Knee & Ankle Dysfunction/Pain
This is probably one of the most common presenting symptoms in a clinical sports medicine along with the non athletic individual. The two most common causes of patellar femoral syndrome is patellar tendonitis and simple OA changes in the older adults.
Examination requires functional testing to reproduce the patient’s pain and careful palpation to determine the site of maximal tenderness, localised swelling of the patellar tendon maybe present with patellar tendonitis. Effusion (swelling) located underneath the kneecap of the fat pad can cause impingement. Effusion inside the knee joint usually indicates a partial tear of the meniscus (cartilage), which gives rise to locking of the knee. Finally, symptoms of the knee giving way usually indicates anterior cruciate ligament instability.
Ultrasound or MRI examination may be used to image the patellar tendon. This along with the standardised objective tests and the observation help to confirm diagnosis. These findings combined with the clinical picture help to determine the treatment regimen.
In my experience 98 percent of patellar femoral pain and dysfunction is associated with significant focal thickening and muscle tightness around the quadriceps, hamstrings, calf and IT band structures.
In most cases muscle tightness and trigger points in the above mentioned structures respond very well to and integrated approach consisting of ice, ultrasound and or interferential therapy to reduce acute pain and inflammation. Taping to correct abnormal positioning of the patella, VMO strengthening, bracing, correction of abnormal biomechanics.
However, I primarily use dry needling IMS (intramuscular stimulation) to release trigger point formation and deep tissue frictions with longitudal and lateral release techniques to help realign and off load excessive pressure off the patellae. This intervention along with a comprehensive stretch programme tends to bring miraculous results in achieving the restoration of normal knee function.
Rotar Cuff Tendonitis
Tendonitis is a common cause of shoulder pain and impingement in athletes. In this condition, the rotator cuff tendons become inflamed and swollen. Rotator cuff tendonitis can be either primary due to faulty biomechanics or secondary due to excessive loading due to a predisposition such as poor scapulao humeral rhythm. In addition, several trigger points (knotted muscle tissue) are set off throughout the muscular structures of shoulder making certain movements restricted and painful.
The client usually complains of movements such as reaching above the head, behind the back as well as racquet sports, shoulder military presses etc.
On examination there may be tenderness over the supra spinatus tendon, pectorals, infraspinatus and the posterior deltoid structures. Ultrasound scan can also confirm a tear in some of the tendons.
Treatment is usually performed in two parts:
The first part is to treat the tendonitis with digital ischaemic pressure, progressing to transverse frictions throughout the tender bands in the neighbouring muscles that attach and support shoulder. Dry needling (IMS) is used to desensitize and relax the trigger points and taut bands of resistive muscles.
The second part of the treatment is a comprehensive stretching programme of the shoulder and all of its associated muscle groups along with functional movement re-education and strengthening programme.
With KC physio within 4 to 5 treatments most rotator cuff injuries are significantly improved if not fully resolved.
The Achilles tendon is the largest tendon in the body and can withstand heavy loads of tension for long periods. The problem is this structure is avascular (poor blood supply) which explains why this condition is slow to heal. There are several causative factors include poor footwear, change of surface, ballistic jumping and bounding, poor calf and soleus flexibility to name just a few.
Irritation to the Achilles tendon is the most common injury in the lower ankle region. This is secondary to muscle shortening of the calf, soleus, plantaris and the plantar flexor structures. These muscles directly and indirectly attach and affect the Achilles tendon causing mechanical overload as it connects down onto the heel bone. Another structure that flares up in conjunction with AT is the retro-calcaneal bursa, this is located at the base of the Achilles tendon attachment.
The individual usually notices a gradual development of symptoms and typically will complain of pain and stiffness immediately on rising in the morning. This pain then eases with walking or during training, only to recur several hours afterwards.
On examination pain and tenderness is usually felt with digital pressure applied to the calf structures and extreme tenderness is felt upon squeezing the Achilles tendon especially at its attachment point to the heel bone.
Treatment initially requires a reduction of the pain and inflammation using ice, ultrasound and electrotherapy. A heel raise is sometimes administered to reduce excessive loading on the tendon. This is then followed with transverse and longitudal frictions over the paratendon as well as myofascial release to tight calf, soleus, plantaris, and the sole of the foot. IMS (acupuncture) is also employed to release tight muscle bands situated all throughout the posterior compartment of the lower leg.
The next step is to restore full extensibility to the tendon. This achieved through an active stretching programme in standing and kneeling. Finally, after once the pain in the tendon has dampened, a strength programme is introduced. This consists of eccentric loading, which promotes collagen formation along the tendon, thereby increasing the elastic and tensile properties of the tendon. A functional strength programme is then provided. At KCphysio we pledge that within 4-5 treatments Achilles tendonitis will show significant improvement and or will be fully resolved.
Tension Headaches & Neck Pain
This is caused by abnormalities of the joints, muscles fascia and neuromengial structures. Neck pain develops through poor postural head position, whiplash, ligament and muscular sprain, and when left unchecked can lead to spondylosis (wear and tear of the joint structures). It is also not uncommon for the client to report headaches due to mechanical overload of the posterior neck muscles where they tighten where they attach to the base of the skull.
Treatment and management of the neck requires an assessment of any abnormalities present in the muscles joints and fascial tissue. These structures are then treated using the techniques of joint mobilisation, trigger point, acupressure, deep tissue frictions, dry needling (IMS) joint manipulation, stretch, exercise therapy and postural retraining.
The general principles of treatment are performed which include treating one abnormality at a time and assessing the affect of different treatment techniques and comparing to pre and post treatment cervical findings.
At KCphysio in most cases the client will find that even after the first session there will be significant improvement and a reduction in their pain symptoms. This is then followed up with only a few more sessions where the client will notice astounding results with the ability to maintain better head on neck posture.
Low Back Pain & Sciatica
This affects approximately 70 percent of the population, and many will experience low back pain at some point in their lives. The aim with a patient with LBP is to determine the location of the pain, what mechanisms flare up the pain and what factors ease the pain. It is also important to note any referred signs of pain to the buttocks and or legs. The physical signs of LBP is usually that of spasm or myofascial tightness directly adjacent to the spinal vertebral segments anywhere from the thoracic level down to the lumbo sacral level. Additional LBP symptoms includes increased tone and protective muscle spasm of the buttocks and hamstring muscles.
This in turn can trap and compress the sciatic and or spinal nerves hence reducing the nerve impulses to the muscles. This causes the muscles to become very sensitive and tender to digital (finger) pressure applied.
LBP responds extremely well to IMS. Inserting the dry needle into the painful tender bands of the associated muscles of the erector spinae, quadratus lumborum, glute medius muscles. In addition, depending on the client’s threshold, deep tissue release is used to help separate unwanted adhesed muscle and fascial tissue. This then allows for the vertebral segments of the spine for effective mobilisation and if indicated manipulation. This is then followed up with an active and passive stretch programme to help restore and alignment and normalise muscle tone. At KCphysio clients experience pain relief and increased range of motion within the first session. Subsequent sessions give rise to further pain relief and restored function. Finally, this intervention combined with a simple home exercise programme will yield amazing results with only a handful of sessions.
Tennis/ Golfers Elbow
Tennis elbow is an inflammatory condition characterised by moderate to acute pain on the outer side (lateral side) of the elbow which is associated with the common extensor tendon
This injury occurs with excessive use of the wrist extensors and is usually triggered by activities such as tennis, badminton, squash, weightlifting, along with occupational and leisure activities such as typing, sewing, knitting, brick layering, gardening etc.
This condition usually presents with microscopic tears at the common extensor tendon or where the tendon attaches to the bone causing inflammation. This inflammation excretes a form of exudate known as fibrin which converts to fibrosis (scar tissue). Furthermore, focal thickening and trigger points occur at the local muscles around the tendon. The resultant outcome becomes a perpetuating cycle where the scar tissue at the tendon is stretched beyond its capacity and tears again. This cycle can repeat itself many times over as a low grade inflammatory long -term process.
An additional contributing factor can originate from nerve root compression at the C5, 6 segments of the cervical vertebrae. This can compromise nerve supply (Causing Neuropathy) muscle shortening and hypersensitivity to the extensor group of the forearm.
Objective Assessment tests can reveal weakness and pain of these extensor muscles when resistance is applied. Functional tasks such as lifting a kettle, carrying shopping bags etc.
This condition is successfully treated with modalities such as ice, ultrasound, acupuncture at the neck and the arm, deep friction massage at the tendon structure, a graduated strengthening program along with postural advice.
This is a condition characterised by pain and acute tenderness on the medial side of the elbow. This affects the common flexor tendon near or on its bony attachment.
The principals of treatment are the same as tennis elbow.
For further information please contact us.