Optimal Loading for Tendon Rehabilitation

As a physiotherapist having many clients with tendon issues, the biggest question I have is why did injury occur in the first place? Was it due to trauma, is it linked to training loads or is it something else causing effects to the tendons. Our job is to help guide you to have the best rehab getting you back into your sport or activities. This blog will discuss the importance of optimal loading for tendon rehabilitation.

Optimal loading is what physios strive to achieve when talking about rehabilitation, although due to the nature of tissue healing and recovery it can be made difficult to follow a ‘recipe’ program. Therefore we need to adapt our exercises and progress you through the rehabilitation process to get you back to the top of your game.

When deciding what rehab pathway is appropriate we must first look at what stage of injury we are in. There are two key stages of tendon injury, reactive and degenerative. A Reactive tendinopathy can be described as an acute tendon injury where appropriate management strategies would be to de-load the tendon to let the inflammatory process settle down, then proceeding with progressing tendon loading. A degenerative tendon is where symptoms have been present for a while. A good progressive loading program to increase tissue capacity and tolerance to load is needed.

The table below describes the nature of these types of injuries:

Reactive Degenerative
Symptom Acute onset of symptoms, slow to settle down Chronic – long history of symptoms
Age 15-25 30-60
Time 2-6 weeks 3-6 months
Physio management Massage, orthotics, Dry needling etc. Progressive load
Treatment Unload and reload Load,- Heavy and slow

The image below can help us understand the architecture of a tendon. As a tendon injury starts to proceed into a degenerative tendon the striation of the collagen go from being very linear and to being disrupted and become more disorganised.  This demonstrates the change that occurs and therefore it is important to have an appropriate exercise program to prevent further injury.

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Here at Bureta Physio we can help guide you through your injury. We will focus on the injury itself but always ask the question to why this occurred in the first place.

Key points:

  • Depending on the type of injury, we need to work together to establish the best management strategies for rehab
  • Acute reactive tendons may need to be unloaded prior to reloading
  • Chronic degenerative tendons can take months to heal fully
  • As a degenerative tendon develops the architecture of the collagen fibres becomes disorganised. Through loading appropriately we can enable the tendon to be able to adapt to required loading and therefore allowing return to sport.

Please call us on 07 576 1860 to discuss your injury and our team will be more than happy to help.

Written by Braedon Catchpole – Physiotherapist

Concussion is a Mild Traumatic Brain Injury.

Concussions – Written by Kimberley Pilbrow (BHSc Physiotherapy)

With the start of another Winter Sports season now upon us, now is a good time for athletes, parents, coaches, officials & supporters to increase their knowledge about concussion.

Concussion is a Mild Traumatic Brain Injury which occurs when someone receives impact to the head or body causing a force to be transmitted to the brain, ie ‘shaking’ inside the skull. In a concussion injury there is no change to the macro-structure of the brain. Ie there is no permanent damage to the brain. However, there are changes at a micro level, meaning it may take some time to re-access the areas of the brain that were affected.

Historically people believed that to sustain a concussion you must be “knocked out” (loss of consciousness), this is not true- 90% of concussion occur without any loss of consciousness AND Loss of consciousness does not relate to their long-term outcomes. Ie someone who is knocked out may return safely to sport in 3-4 weeks, where as someone who is not may take 3months to recover- there is no relationship between “severity” of concussion and length of recovery.

As Concussion is a brain Injury- there is a wide range of symptoms such as:

Visible Signs:
-loss of consciousness
-slow to get up
-unsteady on feet/poor balance
-poor coordination or inappropriate playing behaviour (eg. standing out of position)
-clutching or grabbing at head
-dazed or confused
-vomiting (>once is of greater concern-take to Emergency Department)
-irritability/changes in emotions

Symptoms:
-dizziness
-headache
-nausea
-drowsiness
-“don’t feel right”
-blurred vision
-difficulty concentrating/remembering

If you (or your child) have an incident like this and have one or more of the following symptoms you should:
1) Be removed from sport immediately
2) Monitored by an adult
3) Seek Medical Attention from your GP or Concussion Trained Physiotherapist (Click here for our team)

A full list of symptoms can be found HERE– the Concussion Recognition Tool is a great resource for parents & coaches

Assessment and Treatment of Concussion:
A concussion must be diagnosed by a health professional. Examination from your Physiotherapist will include a group of tests as required including; SCAT5 or SCAT5 Child Assessment (Symptoms, Neurocognitive processing, Balance), Assessment of neck pain and movements, Neurological Exam, and Eye & Head Movements.
Treatment of each concussion is individual- REST IS NOT BEST!!
Your Physiotherapist will work with you on starting appropriate activities EARLY to aide a gradual return to daily activities (highly supported by research), followed by return to work/school and then return to sport. Your treatment plan may include; education about pacing activities, treatment of the neck joints and muscles, relearning eye tracking movements and gradual exercise progressing back to full function including work and sport specific tasks.

Key Points:
-90% of concussions occur without being knocked out
-If you suspect a concussion, remove the athlete from play IMMEDIATELY
-Seek Medical Assessment from someone trained in Concussion
-Rehabilitation is INDIVIDUALISED
-REST IS NOT BEST!
If you have had a concussion, Bureta Physiotherapy will work with you, your family and your doctor to take you through the required steps for full return to function-including sport, school or work.
Early Diagnosis is important for monitoring symptoms and guiding appropriate rehabilitation, contact us TODAY to book an appointment or discuss if our acute concussion service is right for you.

 

 

Abnormalities found on scans in asymptomatic people.

There have been many studies that have explored the abnormalities within our bodies through using different imaging techniques. The key take home message that research has brought to us is we are not all perfect, even if we are walking around pain free performing all our daily activities without issues.
However when injury does occur we may get x-rays, an ultrasound or refer you to a specialist who can get an MRI which can come back with findings such as a disc bulge. As demonstrated in the infographic above, it shows us that at least 37-96% of individuals can have this problem in their lower back, and up to 87% in their neck.
It is also reported that for men aged between 40 and 70 years old, up to 96% of individuals have shoulder abnormalities . Although these individuals can carry out their daily routine symptom free.
There are many findings on imaging from head to toe that are part of the normal ageing process and yet do not affect any part of our social or work life or our physical activity. What we don’t know is that we may have already been living with them for many years in our lives. This goes to show that even if we have an ‘abnormality’ within our body on imaging, it doesn’t necessarily mean that we are ‘injured’ or that our injuries are as bad as they present.

Image: Leedarrenh

Strain and sprain is not OK!

“The perfect movers, without strain and pain are under 5 year olds”

Stiffness and strain for many is part of life, indeed a modus operandi for many. But imagine if stiffness and strain equates to dysfunction, pain and harm, this forms much of our function and day. I recently attended a Integrated Movement Patterns Course to upskill on the Milicich Method where the emphasis was on non – specific neck and back pain. These methods were derived from analysing the perfect movers of this world; the few uninjured high performing individuals, who work within gravity, pain free. A small percentage are in the adult population and a high percentage are the 5 years old’s and under, the perfect movers of this world; the young who display natural movement synergies. The ability to move their centre of mass with perfect balance is part of our natural physical development, which sets the foundation for future movement.

The Milicich Method aims to facilitate these fundamental movement patterns that are still within our central nervous system and awaken them to treat strain and sprain. Diaphragm function underpins strength and function within these movement synergies undoing habits, utilising language to facilitate existing pathways. These are key to the learning process. Many people have unlearned the pro-gravity system and reprogrammed the anti-gravity system in their brain, working against gravity instead of with gravity.

One aspect of our daily lives that contributes to neck and back strain is lifting and the Milicich Method addresses this concern looking at the way 5 year old’s squat and how power lifters perform. This was instrumental in re-establishing the pro-gravity movement pattern. The natural flat foot squat (FFS) position is a movement that much of the western society has lost. The FFS that every child performs, moves the centre of mass through a vertical range of motion, and this is a very specific sequence of movement incorporating diaphragmatic breathing to engage the power chain, which gains a successful lift without strain within gravity.
If this concept of eliminating strain and sprain, re-establishing fundamental principles of movement and working within gravity is something that you would like to explore then I look forward to facilitating this learning process.

Marcel Gyde
Senior Physiotherapist

Back First Aid !

You’ve hurt your back – what can you do!?! This blog should help to explain what is going on and how to help yourself. Everyone is different, if you see a physiotherapy at Bureta Physiotherapy we can help make an individualised program for you.

Central low back pain –what is it?
Low back pain is very normal; in fact 80% of the population will experience low back pain some time in their life. This often resolves within 3 months, sometimes with recurrent episodes. People often don’t know why it happens and get upset as it can be very irritating and painful, restricting normal everyday activities.

Due to the mechanical pressure our low back gets exposed to, it is the most common part of our spine to get injured.  Most low back pain is caused by overstretching of ligaments and other soft tissue structures around our spine. This is often due to poor posture over a period of time. This soft tissue ‘damage’ is often easily reversible if we address the prolonged poor postures.

What can you do?

  • Don’t panic!
  • Keep moving! It is really beneficial for your back to keep active with light activity
  • Try lying on your stomach, prop yourself up onto your elbows if you are able to do this or onto extended arms
  • If you are unable to do this then you can try the rest position with feet up on a chair (see photo below)
  • Heat and pain relief can help to relieve the pain but not the underlying cause
  • Try some extensions 10x hourly (see image)– the majority of the population respond to this movement for pain relief and to restore some mobility. If this spreads pain into your leg then stop these exercises
  • Avoid aggravating postures
    – try sitting in a hard chair with a straight back, such as a dining room table chair, instead of in an arm chair
    – you can try a lumbar roll (you can source one of these from any physio at Bureta) for sitting
  • Get in to see a physio at Bureta Physiotherapy to help address some of these aggravating postures to prevent this from re-occurring. The physio can also start you on some core strengthening exercise, often seen in pilates classes, to provide some stability to your spine.

rest90

The 90/90 position as a rest position

Are you breathing right?

Do any of these sound like you?

  • Do you struggle with persistent neck or back pain?
  • Struggle with breathlessness during sport, exercise or activities of daily living when you are otherwise healthy?
  • Do you regularly have pins and needles in your hands or feet?
  • Do you have cold or sweaty clammy hands or feet regularly?
  • Do you yawn excessively?
  • Do you suffer from Asthma, allerties, rhinitis, hay fever, sinusitis
  • Do you suffer from facial or jaw pain, Tinnitus
  • Do you suffer from reflux?
  • Have you struggled with your breathing since hospital admissions/surgeries
  • Do you suffer from Panic attacks or chronic anxiety
  • Are you an athlete who isn’t performing at a level that is appropriate to your underlying fitness level?

Research shows that Breathing pattern disorders affect up to 10 – 30% of the general population and atleast 30% of those with asthma.

Faulty breathing patterns can be caused by a variety of reasons from bereavement to tight clothes, from a history of abuse to chronic sinusitis to sitting poorly. Whatever the cause the first step is in addressing and correcting this faulty pattern as the cycle it sets us on otherwise continues to strengthen the effects it has.

Faulty breathing patterns affect different people in different ways. Some patients are more inclined to mental distress, fear, anxiety and co-existing loss of self-confidence. Others may exhibit musculoskeletal and more physical symptoms such as neck and shoulder problems, chronic pain and fatigue. Many are a combination of both mental, emotional and physical factors.

All babies are nose breathers and unfortunately during our lives many of us for a  variety of reasons become habitual mouth breathers. This has a signifcant effect on physcial, physiological and chemical processes in our bodies. The number one aim of the Bradcliffe breathing programme is to restore your ability to nose breath and as a result of this correct a large number of variables that can occur.

In the Western World we seem to have become addicted to “doing”. We are highly prone to stress and anxiety and we struggle to relax. We are stimulation addicts and there are now even things developing such as “Email apnoea” where we hold our breathe when we are emailing. Our increasingly sedentary lifestyles contribute to postures that make correct breathing more difficult but even our elite athletes are affected with breathing pattern disorders which can have significant effects on their performance.

For more information email jacinta@buretaphysio.co.nz or blair@buretaphysio.co.nz ring 075761860 to book an hour appointment with Jacinta or Blair in order to have your breathing programme started today!

Do you suffer from dizziness, vertigo or loss of balance?

Vestibular rehabilitation is an effective treatment for these symptoms caused by an inner ear dysfunction.  The vestibular system sits deep in your inner ear and is made up of three semi-circular canals and the utricle and saccule.  The semi-circular canals detect rotational head movement and the utricle and saccule detects linear and vertical head movement.

The brain receives information from both vestibular systems, your eyes, receptors in your joints and muscles to maintain balance/equilibrium.   When the system is damaged then the information sent to the brain is altered and results in symptoms such as dizziness.

 

Common causes of vestibular dysfunction are:

  • Labrynthitis
  • Vestibular neuritis
  • BPPV (Benign paroxysmal positional vertigo)
  • Menieres disease
  • Acoustic neuroma
  • Oxotoxicity – damage to the system from the use of some medications

Other causes of vestibular dysfunction can also benefit from vestibular rehabilitation including:

  • Post stroke
  • Post head injury: Positional vertigo and particularly BPPV is the most common cause of severe dizziness – it is also common post head injury and can be recognised by the pattern of dizziness which is reproduced when the head is placed in a certain position.

There can be other serious causes of dizziness which need to be evaluated by your doctor or specialist to determine whether vestibular rehabilitation is appropriate for you.

 

How this is treated is dependent on the cause and can include:

  • Specific head, body and eye exercise:
  • Gaze Stabilisation
  • Balance
  • Gait and Strengthening exercises

(These exercises will be performed in the clinic and at home.  These exercises are designed to retrain the brain to recognize and process signals from the vestibular system and coordinate them with information from your eyes and muscles and joints.)

  • Canal repositioning techniques (for BPPV).  When you suffer from BPPV the dizziness is a result of otoconia (small crystals) moving into the semi-circular canals most commonly the posterior canal.  With specific techniques and different head positions the crystals can be shifted back out of the canals reducing dizziness.

 

If you have been suffering from dizziness vestibular rehabilitation can be an effective treatment option for you so contact us now on 075761860 to book an initial vestibular contact (one hour appointment) or contact me directly for further information donna@buretaphysio.co.nz.