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Monday 10:00 - 20:00 Tuesday 10:00 - 20:00 Wednesday 10:00 - 20:00 Thursday 10:00 - 20:00 Friday 10:00 - 20:00 Saturday 10:00 - 20:00 Sunday 10:00 - 20:00

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Nirvana Nook, Francistown (2025)

07/04/2024

🍀 Sports massage

🌸 Specialised type of massage that is designed to help the average athlete or gym fanatic. It is designed to enhance the athletic/gym performance, promote faster recovery/relief from physical activity as well as prevent or treat sports related injuries. It is also for people who do strenuous work.

🍃 Sports teams, kindly WhatsApp or SM me for a quotation.

07/04/2024

🍃 LEVATOR SCAPULAE MUSCLE RELATED NECK PAIN

The Levator Scapulae muscles are located on either side of the neck. They originate on the four upper vertebrae of the cervical spine (neck) and insert, or attach, to the scapula, also known as the shoulder blade at the superior, medial border. These two muscles are involved in elevation, downward rotation and abduction of the scapulae. They are also involved in flexion and extension of the cervical spine(neck), turning of the neck slightly left and right, along with side bending of the neck left and right.

When you wake up in the morning with a crick in your neck, feel a burning pain on the top inner corner of your shoulder blade, or have trouble turning your head to look behind you while driving etc., the culprit may be a Levator Scapula muscle in spasm. The pain can be described as a throbbing, ache, or tightness, and usually presents from the top inner corner of the shoulder blade up along the neck.

🔒 What Causes Levator Scapula Spasm / Trigger Points?

A trigger point is a tight area within muscle tissue that causes pain in that area and/or other parts of the body. The trigger points are shown above as two dark red circles, with the pain referral area also shaded in. Muscle spasm is a tightening of a muscle usually, due to overuse or overstress. It can in itself cause pain and loss of mobility. The following events and activities are likely to activate, or reactivate, tension / pain and trigger points in the levator scapulae.

- whiplash from an automobile accident
- sleeping on the stomach with the head turned/or sleeping in an odd position
- chilling of the muscle during sleep from an air conditioner or draft from an open window
- working at a computer with the head turned for long periods
- holding a phone between the shoulder and ear
- carrying a heavy bag with a shoulder strap
- use of crutches that are too tall and elevate the shoulder
- emotional and mental stress
- Working with your arms raised above your head for prolonged periods of time can also irritate the Levator Scapula. To help reduce neck pain, stabilize your shoulder blade when you raise your arm.
- poor posture with a forward head position puts this muscle under continuous strain causing overuse.

Usually the condition settles after a few days if it is only a once off. Proper hands-on deep tissue massage and dry needling, when used together, can be great to settle the condition either in the short term, or if the condition has become more chronic. Also for the long term, correcting posture, stretching and strengthening of the upper back(particularly middle / lower traps, serratus posterior, rhomboids etc.) and the neck muscles(specifically the posterior neck muscles) can help prevent the condition from returning.

Posture is key to a healthy neck and spine. Try and sit up straight on a comfortable supportive chair, when at work or at home, allowing the shoulders to relax by using the arm rests of the chair. When at a computer, pull the screen close and try to get it up to eye level (say using books underneath it), so your head doesn’t have to be coming forward. The same applies when driving a car. Pull the seat in close to the steering wheel(within reason),and try to position yourself so the shoulders are relaxed and the head isn’t jutting forward. Activities like reading in bed, playing computer games for hours etc. can really tighten up the levator muscles and are a disaster for thoracic and cervical posture in the long term.

07/04/2024

🍀 WHAT IS BICEPS TENDONITIS?

The biceps muscle has two heads, simply named the long head and the short head. With biceps tendinitis, it’s usually the long head (which attaches to the top front of the shoulder) that gets injured. The long head tendon attaches to the shoulder joint capsule, and it is very near other important shoulder structures, such as your rotator cuff.

When the biceps tendon has any kind of abnormal or excessive stress, it may get inflamed. This includes excessive tension (pulling), compression (pinching), or shearing. If this happens repetitively, your body’s ability to heal itself may lag compared to these stresses, and this can lead to pain and injury via inflammation and swelling.

✳ Risk Factors for Biceps Tendonitis:

1. Repetitive overhead movements.

2. Poor movement mechanics and posture.

3. Weakness in the rotator cuff.

4. Age-related changes.

5. Abrupt increase in upper body exercise routine.

✳ How Do You Know If You Have Biceps Tendonitis?

People with biceps tendonitis often have a deep ache in the front of the shoulder. More specifically, pain is usually localized at the bicipital groove.

Sometimes pain can radiate distally down the arm. Symptoms will usually come on with overhead motions, pulling, lifting, or the follow-through of a throwing motion. Instability of the shoulder may also present as a palpable or audible snap when shoulder motion occurs.

✳ Common Symptoms of Biceps Tendonitis:

1. Sharp pain in the front of your shoulder when you reach overhead.

2. Tenderness to touch at the front of your shoulder.

3. Dull, achy pain at the front of the shoulder, especially following activity.

4. Weakness felt around the shoulder joint, usually experienced when lifting or carrying objects, or reaching overhead.

5. A sensation of “catching” or “clicking” in the front of the shoulder with movement.

6. Pain when throwing a ball.

7. Difficulty with daily activities, such as reaching behind your back to tuck in your shirt, or putting dishes away in an overhead cabinet.

Finding a health practitioner who is a skilled manual therapist may help speed up your recovery. Manual therapy is great to loosen tight muscles, mobilize stiff joints, and improve the blood flow in target areas.

📚 Treatment Plan 📚

👣 Step 1: Reduce Inflammation

The first step that any health practitioner should take is to relieve any possible inflammation. Rest and cold compress will help to reduce inflammation and begin the healing process.

👣 Step 2: Range of Motion

Once the pain has begun to subside, you should start to work on improving your pain-free range of motion. This will include not only the glenohumeral joint, which is what most people think of when they think of the shoulder, but also the neck, trunk, scapula (shoulder blade). If you have adequate flexibility in all of these other parts of your body, your glenohumeral joint won’t have to work as hard.

Two important ranges of motion for the shoulder include: flexion and internal rotation. You should be able to reach all the way overhead (full flexion) and have full internal rotation without pain. Having tight muscles in the back of your shoulder can lead to increased stress at the front of your shoulder, right where your biceps tendon is.

👣 Step 3: Build Strength

Early in your recovery, you can work on pain-free strengthening of the muscles in the shoulder as well as the back muscles that support the shoulder.

The rotator cuff muscles help to stabilize and protect the glenohumeral joint, so any basic shoulder-conditioning program should begin with these.

You also want to focus on stabilizing your scapula, which is the base that the humerus moves on. The shoulder girdle must be strong and stable enough to transfer all the forces between your arm and your body, and it must also be mobile enough to move with the humerus to allow for full range of motion.

👣 Step 4: Functional Training

Once you’ve started the healing process, significantly decreased inflammation, gained full range of motion, and have started strengthening, you’re ready for functional training. This is the last and most rewarding part of rehab because you’re now training to regain full strength and function.

You move with your entire body in a coordinated fashion, whether you want to return to playing baseball or carry a basket of laundry. If you move improperly (PTs refer to this as aberrant motion), this places increased stress to your tissues, which can lead to damage over time. So, even if your diagnosis is biceps tendonitis, a good physical therapist will know to treat the entire body. Whatever your goal is after physical therapy, your treatment should teach you to move more efficiently and optimally prepare you to return to your normal life.

07/04/2024

🍀 ELBOW SPRAIN

An elbow sprain occurs when the elbow ligaments are stretched and partly torn. A ruptured ligament can cause instability in the affected area.

The ligament sprains are graded: A Grade 1 injury is a stretch of the ligaments, Grade 2 is a partial tear and Grade 3 is a complete rupture.

▶️ Signs and Symptoms

Immediate pain will be felt with an elbow sprain and swelling may become noticeable. The greater the pain and swelling often the longer the healing process will take.

With a mild sprain the elbow will become tender and stiffen. A greater sprain will cause the skin of the affected area to become red, while the elbow will experience tenderness, warmth and bruising.

A severe elbow sprain will cause heightened pain and limit ability to move the elbow.

Instability of the elbow occurs if it dislocates which can result in deformity of the elbow. This requires urgent reduction of the joint to prevent further damage.

▶️ Treatment – non-operative

There are a number of non-surgical treatments that can be applied to an elbow sprain including rest, ice, pain-relieving medication and bandage support.

Rest
The affected elbow should avoid activity that could provoke pain or increase stress.

Ice
An ice pack can be applied for 15-20 minutes several times a day to reduce pain and swelling. If the elbow becomes excessively swollen recovery will be longer.

Pain-relieving medication
Tablets and creams applied to the skin will help relieve pain.

Bandage Support
Firm bandaging, plaster, sling or a brace protects and restricts the injured elbow keeping it comfortable and ensuring a quicker healing process. However limiting movement beyond two weeks following injury should be avoided to prevent permanent stiffness.

▶️ Recovery
Elbow sprains of a Grade 1 and Grade 2 nature will eventually settle after a few weeks with physical activity to be avoided during that period. A Grade 3 sprain may take up to three months to heal.

An exercise program should be implemented to help restore flexibility range of motion and strength in the elbow.

07/04/2024

🍀 CERVICOGENIC HEADACHE (CGH) Syndrome

• Chronic hemicranial pain that is referred to the head from either bony structures or myofascial soft tissues of the upper CSP, - OA, C1-3 segments.
• The C1-C3 nerves relay pain signals to the nociceptive nucleus of the head and neck, the trigeminocervical nucleus. This connection
is thought to be the cause for referred pain to the occiput and/or eyes.
• The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibres in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) are believed to
interact with sensory fibres from the upper cervical roots. This functional convergence of upper cervical and trigeminal sensory pathways allows the bidirectional referral of painful sensations
between the neck and trigeminal sensory receptive fields of the face and head.
• A functional convergence of sensorimotor fibres in the spinal accessory nerve (CN XI) and upper cervical nerve roots ultimately converge with the descending tract of the trigeminal nerve and
might also be responsible for the referral of cervical pain to the head.

Important to differentiate between: Migraine without aura, Tension-type, and Cervicogenic
headache.

• In Cervicogenic Headache, patient may present with combination of:

- movement dysfunction in whole of Csp
- muscle function impairment
- upper cervical individual joint dysfunction

• Pain and tenderness in sensitive structures in the upper neck, fascia in the head, TMJ,
mandible.
• History is important, look for activities involving some repetitive movement
static posture, maybe previous injury.
• Usually Ipsilateral pain but it can be bi-lateral!
• Patient can report unsteadiness and light-headedness, but fainting is a red flag!

06/04/2024

🍀 MYOGENIC & NEUROGENIC MUSCLE CRAMPS

What Is a Muscle Cramp?

A muscle cramp is a hyperexcitable neurologic phenomena of excessive, involuntary muscle contractions. It is important to distinguish between myogenic and neurogenic muscle cramps, because each has unique pathophysiology and management. The conventional definition of a muscle cramp is a painful contraction of a muscle or muscle group, relieved by contraction of antagonist muscles.

Care must be taken to avoid confusing muscle cramps with other phenomena including central hyperexcitability (eg, dystonia, spasticity, seizures, and stiff person/stiff limb syndromes) and peripheral processes, including tetany, myokymia, myotonia, neuromyotonia (focal muscle stiffness), or myalgia.

🔎 NEUROGENIC MUSCLE CRAMPS

The origin and propagation of neurogenic muscle cramps localizes to peripheral and central targets, including the neuromuscular junction, where mechanical disruption and electrolyte disturbances can influence hyperexcitability and cramp generation. Injury to peripheral nerve components including the motor neuron cell bodies or the motor axons can result in ephaptic transmission and development of muscle cramps.

Dysfunctional intramuscular small fiber sensory afferents (eg, mechanoreceptors and spindles) are also proposed to be involved in cramp generation. Centrally, persistent inward currents mediated by GABAergic transmitters at the spinal level can amplify incoming sensory input and lead to the propagation and amplification of cramp potentials. Disruption of chloride, sodium, and potassium channels and inadequate amino acids concentrations (eg, taurine) disrupt membrane currents to generate muscle cramps.

🔎 MYOGENIC MUSCLE CRAMPS

The pathophysiology of myogenic muscle cramps, in contrast, is usually the result of disrupted energy production in muscle cells and occurs most commonly in metabolic myopathies associated with disorders of glycogen, lipid, or mitochondrial metabolism. Metabolic myopathies cause deficient ATP levels. Because muscle relaxation is an adenosine triphosphate (ATP)-dependent active process, actin and myosin chains do not disengage, causing an electrically silent cramp (ie, contracture). The metabolic defect may also cause accumulation of potentially toxic metabolites that further aggravate ATP deficientcy. Myopathic cramps are also a potential symptom of myopathies linked to muscle membrane or intramuscular structural dysfunction in acquired and hereditary myopathies (eg, muscular dystrophy, congenital myopathies, and inflammatory myopathy).

CAUSES

Physiologic stressors are a common precipitant to muscle cramps. The most common is dehydration, in which electrolyte loss disrupts neuromuscular junction function and membrane stability. Other physiologic stressors include unusually prolonged or strenuous exercise, particularly in a deconditioned state in which muscle tendon shortening is common.

TREATMENT

Infrequent cramps that do not interfere in someone’s life rarely need investigation or treatment. There is no evidence that recurrent muscle cramps lead to significant long-lasting damage to muscles, and serious harm from muscle cramps (eg, tendon ruptures) is rare. If treatment is needed, the avoidance of the offending agent or appropriate electrolyte and vitamin replacement to treat the root cause are warranted. There is level B evidence that vitamin B-complex supplementation can reduce cramp frequency in people who experience at least 6 cramps per week.

In individuals with prominent dehydration (eg, athletes, malnourished individuals, or members of vulnerable populations), care must be taken to ensure adequate electrolyte-rich solutions, particularly high-salt formulations. In pregnant women, there is ample evidence that magnesium replacement is helpful in managing muscle cramps.

Reference: Practical Neurology

06/04/2024

🍀 You need your body more than it needs you! Be intentional about how you treat it, pour life into it and move life through it.

Take your body for tune ups and initiative to keep up regular maintenance before the engine light comes on!

06/04/2024

🔊 SCIATICA

WHAT IS SCIATICA?

💡 Sciatica is the result of a neurological problem in the back or an entrapped nerve in the pelvis or buttock. There are a set of neurological symptoms such as:

➡️ Pain (intense pain in the buttock)
➡️ Lumbosacral radicular leg pain
➡️ Numbness
➡️ Muscular weakness
➡️ Gait dysfunction
➡️ Sensory impairment
➡️ Sensory disturbance
➡️ Hot and cold or tinglings or burning sensations in the legs
➡️ Reflex impairment
➡️ Paresthesias or dysesthesias and oedema in the lower extremity that can be caused by the irritation of the sciatic nerves (the lumbar nerve L4 and L5 and the sacral nerves S1,S2 and S3)

CAUSES OF PAIN

💡 Pain is a result of irritation of the sciatic nerve. it can be constant or intermittend. The pain may be worsened by certain movements like coughing or sneezing (these movements increase the intra abdominal pressure). Sitting, bending, prolonged standing or rising from a sitting position can aggravate or increase the pain.

PAIN PATTERNS

💡 In regards to relief the pain, the supine position decreases the pressure on the herniated disc and will subsequently decrease pain. Pain is located along the distribution of the nerve and can be felt in the back, buttocks, knee and leg. It only radiates to one side of the leg and can result in reduced power, reflexes and sensation in the nerve root. Also gait dysfunction (toe walking, foot drop and knee buckling), paresthesias or dysesthesias are frequent neurological symptoms.

SYMPTOMS BASED ON NERVE COMPRESSION

💡 Sciatica can be caused by the compression or irritation of nerve L4, L5, S1, S2 and S3. The sciatica symptoms depend on which nerve is compressed or irritated.

◾ L4: When the L4 nerve is compressed or irritated the patient feels pain, tingling and numbnessiIn the thigh. The patient also feels weak when straightening the leg and may have a diminished knee jerk reflex.

◾ L5: When the L5 nerve is compressed or irritated the pain, tingling and numbness may extend to the foot and big toes.

◾ S1: When the S1 nerve is compressed or irritated the patient feels pain, tingling and numbness on the outer part of the foot. The patient also experiences weakness when elevating the heel off the ground and standing on tiptoes. The ankle jerk reflex may be diminished.

source: B.W Koes, M.W Van Tulder, W.C Peul. Diagnosis and treatment of sciatica. BMJ.

06/04/2024

🍀 MUSCLE CRAMPS FACTS

1. A muscle cramp is an involuntarily and forcibly contracted muscle that does not relax.
2. Muscle cramps can occur in any muscle; cramps of the leg muscles and feet are particularly common.
3. Almost everyone experiences a muscle cramp at some time in their life.
4. There are a variety of types and causes of muscle cramps.
5. Muscle cramps may occur during exercise, at rest, or at night, depending upon the exact cause.
6. Dehydration is a common cause of muscle cramps.
7. Numerous medicines can cause muscle cramps.
8. Most muscle cramps can be stopped if the muscle can be stretched.
9. Muscle cramps can often be prevented by measures such as adequate nutrition and hydration, attention to safety when exercising, and attention to ergonomic factors.

TREATMENTS AND METHODS OF PREVENTION FOR LEG CRAMPS IN PARTICULAR

a) A relaxing bath before going to bed will ease muscle tightness.
b) Put a heating pad on the affected area.
c) Try an acupuncture treatment to ease tight leg muscles.
d) Make sure that you have enough magnesium or potassium in your body.
e) Stretch your legs before you go to bed.
f) Avoid high-heeled shoes and wear ergonomic shoes
g) Rise slowly and walk around – you can improve your blood flow by shaking your legs.
h) Massage the area by making circular movements.

Nirvana Nook

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Monday	10:00 - 20:00
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