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

Lateral ankle sprains – How should they be managed?

Diagnosis, Treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline – vuurberg et al., 2018.
Lateral ankle sprains, how should they be managed

Lateral (outside) ankle sprains are the most common ankle injury. Approximately 40% of all traumatic ankle injuries occur during sport, and only 50% of individuals seek medical attention.
Due to the poor attention to injury, a large population develop chronic ankle instability. 1-4 years following initial injury, 5-46% of individuals with chronic ankle instability still experience pain, 3-34% has recurrent sprains, and 33-55% report instability.
Risk Factors
Predisposing factors that increase the risk of sustaining a lateral ankle sprain compose of Intrinsic factors (patient-related), and Extrinsic factors (sport, environment).
Intrinsic risk factors
Modifiable risk factors include:
• Reduced strength around the ankle and calf
• Limited ankle mobility and range
• Poor proprioception (“the sense of the relative position of one’s own parts of the body and strength of effort being employed in movement”)
• Low cardiorespiratory endurance
• Increased BMI (Body mass index)
• Preseason deficiencies in postural control/balance e.g single leg stand
Non-modifiable risk factors include:
• Anatomical abnormalities in the ankle, knee alignment, and multiple clinical defects
Extrinsic risk factors
• Sport dependent – Highest incidence of lateral ankle sprains were found in: Basketball, indoor volleyball (landing following jumping), field sports, climbing.
• Playing surface – Natural grass vs artificial turf vs court
• Position played in sport – e.g within soccer, defenders obtain 42.3% of lateral ankle sprains in the sport.
Treatment
Below is some of the latest evidence for the best treatment options, and how we can get you back running around with the kids, or back onto the sports field.

 R.I.C.E (Rest, Ice, Compression, Elevation)
Purpose: to reduce pain and swelling, improve patient function
RICE alone as a treatment is not enough, the best evidence is to apply the RICE principles alongside with exercise therapy.

 Non-steroidal anti-inflammatory drugs (NSAID’S) – E.g Ibuprofen, naproxen, diclofenac
Purpose: to reduce pain and swelling for acute injuries
If you have any concerns in regards to medication please discuss with your doctor.
Adverse effects may include: stomach discomfort, allergic reactions, heart burn, nausea, vomiting, diarrhea and/or constipation and more.

Immobilisation
A minimum of 4 weeks in a low leg cast following an acute lateral ankle sprain results in less optimal outcomes when compared with functional support (brace, tape, tubigrip/bandage) and exercise strategies with duration of 4-6 weeks.
However recent evidence showed a short period (less than 10 days) of immobilisation with plaster cast or rigid support (brace) can be of added value in the treatment of acute lateral ligament injuries as it helps reduce pain and oedema (swelling), and improves functional outcomes

Functional support i.e ankle brace/ tape/ tubigrip
Tubigrip/compression stocking following the acute phase of treatment begins to become unhelpful as it doesn’t provide sufficient support. Therefore using a lace up brace or semi-rigid brace will provide enough ankle support
Ankle braces results in better outcome compared to rigid or K-tape
K-tape is unlikely to provide sufficient mechanical support to unstable ankles

 Exercise
Consist of neuromuscular and proprioceptive exercises
Reduce the risk of recurrent injuries by reducing ankle instability, and associated with quicker time to recovery and enhanced outcomes

 Manual mobilisations
Manual mobilisations provide short term increase in ankle range of movement and can reduce pain in lateral ankle sprains
However manual therapy in combination with exercise therapy results in better outcomes than exercises alone

 Surgical therapy
60-70% of individuals who sustain lateral ankle sprains respond well to non-surgical treatment programmes
Surgery is mainly reserved for patients who have chronic ankle instability and who have not responded to comprehensive exercise-based physio programme.

Other therapies
Other treatment options are can also be used during treatment, although please discussed with your physio if these are beneficial for you.
These including: Acupuncture, Vibration therapy, laser therapy, electrotherapy, shockwave therapy, ultrasound.

Here at Bureta Physio we can properly assess your injury and give you the appropriate recommendations to get you back into what you love doing. Call 07 576 1860 to arrange an appointment time or click here to book online

 

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

Running Injuries: Can I train through?

Authored by Donna Withers – Physiotherapist @ Bureta

This is a common question we get asked. As a runner it is always our goal to be running one hundred percent pain free. Unfortunately in reality this is often not the case as many runners are constantly dealing with a niggle whether it be a slight pain in the knee to a tight calf or a niggling hamstring. These small niggles and aches often don’t bother us enough to need to take time out from running but do stop training from being enjoyable.

There are a wide range of running injuries that are common complaints amongst the running population. These range from severe injuries which require a lot of time off to mild aches that can come and go. You can reduce the risk of needing to take too much time off with how you go about managing your injury. Taking the time to seek treatment and getting a treatment plan that focuses on the causative and underlying factors and developing a long term management plan for prevention which often includes strengthening, stretching and regular maintenance through the use of a roller and massage can significantly reduce time off.

An example of a very common running injury is Patellofemoral Syndrome also known as “runners knee” this is the irritation of the cartilage on the underside of your knee cap. This is commonly seen in runners who don’t have good biomechanics with loading/running. This can be caused by a number of factors i.e. weakness of the quads, gluts, hips or poor foot control/overpronation (rolling in). By focusing on the correct strength exercises which improve biomechanics and therefore reduce the loading of your knee training can be continued by reducing intensity and cross training.

Prevention is always the key whether you have an injury or you are just looking to avoid one your physiotherapist at Bureta can assess your biomechanics and work with you to develop a management plan to keep you out on the track. See our previous blog on some tips for running injury prevention. Remember the best injury cure is injury prevention – happy running!!

Core Strength and Back Pain

What is Core Stability?

This is a term which describes the firmness and stability of your trunk muscles. These are the muscles which wrap around your trunk like a cylinder or brace. They lie between your ribs and your hip bones just like the corsets worn in Victorian times.

The core or trunk muscles are the foundations of the body. The back, arms and the legs work much better if the trunk muscles are stable. When the trunk muscles are working together they support your body when walking, bending, lifting and even sitting upright and give you more energy.

Once working correctly they will also help protect the back from injury.

Why is Core Stability useful in the treatment of back pain?

Pain has been shown to turn muscles off. Pain encourages sufferers to adopt pain relieving positions but ultimately they add to the problem. This leads to recurrent low back pain. Improving core stability will help stop this pain or reduce it a lot and encourage better posture which will prevent further pain. Improving posture may reduce pain immediately. Improving core stability will reduce pain over time.

How can we help you?

We need to teach your muscles how to work again. This training is done one on one with your physiotherapist. Once the muscles are working correctly we can then give you a programme of exercises to improve your strength even further. These need to be monitored and are progressed as the muscles slowly strengthen and work together correctly. We also offer pilates classes and strength classes which incorporate core strength. Call us now to book into our classes. New times and more classes coming 2015…………. New schedule up on website in Jan

Knock knees, flat feet, fallen arches – Should I be concerned about these with my child?

As children grow from babies through toddlers, young children, the dreaded teens and finally to adults they go through many growth stages. During different stages of growth their body is placed under varying stresses. There are a number of factors or biomechanical issues that are good to have checked out by a physio to help ensure your children stay pain and injury free.

Babies-toddlers: during this stage there are a number of milestones which are most often the largest concern. These include the recommended time to sit, crawl, walk and develop higher functions likes socialising and language. It is important to realise that all children develop at differing rates, and some may bottom shuffle instead of crawling or skip it altogether and go straight to walking. If you have concerns at this stage speak with your GP/paediatric nurse or physio. Odds are your child just has quite reached that stage yet.

Toddler-young children: during this stage changes in the alignment of the lower limb and growth spurts can result in a variety of problems. Many children will often suffer ‘growing pains’, flat feet, knock or bowed knees and clumsiness with sport and running. If you notice any of these it is important to have them checked to ensure that growing pains are not muscle/tendon injuries and that foot issues are within normal limits. Unchecked these can go on to generate further problems.

Teens: Once again an important area due to massive growth spurts and changes to the general structure of their body as puberty takes hold. It is also at this stage that we often see dramatic increases in the duration and intensity of activity.

Common problems during this stage for girls include frontal knee pain, ankle sprains, calf tears and shin splints.

For boys common issues include shoulder instabilities, sprained ankles and knees, tendon attachment inflammation (Osgood-schlatters etc) and shin splints.

During the school term between work, sports and after school events it can be hard to find time to get these niggling injuries or pains checked but it is important that these issues are sorted out SOONER rather than later and that the appropriate treatment and rehab programmes can be started.

For a Free assessment voucher or quick chat to see if your child is appropriate for a full assessment give us a call on 5761860 or email buretaphysio@xtra.co.nz for more information.