Plantar Fasciitis

Have you recently noticed a sharp, burning or stabbing pain into the bottom of your foot/heel? Are you noticing it is most uncomfortable when you first get out of bed and walk to the kitchen? If so, you could be suffering from a common inflammatory condition known as plantar fasciitis (pronounced plantar fas-ci-i-tis).

The main symptom associated with plantar fasciitis is pain experienced first thing in the morning, following prolonged periods of rest or sedentary positions and also after extended periods of exercise or standing. Pain is usually located in the heel and arch of the foot, but can occasionally be located into the ball of the foot as well.

The plantar fascia is the thick fibrous tissue on the underside of the foot, starting from the calcaneus (heel bone) and connects along the sole to the ball of your foot. It acts like a rubber band by stretching and contracting as you walk. The plantar fascia can be put under quite a bit of force, particularly when participating in activities with running or jumping movement.

Plantar fasciitis is diagnosed when this soft tissue is inflamed.  This can occur following an acute injury, however it most commonly develops due to overuse.

Factors of overuse plantar fasciitis include:

  • A sudden increase in activity/exercise load
  • Weight gain
  • Poor footwear
  • Poor biomechanics (excessive pronation)

Physiotherapy treatment usually involves initially reducing pain and inflammation. This is done through activity modification, footwear advice and using manual therapy such as soft tissue massage, ultrasound and strapping the arch of the foot.

Our physiotherapists can provide a graded exercise program focusing on stretching and strengthening the soft tissue of the foot and surrounding musculature. Our physiotherapists can also assist in prescribing arch supporting orthotics, if they believe this is indicated.

All of our physiotherapists are skilled in diagnosing and treating plantar fasciitis.  If you have been suffering with this condition and would like some help, don’t hesitate to contact any of our Berwick, Pakenham Lakeside or Clyde North physiotherapy clinics to book an appointment.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a condition involving compression of the median nerve the nerve that runs down the inside of the forearm into the palm side of the wrist (pictured below).

CTS is most common in females aged between 40-60 years old and individuals with diabetes mellitus other risk factors for are:

  • Overloading the wrist and/or fingers
  • Previous wrist fracture or injury
  • Pregnancy
  • Arthritis

CTS is characterised by gradual onset of pain into the palm side of the wrist and numbness or paraesthesia (tingling or pins and needles) into the thumb, index finger, middle finger and the inner half of the ring finger (pictured below).

It is also quite common to experience either tingling or pins and needles at night as a result of carpal tunnel. As well as having pain into the wrist and hand it can also radiate to the forearm, elbow and shoulder.

Individuals with CTS usually present with difficulty or pain with gripping activities like holding a phone, opening a door or opening a jar. Patients may find relief from symptoms by flicking or shaking the hand.

As the condition progresses individuals may report burning like pain and numbness and paraesthesia symptoms may become constant.

Examination by a physiotherapist in which they can complete CTS specific tests to determine if carpal tunnel is the cause of your wrist pain. Nerve conduction tests can also be used in confirming the diagnosis of CTS and if surgery is required.

Treatment initially focuses on de-loading the wrist by:

  • Avoiding aggravating activities
  • Resting the wrist and taking more breaks if your job relies heavily on your hands
  • Applying ice to reduce swelling
  • Wearing a wrist brace or night splinting

Physiotherapy treatment focuses on manual therapy and exercises to assist with improvement of nerve flexibility, wrist and hand strengthening exercises are also a focus of treatment.

Medical treatment involves the use of non-steroidal anti-inflammatory drugs (NSAIDs) as a conservative option. If wrist pain and nerve symptoms do not improve from this a corticosteroid injection can be administered and may provide temporary relief. But if pain and nerve symptoms persist, surgery may be required to help release the compressed median nerve.

If you have wrist pain and any of these symptoms sound familiar please contact our clinics at Pakenham lakeside and Berwick Physiotherapy for a assessment with on of our physiotherapists.

References:  Brukner, P. (2017). Brukner & Khan’s clinical sports medicine. (5th Edition) North Ryde: McGraw-Hill.  Genova, A., Dix, O., Saefan, A., Thakur, M., & Hassan, A. (2020). Carpal tunnel syndrome: a review of literature. Cureus12(3).  Chesterton, L. S., Blagojevic-Bucknall, M., Burton, C., Dziedzic, K. S., Davenport, G., Jowett, S. M., … & Roddy, E. (2018). The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. The Lancet392(10156), 1423-1433.  Bobowik, P. Ż. (2019). Effectiveness of physiotherapy in carpal tunnel syndrome (CTS). Postępy Rehabilitacji, 2019(2), 47-58. doi:10.5114/areh.2019.8502

 

Frozen Shoulder

Have you noticed of late a gradual increase of stiffness and/or pain in your shoulder, sometimes without any obvious mechanism of injury? Wondering why on earth lying on one side of your body at night is agony, and basic tasks like getting dressed or hanging the washing on the line are getting harder and harder?

Frozen Shoulder, referred to as Adhesive Capsulitis, is a condition characterised by painful and/or restricted shoulder movement [1]. The condition involves the shoulder capsule (strong band of ligaments that surround our shoulder joint) becoming thickened and suffering contracture. There is currently some debate over whether the condition is due to inflammation, fibrosis of the capsule, or both [2].

Whilst most cases of Frozen Shoulder are idiopathic (no known cause), cases of Frozen Shoulder can be seen more commonly in people with type 2 diabetes, thyroid disorders, those who have had recently been immobilised after shoulder surgery or have suffered a recent traumatic fall, recent stroke and cancer sufferers, as well as a previous history of Dupuytren’s contracture [3, 4].

The condition is far more common in those over the age of 40, with the most common age group being 40-60 year olds. In addition, Women are more likely than Men to suffer the condition [5].

There are three main stages of Frozen Shoulder, being:

  • Freezing – The ‘Freezing’ stage or ‘Pain over Stiffness’ is usually characterised by sharp pain with movement in the shoulder joint, with progressively worsening movement.
  • Frozen – This phase, also known as the ‘Stiffness over Pain’ phase where pain may diminish, however stiffness usually plateaus or could get slightly worse.
  • Thawing – This final phase involves the progressive increase of movement and reduction of pain [6].

In all the condition generally lasts for between 9-18 months, but can last from 5-24 months [6]. Diagnosis is usually formed by a mixture of symptoms, physical range and strength assessment and imaging [7,8].

Treatment for Frozen Shoulder in our clinic can vary but can involve gentle range, stretching and strengthening exercises, complimented by joint mobilisations and soft tissue release.

Common exercises for adhesive capsulitis include pendular movements, crawling hands up the wall, doorframe and child’s pose stretch, and the use of shoulder pulleys, to gently encourage further range in the affected shoulder by using the non-affected shoulder.

In addition to this, we have seen some success in pain and movement improvements with a short course of prednisolone (oral cortisone). In more severe cases, treatment options can include both corticosteroid injections into the shoulder, or a hydro-dilatation, which is where a combination of saline and cortisone is injected into the capsule in order to distend it, and ‘break’ the contractures in the capsule [9]. Research has shown that initial conservative treatments such as these can be effective in 90% of patients, without the need for surgical intervention [9].

Whilst Frozen Shoulder is at times a scary and frustrating condition, with effective and efficient physiotherapy your symptoms can be managed well, and our physios are extremely well placed to guide you through this. If you think the above condition sounds like you, be sure to come down and see one of our expert therapists for an assessment ASAP!

References:  [1] Dias R, Cutts S, Massoud S. Frozen shoulder. Bmj. 2005 Dec 15;331(7530):1453-6;  [2] Cho CH, Song KS, Kim BS, Kim DH, Lho YM. Biological aspect of pathophysiology for frozen shoulder. BioMed research international. 2018 May 24;2018; [3] Mezian K, Chang KV. Frozen Shoulder. StatPearls [Internet]. 2019 Feb 25; [4] Whelton C, Peach CA. Review of diabetic frozen shoulder. European Journal of Orthopaedic Surgery & Traumatology. 2018 Apr;28(3):363-71; [5] Uppal HS, Evans JP, Smith C. Frozen shoulder: a systematic review of therapeutic options. World journal of orthopedics. 2015 Mar 18;6(2):263; [6] Chan HB, Pua PY, How CH. Physical therapy in the management of frozen shoulder. Singapore medical journal. 2017 Dec;58(12):685;  [7] Kelley MJ, Shaffer MA, Kuhn JE, Michener LA, Seitz AL, Uhl TL, Godges JJ, McClure PW, Altman RD, Davenport T, Davies GJ. Shoulder pain and mobility deficits: adhesive capsulitis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Orthopaedic Section of the American Physical Therapy Association. Journal of orthopaedic & sports physical therapy. 2013 May;43(5):A1-31;  [8] Li JQ, Tang KL, Wang J, Li QY, Xu HT, Yang HF, Tan LW, Liu KJ, Zhang SX. MRI findings for frozen shoulder evaluation: is the thickness of the coracohumeral ligament a valuable diagnostic tool?. PLoS One. 2011 Dec 7;6(12):e28704;  [9] Cho CH, Bae KC, Kim DH. Treatment strategy for frozen shoulder. Clinics in orthopedic surgery. 2019 Sep;11(3):249.

 

Osgood-Schlatter Disease

You may know someone who has experienced anterior knee pain when growing up or may have experienced it yourself. It’s common to hear that this pain is simply ‘growing pains’, but what exactly is the cause for this?

Osgood-Schlatter disease is a condition that affects adolescents who are experiencing a growth spurt and are quite active individuals. This condition is an inflammation of the bone at the top of the tibia (shin bone), which is the attachment site for the patella tendon.

The main symptom experienced is pain when exercising. The location of pain is common across the bony prominence just below the patella (knee cap), known as the tibial tuberosity. Pain is caused by a repetitive strain during exercise/activity from the quadriceps muscle and patella tendon. Swelling, redness and the development of a ‘bump’ can also occur.

Osgood-Schlatter disease is most prevalent in boys aged 11-15 years old, however, it can affect girls who are physically active aged 8-13 years old.

Initial Physiotherapy treatment usually involves manual therapy techniques such as soft tissue massage, heat and/ or ultrasound to reduce muscle tightness in the quadriceps. This aims to reduce the amount of load placed on the patella tendon. Patella tendon taping can also be effectively used to de-load the tendon and reduce pain, swelling and inflammation of the area.

A physiotherapist can then implement an exercise program focusing on muscle stretching, strengthening and activity modification.

This condition may come and go for a period of 12-24 months as the child is still going through an active growth spurt. However, Physiotherapy intervention can assist in managing this appropriately.

Our team of physiotherapists are skilled in diagnosing and treating Osgood-Schlatter disease effectively. If you or someone you know have been suffering with this condition and would like some help, don’t hesitate to contact any of our Berwick, Pakenham Lakeside or Clyde North physiotherapy clinics to book an appointment.

Femoracetabular Impingement

Femoroacetabular Impingement (FAI) is a hip and groin pain condition common in younger, athletic populations, particularly prevalent in the 18 to 35 year old age group [1].

This disorder is caused by premature contact of the acetabulum (hip socket) with the proximal head and neck (the ball of our hip) of the femur during certain movements [2]. FAI is generally characterised by deep seated, intermittent discomfort in the hip and groin areas, which can present as both a deep ache during and after activity, and occasionally a sharper pain in more aggravating positions such as sitting cross legged or when changing direction [3]. The condition is more common in sports or activities that require quick and repeated acceleration [4]. In addition to this primary symptom, pain can also be felt in the buttock, back and anterior thigh [3].

FAI has three main types of presentation, these being:

CAM Morphology

Where the neck of the femur (thigh bone) loses its round contour and thus loses its ability to rotate smoothly inside of the hip socket. This extra bone then abuts the socket on movement. CAM is move common in male patients [5].

Pincer Morphology

Where the rim of the socket extends out over its normal limits, and this ‘overcoverage’ of the socket leads to impingement on movement. This is more common in women [6].

Combined Morphology

A combination of both pincer and CAM morphologies. This was thought to be quite common but a recent longitudinal cohort study found only 2% of subjects had the combined morphology [5].

Physiotherapy assessment of FAI generally revolves around assessment of patients’ hip range of motion, strength of hip musculature and single leg balance. Individuals with FAI usually have a loss of hip abductor strength, hip rotators, as well as pain on a squeeze test of their hip adductors [1, 7]. In addition, reduced ranges of motion in the hip, particularly in hip flexion and internal rotation are common [8].

According to the Warwick Statement of 2016, for FAI to be confidently diagnosed there must be present symptoms and positive clinical signs as outlined above, as well as a positive radiological finding, so your physio may send you for an X-ray to confirm diagnosis [3].

As with any presenting condition, FAI treatment must be tailored to the individual’s own unique characteristics and the demands of their chosen pursuit. Physiotherapy aims to help you continue doing what you love!

De Quervain’s Disease

What is De Quervain’s disease? This is a type of tenosynovitis in the wrist which is very common.

De Quervain’s tenosynovitis is an overload injury of tendons in the thumb. The two tendons that straighten the thumb travel through a tunnel (extensor retinaculum) in the wrist. Thickening or breakdown of these tendons can cause difficulty and pain when gliding through the tunnel. It is caused by repetitive and continuous strain of these tendons under the extensor retinaculum at the back (dorsal side) of the wrist.

Symptoms include pain at the base of the thumb which is exacerbated by movements of the wrist and thumb. Other symptoms can also include a burning sensation in the hand and swelling of the wrist. Pain is often made worse with activities that require turning the wrist away from the thumb (ulnar deviation) and gripping. De Quervain’s typically occurs in 30-50 years old females, new mothers, and manual workers. It is also more typically seen in the winter months.

De Quervain’s will begin gradually when starting a new activity or having a change in your normal routine. Provoking activities will slowly worsen symptoms and eventually you will get pain with most activities involving the hands. It is quite common for De Quervain’s tenosynovitis to affect both hands simultaneously.

One test for confirming De Quervain’s tenosynovitis is the Finkelstein’s test. It involves bending your thumb across your hand in a gripped position and turning the wrist away from the thumb. Pain along the base of the thumb, into the wrist and forearm is a positive result and is a strong indicator of De Quervain’s.

Physiotherapy treatment for De Quervain’s tenosynovitis can include ultrasound, massage, exercise, or splinting. Treatment will initially revolve around pain reduction and management. Once pain or other symptoms have resolved you will be prescribed exercises to gradually strengthen your thumbs to withstand load.

Physiotherapy management for De Quervain’s tenosynovitis is often successful in most cases. Sometimes further management including steroid injections or even surgery may be indicated but is quite rare.

All our physiotherapists can diagnose and treat De Quervain’s tenosynovitis. Should you have an issue in this area and need assistance, please don’t hesitate to contact either Berwick, Pakenham Lakeside or Clyde North Physiotherapy clinics to book in your next appointment.

Single Knee Bends

In this short video Chris explains how a simple movement such as standing single knee bend can tell a lot about someone’s biomechanics and potential issues that might be contributing or causing an injury. Chris is a little shy so no amount of asking nicely would get him on camera.

Adductor Strengthening Exercises – with Sejin An

Adductor strains are common on the sports field and in the work place. Often it can be due to an imbalance or weakness of the adductor muscles on the inside of the leg. In this short video, Se-Jin shows some easy progressive exercises to build strength in the adductor muscles.

Lower Limb Strength – with Nathaniel Martin

In this video, Nathaniel shows us some variations to improve lower limb strength and build some functional strength for the pre season to help with running. It is very important to work on different positions of strength to improve control and function to maximise performance on the sports field and reduce the risk of injury.