What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) is a wrist and hand condition that occurs when a nerve becomes pinched within a tunnel created by the bones of the wrist. The wrist is composed of 8 small bones called Carpals,which, along with ligaments, create a ‘Carpal Tunnel’ on the palmer side of the forearm. This tunnel creates a space for the passage of the Median nerve and theflexor tendons of the fingers. The Median nerve provides both sensory and motor function to the hand, and if it becomes compromised within this space, Carpal Tunnel Syndrome will occur.
Symptoms:
Symptoms of CTS are numbness, pain, and weakness in the affected wrist and hand. Numbness and pain occur along the sensory distribution of the Median nerve, which includes the palmer side of the thumb, index finger, third finger and lateral half of the ring finger. The progression of symptoms is typically gradual, beginning with itching, tingling or mild burning, and in chronic cases can progress to complete numbness, and involve radiating pain up the arm, decreased grip strength and muscle wasting in the thumb.
Common Causes:
CTS is often due to a combination of multiple factors that result in increased pressure on the Median nerve in the carpal tunnel. This condition is rarely due to an issue with the nerve itself. A common contributing factor to CTS is size of the carpal tunnel, as the smaller the passageway, the greater the likelihood of tendon and Median nerve compression. Women on average have smaller and narrower carpal tunnels then men, making them more prone to CTS. Another contributing factor is injury or trauma to the wrist, because the resultant swelling increases the amount of pressure and decreases the amount of space within the carpal tunnel. Repetitive strain injuries to the wrist can cause inflammation and swelling of the synovial fluid surrounding the flexor tendons, which also decreases the space within the carpal tunnel. These repetitive strain injuries can often occur in the workplace, due to use of vibrating tools and machinery, or repetitive typing and use of a mouse at a computer workstation.
Treatment:
Physiotherapy is often used to help treat Carpal Tunnel Syndrome. Therapy for this condition focuses on proper education about the condition and necessary activity modification, prescription of stretching and strengthening exercises and therapeutic modalities as appropriate. Additionally, bracing can be used to help provide wrist support and stability. Wrist bracing is most effective at night to prevent wrist flexion, and during the day while performing repetitive wrist activities. Occasionally, surgical intervention is required for the treatment of CTS, in which the connective tissue creating the roof of the carpal tunnel is cut to create more room for the Median nerve. Physiotherapy rehabilitation is recommended post-surgery to ensure an optimal outcome.
For more information about Carpal Tunnel Syndrome, ask your physiotherapist at Triangle Physiotherapy and Rehabilitation!
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What is Lateral Epicondylitis?
Lateral Epicondylitis also known as “Tennis Elbow” is the most common overuse injury in the elbow. This injury involves partial or complete tears in the extensor tendons of the forearm muscles causing pain on the lateral (outside) elbow on a region known as the lateral epicondyle.Anatomy
The elbow joint is made up of three bones: the humerus (upper arm bone), the radius and ulna (two bones in the forearm). On the distal end of the humerus there are two epicondyles, one lateral (on the outside) and one medial (on the inside).
The muscles that extend our wrist are attached to the lateral epicondyle by tendons. These muscles include extensor carpi radialisbrevis (ECRB) extensor carpi radialislongus (ECRL), extensor digitorum and extensor carpi ulnaris. The tears, and subsequent pain, from lateral epicondylitis usually occurs along these tendons. Most commonly the extensor carpi radialisbrevis (ECRB) is injured, but this injury can occur in any of the other muscles mentioned.
Causes
Lateral epicondylitis usually occurs due to overuse or repetitive movements of the extensor muscles of the forearm. Such an issue can occur due to:
- An over reliance of the extensor muscles because of poor conditioning or injury in the shoulder or upper arm muscles.
- Occupations and nonathletic activities requiring repetitive upper extremity activities and particularly those involving computer use, heavy lifting, forceful forearm pronation (palm face down) and supination (palm face up), and repetitive vibration.
- Improper technique or positioning with equipment i.e. tennis racket.
Risk Factors
While aging is the strongest risk factor associated with lateral epicondylitis, numerous other risk factors have been identified: -work/non-work related activities requiring repetitive movements, -training errors, -misalignments, -flexibility problems, -poor circulation, -strength deficits or a muscle imbalance, -psychological factors.Symptoms
- Gradual increase in pain on the lateral aspect of the elbow.
- Weakness in grip strength.
- Worse pain with activities that involve extension of the wrist, e.g. backhand tennis stroke, repetitive use of a screwdriver, or lifting heavy objects.
- In more severe cases, pain can occur with such simple activities as holding a coffee cup or turning a door knob.
Physiotherapy Treatment
There are different types of therapies to treat lateral epicondylitis, all with the same aim: reduce pain, improve function and strengthen the affected muscle. Some of the ways a physiotherapist can help manage and treat your lateral epicondylitis includes: -Joint Mobilization – Deep Transverse Frictions – Modalities – Ultrasound, Electrotherapy, Cyrotherapy, Laser, Extracorporeal Shockwave Therapy – Orthoses (Bracing)Exercise Therapy
Stretching – The research and literature shows that strengthening and STRETCHING exercises are the most important components of exercise programmes, for the reason that tendons should not only be strong but also flexible. Eccentric Exercises Research has also shown that lateral epicondyitis has shown improvement following treatment utilizing isokinetic eccentric exercise. A great exercise which utilizes this principle is the FlexBar eccentric exercise which has been clinically proven to be effective in providing in improving function with lateral epicondylitis.Click HERE to book an appointment with a physiotherapist at one of our eight locations.
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What is Plantar Fasciitis?
Plantar fasciitis is the most common cause of heel pain. Plantar fasciitis is a repetitive strain injury to the plantar surface of the foot. Tiny micro tears can develop in the ligament with repetitive use. This condition is most common in middle-aged populations however you can develop it at any age. It occurs in people who are on their feet a lot such as athletes and construction workers. You can develop plantar fasciitis in one or both feet.What is the Plantar Fascia?
The plantar fascia is a flat band of tissue that connects your heel bone (Calcaneus) to the base of the toes (Metatarsophalangeal joints). This ligament assists in supporting the arch of your foot.Symptoms of Plantar Fasciitis
Most people experience pain during the first few steps after they get out of bed in the morning. It can also cause irritation, inflammation, weakness and swelling to the bottom of the heel and foot. Symptoms may decrease throughout the day with increased activity but it typically worsens after prolonged sitting, standing, walking or at the end of the day.Factors that predispose you to develop Plantar Fasciitis
There are many factors that can contribute to plantar fasciitis. The most common causes of plantar fasciitis are biomechanical imbalances within the body. This includes tight or weakened muscular structures, leg length discrepancies and excessive flat feet (pronation) or very high arches (supination) of the foot. It often develops with overtraining and repetitive overuse of the foot and ankle. More specifically, plantar fasciitis develops with training or working on unyielding surfaces such as concrete and occupation-related footwear such as steel-toed boots. It can also occur with prolonged standing and weight-bearing activities such as walking or running. As we age, tissue degeneration occurs weakening the supporting structures of the arch of the foot. In addition, during pregnancy, hormonal changes can cause weakening of ligaments such as the plantar fascia. Excessive weight gain also compromises the integrity of this ligament. It can also occur from wearing worn down or unsupportive footwear.Treatment Options Available for Plantar Fasciitis
If this sounds familiar, contact your physiotherapist to set up an initial assessment. Physiotherapists offer a wide variety of treatment options to help decrease the pain associated with plantar fasciitis. Your physiotherapist will create an individualized treatment plan for you consisting of soft tissue techniques, manual therapy joint mobilizations, modalities and a targeted exercise program involving stretching and strengthening the muscles of the foot and ankle. They can also provide you with education regarding proper gait mechanics, running technique, orthotics and splinting options for day and night use. Written by: Natalie Langstaff, Physiotherapy Resident Tags : Orthotics Toronto, Orthotics Mississauga, Orthotics Etobicoke, Orthotics North york, Orthotics Oakville, Acupuncture Toronto, Acupuncture Mississauga, Acupuncture Etobicoke, Acupuncture North york, Acupuncture OakvilleClick HERE to book an appointment with a physiotherapist at one of our eight locations.
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Acute Injury
An acute injury has a sudden onset and is typically caused by a significant or traumatic event. Examples of these conditions include ligament sprains, muscle or tendon tears, joint dislocations, and bone fractures. These injuries are accompanied by immediate symptoms including sharp localized pain, inflammation, swelling, and bruising. Within the first 48-72 hours of acute symptom presentation, it is advised to use ice therapy. In addition to pain control, the effects of ice help reduce swelling and inflammation. Ice application causes a local decrease in body temperature, which reduces metabolic rate and leads to blood vessel constriction. These physiological responses result in less bleeding and fluid accumulation in the area of injury, reducing the amount of swelling and active inflammation. For best results, it is advised to combine ice therapy with rest, elevation, and compression (RICE) of the injured area.
Parameters for ice application:
For use on distal extremities (ex. hands and feet), ice should be applied for 15 minutes or less at a time. For more proximal areas (ex. the shoulder or the hip), ice can be applied for up to 20 minutes. It is important not to exceed this time period, as reverse effects such as blood vessel dilation will occur. Additionally, consecutive sessions of ice therapy should be at least 1 hour apart, to provide the skin time to return to normal temperature between treatments.Chronic Injury
A chronic injury is gradual in onset and is most often caused by repetitive strain or overuse of a joint or muscle group. Examples of these conditions include tendon strains, muscle strains, and joint capsule adhesions. These injuries typically have no active inflammation due to their slow symptom development, and pain is often milder and more diffuse. Heat therapy is indicated in the treatment of chronic injuries to help with pain reduction, to accelerate the healing process, and to restore range of motion, and reduce joint stiffness. Heat application causes blood vessel dilation and an increase in the metabolic rate, resulting in increased blood circulation, increased enzyme activity, and an increase in available oxygen to the tissues. These effects accelerate the rate of healing in the area of injury. The use of heat also causes an increase in the extensibility and elasticity of soft tissues (such as muscles, tendons, and ligaments) allowing for increased range of motion and joint flexibility. Heat can also be applied to any of the above acute injuries after the first 72 hours have passed, or the swelling and inflammation have resolved. This is because at this stage of the injury, the goal of treatment changes from restricting acute inflammatory activity to tissue stretching and healing.Parameters for heat application:
Heat may be applied to any injured area for 15-20 minutes at a time. In order to prevent burning, the temperature of the heat should be kept below 45 degrees Celsius. Important Tips:- Heat or ice should not be applied to an area where sensation is impaired
- Don’t apply heat over a region of a known or suspected blood clot
- Do not apply heat over the low back or abdomen of a pregnant woman
- Do not apply heat or ice directly over an open wound
- The positive effects of both heat and ice therapy are best observed when combined with physical therapy and exercise!
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Causes of ankle sprain
Any movement that suddenly twists the foot beyond the natural range of motion can cause an ankle sprain such as:- Landing wrong when jumping or running on to an uneven surface.
- Stepping off a curb wrong
- Slipping on ice
- Tripping on a hole in the ground
Consequences of ankle sprain
When an ankle is sprained, the ankle bone itself is uninjured. It is the ligaments surrounding the ankle bone that suffer. Ligaments are structures in every joint in the body that help control the joint’s movement. The ligament will become injured if it is stretched too far which could result in a partial or complete tear. There are two different types of ankle sprain.- The inversion ankle sprain is the most common type of sprain and occurs when the foot falls inward and stretches the outer ligaments too far. Pain occurs on the outside of the ankle and not on the inside of the ankle.
- The eversion ankle sprain occurs when the foot is twisted outwards and the inner ligament is stretched too far. Pain will occur on the inside, and not the outside, of the ankle.
The Severity of an Ankle Sprain
First-degree symptoms – a first-degree ankle sprain is when the ligaments have been stretched but not torn. Symptoms include:- Mild pain
- Some swelling
- Some joint instability
- Mild joint stiffness
- Difficulty jogging or jumping
- Significant swelling
- Bruising
- Moderate pain
- Some loss of motion or use of the ankle
- Trouble walking
- Severe swelling
- Severe pain
- Instability of the joint
- Extreme loss of motion
- Walking can be quite painful
Treatment for Ankle Sprains
Rest – especially in the first 24 to 48 hours Ice – for the first 48 hours for 20 minutes at a time Compression – wear a brace or a wrap that is snug, but not cutting off circulation Elevate – above the heart as often as possible Physical therapy is a mainstay. Patients should learn to strengthen the muscles around the ankle, particularly the peroneals. An ankle brace can be used in an athlete until a therapist believes that the ankle is strong enough to return to play without it. Surgery is rarely indicated but may be needed in a patient who has cartilage damage or other related injuries. Ligaments are only repaired or strengthened in cases of chronic instability in which the ligaments have healed but not in a strong fashion.Frequently Asked Questions
What is a high ankle sprain and is that different from a regular ankle sprain?
A high ankle sprain refers to tearing of the ligaments that connect the tibia to the fibula (this connection is also called the syndesmosis). These are different and much less common than the standard lateral ankle sprains, meaning those that occur on the side of the ankle.Do ankle sprains ever need to be repaired acutely?
Ankle sprains rarely, if ever, needed to be treated with surgery. The vast majority simply need to be treated with rest, ice, compression and elevation followed by physical therapy and temporary bracing.I have sprained my ankle many times. Should I be concerned?
Yes. The more you sprain an ankle, the greater the chance that problems will develop. For example, turning the ankle can lead to damage to the cartilage inside the ankle joint. You should see your doctor if this is occurring. To get your ankle assessed, schedule a consultation with a physiotherapist at Triangle Physiotherapy and Rehabilitation!Click HERE to book an appointment with a physiotherapist at one of our eight locations.
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Low Back Pain/ Hip Dysfunction caused by poor posture
The average person’s work week consists approximately of 40 hours, for a lot of those the majority of that time can consist of them sitting at a desk on a phone or computer. That time doesn’t even factor in commute time as well as dinner and lounging at home. Experts say that the average person can spend more than half their waking hours in a sedentary state.
It is well known that sitting for long periods of time can cause a lot of negative effects such as strain on your cardiovascular system as well as an increase risk in colon cancer. But what a lot of people don’t know about it is the actual physical disorders that come with sitting for long periods of time, such as weaker/underused abdominal muscles, weak glutes whiles shortening your hip flexors making them tight and decreasing Range Of Motion in your hip. This muscular imbalance can begin to force other muscles that are not commonly used to become overworked and tired and furthermore contribute to a muscle imbalance, which can cause hyperlordosis, kyphosis, and scoliosis, as well as a twisted pelvis. Tight low back muscles can pull and twist your spine which could lead to degenerative disk disorder (DDD), or a subluxation of one or several vertebrae. When you decrease the activity of muscles you begin to decrease the electrical activity going to those muscles which begins to make them weak and underdeveloped which could lead to atonic muscles. The decreased angle in the hip while sitting for long periods can cause a decrease in blood flow to your legs decreasing the amount of blood, oxygen, and nutrients that can feed your muscles making for leg cramps and sometimes swelling in the feet due to lack of venous return.
Luckily Massage and Physiotherapy can be used as a preventative as well as therapy for the many conditions that sitting for long periods of time can cause. The main focus of both is too focus on the muscular imbalance and to bring you back to your norm as much as humanly possible. Some of the main areas of focus during treating is to loosen tight hip flexors, increase neurological function in the low back, glutes, and abdominals, loosen up Para spinal muscles which will decrease the risk of DDD and subluxation of the spine. During a massage the pressure and direction of stroke will help to increase blood flow to your low back and hip as well as into your legs providing oxygen and nutrients to areas that are being malnourished due to lack of blood flow.
The best was to prevent any disorders caused by sitting to long is simply to stand up and move around. Experts say you should stand up for at least 5 minutes every hour to get muscles working and blood flowing. Staying hydrating is very important during any point of the day for it helps keep muscles elastic (including your heart muscles), the spine works like a pump while moving bringing fresh water to your vertebral disks keeping them hydrated. Some offices have implemented standing desks or the use of exercise balls in place of regular chairs which can keep workers constantly moving, keeping blood flowing and muscles working. Stretching and strengthening exercises are very important to maintain healthy muscles, stretching out hip flexors to maintain full ROM in the hip, strengthening core either by doing push ups or the plank, stretching out your low back and abdominal area by doing both the cat and cow pose, and finally strengthen your back by doing rows and one arm rows.
Written by: Sean Cameron, RMT
Sources:
http://www.webmd.com/fitness-exercise/20140407/sitting-disease-faq
http://www.cbc.ca/news/business/sitting-for-too-long-can-kill-you-even-if-you-exercise-study-1.2918678
http://www.health.harvard.edu/blog/much-sitting-linked-heart-disease-diabetes-premature-death-201501227618
http://fitness.mercola.com/sites/fitness/archive/2015/05/08/sitting-too-long.aspx
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Definition
Posture is a “position or attitude of the body, the relative arrangement of body parts for a specific activity, or a characteristic manner of bearing one’s body.” i.e. posture is another word that most therapists use interchangeably with ‘alignment’ So, why is posture important? Each individual is unique in terms of personality and physical shape, so shouldn’t posture be unique to each person too? Yes and no. While we each have our own preferences and habits, there’s definitely a right way of alignment for optimum health.Curves of the spine
The spine curves forward at the neck and lower back, known as LORDOSIS. It curves backwards at the mid-back, known as KYPHOSIS. Excesses in any of these curves causes imbalance and asymmetry.
Examples of non-ideal postural alignment
Ideal alignment: Ears in line with shoulders in line with hips, knees and ankles Kypholordosis: Exaggerated curves in mid and lower back Flat back: Flattening of the curves of mid and lower back, most commonly seen in office-workers Sway back: Forward shift of the pelvis in relation to the hips leading to a flattened low back and more curved mid backEffects of poor posture
- Impaired mobility manifested by tightness in certain groups and weakness in others
- Excessive compression of joints leading to herniated discs, facet dysfunction, impingement etc
- Reduced lung capacity
- Impaired digestion
- Compression on nerves and/or blood vessels
How do I fix it?
To put it simply, sit up straight! The more we actively try to maintain our spine in a neutral alignment, the less damage we cause. Here are some tips to help minimize the effects of improper alignment.- Take frequent breaks, whether you are in a job that is sedentary or physically taxing. Repeated load-bearing movements such as lifting or sustained positions such as sitting at a desk for many hours are both equally detrimental.
- Correct slouching by remembering to stand so that your head is stacked squarely above the chest and the pelvis is directly over the center of the knees and ankles. Stand with your back against a wall and draw your shoulder blades down and take a deep breath.
- Use an ergonomically designed workstation. A chair with the right amount of curvature in the lower back area will align the entire spine to a good neutral position.
- Adopt a sound lifting technique. Do a “squat-lift” v/s a “stoop-lift”. Use a hand truck or a dolly if possible. For more information on how to lift, see a physiotherapist for a work-safety consultation.
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