All posts in Headache

The big toe is a critical part of the forefoot that allows us to walk, run, climb and balance.  It bears more weight than any of the other toes and plays a very important role in propulsion.

The base of the big toe is made up of a joint between the metatarsal and phalanges (toe) bones.  One disorder affecting this joint is a condition called Hallux Rigidus.

Hallus Rigidus is a degenerative condition mostly seen in middle age.  As the name suggests stiffness and pain are the major signs of this condition.  Sufferers find that both the stiffness and pain restrict any activity involving movement at the big toe.  Walking, running, squatting and climbing may get progressively more difficult as the condition progresses.

The most common cause of Hallus Rigidus is osteoarthritic change in the joint.  Poor foot biomechanics, previous joint trauma and family history may be some of the factors involved in its development.

In normal walking the big toe must extend prior to push off to assist with propulsion of the foot.  In the presence of Hallux Rigidus this is not possible affecting the efficiency of foot function and a shortening of the stride length.  As the degeneration progresses the joint will stiffen further and bony thickening around the joint margins may develop.

Apart from Orthopaedic intervention there are a number of management tools available to your physiotherapist experienced in dealing with this area of the foot.

A thorough examination of the foot function will be undertaken and your physiotherapist will discuss these findings with you.

An X-Ray may be indicated to determine the extent of any bony and joint changes.

Early intervention using very specific joint mobilising techniques can help maintain joint motion by reducing ligament contracture.  This helps keep the joint mobile and should reduce the pain associated with joint stiffness.

Orthotics may be prescribed to help normalise foot function which may be a contributing factor to developing the condition.  Footwear advice may include the use of stiff soled or rocker shoes to reduce the load on this joint during push off.

It should be noted that this conservative management will not cure the condition but should help to prolong the useful life of the joint and make walking more comfortable.

Mike Stewart

Mike Stewart is a Physiotherapist at the Oamaru Physiotherapy Clinic.  He has post graduate qualifications in Manipulative Physiotherapy and Sports Medicine and is a Registered Physiotherapy Acupuncturist.

He toured as a Physiotherapist with the Maori All Blacks for 14 years up until 2008.

Source:  Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk

Why you should warm up:

• Raises your heart rate to prepare your body for physical exertion
• Speeds up nerve impulses which improves your reflexes
• Reduces muscle tension
• Sends oxygenated blood to your muscles
• Reduces your risk of injury and prevents tissue damage
• Increases your flexibility and joint mobility

Why you should cool down:

• Helps to gently return your heart rate, breathing and blood pressure to normal
•  Improves your flexibility
•  Reduces your risk of injury
•  Removes naturally occurring waste products from muscles and helps reduce your risk of soreness

We provide injury management for everyone wanting fast, effective help to return full activities.  We spend extra time to ensure complete recovery and prevention of recurrence to keep you at peak performance so you enjoy life to the full- because your body deserves the best of care.

 We know you have a choice.  Choose us for:

1. Perfect central city location.
2. Experienced team to treat a full range of injuries and conditions.
3. Easy to get appointment times to suit.
4. Seen on time, every time.
5. Information on your progress from visit to visit.
6. All appointments 30 minutes.

Winter is certainly here and for those of you who injure        out in the cold remember that hopping into a hot bath once you get home is likely to make matters worse not        better, especially if there is acute inflammation- better to stick to the RICE program (Rest, Ice, Compression, Elevation).

If you are waiting for your injury to go away don’t wait more than 5 days             or you may end up with more problems as a result of poor healing or   compensation patterns.

Always best to get some advice from one of our team of Physios- even if you only need a couple of sessions, we can tell you how to get the best resolution of the    problem.        

Ensuring your body gets the best of care- so you can get the best out of life.

 Here are some tips to help ensure a successful, speedy resolution.

For all appointments call 04 499 3504.

How many hours do you sit for each day? We spend more time sitting than doing anything else and it is detrimental to our health. It has long being known and publicised that we all need to do more physical activity but have you ever considered that the time you spend being sedentary has a greater impact on you health status? One in three New Zealander adults is overweight and one in four is obese. In children, one in five is overweight, and one in twelve obese. What is worse is that these statistics are growing, exponentially.

How many hours a week do you spend watching TV or at the computer, driving, and sitting at work? Too many is the answer for most of us. If you are spending 4 or more hours each week watching TV you are putting yourself at increased risk of cardiovascular disease, diabetes, certain cancers, hypertension, high cholesterol.. the list goes on. What we really need to do is get up! Stand and walk for as much of the day as you can, park further away from work, or don’t take the car at all! Go for a walk in your lunch break or after dinner, it’ll all help decrease your sedentary time and increase your physical activity levels.  School and high school children should be encouraged to walk or bike to school, take part in extracurricular activities and sports at school and play outside during their spare time, not sit watching TV or playing the computer.

Physical activity recommendations include 30mins of moderate intensity activity performed on five days of the week. This includes a brisk walk, cycling, aerobics, swimming or other aqua activities. Or you can do 20 minutes of vigorous activity. The more the better! And if you are overweight, 60 minutes of moderate exercise on five days per week is recommended. This can be accumulated in 10 minutes bouts during the day. Include lots of breaks during your sedentary time, this has been proven to help reduce your waist circumference, body mass index and trigylceride levels in your blood. The more you get up and be active, the better it is for you health, mowing the lawns, doing the garden and taking out the trash are all going to be better than sitting down for that time.  Sit less and stand more!

Philippa King is a physiotherapist at the Oamaru Physiotherapy clinic.  She is undertaking postgraduate study in Sports & Exercise Medicine and Acupuncture.   Philippa is actively involved with North Otago Rugby, providing physiotherapy services for the Heartland team.

Source:  Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk

Is Your Headache Really a Neck Ache?

For many people, headaches start as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, forehead or behind the eyes. This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck or muscles can cause referred pain to your head.

Does this sound like you?

• Pain radiates from the back to the front of your head?
• Headache with dizziness or light-headedness?
• Headache  brought on or worsened by neck movement of staying in the same position for a long time?
• Headache which always feels worse on the same side of your head?
• Headache eased by pressure to the back of your skull?
• Headache which persists after your doctor has checked for other causes?

How Physiotherapy Can Help:

1. Mobilisation                                        5.  Functional and rehabilitative exercise
2. Manipulation                                      6.  Encouraging normal activity
3. Massage                                              7.  Postural assessment, correction and advice
4. Relaxation therapy                             8.  Muscle activation and re-education

We Want Your Headache!

Your physiotherapist can also offer you self-help advice on ways to correct the cause of headaches, such as practical ergonomic tips for work and in the home; adjusting furniture, relaxation, sleeping positions, posture and exercise.

Treatment:     Postural neck ache can usually easily be treated with some gentle mobilisations by a    physiotherapist and a stretching programme to prevent recurrence. Headaches are often caused by disorders of the neck or physical and emotional tension. Physiotherapists can successfully treat headaches originating from the neck or soft tissues and show you how to prevent the pain from occurring. – Even if you think your headache doesn’t come from your neck we can often help to reduce the intensity. At Central City Physio the therapists have had special up-skilling to give them ‘the edge’ to take away your headache!

For all appointments call 04 499 3504.

Ankle Sprain

Normally caused by rolling your ankles.

Important to make sure it fully resolves as a lack of ankle movement can cause knee or foot problems.

Tip/      If you’re playing netball, soccer or any contact sport wear the correct shoes and make sure you have strong ankle, lower leg and foot muscles – if you do roll your ankle rehabilitation should strengthen these muscles.

Knee Ligament Injuries

Normally as a result of cutting or fast changes in direction – common in netball, basketball and soccer.

Tip/ Make sure you’re fit before the season starts – work on strength, endurance and flexibility.

Shoulder Injuries – the dreaded rotator cuff

Not just seen in sports injuries – our most common injury at the Clinic.  Just “overdoing it” can damage the cuff – the small muscles weren’t designed for hard work.

Tip/      Don’t suddenly play tennis/golf/squash or swim for a lot longer than you’re used to and don’t overdo the weights at the gym – your good posture and form is vital to help avoid these injuries.

Low Back Disorders

80 percent of the population suffer from low back pain in their lives – and 80 percent of those have recurring problems.  Often caused by poor posture or sports technique and muscle imbalances.

If you have a low back problem you should seek help to sort it out properly and get advice on how to prevent those all too common recurrences.

Neck Pain

A real ‘pain in the neck’.  Often caused by poor flexibility or sudden movements.

 DO THIS EXERCISE AND YOU MIGHT JUST GET ALL 5 INJURIES!!

 For all appointments call 04 499 3504.

School bags are getting heavier and our kid’s necks, shoulders and spines are bearing the brunt.

Secondary school students carry the heaviest loads at a time when their adolescent spines are developing and their muscular strength has not reached adequate levels of maturity.  Research shows that up to 77% of secondary school students report musculoskeletal symptoms in the neck, shoulders, upper and lower back.

Heavier school bags and longer carriage duration are thought to be contributing factors in the development of this pain.  Research in New Zealand has shown average bag weights at around 11-12% of body weight in secondary school students.  The accepted International guideline for this age group is a maximum of 10%.

The issue appears to be greatest at secondary school where students often do not have access to lockers.  These students carry the full load of a day’s books not only to and from school, but around school each day.  On sports days these bag weights increase or the students carry an extra bag contributing to the load.

Students carrying greater than 10% of their weight are certainly placing themselves at risk of developing pain.

Apart from the obvious need to reduce the weight of our bags to internationally acceptable standards (10% of body weight maximum) there are a number of other factors that we can influence to reduce the risk to our shoulders and spines.

School Lockers

Access to school lockers allows students to store heavier texts during the day and access them only when required.  This single factor can reduce bag weight considerably.

Bag Selection

Backpacks are the best option for school bags as they allow equal weight distribution over the shoulders and upper back.  They must be worn correctly on both shoulders to achieve this.  Tighten the adjustable shoulder straps to keep the weight against the spine and choose a bag that fits the students back.  Shape and depth is an important factor to keep the contents of the bag as close to the spine as possible.

Inclusion of a padded waist strap allows weight to be carried through the hips reducing shoulder and neck load.  All bag straps should be adjustable and shoulder straps need to be wide enough to distribute the weight.

Packing Backpacks

Heavier books and items need to be packed as closely to the spine as possible and preventing items moving during carriage will help to reduce the stress on the shoulders and back.

Addressing the problem associated with backpacks is an important factor in protecting our children’s spines for the future.

Mike Stewart is a Manipulative Physiotherapist at the Oamaru Physiotherapy Clinic.  He has post graduate qualifications in Manipulative Therapy and Sports Medicine and is a Registered Physiotherapy Acupuncturist.

He has toured as a Physiotherapist with the Maori All Blacks from 1996 to 2008.

Source:  Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk

There’s a mouse in my office!

WHY SHOULDER AND NECK PAIN MAY BE A RESULT OF THOSE PESKY CREATURES

They’re everywhere you look these days – rampant in office cubicles, even invading our homes!  While the majority sit quietly on our keyboard tray, some like to hang out on our desk or other nearby locations.  Seemingly harmless, these pesky little creatures can often cause unnecessary pain and tension in the shoulders, neck and upper back.

A growing number of computer users are suffering from neck and/or shoulder conditions directly related to incorrect working postures and chronic repetitive strain.  This strain can lead to chronic muscle tightness and spasm in the shoulders and neck.

This may eventually lead to arm pain and even weakness in your hands.  Be sure to seek help from a Physiotherapist if you pain is persisting or worsening.

WHAT CAN YOU DO TO AVOID THIS…

Be sure your workstation is set up for YOU!  Follow the 90 degree rule at your desk to avoid unnecessary upper body strain and tension.

Knees, hips, and elbows should all be at 90°, when sitting up straight in your chair.

If you need to raise your chair to accommodate your elbows, try placing old telephone books under your feet so you can reach the floor comfortably.  Placing your mouse directly beside your keyboard will help avoid any unnecessary movements between the two and will keep your elbow at 90° when using the mouse.

The ankle is the most commonly injured joint in the body.  A sprain occurs when the ankle is twisted in a sideways motion resulting in injury to the ligaments and soft tissues that restrain the joint.

How Do Ankles Sprain?

The most common type of ankle sprain is when the foot and ankle are rolled inward stressing all the ligaments on the outside of the ankle.  90% of ankle sprains occur in this way.

Landing and jumping sports like netball and basketball have a high incidence of ankle sprain.  High heel shoes also increase the risk of sprain.

Symptoms

The degree of symptoms tends to correlate with the degree of injury.

Ankle sprains are classified into 3 grades.

Grade 1 sprains involve a mild stretch of the ligament which usually resolves within 2-7 days.

Grade 2 sprains are moderate injuries involving a partial tear of the ligament.  The ankle is moderately swollen and very painful.

Grade 3 sprains are severe and involve a complete rupture of the ligament.  They are significantly swollen but may not be that painful.  The ankle will often feel unstable.

First Aid Measures

RICE – Rest, Ice, Compression and Elevation is still the treatment of choice in the early stages of any acute ankle sprain.

RICE controls the swelling, eases the pain and prevents further tissue damage.

Should I Seek Treatment?

If the ankle swells considerably and it is difficult to walk it would be advisable to seek assessment from your GP or Physiotherapist.

It is important to ascertain the grade of injury to determine the management required.  They will carry out a physical examination to assess this structural damage.  An important part of this examination is testing the integrity of 2 main stability ligaments.

Management of a grade 3 ankle sprain is critical.  The damaged ligament must be immobilized to some extent (ankle stability brace) to allow the healing process to repair the ligament.

Poorly managed grade 3 sprains often result in a lifetime of instability.

Rehabilitation of grade 2 & 3 ankle sprains involves restoration of proprioception (balance reactions), muscle strength and normal ankle range.

Do I Need a Brace or Strapping?

Elastic braces may be beneficial for controlling swelling and giving balance feedback.  This type of brace does not restrict ankle motion and will not prevent a sprain.

Ankle strapping restricts joint motion and is used in the acute stage to protect healing ligaments as well as in the early stages of returning to sport.
Rigid braces generally stop the ankle from twisting sideways and are used for unstable ankles in the acute stage to promote healing and in chronic unstable ankles to prevent injury while playing sport or walking on rough ground.

Mike Stewart is a Manipulative Physiotherapist at the Oamaru Physiotherapy Clinic.  He has post graduate qualifications in Manipulative Therapy and Sports Medicine and is a Registered Physiotherapy Acupuncturist.

He has toured as a Physiotherapist with the Maori All Blacks from 1996 to 2008.

Source:  Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk

Balance – the ability of our body to maintain equilibrium when we stand, walk or perform our daily activities.   As ‘toddlers’ we toddled as our growing bodies developed the pathways that today enable us to balance.  We unconsciously do it all of the time but at some stages of our lives it is harder to achieve and maintain balance.

Athletes and sports people spend many hours perfecting specific skills for their sports which all involve honing their balance. Imagine Daniel Carter kicking goals, or Irene Van Dyk shooting hoops if unable to balance. Even lesser athletes amongst us can improve our performance with enhanced balance skills.

Certain illnesses or damage to the brain can impair our ability to maintain balance.  As we age our balance deteriorates and requires training to maintain the skills we have mostly taken for granted all our lives.

To understand our changing ability to balance it helps to understand some of the anatomy or the ‘nuts and bolts’ that make it work.  Our balance control centre is in the brain in particular, the cerebellum. This area receives and processes information from three types of sensors in other parts of the body and then co ordinates our muscles to respond to maintain balance.

The eyes send visual cues to the brain. An  example of how this visual feed-back helps is when we walk straight down a passageway in day light, but at night with the light off it is hard to  keep straight and off the walls.

The inner ear or labyrinth contains a series of fluid filled canals.  As our body and head position changes the fluid moves, generating feedback to the brain rather like a 3D spirit level.

The third set of sensors are the proprioceptors; nerve endings found in muscles, tendons, joints and skin. These are sensitive to stretch and pressure.  A simple test of their sensitivity is to bend your finger right backwards- it is the proprioreceptors that tell you to stop! And in weight bearing joints that message contributes to your ability to balance.

At different times our ability to balance can be compromised, either by our brain’s inability to receive and process the sensor’s feedback (e.g.; head injury), the sensors feeding inadequate information to the brain (e.g.; inner ear infection or  reduced proprioception in an ankle joint after an ankle sprain), or by our body’s inability to react to the brain’s instructions (e.g.; muscles not strong enough or  joints too stiff to perform the balance correction)

Test Your Balance – Find a safe space where there is something solid to support yourself if you do lose balance. As you attempt these exercises assume the position and try to hold it for 10 seconds. When you can achieve this, attempt the same position with your eyes closed, again aiming to be able to hold for  10 seconds before progressing to the next level of exercise.

i) Stand with both feet together

ii) Stand with one foot in front of the other-heel to toe

iii)Stand on one leg

iv) Stand on one leg  on a soft surface (folded towel)

If you are of advanced years and your balance is not as stable as you would like, discuss your problem with your GP or Physiotherapist who is able to help identify why your balance is impaired and may recommend a balance strengthening exercise programme.

If you are younger, (especially if you are an active sportsperson) and are  unable to maintain balance while standing  on one foot with your eyes closed for at least 10 seconds you also would benefit from a specific balance exercise  programme.

A balance exercise programme will include exercises to sharpen up your balance sensors, strengthening exercises for your trunk (core muscles), hip extensor (butt) muscles, quadriceps (thigh) muscles and calf muscles, as well as stretches.

Balance is an integral part of general fitness and is essential in prevention of falls.  Subtle changes in balance are an indication that it may be time to seek some assistance from your Physiotherapist.

Jeannie Brown is a Physiotherapist at the Oamaru Physiotherapy Clinic.  She has a wealth of physiotherapy experience in the management of orthopaedic and musculoskeletal conditions.

Source:  Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk