Category: Blog

 

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!

 

Whiplash Definition

Whiplash (or Whiplash Associated Disorder) occurs when your head and neck is suddenly jolted backwards and forwards (or forwards then backwards) in a whip-like movement, or is suddenly forcibly rotated which may occur in a rear-end or side impact car accident. This may cause, neck muscles, ligaments and joints of the neck to stretch more than normal (sprain) and may result in pain. We frequently use the analogy of the sprained ankle to describe what happens in the neck. The nature of injury and the severity of symptoms vary between different people. A relatively minor accident may cause a big impact to an individual whereas for others there may be no symptoms. The recovery time is also variable from one individual to another.

Common Symptoms

• The main symptoms are pain and stiffness in the neck. It may take several hours after the accident for symptoms to appear. The pain and stiffness often become worse on the day after the accident. You may also feel pain or stiffness in the shoulders or down the arms. There may be pain and stiffness in the upper and lower part of the back.
• Headache is a common symptom.
• Dizziness, giddiness, light-headedness, unsteadiness and a feeling of off balance has been reported in 75% of whiplash patients.
• Blurred vision, pain in the jaw or pain on swallowing, and unusual sensations of the facial skin may occur for a short while, but soon go.
• Some people feel tired and irritable for a few days and find it difficult to concentrate.
• Some people may feel distressed after the motor vehicle collision and these feelings usually settle with time and recovery.

Recovery

Many people recover within a few days or weeks. For 20-25% of patients it may take several months to experience substantial improvement in symptoms. Ongoing symptoms may vary in their intensity during the recovery period.

Investigations

There is no definitive test for whiplash. X-Ray, CT, MRI do not demonstrate hard objective evidence of damage following whiplash injury. Neck (cervical spine) x-rays may be taken to rule out injuries such as bone fractures or dislocations.

Self-Management

The Australian Whiplash Injury Recovery – a Self Help Guide is an excellent resource for patients recovering from whiplash giving plenty of practical advice, exercises to optimise recovery. Stay active and do as many of your normal activities as possible. Some more vigorous activities that place undue stresses on your neck may need to be avoided in the early stages of recovery. Plan gradual increases in activity and exercise levels so that you can successfully return to full participation in your regular activities, hobbies or sports. Continue or resume working perhaps in a reduced capacity at first. It may be necessary to change some work routines for a while. Talk to your employer and colleagues so that you can plan your workload effectively. Don’t be afraid to ask for help from family, friends and colleagues. A good posture will help and minimise stress on your neck, change position regularly during the day.

Physiotherapy

If things are not settling we can advise you how best to manage your symptoms. We assess joint movement, neck muscle strength, neck tenderness and sensitivity. Our treatment approach for whiplash injury is evidence based, meaning it is based upon published research that demonstrates their effectiveness in whiplash injury. Hands on treatment including mobilisation and manipulation combined with exercise including neck strengthening, proprioceptive (balance) and oculomotor (eye movement) exercises have been shown to reduce pain and improve ability to perform everyday activities. Taping may also be part of treatment.

Medication

Painkillers are often helpful and may be recommended by your doctor. Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day. Anti-inflammatory painkillers may be used alone or at the same time as paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers. A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. A muscle relaxant such as diazepam is occasionally prescribed for a few days if your neck muscles become very tense and make the pain worse.

If you have any additional questions about Whiplash or to make an appointment, please call 797-9545.

Elaine Maughan MISCP, MSc

What is dry needling?
Dry needling is a technique which involves the insertion of a single use, sterile, acupuncture needle into a myofascial (muscular) trigger point. A trigger point is a tight band within a muscle which can cause and contribute to pain within the body. Research has shown that biochemical changes occur in these trigger points and that the insertion of the needle reverses these biochemical changes, which results in reduced pain.

Which conditions can be treated with dry needling?
Dry needling can be beneficial in the treatment of several musculoskeletal problems. Below is a list of conditions that can be treated using dry needling:
• Back and neck pain
• Cervicogenic headache
• Shoulder impingement or rotator cuff injuries
• Pelvic pain
• Buttock and leg pain (including sciatica)
• Muscle strains (e.g. hamstring strain)
• Knee pain
• Calf tightness/cramps
• Achilles tendon pain

What is the difference between dry needling and acupuncture?
Dry needling and acupuncture use the same type of needles, however, different techniques are utilised. Acupuncture is a form of alternative medicine and a key component of traditional Chinese medicine involving thin needles inserted into the body at acupuncture points. Dry needling is based upon Western medicine principles and involves the insertion of thin needles into trigger points. These trigger points are different to traditional acupuncture points.

How does dry needling work?
Research studies have shown that inserting needles into trigger points causes biochemical changes which alleviate pain. For dry needling to be successful it is essential that a local “twitch” response is elicited when the needle is inserted into the myofascial trigger point.

Is it painful?
Upon insertion of the needle into the skin you may feel a small pin prick. Once the local twitch response is elicited the patient may experience a brief painful reaction. Patients often describe this painful reaction as a cramping sensation. It is important to remember that a local twitch response is necessary for a therapeutic effect to occur and therefore it is a desirable reaction.

Are there any side effects?
After dry needling it is common to experience some post treatment soreness. This soreness can last from 30 minutes to 2 days. Once this pain has subsided the patient should experience an improvement in their initial symptoms.

Are the needles sterile?
Yes. We only use sterile, single use, disposable needles.

Are there any reasons why I should not have dry-needling?
The following people should not have dry needling:
• People who are on blood thinning medication
• Those who have a history of epilepsy
• Women who are in their first trimester of pregnancy

What can I do after treatment?
Your physiotherapist will advise you to use heat after treatment to help reduce any post treatment soreness. Dry needling will be combined with other treatment techniques such as manual therapy and your physiotherapist will advise you on the best exercises to perform in conjunction with your treatment.

Have all physiotherapists undergone dry needling training?
Dry needling is currently not part of the physiotherapy undergraduate degree. It is a post graduate qualification. Here at IONA Physiotherapy, Aileen has undertaken several dry needling courses. If you would like to book an appointment with Aileen please phone (01) 7979545.

Rory McIlroy recently sustained a lateral (outer aspect of ankle) sprain while playing soccer with friends. Unfortunately for Rory, this will keep him out of this year’s British Open Championship. According to media reports, he sustained a ruptured ATFL and a tear of his joint capsule. So, how does such an injury occur, what is an “ATFL” , how is it diagnosed and what would physiotherapy rehabilitation typically involve? Read on…….

Mechanism of Injury
Lateral ankle sprains commonly occur in sports such as football, hurling, soccer, basketball, tennis and gymnastics. These injuries can occur when the athlete is twisting or lands awkwardly. The typical mechanism of injury is where the ankle is rolled so that the sole of the foot points inwards. In this position the ligaments on the outside of the ankle becomed stretched. Depending on the force of the injury, different ligaments can get over stretched and result in a ligament sprain/tear. Different grades of ligament sprain exist and range from a grade 1 to a grade 3. A grade 1 injury is a mild ligament tear, a grade 2 is a moderate ligament tear, and a grade 3 is a severe (ruptured) ligament tear.

Anatomy
“ATFL” stands for anterior talofibular ligament. This ligament runs from a bone in the outer aspect of the lower leg called the “fibula” to a bone in the foot known as the “talus” and offers stability to the ankle joint. The joint capsule is a leathery type substance that offers further stability to the ankle joint. According to twitter reports, it is these two structures that Rory has injured – a complete rupture of his ATFL (grade 3) and a tear of his joint capsule.

Diagnosis
In the event of an ankle injury a chartered physiotherapist will complete a thorough assessment to determine the extent of the injury and which structures are involved. Gait, ability to weightbear, range of motion, swelling, bruising, propriocetion, and tenderness on palpation will form part of the assessment. In severe lateral ankle sprains the patient may also have suffered a fracture. If the Physiotherapist suspects a fracture an x-ray will be advised. Most lateral ankle sprains do not require an MRI scan. In severe lateral ankle sprains an MRI scan may be requested to determine the extent of the injury. If after 4-6 weeks progress is slower than expected, then an MRI scan may be requested to determine associated injuries.

Rehabilitation (this is a general overview and not prescriptive, optimum management is based on individual assessment.)
Stage 1 (0 – 72 hours) – The main aim of stage 1 is to reduce inflammation and pain. This is achieved by:
• RICE – rest, ice, compression, and elevation
• Anti-inflammatories – gel or tablets
• Crutches – if the patient is unable to weight bear with a good gait pattern
• Camboot – in severe cases to immobilise the ankle and reduce inflammation

Stage 2 (72 hours – 2 weeks) – The main aim of stage 2 is to regain range of motion and achieve a normal gait pattern
• Massage to reduce muscle tightness
• Manual therapy to reduce joint stiffness
• Exercises to improve range of motion and proprioception
• Increase weight bearing on the injured leg

Stage 3 (2 – 6 weeks) – The aim of this stage is to regain proprioception and strength
• Strengthening exercises
• Progression of exercises to improve proprioception
• Gradual return to activity

Stage 4 – The main aim of this stage is to return to sport and prevent recurrence in the future
• Sport specific exercises to regain full strength, proprioception, and coordination
• Running program
• Agility program

What is TPI?
Titleist Performance Institute (TPI) is the world’s leading educational organization dedicated to the study of how the human body functions in relation to the golf swing. TPI was founded in 2003 and over the last 12 years it has studied thousands of golfers of all abilities. From these studies, TPI has collected an enormous amount of data on golfers such as size, shape, age, and fitness level. From this data, TPI has learned how a correctly functioning body can allow a player to swing a golf club in the most efficient way possible.

TPI has also examined how physical limitations in a player’s body can adversely affect the golf swing and potentially lead to injury. The group at TPI do not believe that there is only one correct way to swing a club, rather they believe in an infinite number of swing styles. However, they do believe that there is one efficient way for every player to swing and this depends on the physical capabilities of the player.

What is TPI screening?
Physical capabilities will differ for each golfer and therefore the most efficient swing is not the same for every golfer. To determine physical capabilities, a golfer must first be screened. This screen will begin with a client history and a discussion about current health. Then the golfer’s swing will be recorded using a high speed camera. Following this, the player will be assessed on 12 tests which focus on movement quality, physical fitness, and strength. Once the screen is completed, the results are used to develop a plan for this player. This plan may include fitness training, physiotherapy treatment, and coaching of swing mechanics and biomechanics.

Golfers whose game is limited by pain
Players who present with pain will undergo physiotherapy assessment and treatment. Once the pain has resolved the player will then undergo TPI screening. This screening will help in the development of an exercise plan for the player which will make their swing more efficient, improve their game, and reduce golf-related injuries.

Golfers who wish to improve their game
Players who wish to improve their game will undergo TPI screening. From this screening an exercise program will be developed. This exercise program will help the player develop a correctly functioning body which will lead to a more efficient swing and lower scores. Hands-on treatment may or may not be appropriate depending on the findings of the screen. Hands-on treatment can be very effective at increasing shoulder turn, spinal mobility, and hip mobility.

Do I have to be a Professional Golfer?
No. Golfers of all abilities will benefit from TPI screening. Everyone from professionals to weekend golfers can develop a more efficient swing and lower their scores.

Where does the screening take place?
The screening will take place within IONA Physiotherapy, Cian House, 1 Cian Pk, Drumcondra, Dublin 9.

What is Pilates?

Pilates is a whole body type of exercise that focuses on strengthening (particularly deep abdominal, back and shoulder blade muscles), flexibility, co-ordination and breathing. This total body workout promotes muscle balance and postural awareness. It is therefore favoured by athletes who want to avoid injury, those rehabilitating following an injury, people who want to become more active and improve posture and those who want to maintain lean, toned muscles without building bulk.

The Pilates system of exercise was originally developed by “Joseph Pilates”, a German, in the 1920’s. Since then, with advancement in scientific and biomechanical knowledge, many of the exercises have been modified but still reflect the basic principle that a “strong core” allows for easy, efficient movement throughout daily life.

What is Clinical Pilates?

Clinical Pilates is an adaptation of the original type of pilates exercises that have been developed and modified by physiotherapists to reflect current scientific evidence with regard to injury prevention and rehabilitation. Clinical Pilates is taught by a qualified physiotherapist who has also trained as a pilates instructor. Crucially, the class sizes are small. This allows the physiotherapist to give each participant individual attention ensuring that each exercise is mastered with precision and control.

Each pilates exercise can also be modified by the physiotherapist for each individual participant, depending on their level of ability and the nature of their injury. Please let us know if you currently have an injury so that we can tailor your pilates programme specifically for you.

I have an injury, can I do Pilates?

In most cases- yes! Please speak with Ciara Shields before signing up for a course of classes so that we can discuss if you are ready to start and so that we are aware of the types of modifications that will need to be made throughout the class. Pilates is not a substitute for having your injury treated, but is often a great addition to your rehabilitation programme to aid your recovery.

Should the exercises hurt?

No. The exercises should feel like an effort and you should feel your muscles are being exerted but the exercises should not cause pain. Please stop an exercise if it is causing you pain and let your instructor know. Often a simple modification or correction by the instructor will allow you to continue the exercise. It is your responsibility to let the instructor know if an exercise is hurting or does not feel right for you.

Pilates in Pregnancy
Antenatal Pilates classes, like all of our other pilates classes are always run by a chartered physiotherapist. Classes will be commencing on 31st of October 2015. These are suitable for women from the second trimester onwards. Please phone to register your interest.

Post Natal Pilates- when can I start?

You can start after your six week check up (normal delivery) or after 10 weeks post C-Section. However, this is not a deadline! You may feel for a variety of reasons that you would prefer to wait a little longer and this is perfectly okay. In the meantime, you will benefit from doing some gentle pelvic floor and deep abdominal muscle exercises – and may prefer to have a one on one session for an individual assessment and exercises prior to signing up to a course of classes.

We have not started a specific post natal class yet, but you are welcome to join a beginners class (even if you have done pilates before. ) It is important that you do the right type of abdominal exercises in the early days, to allow any separation of your tummy muscles to close, otherwise all your effort will be counterproductive. If you, or a group of your friends would like to form a group for post natal pilates, please let us know and we will try to facilitate!

Where are the classes located?

The Clinical Pilates classes will run in our newly built pilates studio within IONA Physiotherapy, Cian House, 1 Cian Pk, Drumcondra, Dublin 9.

What should I bring and wear?

A towel, a bottle of water and comfortable clothing. Clothing needs to be loose enough so that you can move easily but not excessively baggy or bulky- this way, the instructor can easily see your movements. If you are an asthmatic, please bring your reliever inhaler.

What time should I arrive?

For your first pilates class with us, please arrive 15 minutes before the class is due to commence. Please use this time to fill out a questionnaire that will be left in the reception area for you. You can bring this into the class with you and give it to the instructor. There may be a class in progress while you arrive or the physiotherapist may be currently with a patient. Please wait in the reception area and your class will be called from this area.

Can I bring my personal belongings into the class?

Please use the designated area outside the pilates studio to store your shoes and coat. For the comfort of all participants, the pilates studio is a “no shoe zone.” Please bring any valuables you may have (phone, money, laptop etc) into the class with you.

What if I can’t attend a class?

A course of classes are booked and prepaid in advance. Please let us know if you cannot attend a specific class. We will do our best to facilitate your attendance of another class within a week of your missed class, however this may not always be possible. Your co-operation is appreciated in this regard.

Reasons to contact Ciara Shields MISCP before booking a course of classes

• Have you ever been diagnosed with low bone density or osteoporosis? If so please forward me a copy of your dexa scan and contact me prior to booking a course of classes.
• If you are pregnant, have had a baby in the last 6 months, or know that you have a separation of your tummy muscles (diastases) please contact me prior to booking a course of classes.
• If you have any concerns as to whether a pilates class is suitable for you, please do not hesitate to contact me!

A common question that we are often asked in clinic is whether ice or heat is apppropriate to use on an injury and if so, which. In this blog we will outline the rational behind choosing ice or heat and give some common clinical examples.

When ice is placed on an area it causes constriction or narrowing of blood vessels. This in turn, leads to a reduction in swelling and inflammation because a constricted blood vessel allows less leaking of fluid and inflammatory chemicals through the wall of the blood vessel into the surrounding tissues. In an acute injury (e.g. ankle sprain/ ligament injury to knee), where there is a risk of swelling, the injured part will benefit from ice. You can use a packet of frozen peas wrapped in a damp tea towel or an ice pack for ten minutes at a time. Ten minutes is sufficient to allow the tissues to reduce in temperature and the blood vessels to constrict. Be careful with ice, too long can cause frostbite!

Heat has the opposite effect to ice. Heat causes blood vessels to dilate or get larger, allowing more blood flow into the area and even more importantly, muscle relaxation. Heat is useful for more chronic conditions that are due to overuse, such as a muscular ache around the top of the back and shoulders from prolonged sitting at a computer in a poor position. In fact heat is often helpful for back pain, particularly when there is muscle spasm present. When muscle spasm is present as a symptom of back pain, the continuous contraction of the muscle in spasm starts to generate pain in its own right. Reducing that spasm (e.g with heat) can help with the pain. You could use a towel or facecloth soaked in warm water or a hot water bottle/ hot pack (warm, not hot.) Never put heat on an acute injury (such as an ankle sprain) as it will make the swelling worse. Think of what happens to your feet on a warm day- they swell and are more difficulty to get into your shoes.

Applying ice or heat is a first aid measure and a step towards recovery. However it is important to receive appropriate advice and treatment for your injury in order that you make a full recovery. Contact IONA Physiotherapy if you have had an injury, we would be delighted to help.

There is overwhelming evidence that exercise has very wide-ranging health benefits, and many health professionals argue that the absence of regular exercise is the biggest public health issue of our time. Most of us recognise that smoking, diabetes and obesity are bad for our health. “Smokadiabesity” is a slightly humorous word sandwich term that has been coined to describe the serious situation when all three factors coexist in an individual, and few would argue that the prognosis for such a diagnosis appears grim. What may surprise many is that when a large population was studied in the Aerobics Centre Longitudinal Study (very large study based in Dallas, Texas- where patients have been followed since 1970), it was found that individuals were at greater risk of premature death due to lack of regular physical activity than “smokadiabesity.” This has profound implications for us all. It is obviously important that traditional parameters such as weight, blood pressure, cholesterol etc. are measured, but it is just (if not more) important that we measure how much physical activity we take, and make improvements if we are below par! The minimum recommended is 30 minutes of walking 5/week, according to Professor Steven Blair, University of South Carolina, who is considered a leading expert in the field of exercise and health.

At IONA Physiotherapy, we are passionate about the importance of exercise in maintaining health. We can help if you need an injury treated so that you can get back to your activity/sport, or if you need advice on just getting started! Whichever end of the spectrum your fitness lies, remember that exercise is definitely good for you, exercise is medicine.

Injury can occur when a high load is applied a small number of times (e.g. fall off the top of a ladder) or a small load is applied numerous times (e.g. long distance running.) It is the latter that can lead to overuse injuries. Individual tolerance levels vary, meaning that some people can develop an overuse injury at smaller loads and less repetition than others.

The type of training you are doing is also hugely important. Certain activities involve loads that are variable in terms of direction of the load (e.g. tennis players continually change direction depending on where on the court the ball is in play.) Conversely runners tend to run in the same direction, repeating the same motion again and again, loading the same tissues with each step.

One factor that will influence your ability to tolerate your training regime and avoid an overuse injury is flexibility and this naturally reduces with age. You may have got away without paying enough attention to stretching when you were younger but you are unlikely to always get away with this! For example, one factor that can predispose runners to developing plantar fasciitis is inadequate flexibility of their calf muscles. Other factors which influence your tolerance include your biomechanics, muscles strength, training regime, training environment etc. Patellofemoral Pain Syndrome (Runner’s knee) is a good example of this- as pain may occur due to a problem with the biomechanics of the foot, inadequate muscle strength (core, gluts and quads muscles), increasing the level of training too quickly or training on the wrong type of surface (e.g. running on a slope with one foot up and one foot down the slope.)

It is important if you develop an overuse injury that you observe “relative rest.” In other words, that you reduce the load on the injured tissue to a painfree level- through modification of your training regime and/or improving your biomechanics (tape/orthotics/specific exercises etc.) Don’t take complete rest and a wait and see approach! Such an approach does not address the underlying problem and just leads to loss of strength and fitness. At IONA Physiotherapy we can diagnose what the injury is, why it occurred and implement an effective treatment plan. Contact us at 01 7979545 for further details.

For recreational runners the incidence of running related injuries is 10 per 1000 hours of running, which is relatively high compared to other sports. Knee injuries, such as Patellofemoral Pain syndrome are the most common (19%), followed by foot injuries (17%), such as plantar fasciitis or stress fracture, but lower back, thigh, lower leg and ankle injuries are also common.

Overuse injuries, such as tendinopathy, shin splints or stress fracture are more common than acute injuries such as ankle sprain or calf strain, which means you will usually have some warning signs or early pain to signal an injury is on the way so don’t ignore early symptoms that are persistent.

There are certain factors that help predict injury and these are listed below. This is very helpful in terms of injury prevention, as addressing these factors reduces the risk of developing a subsequent injury.

Predictors of Injury:
1. Previous lower limb injury in the last year – ensure your complete your rehab from any previous injury
2. Weekly mileage greater than 40 miles (64 km)/ week
3. Training errors like speed training. Interval training e.g. interspersing running with walking actually lowers your risk of injury
4. Less than 3 yrs running
5. Biomechanical abnormalities e.g. genu valgum (knock knees) or genu varum (bow legged), over pronation (flat foot) or supinated foot (high arched foot) type.
6. Muscle Weakness i.e. gluteal muscles

At IONA Physiotherapy we can screen to determine if you are at risk of developing a running injury and give appropriate treatment and advice regarding injury prevention that is specific to you. If you already have an injury, we can diagnose and treat the injury and give you a specific plan to prevent recurrence, as well as advise you on footwear and running technique, if necessary. Contact IONA Physiotherapy and we will be glad to help.