Author: Ciara Shields

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COVID-19: Level 3, 4, and 5 restrictions and access to Physiotherapy.

Here are some frequently asked questions and answers.

Q: Can I still attend a physio appointment under level 3, level 4, and even level 5 restrictions or lockdown?

A: Yes, IONA Physiotherapy clinic is open and will remain open under all levels of Covid restrictions, as an essential health service provider.

Q: What precautions are in place for my visit to the clinic?

A: At IONA Physiotherapy, we have put rigorous infection control measures in place to keep you and our staff safe.  The consultation begins with a video call prior to entering, outside the clinic, where you will be asked some screening questions. 

The physiotherapist will be wearing PPE and adhering to strict infection control guidelines.  All staff temperatures are checked every day.  Your temperature will be taken on entry.  You will be given a brand-new medical grade mask for your visit.  The level of protection from a mask is really important, so we use a specific grade that is used in hospital settings (EN 14683:2019.) 

We will open the doors for you, and take payment through your phone to minimise touch points.

Touch-free hand sanitizers are in every room and hallway of the clinic.  Both you and the physiotherapist will use the sanitiser before your appointment begins and again as you exit the building.

We have a one-way system in place, to ensure you do not physically meet any other patients on entry or exit.

We have put enormous effort and planning into our health and safety response to Covid-19.  Our motto is to give each patient the same level of care as we would our own nearest and dearest.  Our in-house Covid safety plan is 80 pages long!  We won’t bore you with the details, but you can get a sense of our level of attention to detail by watching our health and safety video here. 

Q: What if I need physiotherapy but am cocooning, or prefer not to visit the clinic?

A: No problem, we have a video-link appointment option that can ensure you get access to physiotherapy without needing to attend in-clinic.  This is through doxy.me which is really easy to use.  You don’t need to download any software, we just send you an email or text with a link, which you then click on.  Remember to allow your microphone and camera.

Note: Do not attend if you are experiencing symptoms, have been a close contact with a confirmed case, you or anyone of your household are waiting to be tested/ waiting on a test result, or you have been abroad in the last 14 days.  Please phone first.

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Hamstring Muscle Injuries

Hamstring Muscle Injuries

If you are involved in sport, at any level, you will know someone who has had a hamstring injury, or you may have even had a hamstring injury in the past yourself.

 

What are the hamstrings?

They are a group of muscles located at the back of your thigh. Their primary function is to flex (bend) the knee and extend (straighten) the hip. They also have other functions, such as stabilising the knee joint and the pelvis.

They are named Bicep Femoris, Semitendinosus, and Semimembranosus.

There is also a 4th muscle that blends with the hamstrings called Adductor Magnus

How do they get injured?

There are a few ways in which a hamstring can get injured, but typically the mechanism of injury may be:

  • Running / sprinting

  • Kicking

  • Bending over from the hip

 

 

Rehabilitation

Adequate rehabilitation is essential, and your chartered physiotherapist will guide you through this process. The length of time from injury to a safe return to your chosen activity will largely depend on the severity of the muscle injury.

Muscle injuries are graded either: Grade I, Grade II, or Grade III.

Grade I muscle injury: A mild muscle strain

Grade II muscle injury: A partial muscle strain

Grade III muscle injury: A complete muscle tear or rupture

Thankfully the most common injuries are the Grade I and Grade II strains.

 

Rehabilitation Process

The overall aim of the rehabilitation period will be to strengthen your hamstring back to its pre-injury level and stronger.

Your physiotherapist will structure your rehabilitation into phases. Initially the goal will be to eliminate pain from walking and day to day activities. Once that landmark is achieved you can start loading (strengthening) your hamstring.

As the primary functions of the hamstring muscle group include flexing the knee and extending the hip, the strengthening exercises prescribed will reflect this.

Your program may include the following exercises:

  • Bridge

  • Squat

  • Split Squat

  • Deadlift

As well as strengthening exercises your physiotherapist will aim to include running as early as possible into your program. As you progress and get closer to full fitness some plyometric exercises will be added as well as some running drills.

 

Return to sport

You will set specific goals around return to sport with your physiotherapist. Your physiotherapist will explain and set out the specific criteria that you must meet in order to achieve these goals. This will help you understand your progress and achieve a successful outcome.

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Patellofemoral pain

Patient education leaflet, taken from international experts in Patellofemoral pain- Barton and Rathleff 2016.

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Back Pain Quiz

A man problem chronic low back pain and skeleton isolated

Which of the following statements are True or False:

  1. Bed rest is helpful for back pain.
  2. Back pain is caused by something being out of place
  3. Exercise is safe and good for back pain.
  4. Heavy school bags cause back pain
  5. Stress, low mood and worry influence back pain

 

 

Answers:

1.False. In the first few days after the initial injury, avoiding aggravating activities may help to relieve pain, similar to pain in any other part of the body, such as a sprained knee.  However, there is strong evidence that getting moving early is very important in order to make a good recovery.

In contrast, prolonged bed rest is unhelpful, and is associated with higher levels of pain, poorer recovery and longer absence from work. In fact, it appears that the longer a person stays in bed, this increases rather than decreases their pain.  Get moving early to get better quicker.

2. False.  There is no evidence to support that back pain is caused by joints, bones or pelvis being out of alignment.  Manual therapy can help to ease pain by reducing muscle spasm, and improving movement, but this is not as a result of something being “put back into place.”

3. True.  There is overwhelming evidence that exercise is helpful both in terms of prevention of back pain and in terms of recovery if you are suffering from back pain.  However, starting an exercise programme can be hard when you are in pain. It is normal for muscles to be a little sore after starting a new exercise regime, however this temporary increase in pain does not signify damage.

4.  False.  This is a really interesting one! Research has not found a link between children carrying a heavy bag and development of back pain.  However, if a child or their parent believes that heavy school bags can cause back pain, then the child is more likely to develop back pain.  Research has shown a link between fear and the development of back pain.

5. True   How we feel influences the amount of pain we feel.  Stress, anxiety and low mood can make pain feel worse.  So, whether it’s listening to music, going for a walk, or just “hitting the pause button” for a few minutes every day- find something that you enjoy, that relaxes you, and is good for your mood.

 

 

So now you know, some of the common myths about back pain.  Interesting isn’t it!  Now, spread the word………

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Greater Trochanteric Pain Syndrome

Sports hip injury koncept

Otherwise known as GTPS, can be one of the causes of pain on the outside of the hip.  GTPS involves the tendons and bursae (small fluid filled sacs) which surround an area of bone on the outside of the hip known as the greater trochanter.

 

Symptoms include pain lying on that side, pain on the outside of the hip which gets worse with prolonged use and pain climbing stairs.

Risk Factors:

  1. Crossing your legs!
  2. Training error- too much too soon, leaves tendons vulnerable to injury (tendinopathy.)
  3. Repetitive Training
  4. Tight ITB (iliotibial band)
  5. Poor core stability
  6. Standing on one leg for prolonged Periods

 

Treatment will start with your physiotherapist taking a  detailed history followed by physical examination and a biomechanical evaluation.  Your treatment plan  is likely to include some modification of your current exercise regime and an exercise programme.  It will be tailored to your current function, with consideration given to contributing factors identified during examination and your goals

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Physiotherapy after a Fracture

Closeup of a broken arm in a cast isolated on white background.
1.Seek advice from your physiotherapist about which exercises you can do from the outset, even if you are being immobilised in a cast. For example, if in a cast for a wrist fracture, moving the joints above (neck, shoulder and elbow) and below (hand) will reduce the amount of physiotherapy you need afterwards. Seek advice, what you are allowed to do will depend on your fracture.
2. Once the bone has healed enough (united) your cast will be removed and you can start physiotherapy. Your exercises will begin gently with a focus on controlling swelling and will be progressed so that you achieve good movement, strength and function.
3.Its really helpful if you can bring your x-ray reports (or other imaging) along to your first physiotherapy appointment so that your physiotherapist can find out more about your specific injury.
For appointments phone the clinic on 01 7979545
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Tendinopathy

3d rendered illustration of the achilles tendon

The achilles tendon at the back of the ankle is one of the  the more commonly known tendons in humans, it connects the calf muscle to the heel bone.  Tendons connect muscles to bones.  Pain and dysfunction in a tendon is known as tendinopathy (previously known as tendonitis.) So, how do tendons become injured? Every tendon has a certain capacity to bear load and when this capacity is exceeded, the tendon can become injured and painful.  This capacity varies from tendon to tendon and between individuals.  There has been some very exciting research in this field over the last number of years, and it is known that under the microscope painful tendons look different to normal tendon.  A type of protein, known as collagen, which forms part of the structure of tendons becomes altered and disorganised, changing the micro architecture of the tendon.  We now know that complete rest is detrimental to the tendon and surrounding muscle and does not aid long term recovery.   Research strongly supports the use of a gradual strengthening programme, over passive treatments (painkillers, electrotherapy, injection) in the rehabilitation of tendon injuries.  A good rehabilitation programme reduces pain and improves the tendon’s capacity to bear load again, allowing you to return to your activity.  Take home messages:

  • If you suddenly increase your activity, so that a tendon is taking more load than it’s capacity, is is more likely to become injured.
  • Complete rest is detrimental to a tendon in the long term.  Reducing the load (but not complete rest) initially is advisable (for example, perhaps walking instead of running.)  Use it or loose it!
  • Don’t have an injection into the tendon without trying a good strengthening programme first.

 

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Best Technique for Squat

Poor squatting technique can adversely load the body, leading to injury e.g. spine, hip and knee.  It is useful to use a mirror from the side and then the front in order to check the technique of your squat.  With good squatting technique, you should certainly feel your muscles working but no feeling of strain or ache.   Things to watch for:

  • Looking from the front: the centre of your knee cap, should line up over your middle toe, no knock knees!
  • Looking from the side, your knees should not move forward in front of the ankle joints, the knee should be directly above the ankle joint
  • Looking from the side, your lower back should stay in neutral (gentle hollow), and the spine should neither bend nor arch as you squat
  • As you squat, lift your arms up to counterbalance, and bring them down again as you return to standing.  This will help to stop you from falling over!
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Top tips for your workstation, from IONA Physiotherapy in Drumcondra

Physiotherapy in Drumcondra

For many of our patients at IONA Physiotherapy in Drumcondra,  ever increasing computer usage can  be associated with neck, shoulder and even arm pain.  Often, if the computer workstation is not set up well, this neck and shoulder pain gets worse, the longer you spend at your computer.   Sound familiar?   The good news is, is that there is lots you can do to optimize your workstation and minimize discomfort!  Neck and shoulder pain is one of the most common complaints that we see at IONA Physiotherapy in Drumcondra, and an analysis of the workstation is an important part of the assessment.  Based on the most common mistakes that we see, here are our top tips!

Top tips for Improving your computer Workstation

  • If you use a laptop, make sure that you can separate the keyboard from the screen. An old keyboard that you can plug into your laptop will do the trick, allowing you to move the screen away from you to the correct position.
  • The top of your screen should be level with your eyes, and should be placed directly in front of you.
  • If you need glasses for the computer, wear them!  Otherwise, you are likely to lean your head excessively forward to read the text, causing strain which can lead to neck and shoulder pain.
  • Ensure that there is enough cord attached to your keyboard to allow you to place your keyboard close to you. Your arms should not need to reach forward to use the keyboard.
  • Similarly, you should be able to easily reach the mouse with your arm comfortably by your side. Consider a shorter keyboard if you don’t frequently use the number’s keys on you keyboard.
  • Your feet should be flat on the floor, if your feet don’t reach the floor while sitting back into your seat, use a foot rest.
  • The chair should be firm but covered with soft padding.  Ideally it should have a lumbar support to support the natural hollow in your lower back.  The backrest should recline roughly 15 degrees, and lock into position, allowing you to rest back into your seat.
  • If the chair has arm rests, they should slide under the desk, allowing you to get close enough to your keyboard.
  • Use a document holder between your keyboard and screen if your work combines computer and paper work.

 

What next?

The above are some examples of the most common mistakes that we see at IONA Physiotherapy in Drumcondra.  This does not take the place of a thorough assessment by a physiotherapist, but it’s a good start!  For further information regarding the set up of your work station, click on the following link:

https://www.osha.gov/SLTC/etools/computerworkstations/checklist_purchasing_guide.html

 

We hope that the above helps, however if you continue to have ongoing pain or discomfort, then we recommend that you make an appointment at the clinic for an assessment.  Please phone 01 7979545 for appointments.

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Inspired by the Dublin City Marathon to start Recreational Running?

 

This weekend will see almost 20,000 people take to the streets of Dublin to participate in the annual Dublin City Marathon. If this inspires you to think about taking up running, there are some helpful tips you should know to reduce your risk of developing a musculoskeletal injury.

In April, Louise took part in RCSI’s public lecture series (RCSIMyHealth) and explored the topic of how to prevent injuries as a recreational runner, as part of an evening of lectures on the topic of Active Lifestyles – are they Helpful or Harmful? No surprise to summarise the evening’s discussion that an active lifestyle carries with it significant health benefits, including adding years to your life. Participation in sport of course does carry some risk of developing a musculoskeletal injury but research evidence is building on how best to identify who is at risk of such injuries, and more importantly, how to go about preventing these injuries.

Louise Keating’s 20 minute lecture summarises this evidence and should be of help to the novice runner or even seasoned marathon runner.

Good luck to those of you taking part in the Marathon on Sunday!