. They can recommend exercises that are suitable for your specific condition and guide you through proper form to prevent injuries.

Finding the Right Approach

The best approach to managing knee osteoarthritis involves a combination of physiotherapy and exercise tailored to your individual needs. At Out of the Box Physio, our experienced physiotherapists can develop a personalised treatment plan to help you achieve your goals.

Don't let knee osteoarthritis limit your enjoyment of life. Take the first step towards managing your condition by contacting us today for an appointment.

Book an appointment

Understanding and Managing Hip Osteoarthritis: A Focus on Physiotherapy and Exercise

What is Osteoarthritis

Hip osteoarthritis, often referred to as "wear and tear" arthritis, is a common condition that affects millions of people. It occurs when the cartilage, a smooth, protective tissue that covers the ends of your bones, gradually breaks down. This can cause pain, stiffness, and reduced mobility in your hip joint.

While hip osteoarthritis can be a challenge, there are effective ways to manage it. A cornerstone of treatment is physiotherapy and exercise. These approaches can help reduce pain, improve mobility, and enhance your overall quality of life.

Physiotherapy
A physiotherapist can provide tailored exercises to strengthen the muscles supporting your hip, improve flexibility, and reduce pain. They can also teach you proper body mechanics to protect your hip joint.

Exercise
Regular physical activity is crucial for managing hip osteoarthritis. Low-impact exercises like swimming, cycling, and walking can help maintain strength and flexibility without putting excessive strain on your hip. Your physiotherapist can guide you on suitable exercises based on your condition.

Additional Tips for Pain Management

Weight management: If you're overweight, losing even a small amount of weight can significantly reduce pressure on your hips.
Heat and cold therapy: Applying heat or cold packs to your hip can help alleviate pain and stiffness.
Assistive devices: Using a cane or walking stick can help reduce stress on your hip joint.
Medication: In some cases, over-the-counter pain relievers or prescription medications may be necessary to manage pain.

Sample of Exercises for Hip Osteoarthritis

Remember, it’s essential to consult with your healthcare provider or physiotherapist before starting any new exercise program.

Glute Bridge: Lie on your back with knees bent and feet flat on the floor. Lift your hips off the ground, squeezing your buttocks, and hold for a few seconds. Lower slowly and repeat.

Clamshell: Lie on your side with knees bent and feet together. Lift your top knee, keeping your feet together, like opening a clamshell. Hold for a few seconds and lower.

Heel Slides: Lie on your back with knees bent and feet flat. Slide one heel out as far as possible, then slide it back in. Repeat with the other leg.

Consistency is key when it comes to managing hip osteoarthritis. By incorporating physiotherapy, exercise, and other self-care measures, you can effectively reduce pain and improve your mobility. Regular check-ups with your healthcare provider are important to monitor your condition and adjust your treatment plan as needed. Early detection and management of hip osteoarthritis can make a significant difference in your quality of life.

Osteoarthritis is a condition we treat on a daily basis here at Out Of The Box Physiotherapy and we have helped many patients delay and even avoid having to have surgery. Try physio first, you might just be surprised by what we can help you achieve.

What a pain in the neck

Wry neck

Wry neck, also known as torticollis, is a painful condition characterised by stiffness and limited neck movement. It often occurs suddenly and can make it difficult to turn your head in one direction. While it can be uncomfortable, wry neck is usually a temporary condition that responds well to treatment.

To effectively address wry neck, it's essential to understand the different types.

Facet Joint Wry Neck:

This occurs when the small joints between your vertebrae (facet joints) become inflamed or irritated. It often leads to sharp, localised pain. Symptoms may include:

Sudden onset of neck pain
Limited neck movement, especially in one direction
Tenderness in the affected area

Discogenic Wry Neck:

This type arises from issues with the intervertebral discs, the cushions between your vertebrae. It can cause a dull, aching pain that may radiate to your shoulder or arm. Symptoms may include:

Gradual onset of neck pain
Stiffness and reduced range of motion
Pain that worsens with movement

Common Causes of Wry Neck

Several factors can contribute to the development of wry neck:

Poor Posture: Spending extended periods hunched over a computer or smartphone can strain neck muscles and lead to misalignment.
Sleeping Position: Sleeping on an uncomfortable pillow or in an awkward position can put undue stress on the neck.
Muscle Strain: Overexerting neck muscles through physical activity or sudden movements can cause inflammation.
Whiplash: A sudden jolt to the head and neck, such as in a car accident, can result in neck muscle and ligament damage.
Degenerative Changes: Age-related wear and tear on the cervical spine can contribute to wry neck.
Infections: In some cases, viral or bacterial infections can cause neck stiffness and pain.

The Role of Physiotherapy in Wry Neck Treatment

Physiotherapy is an effective treatment for wry neck, offering a range of benefits:

Pain Relief: Physiotherapists use various techniques, such as massage, heat therapy, and ultrasound, to reduce pain and inflammation.
Improved Range of Motion: Gentle stretching and mobilisation exercises help restore normal neck movement.
Posture Correction: Physiotherapists can assess your posture and provide guidance on improving it to prevent future episodes.
Muscle Strengthening: Exercises designed to strengthen the neck and shoulder muscles help support the cervical spine.
Education and Prevention: Physiotherapists can teach you about proper posture, ergonomics, and self-care strategies to manage symptoms and prevent recurrence.

Hands on treatment for neck stiffness

Manual therapy is a cornerstone of wry neck treatment. It involves skilled hands-on techniques to treat the musculoskeletal system. When applied to wry neck, it can be instrumental in restoring range of motion, reducing pain, and promoting overall neck health.

Here are some common manual therapy techniques and how they are helpful in the management of neck pain and stiffness.

Joint Mobilisation: This technique involves gentle movements to the neck joints, helping to restore normal movement and reduce stiffness. By improving joint mobility, manual therapists can effectively address the restricted range of motion often experienced with wry neck.
Soft Tissue Massage: This involves applying pressure to tight and tender muscles, helping to release muscle tension and improve blood flow. By reducing muscle stiffness, soft tissue massage can enhance neck flexibility and range of motion.
Muscle Energy Techniques: These techniques involve using gentle pressure and patient contraction to improve joint mobility and muscle flexibility. They can be particularly effective in addressing joint restrictions and muscle imbalances associated with wry neck.

Beyond restoring range of motion, manual therapy offers several benefits for managing wry neck:

Pain Relief: Many manual therapy techniques, such as soft tissue massage and trigger point therapy, can effectively reduce pain associated with wry neck by releasing muscle tension and improving blood flow.
Posture Correction: Manual therapists can assess your posture and identify any imbalances that may contribute to wry neck. Through hands-on techniques and exercises, they can help correct postural issues and reduce strain on the neck.
Education and Prevention: Your physiotherapist can provide valuable education on proper posture, ergonomics, and self-care strategies to help prevent future episodes of wry neck.

It's important to note that manual therapy is often combined with other treatment modalities, such as exercise, heat or cold therapy, and patient education, to achieve optimal results.

Wry neck can be a bothersome condition, but it is very treatable. If you're experiencing persistent neck pain, don't put up with it any longer, we can help you.

How much exercise do you need to do?

Staying active regularly is essential for good physical and mental health and wellbeing.

This is true no matter how young or old you are. But the amount of activity varies, depending on your age.

There is also good evidence to support the role in regular physical activity in the management of chronic pain and also in the management of many chronic lifestyle diseases.

For adults, here are some of the things that regular physical activity can do:

reduce the risk of, or help manage, type 2 diabetes and cardiovascular disease
maintain or improve blood pressure, cholesterol and blood sugar levels
reduce the risk of some cancers
prevent unhealthy weight gain and help with weight loss
maintain strong muscles and bones
create opportunities for socialising and meeting new people
help develop and maintain physical and mental wellbeing.

So with the benefits of being physically active now clear, the real question is how much do you need to be doing.

To start with, before reading these recommendations, it is important to note that anything is better than nothing when it comes to physical activity, so if you are currently not doing any, and these guidelines feel like a lot or too much, then doing some is better than none. The important thing is just to get started.

The other important factor from a physiotherapy perspective is that gradual, progressive increases are your best bet to make sure you do not end up with overuse conditions to the tendons or bursas. I like to use the 10% rule as a good guideline to ensure progress to gradual and gentle on the body. This means no more than a 10% increase on load and/or volume each week.

Physical activity recommendations

Adults should be active most days, preferably every day. Each week, adults should do either:

2.5 to 5 hours of moderate intensity physical activity – such as a brisk walk, golf, mowing the lawn or swimming
1.25 to 2.5 hours of vigorous intensity physical activity – such as jogging, aerobics, fast cycling, soccer or netball

an equivalent combination of moderate and vigorous activities.

Strengthening activities should be included for at least 2 of the days per week (this is things such as push ups, squats, resistance training).

As your trusted healthcare professionals we are well placed to help you put together a physical activity that will work for you. Our group programs are also a great option to get your dose of strength work and we are seeing an increasing number of our clients do these programs twice per week to make sure they are getting the recommended amount of strength work done each week.

We are can help put a program together so book yourself in for a review today

Yours in health

Chris from Out of the Box Physiotherapy

What you need to know about Rotator Cuff tears

What is the Rotator Cuff?

The rotator cuff is a group of four muscles and their tendons located around the shoulder joint. These muscles—supraspinatus, infraspinatus, teres minor, and subscapularis—work together to stabilise the shoulder joint and facilitate a wide range of motion. The rotator cuff plays a vital role in lifting, rotating, and moving the arm, making it essential for everyday activities and sports performance.

Types of Rotator Cuff Tears

Rotator cuff tears can occur gradually over time due to wear and tear or suddenly as a result of injury. There are two main types of tears:

Partial Tears: In partial tears, only a portion of the tendon is damaged. This type of tear only goes partially through the thickness of the tendon. This type of tear may not completely disrupt the function of the rotator cuff and may be less symptomatic.
Full-Thickness Tears: With this type of tear, there is detachment of part of the tendon from the bone.When only a small part of the tendon is detached from the bone, it is referred to as a full-thickness incomplete tear. When a tendon is completely detached from the bone, it is referred to as a full-thickness complete tear. With a full-thickness complete tear, there is basically a hole in the tendon. This type of tear can significantly impact shoulder function and may require surgical intervention for repair.

Causes of Rotator Cuff Injuries

Understanding how the rotator cuff is typically injured is crucial for prevention and effective management. Rotator cuff injuries can result from various factors, including:

Overuse: Repetitive overhead activities, such as throwing, lifting, or reaching, can place excessive strain on the rotator cuff muscles and tendons, leading to gradual wear and tear over time. Athletes involved in sports such as baseball, tennis, and swimming are particularly prone to overuse injuries of the rotator cuff.
Trauma: Acute trauma, such as a fall onto an outstretched arm or a direct blow to the shoulder, can cause sudden tears or strains in the rotator cuff tendons. These injuries are common in accidents, sports-related collisions, or activities involving sudden forceful movements.
Age-related Changes: As we age, the tendons of the rotator cuff may degenerate and become more susceptible to injury. The gradual weakening of the tendon structure, coupled with decreased blood flow and tissue elasticity, increases the risk of tears and impingement in older adults.
Muscle Imbalances and Weakness: Weakness or imbalance in the muscles surrounding the shoulder joint, including the rotator cuff and scapular stabilisers, can disrupt the dynamic stability of the shoulder and increase the risk of injury. Muscle imbalances may develop due to poor conditioning, sedentary lifestyle, or previous injuries.

Management of Rotator Cuff Tears

The management of rotator cuff tears depends on various factors, including the severity of the tear, the patient's age, activity level, and overall health. Treatment options may include:

Physiotherapy: Physiotherapy plays a crucial role in the management of rotator cuff tears. A skilled physiotherapist can design a personalised rehabilitation program to strengthen the muscles surrounding the shoulder joint, improve range of motion, and reduce pain. Through targeted exercises and manual therapy techniques, physiotherapy aims to restore function and prevent further injury.
Some other options (to be used with physio, not instead of): In cases of mild to moderate rotator cuff tears, conservative treatments such as relative rest / de-loading, ice, anti-inflammatory medications, and corticosteroid injections may be recommended to alleviate pain and inflammation.
Surgical Intervention: For severe or full-thickness rotator cuff tears that do not respond to conservative treatments, surgical repair may be necessary. During surgery, the torn tendon is reattached to the bone, either arthroscopically or through open surgery.

How we can help

Numerous studies have demonstrated the effectiveness of physiotherapy in the management of rotator cuff tears. A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy found that conservative treatments, including physiotherapy, were effective in improving pain and function in patients with rotator cuff tears. Physiotherapy interventions, such as progressive strengthening exercises, manual therapy, and therapeutic modalities, have been shown to enhance shoulder strength, mobility, and overall function, leading to improved patient outcomes and satisfaction. For this reason, we alway recommend starting management of your rotator cuff injury with physiotherapy first. We can often achieve a lot over a 6-12 week rehabilitation program. We have saved countless numbers of people from having surgery.

Rotator cuff tears can significantly impact shoulder function and quality of life. While surgical intervention may be necessary in severe cases, physiotherapy remains a cornerstone of conservative management, offering safe, non-invasive interventions to improve pain, function, and overall shoulder health. If you're experiencing shoulder pain or suspect a rotator cuff tear, consult with our physiotherapy team for an accurate diagnosis and personalised treatment plan.

All about Knee Osteoarthritis

Knee osteoarthritis (OA) is a prevalent joint condition affecting millions of people from all walks of life. This degenerative disease often leads to pain, stiffness, and reduced mobility, significantly impacting one's quality of life.

Knee osteoarthritis can be divided into two types, primary and secondary. Primary osteoarthritis is articular degeneration without any apparent underlying reason. Secondary osteoarthritis is the consequence of either an abnormal concentration of force across the joint as with post-traumatic causes or abnormal articular cartilage, such as rheumatoid arthritis (RA).

The defining feature of osteoarthritis is the breakdown and loss of articular cartilage. In the knee, articular cartilage covers the top of the tibia (shinbone), the bottom of the femur (thigh bone) and the back of the patella (kneecap). Articular cartilage protects the surfaces of these bones where they meet at the joint. During the development of osteoarthritis:

Cartilage weakens. The composition of the articular cartilage changes, becoming weaker. This change in composition is especially common in older age.

Cartilage becomes damaged. The weakened articular cartilage thins or wears away.

Cartilage may attempt to heal. The damaged cartilage may attempt to produce new cells, but it is not enough to replace the missing cartilage. In addition, these new cells may grow in irregular, bumpy patterns rather than the smooth pattern of the original cartilage.

Meniscus damage is likely. Damage to the knee’s meniscus is likely to also occur. Because meniscal cartilage is different from articular cartilage, meniscus damage is considered a separate but related condition to knee osteoarthritis.

When cartilage is damaged, bones experience more friction and impact. This can cause the bone to undergo changes. For example:

Bone spurs. Abnormal bony growths, called osteophytes or bone spurs, develop on the bone at the knee joint. It is believed that bones produce bone spurs to compensate for deteriorated or missing cartilage by redistributing weight loads. The bone spurs can create more friction in the knee joint, leading to discomfort and pain. It is important to note that bone spurs are a normal sign of aging, and the presence of them alone is not a cause for concern.

Subchondral bone sclerosis. The surfaces of the tibia and femur that lie just beneath knee cartilage can change in composition and harden. (“Chondral” means cartilage; subchondral bone is located just beneath cartilage. “Sclerosis” means hardening.)

Cysts and bone marrow lesions. The bone underneath damaged or missing knee cartilage may develop cysts (typically referred to as “subchondral cysts”) and areas of abnormal swelling called bone marrow lesions. These lesions may be associated with knee pain.

Common signs you can look for

Recognizing the early signs of knee osteoarthritis is crucial for timely intervention and management. Some common symptoms include:

Knee pain, particularly during weight-bearing activities or after prolonged periods of inactivity

Stiffness and limited range of motion in the knee joint, especially in the morning or after sitting for extended periods

Swelling and tenderness around the knee joint

Audible cracking or popping sensations (crepitus) when moving the knee

Development of bone spurs around the joint, visible on X-rays

Weakness or instability in the knee, leading to difficulty walking or performing daily activities

Management Options for Knee Osteoarthritis

While knee osteoarthritis is a progressive condition with no cure, several management strategies can help alleviate symptoms and improve joint function. These include:

Lifestyle modifications: Maintaining a healthy weight through diet and exercise can reduce the strain on the knee joint and alleviate symptoms. Low-impact exercises such as swimming, cycling, and tai chi can improve joint flexibility and strengthen the surrounding muscles without exacerbating pain.

Medications: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation associated with knee osteoarthritis. In severe cases, corticosteroid injections may be administered directly into the knee joint to provide temporary relief.

Physio: A tailored exercise program designed by a physio can improve joint stability, range of motion, and muscle strength around the knee. Best practice also includes exercises that focus on neuromuscular control of the knee joint in addition to pure strength. Therapeutic techniques such as manual and soft tissue therapy may also be beneficial

Assistive devices: Using supportive devices such as knee braces, orthotic shoe inserts, or walking aids can help alleviate pressure on the knee joint and improve mobility, especially during flare-ups or activities that aggravate symptoms.

Surgical interventions: In cases of severe knee osteoarthritis that do not respond to conservative treatments, surgical options such as arthroscopic debridement, osteotomy, or total knee replacement may be considered.

Conservative management with your physiotherapist should be the first treatment option for your knee osteoarthritis. We have seen several patients be able to forgo the immediate need for surgical intervention while being under our care and guidance. The best strategy is to seek help sooner rather than later, as in some cases that have been left too long, the knee is simply too stiff and too sore to be able to tolerate any physiotherapy intervention.

If you are over the age of 45 and have a stiff and or painful knee, then having a chat with us could be one of the best things you can do for yourself this year. Action now, might save more drastic action later on.

Yours in health

Chris and the team from Out of the Box Physiotherapy

Updated Exercise Class Timetable

Please see our updated timetable for our Physio Strong Exercise Programs that came into effect from February 2024. This shows the addition of the new Physio Strong Bones Program on Thursdays at 2pm.

Trying to beat that annoying heel pain? Read on

Heel pain, Plantar fasciopathy or Plantar Fasciitis (it doesn’t really matter too much what we call it), is a prevalent foot condition that we see almost daily in the clinic. It can range from mild to severe and the functional impacts it has on our lives makes it one of the more annoying conditions for our patients.

Over the course of my almost 20 year career, a lot has changed in the guidelines surrounding best practice management of the condition and thankfully, in my opinion, we are now much better at managing it. However, time and time again, I continue to see patients who have been elsewhere (even so-called “Foot Doctors”) miss out on one key component of their rehabilitation.

This blog will shed some light on what Plantar Fasciopathy is, what we know about some factors that contribute to it occurring and how it is managed, including a key exercise that should be done in the majority of cases.

What is Plantar Fasciitis?

Plantar fasciitis occurs when the plantar fascia, a strong band of tissue that supports the arch of your foot, becomes irritated and inflamed. This inflammation can lead to heel pain, especially during the first few steps in the morning or after a period of rest or sitting. Heel pain is the most common area of pain reported but it is not the only place where symptoms can be present.

So what exactly is the plantar fascia? The plantar fascia runs from the calcaneus to the phalanges. Utilising its inherent tensile strength, it prevents the collapse of the arch of the foot upon vertical load transmission from the weight of the body.

Who Gets Plantar Fasciitis?

Plantar fasciitis can affect anyone but we have learnt over the course of time that there are some factors that do tend to correlate with presentations of painful heels. Here are the main ones.

Age and Foot Mechanics: As we age, the plantar fascia becomes less flexible, making it more susceptible to injury. Individuals with flat feet or high arches may also be at a higher risk due to altered foot mechanics.
Ankle flexibility: A lack of the ankle movement known as dorsiflexion is noted as being a risk factor for developing the condition.
Occupation and Activity Level: People who spend long hours on their feet or engage in activities that place repetitive stress on the plantar fascia, such as running or ballet, may be more prone to developing this condition.
Loading: A rapid change in loading can bring on the symptoms. Starting and running or walking program can bring on heel pain, so too can high intensity exercise programs with skipping and jumping movements. Changing to a new job on your feet can also lead to relative overloading.
Poor footwear: Shoes can be a factor, particularly old ones or ones that are not the right type for the activity you are doing. Often a good place to start before orthotics.
Weight gain and obesity: Excess weight puts additional strain on the plantar fascia.

How is Plantar Fasciitis Managed?

Effective management of plantar fasciopathy involves a combination of lifestyle modifications (i.e less walking), physiotherapy, and, in some cases, medical interventions.

Key aspects of management include:

Rest and Ice: Resting the affected foot and applying ice can help reduce inflammation and alleviate pain.
Footwear: Wearing supportive shoes with proper arch support can reduce strain on the plantar fascia.
Stretching Exercises: Gentle stretching exercises for the Achilles tendon and the plantar fascia can help improve flexibility and reduce tension.
Orthotics: Custom or over-the-counter orthotic insoles can provide additional support and cushioning. These days, research is generally conclusive that prefabricated over the counter orthotics are just as effective as custom built ones.
Soft tissue management of lower limb muscles: Joint mobilisation and massage to help improve ankle function can be assistance.
Taping: in our clinic, we use what is known as a treatment direction test using tape to trial how the foot might respond to arch support in the form of an orthotic. It not only helps to settle down the pain, but can provide good insight into longer term solutions.
Strength and tensile exercises: a specific type of calf raise where the load is progressively increased over the course of several months to help make the plantar fascia more accustomed to loads and increase its load capacity. This for me is the key to a successful treatment plan and is the one thing that most of my patients have not previously done or been told to do.

Timeline

In my experience, plantar fasciitis that is going to settle with physiotherapy will usually do so by around 3 months. This amount of time is usually needed to improve the capacity of the plantar fascia in regards to load and also provides a good amount for 1st toe and ankle mobility to improve.

Despite good adherence to the treatment plan, then if symptoms persist beyond 6 months I would usually be looking to refer for medical opinion and possible management using shockwave therapy, cortisones and anti-inflammatory medications.

There is very rarely ever only one thing that contributes to the development of plantar fasciitis. This means that a comprehensive treatment plan that looks at all variables is put in place. Physiotherapy is best placed to help you with this and with the right plan and a little patience, you should see improvement.

If you have been putting up with heel pain that is not going away then come and see us, we can help.

Yours in health
Chris from Out of the Box Physiotherapy.

Middle back pain: aka Thoracic Spine Pain

We continue to see lots of patients suffering with pain in the middle section of their back. These patients have often had worsening pain in the area across days or weeks before they come and see us. This article will help to explain the role that physiotherapy can play in management of thoracic spine pain.

Anatomy 101:
The thoracic spine, located in the mid-back region, consists of 12 vertebrae (T1-T12) that connect to the ribs, forming the thoracic cage. This part of the spine plays a pivotal role in maintaining stability and supporting our body's movements, acting as a bridge between the cervical and lumbar regions.

Common Sources of Pain:
Poor Posture: Modern lifestyles often involve prolonged sitting, hunching over screens, or slouching. This can lead to poor posture, causing strain on the thoracic spine and surrounding muscles.

Muscle Imbalances: Weakness or tightness in the muscles supporting the thoracic spine can disrupt its natural alignment, contributing to discomfort.

Herniated Discs: Although less common in the thoracic region compared to the cervical or lumbar spine, herniated discs can still occur, leading to localised pain and potential nerve compression.

Overuse or Repetitive Movements: Activities involving frequent rotation or lifting can strain the thoracic spine, leading to pain and dysfunction over time.

How Physiotherapy Helps:
A skilled physiotherapist will conduct a thorough assessment to identify the root cause of your thoracic spine pain. This may include analysing your posture, muscle strength, and range of motion. Treatment techniques will include:/

Targeted Exercises: Physiotherapy involves tailored exercises to address muscle imbalances, strengthen supportive muscles, and improve posture. These exercises aim to restore proper alignment and alleviate pain. We love our back balls for this section of the spine as they are a great way to self-mobilise the spine at home between physio visits.

Manual Therapy: Hands-on techniques, such as massage and joint mobilisation, can help release tension in tight muscles and improve the mobility of the thoracic spine.

Posture Education: Your physiotherapist will provide guidance on maintaining good posture during daily activities and offer ergonomic advice to prevent future issues.

Pain Management: Physiotherapy may include modalities such as heat or ice therapy to manage pain and reduce inflammation in the affected area.

Thoracic spine pain is a condition where traditional physiotherapy techniques remain highly effective. Manual therapy and soft tissue therapy along with mobility exercises targeting the area will all help. We love treating this part of the spine as we can generally start to make a big difference in your pain quite quickly. If you have middle back pain, stop suffering, we are here to help.

Usually, in a short block of treatment across 2-4 weeks, we can see a significant improvement in your middle back pain.

Cervicogenic Headaches: Your headaches might be coming from your neck

Neck related headaches, often referred to as cervicogenic headaches, are quoted as accounting for up to 20% of all chronic headaches. There are certain factors that can increase the likelihood of suffering from cervicogenic headaches. Things such as previous neck injuries and trauma (eg. whiplash), occupational demands, and postural loads are all possible factors.

What are Cervicogenic Headaches?
Cervicogenic headaches are a distinct type of headache that originates from the neck or cervical spine. Unlike tension headaches or migraines, cervicogenic headaches are specifically linked to dysfunction or abnormalities in the neck. The pain is often felt on one side of the head and may be accompanied by neck pain or stiffness. The headache might also be triggered by movements of the neck.

How They Differ from Other Headaches:
Distinguishing cervicogenic headaches from other types is crucial for effective treatment. Tension headaches typically result from stress or muscle tension, while migraines are often associated with neurological factors. Cervicogenic headaches, on the other hand, stem from structural issues in the neck such as muscle imbalances, or joint dysfunction.

How Physiotherapy Helps:
Physiotherapy plays a pivotal role in alleviating cervicogenic headaches by addressing the underlying musculoskeletal causes. Physiotherapists employ a variety of techniques, including:

a. Manual Therapy: Hands-on techniques to manipulate and mobilise the neck joints, reducing pain and improving mobility.

b. Exercise Prescription: Tailored exercises to strengthen and stretch specific muscles, correcting imbalances and improving posture.

c. Posture Education: Educating patients on proper ergonomics and posture to prevent recurring issues.

d. Soft Tissue Mobilisation: Techniques such as massage or myofascial release to address tight or tense muscles in the neck.

How Long Patients Typically Take to Get Relief:
The duration for relief varies from patient to patient, depending on the severity of the condition, adherence to treatment plans, and individual response to therapy. Some patients experience significant improvement after a few sessions, while others may require a more extended period for lasting relief.

How to Prevent Headaches from Returning:
To prevent the recurrence of cervicogenic headaches, patients are encouraged to:

a. Follow Exercise Programs: Consistently engage in prescribed exercises to maintain neck strength and flexibility.

b. Adopt Healthy Habits: Incorporate proper posture and ergonomic practices in daily activities, especially during prolonged periods of sitting or working.

c. Manage Stress: Practise stress-reduction techniques such as meditation, deep breathing, or yoga to minimise tension-related triggers.

d. Regular Physiotherapy Check-ups: Periodic visits to a physiotherapist for assessment and adjustments can help identify and address potential issues before they escalate.

At Out of the Box Physio, we understand the impact cervicogenic headaches can have on your life. Through personalised physiotherapy interventions, we aim to not only relieve your immediate pain but also provide you with the tools to prevent future headaches. Take the first step towards a headache-free life by scheduling a consultation with our experienced physiotherapists. Your journey to lasting relief starts here.

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