West Cork Pain Relief

14/11/2023

Patellar tendinopathy (PT) which is also known as jumpers knee is commonly seen sports which involve running & jumping. This musculoskeletal disorder is characterised by progressive activity-related anterior knee pain and patellar tendon dysfunction. This disorder can lead to disability in both athletes and non-athletes.

Risk Factors
Hamstring and quadriceps muscle tightness, reduced ankle dorsi flexion, hyoerpronation of the foot, poor joint coordination, increased training volume and intensity of training are some common risk factors for PT. Training on hard courts and synthetic turf can also increase risk of injury.

Treatment
Various types of treatment are used in management of PT. These include rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, extra corporeal shock wave therapy, percutaneous electrolysis, and and surgery. Even though various treatment options are available for PT, no single method has proven to result in consistent and near complete recovery in patients. Conservative management is considered to be the first line of treatment in PT, in the form of medical & physical therapies.

Rehabilitation Protocol
The proposed three stage rehabilitation protocol is based on latest research. The exercise dosage is not mentioned in this post as it will vary from patient to patient.

Stage 1 should focus on pain modulation and load management, especially in the case of in season athletes. Strength imbalances and poor flexibility should be addressed at this stage. Load management and activity modification are some of the most effective methods to reduce pain and other symptoms of PT. However, it is also important to avoid complete cessation of activities as this may further reduce the loading capacity of the tendon. Reducing the volume and frequency of training, removing high load energy storage activities such as elrunning, jumping etc. from the training are some of the most effective methods of load management of the tendon. Studies show that sustained mid-range isometric exercise is an effective method of pain reduction in PT.

Stage 2: Once the patient can perform isotonic exercises with minimal pain, heavy slow resistance exercises and eccentric exercises can be initiated. Exercises such as squats, hack squats and leg press from knee extension to 90° of knee flexion can be introduced. A gradual progression of the exercises are recommended. Exercises involving single limb can be performed as the condition progresses. Additional resistance can be provided by means of weighted belts, vest or bags with weight.

Stage 3: The major focus of functional strengthening is on movement pattern and kinetic chain deficits, as well as on the high load tendon capacity. Once the movement pattern and kinetic chain is improved the training can progress to plyometric and sport specific activities. High energy training such as skipping, jumping, sprinting and bounding movements along with agility training should also be included in the training program.

Attached in the video are an example of some isometric exercises that may be prescribed during stage 1 of the rehabilitation protocol.

31/10/2023

Thoracic Spine Mobility

Today's video covers 4 mid-back mobility exercises that can be used to improve spinal mobility and reduce pain in the mid-back region. The mid-back or thoracic spine is made up of twelve vertebrae (T1-T12) and naturally assumes a slightly rounded or kyphotic curve. Because the thoracic spine also has connections to the ribs, it is naturally more stable and less mobile than either the lumbar or cervical spinal regions.

Interestingly, previous research has shown that mobilizations directed at the mid-back can be helpful in terms of reducing both shoulder and neck pain. In the clinic, we often teach patients how to self-mobilize the thoracic spine when treating low back, shoulder and neck issues. Here's 4 examples of common exercises prescribed in clinic.

1. CAT COW
Alot of people know this one. Go from a rounded flexed position and alternate to and from an extended position to work on both thoracic flexion and extension.

2. KNEELING THORACIC EXTENSION
Place both hands on a yoga ball. Roll the ball forwards with both hands so your head comes between both hands and you'll come into shoulder flexion, you will also see you get thoracic extension with this exercise.

3. THORACIC EXTENSION MOBILISATION
A good exercise for people that are rounded at the shoulders, common with people that have desk based jobs. Roll gently up and down on foam roller keeping your bum up off the floor. When you find a particular area of discomfort, sit your bum down and then bring the back of your head towards the floor (extension). No firm rules on how many times you should do this but I generally tell patients to work on a region for 1-2 minutes and find the tender spots. Once the tender area is found sit the bum down and arch back for 5-10 seconds.

4. THORACIC ROTATION
Lay on your side and bring your knees up to approximately hip height (90°). Place your bottom hand on your thigh and hold it there. Now reach up with your top arm and rotate backwards bringing the back of your hand towards the floor. Hold for approx 5-10 seconds and return hand up in the air between reps. DON'T FORGET TO DO BOTH SIDES.

REMEMBER
You don't have to perform every exercise four times per day. You could do one in the morning, one in afternoon, one in the evening and one at night.

Any questions just leave it in the comments and I'll get back to you as soon as possible.

17/04/2023

Another Week closer to the big day and we come bearing more good news!! 💚

We have a fabulous competition that will be running for the next two weeks both on here and Instagram!! The prize below is sponsor by Darren in West Cork Pain Relief!! 💪🏼

The prize is compacted with all your recovery and exercise needs such as an exercise ball, yoga mat, foam roller, exercise wheel and much much more!! 😳

To Enter, all you have to do is :

1. Like this post 👍🏼
2. Share this post 📲
3. Tag who you think would love this as much as you in the comments below!! 💬

Make sure you are liking / following our page to make sure your entry is valid!! Winner will be announced on Tuesday the 2nd of May!!!🎁

So get entering guys and best of luck to all 💚🏃‍♂️🏃🏼‍♀️

01/04/2023

Double Knots v Single Knots

A paper with fascinating findings just published in latest edition of JOKESPT.

What do you make of it?

Will you start double knotting instead of single knotting?

Let us know in the comments below

17/12/2022

Anterior Cruciate Ligament (ACL) Rupture.

Watch mechanism of injury in video with caution 😲
Notice the anterior translation of the tibia in relation to the femur in the video below. 😬

Did you may know ACL rehabilitation for a safe return to sport can be a long process lasting approximately 8-12 months post surgery?

In this post I am focusing on phase 2 of a typical 6 phase of rehabilitation process.

Phase 2 (approx 1- 3months) rehabilitation post ACL reconstruction should focus on regaining strength, balance and basic co-ordination. Clinicians should use a clinical reasoning approach in prescribing an exercise rehabilitation program and management advice for each phase. This post briefly suggests typical exercises for phase 2 but programs should always be individualised.

Regaining muscle strength, balance and co-ordination are the goals of phase 2. This phase usually commences with easy bodyweight type exercises and progresses into a gym-based regime with a mixture of resistance, balance, and co-ordination exercises.

It's important for clinicians and patients to 'listen to the knee' during this phase and only progress as quickly as the knee will allow. Increase in pain and/or swelling are the two main symptoms that indicate that the knee is not tolerating the workload.

Typical exercises and management activities during this phase include lunges, step-ups, squats, bridging, heel raises, hip Abduction strengthening, core exercises, balance, gait re-education drills, and non-impact aerobic conditioning such as cycling, swimming and walking. Some clinicians may start some introductory impact style activities such as walk-jogging or mini jumps during this phase, but the bulk of this type of training should be reserved for phase 3.

The three most important goals for phase 2 are:
- Regain most of your single leg balance
- Regain most of your muscle Strength
- Single leg squat with good technique and alignment

Typically before a patient returns to running we put them through these tests at the end of phase 2:
1. Passive Knee Extension: Equal to other side
2. Passive Knee Flexion: 125°+
3. Swelling/ Effusion: Zero
4. Functional Alignment Test: Pass/fail
5. Single Leg Bridges: >85% compared to other side or >20 repetitions
6. Calf Raises: >85% compared to other side or >20 repetitions
7. Side Bridge Endurance Test: >85% compared to other side or >30 seconds
8. Single Leg Squat/ Sit to Stand: >85% compared to other side or >10 repetitions
9. Balance: Eyes open >43 seconds, eyes closed >9 seconds
We also put our patients through two supplementary tests which are considered a bonus for each phase of the ACL rehab protocol and should be strongly encouraged when the patient is returning back to high level jumping, cutting and pivoting sports.
10. Single Leg Press: 1 rep max at 1.5 bodyweight
11. Squat: 1 rep max at 1.5 bodyweight

Attached in this video are just some of the exercises typically prescribed in phase 2 of ACLR rehabilitation:
- Forward Lunge
- Bulgarian Split Squat
- Step Ups
- Single Leg Bridges
- Sit to Stand Single Leg
- Heel Raises
- Goblet Squats
- Wall Sits
- Side Plank
- Standing Hip Abduction
- Single Leg Balance

17/11/2022

𝗢𝘀𝘁𝗲𝗶𝘁𝗶𝘀 𝗣𝘂𝗯𝗶𝘀
~~~~~~~~~~~~

🔎 Osteitis p***s is defined as an idiopathic, inflammatory condition of the p***c symphysis and surrounding structures, most likely related to overuse or trauma.

📽️ Attached is a video of exercises commonly prescribed in stage two rehabilitation for osteitis p***s.

🧠 Quick Facts
1. Osteitis p***s is characterised as groin pain most commonly seen in the athletic population, specifically field sports that involve kicking and running. (GAA, soccer, rugby, running).
2. Patients often present with groin pain made worse with activity.
3. Plain radiographs and MRI may aid in diagnosis.
4. The condition is usually treated with NSAIDs, activity restriction, physical therapy and a graded approach to rehabilitation.
5. In rare cases, surgical intervention may be required.

✅ Treatment
The first option remains conservative management which includes; rest, NSAIDs & progressive physical therapy. it may take some athletes six months or more to return to pre injury level but more commonly, most return by three months.

Recent studies underline the importance of an individualised progressive rehabilitation program. in this program, patients are moved through four stages of rehab.

Stage 1: the focus is on pain control and improving lumbopelvic stability. Gentle prolonged stretching excluding the adductors and ischiop***c muscles is started along with cycling on a stationary bike for cardiovascular training.
Stage 2: Swiss balls and other aids are indicated for performing resistance and strengthening exercises of the pelvis, abdominal and gluteal muscles. Resistance hip strengthening with resistance bands are also indicated.
Stage 3 & 4: Includes eccentric hip exercises, side stepping with bands, lunges and squat exercises as well as progressive sport specific training. Running is gradually increased and changes of pace and direction are introduced. kicking is also permitted at the end of this stage.

🤸‍♂️ Rehab in this video include exercises for the posterior chain, core, hip abductors, hip Flexor and hip adductors

📚 Giai Via, A. Frizziero, A. Muffulli, N. et Al. (2019) Management of osteitis p***s in athletes: rehabilitation and return to training - a review of the most recent literature. Journal of Sports medicine. 10 (1) pp. 1-10.
Dirkx, M. Vital, C. Osteitis p***s stat pearls available: https://www.ncbi.nlm.nih.gov/books/NBK556168/
Jardi J, Rosa's G, Pedret C, et Al. osteitis p***s: can early return to elite competition be contemplated? Transl Med UNiSA. 2014;10:52-58
Jarosz BS. Individualized multi-model management of osteitis p***s in Australian rules footballer. JChiropr Med. 2011; 10 (2): 105-110
Sudarshen A. Physical therapy management of osteitis p***s in a 10-year old cricket fast bowler. Physiother Theory Pract. 2013; 29(6): 476-486
Vijayakumar P, Nagarajan M, Ramli, A. Multi-model physiotherapeutic management for stage four osteitis p***s in a 15 year old soccer athlete: a case report. J Back Musculoskeletal Rehabil. 2012; 25 (4): 225-230

10/11/2022

𝐌𝐞𝐧𝐢𝐬𝐜𝐮𝐬 𝐓𝐞𝐚𝐫𝐬
———
📚The meniscus is a C-shaped tissue between your femur (thigh bone) and your tibia (shin bone). Each knee has a medial (inner side) meniscus and a lateral (outer side) meniscus. The meniscus is composed of water, collagen, proteins and other cellular elements.

🧠𝐖𝐡𝐚𝐭 𝐢𝐬 𝐭𝐡𝐞 𝐟𝐮𝐧𝐜𝐭𝐢𝐨𝐧 𝐨𝐟 𝐚 𝐦𝐞𝐧𝐢𝐬𝐜𝐮𝐬? The meniscus is a shock absorber that helps optimize force transmission across the knee and protects the cartilage on the end of our femur and tibia. The medial meniscus is also a secondary stabilizer to the ACL as it can prevent anterior translation (forward shifting) of the tibia.

🩹𝐃𝐨𝐞𝐬 𝐭𝐡𝐞 𝐦𝐞𝐧𝐢𝐬𝐜𝐮𝐬 𝐡𝐚𝐯𝐞 𝐠𝐨𝐨𝐝 𝐡𝐞𝐚𝐥𝐢𝐧𝐠 𝐚𝐛𝐢𝐥𝐢𝐭𝐲? Tears in the outer 1/3 of the meniscus have healing potential because there is blood flow to that area. However, tears in the inner 2/3 generally do not heal well as a result of poor circulation.

🔪𝐃𝐨 𝐚𝐥𝐥 𝐦𝐞𝐧𝐢𝐬𝐜𝐮𝐬 𝐭𝐞𝐚𝐫𝐬 𝐧𝐞𝐞𝐝 𝐬𝐮𝐫𝐠𝐞𝐫𝐲? No. All meniscus tears do not require surgery. Surgery is indicated if you have mechanical symptoms such as locking. Otherwise, you should try conservative management first. This includes NSAIDs (anti-inflammatories), physical therapy, and finally, injections. If you fail conservative therapy and do not have arthritis, you may then be a candidate for surgery.

🏋🏼‍♂️𝐖𝐡𝐢𝐜𝐡 𝐞𝐱𝐞𝐫𝐜𝐢𝐬𝐞𝐬 𝐬𝐡𝐨𝐮𝐥𝐝 𝐈 𝐝𝐨? Exercises that encourage knee mobility, motor control and strength can help to reduce pain and improve function. Watch the video to see a short list of exercises with useful progressions that may help you. e.g Straight Leg raise for two weeks before progressing to resisted straight leg raise.

📞📱Any questions drop me a message, WhatsApp chat or call 0867264559

1️⃣Straight Leg Raise 👉 Resisted Straight Leg Raise
2️⃣Single Leg Bridge 👉 Elevated Single Leg Bridge
3️⃣Hamstring Curl 👉 Resisted Hamstring Curl
4️⃣Wall sit 👉 Goblet Squat
5️⃣Step up 👉 Box Step Up

18/08/2022

https://www.theguardian.com/lifeandstyle/2022/aug/18/good-posture-doesnt-prevent-back-pain-and-bad-posture-doesnt-cause-it?s=09

The idea that slouching will damage your back lacks evidence. But there are other factors known to be important for spine health

06/05/2022

'I've recently had low back pain, should I get a scan?'

This prospective study by Carragee et al. 2006 investigated if first-time episodes of low back pain are associated with MRI findings.

MRI is frequently used to evaluate first time episodes of serious low back pain. Common degenerative findings are often interpreted as recent developments and the probable cause of the new symptoms.

This study evaluated 200 subjects (people) with a lifetime history of NO significant low back pain problems and had MRI on evaluation. Subjects were contacted every 6 months over a 5 year period and if the subject had experienced acute low back pain, they then underwent an MRI and these MRI results were compared to the first MRI results taken at evaluation.

During the 5 year observation period of 200 people, 51 (25%) were evaluated with a lumbar MRI for clinically serious low back pain. These 51 people all had MRI before and after Acute onset of low back pain. Of these 51 people only 2 had new findings of probable clinical significance (4%).

Findings on MR imaging within 12 weeks of serious LBP are highly UNLIKELY to represent any new structural change. Most new changes (loss of disc signal, facet arthrosis, and end plate signal changes) represent progressive age changes not associated with acute events.

05/01/2022

Saw this video doing the rounds again recently.

Your discs are not jelly doughnuts and they don't 'slip'.

Anybody telling you to avoid bending over or squatting in case your disc 'slips' hasn't read any research over the last 10-15 years.

27/01/2021

𝐊𝐧𝐞𝐞 𝐀𝐫𝐭𝐡𝐫𝐢𝐭𝐢𝐬

🔎Osteoarthritis (OA) is degenerative condition of the cartilage present in our joints and most commonly affects the knee and hip. Symptoms usually include pain, swelling, joint stiffness, limited range of motion and difficulty with many functional tasks. Severe pain or functional loss associated with OA of the knee or hip often leads to joint replacement surgery.

🧠Many individuals with OA are told that exercise will harm their joint(s) and encouraged to avoid many activities. While it is important to respect one’s symptoms and progress gradually, it should be known that properly dosed exercise can actually improve joint health. Furthermore, strengthening the muscles that surround a given joint can actually help to reduce stress on cartilage and other sensitive structures.

🏋🏼‍♂️Maybe the main takeaway from this research is that a simple home exercise program can have a dramatic impact on the life of an individual with OA of the knee.

✅See a few exercises below that can be used to improve strength of the muscles of the lower quarter and overall joint health

1️⃣Clamshell
2️⃣Banded Hip Abduction
3️⃣SL Calf Raise
4️⃣Single-Leg Bridge
5️⃣Split-Squat
6️⃣Ball Hamstring Curl
7️⃣Step-Up

📚Reference: Bricca A, et al. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. Br J Sports Med. 2019.

04/01/2021

𝐏𝐥𝐚𝐧𝐭𝐚𝐫𝐟𝐥𝐞𝐱𝐨𝐫 𝐓𝐫𝐚𝐢𝐧𝐢𝐧𝐠
———
👣The primary ankle plantarflexors or calf muscles include the gastrocnemius and soleus muscles and contribute to both ankle and knee movement.

🔎Other smaller plantarflexors include: plantaris, flexor hallucis longus, flexor digitorum longus, tibialis posterior, peroneus brevis & peroneus longus.

🧠Exercises that train the plantarflexors can help to reduce the likelihood of suffering a foot/ankle injury, such as achilles tendon tears, ankle sprains & plantar fasciopathy. Calf strengthening can also help protect joints and other tissues farther up the kinetic chain.

💪🏼If calf strengthening is not a regular component of your resistance training program, then be sure to add the exercise shown in the video and aim for 3 sets of 8-12 slow, controlled repetitions 2-3/week.

✅If you want to test your calf strength first, here are the maximum number repetitions you should be able to do in one set by age group:

20-29yrs: Males 37, Females 30
30-39yrs: Males 32, Females 27
40-49yrs: Males 28, Females 24
50-59yrs: Males 23, Females 21
60-69yrs: Males 19, Females, 19
70-79yrs: Males 14, Females 16
80-89yrs: Males 10, Females 13

📚Reference: Hébert-Losier K, et al. Updated reliability and normative values for the standing heel-rise test in healthy adults. Physiotherapy. 2017.