What is this 5x50 Challenge I keep hearing about?

Have you overheard someone talking about the 5x50 Challenge? Has someone passed you a business card yet you don't know what it's about? Or are you fully signed up and raring to go on 9th September?

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With all this sport (dare we say the "O" word?!) going on at the moment, you may be feeling inspired to get fit, or at least motivated to put a little more exercise into your day. Well, that's where the 5x50 Challenge comes in. Starting on the 9th September this year, Kelly Mason and her team are hoping to encourage people all over the world (but particularly up in Glasgow!) to get out each day and walk, cycle, jog or run 5km (just over 3 miles).

First Class Physio has a team entered! Not competitively, but simply as a means of providing motivation and support in completing the 50 days. The benefits will be numerous but will include: increased endorphins (happy hormones - we could all do with a few of those!), weight loss (if you're consuming the same number of calories but using more up, you'll look fabulous in the run up to the Christmas period), healthier heart and lungs, reduced chance of Diabetes Type II (which is weight and diet related) and not to mention the kudos for meeting the challenge of exercising every day for 50 days!

Not only will you have the benefit of exercising every day, you'll also have the chance to support the group's Charity Partner. If every person entering gives £5 to register for the event, the charity will get a pretty hefty bonus in helping to change the lives of people across the UK and in some of the world's poorest countries.

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If you're concerned about your physical fitness before you start a challenge like this, speak to your GP or visit us in the clinic to sort out those niggles and pains before exercising.

And if you are interested in finding out more, or want to register to take part in the challenge, have a look at the website www.5x50.co.uk/take-the-challenge.

How will physiotherapy help you?

When you hear the word physiotherapy, what do you think of? A football match and the person running on with the bag to aid the stricken drama que... sorry, the injured player? The athletes at the Olympics and their fancy coloured tape? Or do you have personal experience of working with a physiotherapist, and know us more for working with people with disabilities, working with sports-men and -women to improve their fitness or helping injured people learn to walk again?

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Many of you lovely blog-readers will know, or know of, a physiotherapist, but not know much about what sorts of skills they have or how you could benefit from them. That's where this blog comes in!

Here are a few 'did you know' items about the physiotherapists at First Class Physiotherapy:

• We use movement, exercise, education and advice along with our own manual skills and banks of knowledge to help people manage their pain and other symptoms and prevent disease
• We can promote recovery from an injury to help you get back to full function (and back to work) as soon as possible
• We understand that injury or pain affects you as a person and we design a treatment program around what you expect, what is realistic and what is most beneficial for you
• We promote health not only through physical treatment but also advice on how to lose weight and give up smoking (amongst many other things!)
• We can help you stay relaxed as well as preventing injury by offering sports massage, Swedish massage and hot stones massage (all together now, aaaaaahh)
• We offer a mobile service to your workplace or home so that you don't have to take extra time out of your day to visit the clinic
• We can help you access physiotherapy through an insurer so that you don't have to pay up front

A typical patient we may see will have back pain (much like 60-80% of the population at some point in their lifetime) and will be wondering whether or not to see their GP. That's an excellent start, and will help you find the right pain medication if that is the route you'd like to take. The GP might then refer you on to a physiotherapist, and through the NHS in the Glasgow area, you could wait up to 6 months for an appointment. Hmm, that's quite a long time to be stuck with a sore back... Happily, your back pain will most likely have resolved by then.

Instead of waiting to find out if your pain does become chronic (in other words, if it lasts longer than 3 months), you could self-refer to see a physiotherapist.


That's where First Class Physiotherapy comes in! We're here to offer you an appointment - even before you see your GP - within 48 hours of you first contacting us. Even if it's just for advice or reassurance, if you are concerned about a pain, stiffness or weakness contact us today, and put yourself on the road to recovery. Then you'll have first hand experience of what a physiotherapist really does when she's not nursing the drama queens!

Whiplash (and how to cope with it)

At a networking event last week, I was asked if we see many patients with whiplash. I replied that we do, and it's one of the most common problems we treat in the clinic. Here is some information about how whiplash is caused and what you can do if you are suffering from WAD.

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Whiplash (or to give it its Sunday name: Whiplash Associated Disorder) can be a very debilitating disorder, but on a brighter note, is usually short-lived. The name "whiplash" refers to the mechanism of injury rather than the injury itself. Most of us associate it with car accidents, but in fact it is quite common for whiplash to be seen after contact sports injuries or falls - anything where the body is travelling at speed in one direction and then is suddenly stopped or rapidly thrown in the other direction, "whipping" the head as it goes.

This all sounds very painful.

The symptoms usually include inflammation (redness, heat, swelling, immobility and, yes indeed, pain) and bruising to the soft tissues and joints in the spine. These might include the cervical (neck) muscles, intervertebral discs and joints, the vertebrae (bones) themselves, nerves, ligaments and tendons. You might also feel stiffness in your neck, and muscle spasms around your neck, shoulders and into your arms.

Still more bad news to come, but don't worry, it gets happier soon...

You may also feel some stranger symptoms such as pins and needles, numbness or altered sensation in your arms and hands, along with dizziness or headaches. And it is not unusual for any of these symptoms to appear hours or even days after the accident or fall.

Ok, now for some reassurance.

Although you may be experiencing some or all of these symptoms, it is important to remember that no serious damage has been caused. It is most likely that these symptoms are caused by the neck not moving properly, and not by any permanent or serious damage.

Phew!

The symptoms may persist but the body has a natural ability to repair and restore itself. Bear in mind these tips for things that you can do to help speed up this process.

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Pain Relief

If you've seen your GP, you may already have been prescribed painkillers and anti-inflammatories (such as ibuprofen) and these can help you manage your pain in the first few weeks. You might also find that using an ice pack or heat pack can help alleviate some of the worst symptoms. One more thing: whiplash symptoms are generally worsened by tension so keeping your stress levels to a minimum and trying to relax your muscles can really help.

Posture

We physiotherapists do love to nag about posture, but seriously: maintaining good posture while sitting, driving and standing will support their muscles in their optimal position. If you sit at a desk or spend long periods in one position, try not to slouch and do take regular breaks. Performing gentle movements of your neck and shoulders will also help stop you from stiffening up.

Sleeping

It's really important to keep your head supported when you're sleeping - in other words, do not sleep without a pillow! Depending on your size and your sleeping position, the number of pillows you require will vary but remembering that your head should remain in line with the rest of your body will help you choose the right pillow set-up. If you sleep on your back, one pillow should support you, and if you sleep on your side, two pillows is usually right. The thickness and firmness of your pillows will also have an effect.

Exercise

Keep moving. It is important not to let your muscles stiffen up any more than they already have. The earlier you get things moving, the sooner the symptoms will settle. Try not to avoid too many activities (such as washing your hair, walking the dog) as early return to these can be helpful. Prolonged inactivity slows down recovery and may cause symptoms to worsen.

Some activities may involve pain but this is rarely harmful.

So, here are some simple exercises you can do to help alleviate your whiplash symptoms.

Neck retractions

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Sitting or standing in an upright position, pull your chin in as shown. Your head should not tip forwards or backwards, but should stay in a neutral position. You should feel a stretch up the back of your neck. Repeat 10 times.

Side flexion
Bend your head to one side, bringing your ear down towards your shoulder. You should feel a stretch on the opposite side of your neck. Hold for 5 seconds, the repeat on the other side.

Rotation
Turn your head to look over your shoulder. You should feel a stretch in the opposite side of your neck. Hold for 5 seconds, then repeat to the other side.

Each of these exercises is meant to be undertaken after you have sought medical advice, and along with physiotherapy treatment. If you are suffering from whiplash, contact us now on 01412372721 to book an appointment or to take advantage of one of our free 15 minute consulations.

ACL Injuries - just in time for Euro 2012!

Quite a few people have been asking about specific injuries and with Euro 2012 heating up we’ve decided to cover injuries to the knee – specifically the anterior cruciate ligament (ACL), a “favourite” with footballers.

The knee joint is the largest joint in the body, and is made up of: 4 bones (the femur [thigh bone], patella [knee cap], tibia and fibula [your shin bones]), an extensive network of ligaments and muscles, menisci (that’s the cartilage) and bursae (for shock-absorption). Just for clarification, your knee joint should be able to flex (bend) and extend (straighten) and have a small degree of rotation.

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The ligaments provide the joint stability, sort of like straps holding the bones together. Around the knee there are 4 ligaments – one at each side (the collaterals), and 2 inside the knee (the cruciates), each having a specific role in joining the femur to the tibia and fibula, and stabilising the knee while it bends and straightens.

If one of these ligaments is over-stretched or injured, the knee will become less stable. Ask most sports people and they’ll tell you that the most frequently injured ligament is the anterior cruciate ligament (ACL). Its purpose is to limit rotation and the forward movement of the tibia, so the most common way to injure this ligament is by twisting the knee.

If this happens, your physiotherapist will ask you questions (we love questions) and then examine you in order to classify a sprain as one of 3 grades depending on the extent of the damage. You can expect to experience corresponding symptoms. 

• A grade I sprain is where some of the fibres are damaged, and you'll likely feel some pain in the area as well as local swelling and inflammation. 
• A grade II sprain is when there is more extensive damage to the fibres. You'll feel moderate pain and moderate joint swelling (this is termed effusion). 
• Finally, a grade III sprain is a complete rupture to the ligament - in other words where the ligament has snapped. There is immediate pain and swelling, and you may also hear the knee ‘pop’.

Sometimes an X-ray is taken to rule out any associated broken bones and the use of MRI scan can be used to identify the soft tissue injury and ascertain whether any other structures have been affected.

When the swelling settles the most common symptom with grade II and III sprains is joint instability. You might not experience any symptoms when moving in a straight line, however, twisting or turning on the affected leg may cause the knee joint may give way or buckle.

After an ACL injury, some people may be able to return to normal activities following a period of physiotherapy to help strengthen the muscles around the joint - these act as the joint stabilisers to "lighten the load" of the ligaments. However, there is an increased risk of re-injury. Others, especially those who participate in regular sporting activities which require them to twist and turn or those who have sustained other soft tissue injuries may require an operation to ‘repair’ the damaged ligament.

The ligament itself can sometimes heal or be stitched together, however, in most cases an ACL reconstruction is the only option. This involves using a tendon (connective tissue which joins muscle to bone) to make a new ACL (more about which ones in a second). Your consultant will normally wait until the swelling has settled and the knee has regained full range of movement before carrying out any surgery, so physiotherapy can be beneficial to help with this.

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The operation is a quick key-hole procedure, usually completed at a day surgery and most often involves the use of your own tendons as the graft material. The two common tendons used are the hamstring tendon or the quadriceps tendon (the muscles at the back and front of your thigh respectively), and this is based on the surgeon’s preference. The tendon that has been removed will re-grow over time but during this process the other tendons perform the work required.

Following the operation your wound will be covered with a bandage or tubigrip, and you'll need crutches to help you get about (plenty of scope for gleaning some sympathy!) A physiotherapist will be involved immediately following your operation and your rehabilitation will start right away.

In the early stages the main aims are to reduce the swelling and regain full movement of the joint. You can expect to ditch the crutches after 2-3 weeks, and get back to driving after about a month (but do make sure that you are able to perform an emergency stop safely and without pain before returning to the roads). 

The type of work you do will affect when you are able to return to work. If you have a sedentary job then you will be probably be back behind your desk about a month after the operation. If you perform manual work it will be more like 3 months before you can return to work. You could take up cycling (on a static bike) and jogging (on a treadmill) about 2-3 months post-op, and your physiotherapist will create a strengthening programme specifically for you as the graft begins to heal, the swelling goes down and your knee begins to move more freely.

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It is important to note that the graft is at its weakest in the first 10 weeks or so, just when you're starting to feel great, so don't push it! Unfortunately for all you sporty people, the return to your twisting and turning sports isn't recommended until at least 7 months post-op.

If you think you have injured your ACL, or you have knee problems in general, talk to your physiotherapist or GP for advice. Until then, enjoy Euro 2012!

Clicking Joints - Is It Normal?!

Whilst writing this post I've been discussing it with patients and friends and it seems we all have stories about our joints that click! My personal party piece is a clicking temporomandibular (jaw) joint, and in the clinic Physio Rachel has "clicky hips".

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If the definition for "normal" is something which the majority of people agree to having, then clicking joints are indeed normal. But what causes them?

Well, there are 3 main theories about the reasons for joints cracking and clunking away. The first is bubbles of nitrogen being present in the fluid inside a joint and smaller "crackles" can sometimes be attributed to this.

Louder "popping" noises are usually due to bones rubbing and sticking together as we begin a movement and then release with a "pop" as the friction is released and the bones move independently.

Take the thigh bone and knee cap (the femur and patella) for example. When you begin to bend your knee, the patella is pulled upwards (within the quadriceps tendon - more about this in a second) in a groove in the femur. It should move smoothly, however it often moves up the side of the groove as the tendon stretches. Then, as the pressure is increased (the further you bend your knee) it "pops" back into place in the groove.

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Almost everyone I speak to reports clicking in their neck when they turn their head. This is most likely caused by the same sort of “rub and release” as described in the knee, it’s just that the joints in the neck are much smaller, so the sounds are more crackly than clunky.

Usually no damage is done, and the popping causes no harm whatsoever. It can be a little uncomfortable as the structures are stretched, but unless the muscles are very weak or damaged there is little chance of something like a dislocation occurring.

Repeated clicking can sometimes irritate the joint and in order to provide less friction and more shock absorption, the joint fills with extra fluid. This can be inside the joint capsule itself, or into fluid-filled cushions called bursae. Very occasionally with persistent painful cracking of the knee, your GP or physiotherapist might diagnose chondromalacia (or “runner’s knee”), which is irritation of the cartilage on the underside of the patella.

For those of us who love to crack our knuckles (I have to say I'm not one!) there is a very persistent rumour that this leads to larger joints or arthritis, though this is largely untrue. The name given to this kind of popping joint is usually “fixation”. Here's why...

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Most of the joints of the body have two congruent parts, and because one fits so well onto the other, it’s possible for them to “stick” together. This usually happens in joints that have not been moved in a while (like the joints in your spine and neck, or your knuckles). When this happens, the fluid in the joint space creates a vacuum and sucks the two congruent parts together (kind of like the vacuum you’d see if you had two panes of glass stuck together with a film of water in between).

The popping sound in this case, and especially with the knuckles, is the vacuum being released.

The last reason for joints clicking is weakness in muscles which can slacken the tension of tendons crossing your joints, or cause the tendon to cross that joint at a slightly different angle. This means that the bones may meet at the joint at a slightly different angle to normal. So for instance, in the shoulder, if you hear a click when you lift your arm, this is probably due to the joint being in a slightly different position to normal to begin with, then clicking into place as you move and the weaker muscles tighten and correct the position.

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There are obviously a few anomalies with clicking joints too. With regards to the temporomandibular joint, "clicky jaws" are sometimes due to the lower jaw not being far enough forward in the joint.  This can be corrected with a splint but only if the joint is very painful in the first place (in which case, visit your GP or dentist!) 

Clicking thumb joints can sometimes be attributed to a sesamoid bone being present. This is a small bone nestled inside the joint capsule or tendon (interesting fact coming up! The patella, or knee cap, is a sesamoid bone. It is embedded inside the tendon of quadriceps on the front of your thigh). Sesamoid bones are really very rare in thumbs though.  

The upshot here is: unless your joints click persistently with small movements and/or they are painful and swollen, they are probably healthy. And since almost everyone clicks at some point, we must be normal, hurray!

Repetitive Strain Injuries

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Repetitive strain injuries (or RSIs) are exactly that: strain that is caused by doing something over and over again the same way. It has a lot of other fancy names too (upper limb disorders, occupational overuse syndrome, isometric contraction myopathy - eek!) but for now, we'll stick with RSI since it's descriptive enough.

RSIs are the most common form of work-related injury and can be found in people who work in manual or office based jobs - in other words, pretty much everyone. The muscles of the fingers, wrists, hands, arms and shoulders are the ones we're going to talk about.

Imagine you work at a checkout, and you spend all day sitting down twisting from left to right while you swing shopping across the scanner. This is the definition of repetitive, and you can imagine how tired and sore your back and arms would be. What do you mean, this won't apply to you as you work in an office?

Okay, imagine you work at a desk (I'm guessing this will be a lot easier to imagine for the majority of people reading), and rather than the constant movement from left to right that our checkout worker has, you now seem to be mostly maintaining a static posture, with only your arms moving as you type or write.

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Hmm, sounds familiar, doesn't it?

The body is extremely good at protecting and repairing itself, but if we spend hours making the same repetitive movements, this healing is not able to keep up with the small amounts of damage we do over and over again. It may take months or even years for the symptoms to show: these can be a slight ache which develops into pain over time, along with numbness and pins and needles in the upper limbs.

If you are feeling any of these, there are a few things you can do to help:

• It might sound silly but a warm up and cool down of the muscles used can work wonders - stretching and changing positions through lots of short breaks will really help (e.g. stand up to take a phone call)
• Make sure your seating position is optimum (see our earlier post on posture) and that you make good use of equipment designed to make your work more comfortable
• Make sure you have some time to relax throughout the day - there is nothing like a stress-busting few minutes of calm to ease aches and pains
• A genius, if not very obvious, piece of advice is make sure your clothes fit well so you can move freely (anything that constricts you stops your muscles warming up and makes it difficult to reach for things)

  

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• Speaking of reaching: do have most things within easy reach like the mouse and keyboard
• If you use the phone a lot throughout the day, do obtain a headset rather than wedging the phone between your ear and shoulder

If the symptoms are worsening, then try to rest the area affected. Painkillers and anti-inflammatories may help, along with heat or cold packs to reduce the sensation of pain.

If you must continue the tasks which cause your pain, you might find supports like wrist splints useful.

Ask a physiotherapist for more advice on pain relief, exercise and how to avoid a recurrence of your symptoms.

Referred Pain

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Many of you will have heard of referred pain, especially those who have seen a physiotherapist or their GP about back or neck pain, but what do we mean by "referred pain"? Is it pain that someone else has recommended to me? Pain which is passed on to somewhere else?

Thankfully, not the former. The latter is pretty close.

Referred pain is pain which is felt in a location other than the actual area of injury. So for example, people with sciatica most likely have pinched nerve roots in their lower backs but frequently feel horrible hot or shooting pains in their buttocks and thighs. Sometimes right down into their feet. It's not the thigh, or the foot that is injured, but the nerve itself, which then sends on these "pain" messages along its length (how very kind of it).

Nerves are like the electric wires of our body, and they connect our brain and spinal cord (our central nervous system) to the rest of our body. For instance if you want to wave to Jean over there, your brain will "tell" your hand to move by passing an electric signal down the spinal cord to the shoulder, arm and hand which will then activate your muscles to move.

Similarly, when you touch something cold or hot, or when you hold something solid or soft, your nerves pick up that message and send it up to your brain to interpret the sensation. 

We covered a fair bit of anatomy in the last post (scroll down to The Demon Back Pain for more information...) so we have a better idea of how the nerves leave the spinal column in neat spaces between the vertebrae. If the spaces become narrow, the nerves are pinched or "impinged". Likewise, the impingement can happen if you have extra tension along the nerve pathway (you see, nerves don't just travel on a path between things to get to their destination, they weave in and out, they branch off and they reach almost every structure in your body).

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As soon as the nerve picks up this impingement, the messages which it sends to the brain become confused. Instead of a perceiving a pinching at the neck or in the lower back, the electric signals are passed outwards from the spinal column (so into your shoulder or arm, or into your thigh or calf) where they can be misinterpreted as pain, or tingling or even numbness. If the messages being carried back down the nerve to power the muscles are confused, sometimes the problem becomes a weakness in those muscles.

A physiotherapist will determine where the referred pain is coming from as he/she will know which nerves come out from the spinal column in each space and which structures they supply.

Once this has been determined (by testing your sensation and the power of specific muscles) we can use manual therapy to help alleviate the pain, and give you exercises to help widen the spaces and help resolve the impingment. Happy days all round!