Blog Posts

Heavy head or a Weak Neck?

22/11/2018

Neck pain from the musculoskeletal system (that’s our joints and muscles) is common affecting 70% of us in our lifetime and 50% of us in any one year. It is likely to reoccur. In summary neck pain is one of the leading causes of disability.⁽¹⁾ When this is examined more closely, we find pain changes the way the neck will coordinate head-support and movement in different ways.

First there is reduced endurance of the supportive neck muscles. They don’t activate and contract smoothly, they fatigue quickly leaving the neck joints (both facet and intervertebral disc joints) assuming more of the work load. As well as control loss, there is strength loss. Second, the joints stiffen become less flexible and are easily irritated. Thirdly head movement accuracy is affected, meaning when tested, a neck pain sufferer cannot look away and return to the same position.

Exercise is recognised in research trials and clinical guidelines as beneficial,⁽²⁾ but it is not a one size fits all approach. That’s because there are many kinds of musculoskeletal neck pain. For example neck pain from whiplash is different to that of a headache or migraine sufferer, and again different from the pain of age related changes. Combination pains do occur and on occasion the involvement of the nerve system can make neck pain more complex.

This highlights that neck pains can have different mechanisms of ignition and different mechanisms of being sustained.

Complexity doesn’t mean complicated

Physiotherapists deploy sophisticated examination tools to detect the mechanisms underlying the pain (or pains). Relying on a search for a crooked part in the neck alone can lead to the wrong decisions on diagnosis and treatment. With examination of the mechanisms of neck pain and an account for bodily structure is complete, we can then make a treatment plan to address these factors and the different kinds of neck pain present.

Treatment can include specific exercise, joint movements (manipulation) and lifestyle/ergonomic advice. There is growing evidence to support such an approach.⁽³⁾

References:
1. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. (2017). The Lancet, 390(10100). doi: 10.1016/s0140-6736(02)65865-9
2. Fredin, K., & Lorås, H. (2017). Manual therapy, exercise therapy or combined treatment in the management of adult neck pain – A systematic review and meta-analysis. Musculoskeletal Science And Practice, 31, 62-71. doi: 10.1016/j.msksp.2017.07.005
3. Falla, D., & Hodges, P. (2017). Individualized Exercise Interventions for Spinal Pain. Exercise And Sport Sciences Reviews, 45(2), 105-115. doi: 10.1249/jes.0000000000000103

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Running After ACL Reconstruction

13/11/2018

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As per our previous blog post we continue to explore the main challenges after an anterior cruciate ligament reconstruction (ACLR). Our recent posts discussed the pillars for excellent rehabilitation and this post aims to explore when individuals are ready to return to running after surgery.

Running is often noted as a major milestone for patients as it signifies the ability to move dynamically and work up a sweat. Although there are often strict instructions for this process it is quite a freeing experience for patients.

A great research piece published in the British Journal of Sports Medicine has reviewed the important elements to consider before returning to running. Not surprisingly the return to running should be individualised to every patient. Every person’s knee is different, some people do their rehab more than others and sometimes each surgery is quite different. Therefore the return to running should not be a blanket rule or a one size fits all approach.

Having said this, the research paper found that the average time for the return to running was 12 weeks and the authors commented that no universal timeline exists. BUT returning to running is not about the lapsing of a time period! Physiotherapists have strict criteria before running is commenced. This will include good lower limb muscle strength, patient completing regular rehabilitation, close to 100% knee range of motion, minimal pain and good dynamic knee control among other thing.

If you are unable to tick off each of the above areas running should not be a given just because the surgery was more than 12 weeks ago. Time doesn’t heal all wounds.

If you have any questions regarding the process of ACLR rehabilitation or are unsure of your running status get in touch with one of our physiotherapists here at PeakMSK Physiotherapy.

References:
Rambaud, A. J. M., Arden, C. L., Thoreux, P., Regnaux, J. & Edouard, P. (2018). Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review. British Journal of Sports Medicine, 52, 1437-1444.

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Your Nerves in Motion

9/11/2018

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Did you know nerves can be quite thick structures lying alongside muscles and tendons thorough the arms, legs and trunk? Over the weekend I will be lecturing and teaching my fellow physiotherapists about them for the Australian Physiotherapy Association. Treating nerves and the pains from them (neural mobilisation) is something that has interested me throughout my career, and the techniques were developed by Australian physiotherapists.

sliding gliding bending

These ‘peripheral’ nerves are like flexible telescopes that can coil up, stretch out, slip, slide and change their shape to adapt to movement. Their internal make up and architecture allows this amazing flexibility and adaptability. So what can go wrong?
Nerves transport messages but also a variety of substances to muscles, joints, skin and every organ in the body. They can also be a source of pain themselves, just like any other body part. When their health is altered by injury, pressure, lack of oxygen or inflammation, they become less tolerant to flexing and sensitive to movement and pressure.

How Physiotherapy Benefits

This scenario is seen in some musculoskeletal problems, such as sciatic (back and leg) pain, nerve root problems, carpal tunnel and tarsal tunnel. We can help by providing movement to unload or protect the nerve, relieve aggravation, progressing towards normal nerve sliding and recovery.

Systematic Review Research findings have shown efficacy in this for plantar heel pain, neck and low back / sciatic pain [1-2]. Other benefits have been associated with these techniques, but more research will be needed.

What do these techniques do? Aside from relief of pain, effects on swelling, inflammation and tenderness, there is a benefit on flexibility. Often what is felt by people as muscle tightness is actually the muscle tensing to protect the sensitive nerve. This may be a good thing but may suggest an unhealthy nerve that requires careful handling and treatment. Laboratory research findings suggest there may be positive anti-inflammatory effects as well and this is undergoing more research.

References:
[1] Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi A 2017 The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta- analysis. Journal of Orthopaedic and Sports Physical Therapy 47 (9): 593-615.
[2] Neto T, Freitas S, Marques M, Gomes, L, Andrade R 2018 Effects of lower body quadrant neural mobilisation in healthy and low back pain populations: a systematic review and meta-analysis. Musculoskeletal Science and Practice 27: 14-22.

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