Peak MSK Blog

Do you suffer from Hip pain?

29/11/2019

Do you suffer from Hip pain?

Hip pain and soreness around the hip joint are amongst the more common problems that patients see physiotherapists about. Difficulty lying on the hip, crossing the legs or even standing too long or getting out of the chair can be a hefty and painful task for those that suffer from hip pain. The pain can also be present during the night, making sleep difficult. Other regional hip joint and back joint conditions need consideration, however there are key features in the assessment that direct physiotherapists to look more closely at the tendons of the hip joint.

The primary causes of hip pain are recognised as hip tendon overload injury (tendonopathy), hip joint or low back joint issues. It is the most prevalent lower limb tendon overuse injury and also the most debilitating. It is often associated with hip bursitis, however research1 suggests the bursa (helps to reduce the friction between two moving tendons) is only sometimes inflamed and if so, then it is a component of the overall problem.

There are 2 essential steps to managing lateral hip pain

1. Reduce excessive load (compression) on the hip tendons

Stand evenly: avoid standing with most weight on one leg (“hanging on one hip”);
Sit without crossing the legs;
Avoid sitting on seats which are too low;
When lying on the side, place a large and firm pillow between the legs to avoid the affected leg dropping down towards the other leg.
Modify load such as reducing or avoiding hills;
It is important to continue to exercise if able, unless severe symptoms when a short break from exercise may be necessary.

2. Increase the tendons capacity for load

Exercise –The exercises are started in side-lying and progressed to standing to improve postural control, movement patterns and strength in standing, sit to stand, single leg stand, squats, climbing steps and running.

References
1. Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H., & Vicenzino, B. (2015). Gluteal tendinopathy: A review of mechanisms, assessment and management. Sports Medicine, 45, 1108.

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Shoulder Impingement? Learn How to Get Rid of Pain Fast!

19/11/2019

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The shoulder is a very complex joint that is one of the most mobile joints in the human body, at the cost of joint stability. One of the most common issues that clients present is a shoulder impingement. A shoulder impingement is typically identified by pain in the shoulder when you raise your arm over your head, swelling, tenderness, night pain especially when lying on the affected shoulder and possibly an aching pain at rest⁽¹⁾. Here are some tips on how to get rid of that annoying shoulder pain for good.

Tip 1: Avoid Aggravating Activities

How can you expect your shoulder to get better if you keep exposing it the activities that make it worse? It may sound really straight-forward, but many people get this first simple step wrong. The body cannot heal itself if you don’t allow enough time for it to do so. Avoid aggravating positions such as overhead movements, lifting and sleeping on the painful shoulder. We call this controlling the load and is a good first rehab step.

What to do instead? Try to use the non-affected shoulder to perform overhead and other aggravating activities. When you do use your affected shoulder, try to keep your elbows pointing towards the ground and close to the side of your body.

Tip 2: Build scapula stability

The scapula is frequently referred to as the shoulder blade and plays an important role in stabilising the shoulder. A common postural presentation in people presenting with a shoulder impingement is a rounded shoulder and forward head position. This posture causes problems at the shoulder as it decreases the sub-acromial space, which is the space where the rotator cuff tendons pass through⁽¹⁾. As the space gets smaller, this compresses the rotator cuff tendons causing pain when you elevate your arm. Over time, tendons poorly tolerate being compressed, but they like being strengthened.

What to do instead? Try to be mindful of your posture and ensure your shoulders don’t roll forwards. Shoulder retraction exercises are very helpful at correcting scapula position and enhancing posture. Taping can also help to get the shoulders back and improve posture. Click on the link below to see a demonstration of an effective exercise to build scapula stability.

Tip 3: Strengthen Rotator Cuff Muscles

People with shoulder impingements commonly present with weakness in their rotator cuff muscles⁽¹⁾. The Rotator Cuff muscles incorporate four distinct muscles at the shoulder and their tendons, which provide strength and stability during motion to the shoulder complex. Rotator cuff strengthening exercises are important at restoring muscle balance/ratios and preventing muscle wasting⁽¹⁾. Click on the link below to see a demonstration of an effective exercise to strengthen rotator cuff muscles.

Link to Video:
https://www.facebook.com/PeakMSKPhysio/videos/2440261592903338/

References
1. Cools, A. 2014. Br J Sports Med: 692-7

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Temporomandibular Disorder

9/11/2019

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The hinge joint between the jaw and head is unique, allowing the hinge opening action to be combined with sliding in any direction. This is because the Temporomandibular Joint (TMJ) has a tiny disc inside the hinge. The jaw rotates on the disc (hinge action) and the disc slides the jaw forward or sideward (glide action). Try chewing something to understand this. It is a fascinating part of the body. Here is a picture.

This part of your body is important for eating, breathing, talking and social expression. Problems occur with limited opening, painful clicking on opening or difficulty to chew food. Have you or are you suffering from pain and stiffness in your face, jaw, temple or in front of your ear in the last month? Or your hearing feels odd or echo-like? You probably have a problem with this area of your face. We call these Temporomandibular Disorders (TMD).

TMDs are very common, with estimates of anywhere from 40-75% of the population suffering at some time, of which only about 10% of sufferers seek help. About 40% will resolve over time. The remainder need help.

Flores 2016

Physiotherapy is key to many in recovery. The neck is intimately related biomechanically to the jaw. To understand this, think of the head and neck as an upside down pendulum. A complex neural network of muscles and control systems guide head, neck and jaw rest position.⁽¹⁾⁽²⁾⁽³⁾ Head neck position can even alter elevation of the larynx and can influence voice.⁽⁴⁾

Research demonstrates that TMD sufferers are more likely to have altered neck/jaw posture, restricted neck movement, as well as altered TMJ motion.⁽⁵⁾⁽⁶⁾

Physiotherapy treatment focuses on manual treatment to eliminate painful clicks, restore joint gliding and muscle memory (jaw and neck muscle motor control and strength). Education on the condition, self-care, lifestyle and ergonomic factors are important. Every patient journey is different as TMD is a broad term which covers problems of muscles, or joints, the joint disc or a combination of all three. There are always simple self-care solutions we ask people to follow, particularly regarding jaw and mouth bracing, tightening or chewing during the day. We call these parafunctions, increased mouth activity when nothing is in the mouth. The muscles work too much and the TMJ is repetitively and needlessly compressed, which can cause issues.

Physiotherapy treatments are shown to improve mouth opening and reduce pain in several research trials.⁽⁷⁾⁽⁸⁾⁽⁹⁾

Time to smile!