All About Arthritis

Arthritis

You will develop arthritis at some point in your lifetime. It can be very mild, causing a little stiffness as you age, or it can be extremely painful and debilitating. Fortunately, there are things you can do to prevent and manage this condition.

Arthritis is not actually a disease. Arthritis is a term used to describe joint inflammation (“arthro” = joint;  “itis” = inflammation). When inflammation is present, the joint is usually painful. However, not all joint pain is arthritis. Problems like trigger points, sprains, or tendinitis can cause pain, but the joint itself remains healthy.

Arthritis refers to problems with the joints. There are over a hundred different forms of arthritis and growing. The forms relate to wear and tear of the cartilage such as osteoarthritis (OA) which is by far the most common. It affects approximately 400,000 people in Ireland. The second most common form of arthritis is rheumatoid arthritis (RA) which is associated with inflammation in the joints. In Rheumatoid arthritis the body’s own tissues in the joints are attacked. About 1% of the adult population in Ireland is affected by Rheumatoid arthritis.

Osteoarthritis

Osteoarthritis

Doctors will often refer to this type of arthritis as degenerative joint disease, or if it affects the back, degenerative disc disease. It sounds scary, but it’s the most common and least serious type of arthritis. Osteoarthritis is simply wear and tear of the cartilage on the ends of the bones. One research study found that 37% of all adults have osteoarthritis in their hands or feet. Everyone over sixty-five years of age has it to some degree. However, because the cartilage is not sensitive to pain, you most often do not know you have it.

Stiffness is a key feature of osteoarthritis. Typically, your joints feel stiff in the morning and will loosen up after you move around for awhile. Sometimes the joints will make crackling or crunching sounds with movement. In the early stages, you will only feel pain after excessive activity. The pain is usually an aching sensation within the joint. You will seldom see swelling because inflammation in the joint tends to be minimal.

Rheumatoid arthritis

Rheumatoid arthritis is not nearly as common as osteoarthritis. It occurs in only about 1% of adults.

This type of arthritis is called systemic arthritis because it can affect many of your body systems. For example, it can affect your heart, lungs, nerves and skin. Whereas osteoarthritis usually develops as you get older, rheumatoid arthritis can occur at any age.

Usually the symptoms appear over a period of weeks or months and are accompanied by fatigue, fever, and diffuse pain. Subsequently, specific joints become inflamed and are painful, tender, swollen and red. Many joints become involved and both sides of your body are affected equally. There are periods when it goes into remission. It’s progressive however and overtime the involved joints often become somewhat deformed.

New Services and Skills

As a member of The Irish Association of Physical Therapists and like all primary healthcare professionals, we are obliged to make sure we keep our skills up to date. This is formally called continuing professional development (CPD) and has been revised recently to be in line with similar healthcare providers. Over the last year I have completed a number of courses that I hope will add to my ‘toolbox’ and improve my skills and outcomes as a Physical Therapist. I have used all of these skills over the last few months depending on the client and their presentation. Here is a few of them and a brief explanation of what it is and how it can help you.

Kinesiotaping

During the 2012 Olympic games, numerous athletes wore a bright colored tape on their shoulders, knees, and backs called kinesiotape. David Beckham, Lance Armstrong and Serena Williams are also fans of the tape. The Kinesio Taping method involves taping over and around muscles in order to assist and give support to muscles or to prevent over-contraction of muscles, depending on patient presentation. Kinesio Taping can easily be integrated into a patients’ existing treatment plan. It also can be used on clients with postural problems and tightness in typical areas (neck shoulders and back).

Dry Needling

Dry Needling involves multiple advances of a fine filament needle into the muscle in the region of a “Trigger Point” (muscle knot). The aim of Dry Needling is to achieve a local twitch response to release muscle tension and pain. Dry needling is an effective treatment for chronic pain of neuropathic origin with very few side effects. This technique is unequalled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits.

The needle used is very thin and most subjects do not even feel it penetrate the skin. A healthy muscle feels very little discomfort with insertion of this needle. However if the muscle is sensitive and shortened or has active trigger points within it, the subject will feel a sensation like a muscle cramp -‘the twitch response’. The patient also may feel a reproduction of “their” pain which is a helpful diagnostic indicator for the practitioner attempting to diagnose the cause of the patient’s symptoms. Patients soon learn to recognise and even welcome this sensation as it results in deactivating the trigger point, reducing pain and restoring normal length function to the involved muscle. Dry needling is similar but not the same as acupuncture.

Spinal Mobilisation Course

Spinal mobilisation is the gentle manual manipulation of the joints in the spine to release the body’s own healing powers which then are able to restore the joints or tissue being treated to normal functioning. This is done in the right place at the right time in the right way. If done correctly it can improve the faulty functioning of body structures such as joints, muscles and tendons.

Shoulder Injury

Torn Labrum

The shoulder joint is a ball and socket joint, similar to the hip; however, the socketof the shoulder joint is extremely shallow, and thus inherently unstable. This means that the bones of the shoulder are not held in place adequately, and therefore extra support is needed to help the muscles stabilize the joint. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within. The labrum circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements. The biceps tendon attaches to the labrum.

How can a labral tear occur?

The labrum can get torn from repetitive, high force movements such as, throwing hard or a tennis serve. Having an extreme stretch of the biceps tendon with exercises like dips or full range bench press can also lead to labral damage. Falling on an out stretched arm or having a hard impact at the shoulder can also lead to a labral tear. The labrum becomes brittle with age and can become more vulnerable to fraying or tears.

What are the symptoms of a torn labrum?

Symptoms of a labral tear depend on where the tear is located, but may include:
An aching sensation in the shoulder joint, Catching of the shoulder with movement, Pain with weight bearing on the arms, Pain and/or loss of range in shoulder internal rotation and reaching across the body.

What are the common types of labral tears?

SLAP Tears
A SLAP (superior labrum anterior to posterior) tear is a type of labral tear most commonly seen in overhead throwing athletes such as baseball players and tennis players. The torn labrum seen in a SLAP tear is at the top of the shoulder socket where the biceps tendon attaches to the shoulder, and when severe can be related to complete detachment of the biceps.

Bankart Lesions
A Bankart lesion is a labral tear that occurs when a shoulder dislocates. When the shoulder comes out of joint, the labrum is torn, and makes the shoulder more susceptible to future dislocations.

Posterior Labral Tears
Posterior labral tears are less common, but sometimes seen in athletes in a condition called internal impingement. In this syndrome, the rotator cuff and labrum are pinched together in the back of the shoulder.

How do I know if there is a labral tear?

A doctor or physical therapist can do movement tests to see if the labrum is irritable but the tests are not considered to be consistent. An MRI is often needed to confirm a labral tear. If a shoulder problem is not getting better a consultation with a physician who specializes in shoulders is advised.

What is the treatment for a torn labrum?

As with any shoulder injuries, initially, the movements which irritate the injury must be stopped and the inflammation controlled. At Premier Physical Therapy we will discuss the daily activities which may be irritating the condition. Icing is critical to control the inflammation in the early phase. Another priority in the early phase is to normalize the shoulder motion with safe stretches, including some to improve internal rotation. Then, a comprehensive shoulder-strengthening program should be undertaken, emphasizing the back part of the shoulder and the ability to keep the shoulder blade in good posture. It is important to progress at a cautious rate so as to not irritate the torn labrum. As the symptoms recede and the strength returns,the mechanics of irritable motions must be addressed. For example, technique refinement with swimming, throwing, weight training, or a work task might be done with coaching or video analysis. In severe cases of labral tears the conservative treatment won’t sufficiently resolve the problem and surgical intervention may need to be explored. Even if surgery needs to be done ultimately the conservative program will make the post operative-recovery faster. At Premier Physical Therapy we make you an active participant in your rehab and not a passive recipient of our care. We will teach you how to fix yourself with the above-mentioned approach and return to your every day activities.

The power of massage

Research report

Massage has been used in every culture throughout history. Not only because it feels so good, but because of its profound effects on health and well-being. The healing powers of this ancient healing art are slowly being revealed to modern researchers as they uncover its effects on a wide range of conditions ranging from eczema and bulimia to HIV and diabetes.

Until about ten years ago, the benefits and effects of massage were not well understood. Massage therapists knew that it could increase blood and lymph circulation, decrease heart rate and blood pressure, improve mobility and reduce people’s pain. However, the impact of massage on the wide range of conditions that a massage therapist treats had never been scientifically examined.

Massage under the microscope

That situation changed when the first institute devoted exclusively to the study of touch was created in 1992 – the Touch Research Institute.

The driving force behind the Touch Research Institute is its director Tiffany Field. Motivated by the death of her own child, she obtained a research grant in 1975 to study child development.

Ten years later, as an assistant professor of pediatrics and psychology at the University of Miami, she was looking for ways to help premature infants develop faster. She noted that they respond with increased weight gains, improved developmental scores, and earlier discharge from the hospital.

The power of massage

Studies from the Touch Research Institute have looked at people of all ages with a variety of health conditions and complaints. The range of benefits is remarkable. Here are some highlights from a few of the many published studies.

Labor pain: Massage during the first 15 minutes of each hour of labor decreased the mother’s anxiety and pain. There was less need for medication and the length of labor was shortened.

Migraine headaches: Massage therapy decreased the occurrence of headaches along with sleep disturbances and distress symptoms.

Asthma: Children with mild to severe asthma who received regular massage were better able to exhale (a problem with asthma because the air passages constrict). In addition, the children suffered less stress and anxiety.

Premenstrual symptoms: After massage therapy there was improved mood and a decrease in anxiety. Pain and symptoms of water retention were also reduced.

Juvenile diabetes: After a month of regular massage, average blood sugar levels dropped into a normal range. The massaged children were also more likely to stick with their treatment regime.

Sexual abuse: Following massage, abuse survivors showed a reduced aversion to touch. They were less depressed, less anxious and had lower levels of stress hormones.

Bulimia: Bulimic teenagers received massage twice weekly for five weeks. The girls had an improved body image and felt less anxious and depressed. Results were similar for those with anorexia.

Pregnancy: Women who had massage through pregnancy showed decreased levels of stress hormones and experienced less anxiety. There were fewer complications before and after birth including fewer premature births.


Pregnancy Massage

Pregnancy can be a joyous time for a mother-to-be. However, the changes in a woman’s body and natural fears and anxiety can also be very stressful, both physically and emotionally.

Side lying position for a comfortable treatment

Many women avoid massage during pregnancy because they don’t think it’s possible to lie properly on the table. Lying prone (face down) will likely be comfortable until the fourth or fifth month. After that the therapist will work on your back as you lie in a semi-prone or side lying position.

Physical therapy massage has a profound ability to decrease stress as well as prevent or minimize many of the common symptoms and discomforts of pregnancy. Regular massage therapy sessions can mean the difference between a comfortable, relaxed pregnancy and one defined by miserable aches and pains.

Physical therapy massage is especially useful because pregnant women are often unable to take many medications that are normally used to manage common problems. Massage can help manage these aches and pains and is completely safe for both the mother and fetus.

According to a recent study published in the Journal of Psychosomatic Obstetrics and Gynecology, the benefits extend beyond just making mom feel good. Researchers found that for women who received regular massage, there were fewer complications both during pregnancy and afterwards, including fewer premature births.

How can physical therapy help?

Massage can have a beneficial impact on a whole range of problems associated with pregnancy, not just muscle aches.

Morning sickness is the nausea and vomiting that many women experience early in the pregnancy. Although it is called morning sickness, it can occur any time during the day or night. As with many other problems, hormones are largely to blame. However, stress also appears to play a very significant role. By using regular massage to relax, the incidence of nausea and vomiting can actually be reduced.

Hormones can also cause constipation as they cause the muscles of the digestive tract to relax. Gentle massage to the abdomen can help relieve constipation by activating a reflex that stimulates movement in the intestines. Massage therapists can also use rocking and passive range of motion techniques to get things moving. Deeper abdominal massage that is often used to relieve constipation in non-pregnant clients is never used, so there is no risk to the fetus.

Headaches are another common problem in pregnancy. A non-drug approach is by far the best way to treat them. Massage has been proven to be extremely useful in dealing with headaches and should be considered the preferred treatment choice. Research shows that headaches become shorter and less frequent with regular massage.

In the second trimester more pronounced physical changes take place. As the abdomen and breasts grow larger, a woman’s posture starts to change. Typically most women develop an increased curve in their lower back or sway back to compensate for the extra weight at the front of their bodies. It’s no surprise that about half of all pregnant women develop back pain.

Massage can help through this period by minimizing muscle imbalances, relaxing tense muscles and improving their blood flow. A physical therapist can help minimize episodes of muscle cramps, spasms, and myofascial pain, especially in the lower back, neck, hips, and legs. Other benefits of pregnancy massage include:

  • Tranquil relaxation and reduce stress.
  • Increase in blood and lymph circulation, which can reduce swelling.
  • Reduces stress on weight-bearing joints.
  • Improves outcome of labor and eases labor pain.
  • Enhances the pliability of skin and underlying tissues.
  • Provides support for the new mother with physical and emotional strains of mothering.

Taming your tension

Muscle tension is like a car that’s idling too fast. The car is revved up and working hard but nothing useful is happening. There’s more wear and tear on the motor. Not only that, but the motor is burning more fuel and creating more pollution.

With muscle tension your muscles are working hard, but are not doing anything that’s useful. The tension doesn’t help you move and it certainly doesn’t make your muscles stronger. It doesn’t really accomplish anything at all.

It does, however, cause a lot of wear and tear on your body. It strains the tendons that hold your muscles to your bones. It pulls the joints tighter together which not only causes horrible grinding and crunching sounds, but also causes the cartilage in your joints to wear out. The tension limits your movement, interferes with your co-ordination and may make you more accident-prone.

The tense muscles burn up the fuel in your muscles, making you feel tired. They also create the equivalent of car exhaust – toxic waste products (called metabolites) that fatigue your muscles and make them feel sore and achy.

You know from experience – tension is not good.

It’s important that you get your tension under control. Not only will you feel more comfortable, but you’ll also prevent a lot of problems from occurring, from kinks in your neck to early arthritis. To manage your tension, it helps to know what causes it.

The culprits

Stress is one of the major sources of muscle tension. When under stress, you become like a turtle trying to pull its head into its shell. Your shoulders round forward and lift up as your head pulls back. If your stress level is high, you may actually notice your shoulders around your ears. More often than not, the stress isn’t quite so significant and the shoulder muscles simply tighten up.

Just sitting or staying still for periods of time will also cause your muscles to tighten up. By remaining static, you are in a sense training your muscles to lock your back or neck in a certain posture. When you begin to move, your muscles remain tense in an effort to maintain your position. It takes some time for the muscles to realize that they can let go and relax. The longer you sit without moving, the more you train your muscles to lock into position and the longer it takes to release them.

In looking at the way that tension is created, you can see that the areas that are most vulnerable to tension are your neck, shoulders and back. Although tension can develop in any muscle in your body, these are the areas that are most commonly affected.

Physical Therapy to the rescue

Massage plays an important role in helping you deal with your tension. As a physical therapist it is possible to adjust how fast your “muscle motors” are idling, just like a mechanic with a sluggish motor.

Physical therapy uses many modalities in affecting change within tightened and tender muscles. The benefits of physical therapy and massage include:

– Increases circulation, allowing the body to pump more oxygen and nutrients into tissue cells and vital organs.

– Stimulates the flow of lymph, the body’s ‘trashman’, which helps fight against toxic invaders. For example, in breast cancer patients, massage has been shown to increase the cells that fight cancer.

– Increased circulation of blood and lymph systems improves the condition of the body’s largest organ – the skin.

– Relaxes and softens injured and overused muscles

– Reduces spasms and cramping

– Increases joint flexibility by stimulating synovial fluid, essential for pain free   movement

– Reduces recovery time, helps prepare for strenuous workouts and eliminates subsequent pains of the athlete at any level.

– Releases endorphins – the body’s natural painkiller – and is being used in chronic illness, injury and recovery from surgery to control and relieve pain.

– Reduces post-surgery adhesions and edema and can be used to reduce and realign scar tissue after healing has occurred.

– Improves range-of-motion and decreases discomfort for patients with low back pain.

– Provides exercise and stretching for atrophied muscles and reduces shortening of the muscles for those with restricted range of motion.

Dealing with Discs

Your back consists of stacked bones called vertebrae. There are discs between the vertebrae that act as shock absorbers and that allow the spine to bend. Each disc consists of a soft semi-fluid center (the nucleus) that is surrounded and held together by strong ligaments.

The discs in your spine can be the source of a great deal of back pain. This pain can range from a nagging ache and sciatic discomfort to excruciating pain that incapacitates you. There are simple measures you can take to reduce the risk of disc problems occurring and to reduce your pain once problems do occur.

To understand how disc pain happens, it is important to understand normal posture. When standing upright there is a natural inward curve in the lower back called a lumbar lordosis. With this natural lordosis, your body weight is distributed evenly over the discs.

Lumbar vertebrae and discs

The lordosis is lost whenever you slouch or bend forward. Back problems develop if you find yourself in these positions for long periods of time. This occurs because the vertebrae are placed in a position that pushes the nucleus backwards and stresses the ligaments at the back of the disc.

If the pressure on the ligaments is severe enough they may become weak and allow the soft inside part of the disc to bulge outward (prolapse) and press on the spinal nerves. This can cause sciatic pain in the buttock or down the leg.

Prevention is best

Ideally, you want to stop back pain from developing by taking some simple steps to reduce strain to your back.

Many chairs don’t offer sufficient support for your lower back. Even well designed chairs can be used improperly. For example, most people sit in the middle of the seat and then slouch backward against the back support.

It is important to maintain the natural lordosis in your lower back while sitting. You can use a specially designed lumbar support that can be attached to your chair or simply roll up a medium sized towel and place it between your lower back and the backrest of your seat.

As well, stand up regularly, put your hands on the back of your hips and bend backwards five or six times.

Many activities around the home like gardening, making the bed and vacuuming cause you to stoop forward. Make sure that you stand upright occasionally and bend backwards to relieve the strain on the back ligaments. If you are doing any lifting, make sure to keep your back straight and bend from your hips and knees.

In the event that your back starts hurting be sure to see your physical therapist right away. They’ll be able to help you out or refer you to a qualified medical professional.

Fibromyalgia

Do you seem to be tired all the time, even after you’ve had a full night’s sleep? Do you feel stiff every morning? Do you ache all over? Do you get frequent headaches?

These symptoms could be the result of stress. However, if you experience these feelings over a long period of time, it could indicate that you have a condition called fibromyalgia.

Because the symptoms are so common, many people go undiagnosed for years with this increasingly prevalent chronic pain disorder. Next to osteoarthritis, fibromyalgia is the most common rheumatic disease. It affects approximately 2% of the population and it is estimated that up to 20% of patients that see a rheumatologist (a doctor specializing in arthritis) are suffering from fibromyalgia.

Typical Fibromyalgia pain pattern

This condition is sometimes referred to as fibrositis or fibromyositis. It usually affects women between the ages of 20 and 50. It’s a syndrome that causes chronic, sometimes debilitating muscle pain. The pain usually occurs where muscles attach to bone and is similar to the pain of arthritis. The good news is that the joints themselves are not affected. The joints do not deteriorate or become deformed as they do in some types of arthritis.

Pain is the most prominent symptom. It usually occurs in the neck, shoulders and back. People with fibromyalgia describe the pain in many ways. Some people report a stiff, aching feeling. Others describe a burning, stabbing, gnawing or radiating pain.

Pain isn’t the only symptom. Many people also experience generalized stiffness. Remaining in one position for extended periods of time, for example sitting for a long car ride, can increase the stiffness. For this reason, it seems to be worse first thing in the morning.

Fatigue is another almost universal symptom. About 90% of sufferers report moderate to severe fatigue. They feel a lack of energy, less endurance with exercise, or the kind of exhaustion associated with the flu or lack of sleep. This can interfere with concentration. Even simple mental tasks can seem extremely difficult.

Other common symptoms include swelling, tender points, headaches, insomnia, depression and neurological problems like numbness and tingling in the limbs.

Fibromyalgia is very difficult to diagnose because the symptoms mimic those of stress and other diseases. To add to the problem, there is no definitive laboratory test that can be done to confirm that you have the condition.

Because the diagnosis is made primarily on the basis of the reported symptoms, people with fibromyalgia are often led to believe that it’s all in their heads and that nothing is wrong.

Sitting on the job

As the workforce has shifted from factories to offices, the incidence of back pain has increased dramatically. Researchers blame this increase on one simple activity that we do all the time – sitting.

Our bodies were not designed to sit for long periods of time. We were made to move.
Almost everyone who sits for long periods of time will develop back pain, even with the use of an ergonomic chair. It’s not uncommon to develop other problems as well. Surveys of office workers indicate that about half of all employees have frequent pain or stiffness in their necks and shoulders. Repetitive strain injuries like carpal tunnel syndrome are becoming more common and about 10% of keyboard users experience wrist pain or discomfort. Who would have thought that sitting could wreak such havoc on your body?

Your body needs movement to operate effectively. If you have a sedentary lifestyle or sit for most of the day, your body is going to start complaining. You have to move.

When your muscles contract, you assist the flow of blood and lymph fluid through your body. The muscles act as a pump. If they don’t contract regularly the blood in your extremities pools and you may get swelling of your feet and hands or those parts may just feel cold because the blood circulation is insufficient.

When you sit for long periods of time certain postural muscles, like your shoulder muscles, become overworked. These will tend to become short and tight from overuse whereas other muscles like your gluteals, abdominal and mid-back muscles, will become weak and atrophy.

microbreak

Lean back in your chair and stretch your arms up and your legs out. Wiggle your fingers and toes. Then do circles with your ankles and wrists. Continue to reach up and back, close your eyes, smile, breathe in deeply and out slowly several times.

In the short time it takes to perform this micro break, you have released the lock of your visual and mental tasks, stretched away muscle tension built up in your hips, spine, and arms and refreshed your body with extra oxygen by expanding your rib cage. You also improved your posture as well as the circulation of blood through your legs and arms. All this in less than 30 seconds!

Caution: Before trying this micro-break, be sure to check your chair for stability so that you don’t tip over.

RICE protocol for your injuries

It’s easy to pull a muscle or sprain a joint. These kinds of injuries may result from simply overdoing everyday activities like gardening or shovelling snow or they can be caused by an accident, like a fall. Use the RICE formula immediately after hurting yourself. You’ll dramatically reduce the time it takes for your injury to heal and get back to your normal routine as quickly as possible.

RICE is an acronym for rest, ice, compression and elevation.

Rest

The simplest and most effective thing you can do is rest. Many people try to “work through” the injury in the hopes that it will go away or work itself out. Injuries don’t spontaneously disappear. In fact, excessive movement will damage the tissue further, increasing the amount of inflammation and pain.

Unless the injury is severe, absolute rest should not exceed 48 hours. Otherwise, your muscles will become stiff and weak, and scar tissue around the injury will tighten up. So as soon as the initial pain and swelling subside, you should begin to gently exercise the injured area.

Ice

Apply ice immediately. The importance of icing your injury cannot be emphasized enough. Ice is a natural pain reliever and anti-inflammatory. It slows down blood flow to the area and reduces internal bleeding and swelling. Depending on the type of injury, your healing time may be cut in half.

Simply place ice cubes in a plastic bag. You can also use commercial gel packs that you keep in your freezer or a bag of frozen vegetables (peas seem to work well). You may find that these mold better to your body. Wrap whatever you’re using in a towel or cloth and apply it to the injured area. Leave it on for 10 to 20 minutes and then allow your skin to warm up. As a general rule, don’t leave the ice on for more than 20 minutes because you may cause frostbite. Ice the injury as frequently as possible, preferably at least once every waking hour.

Compression and elevation

Compression and elevation help reduce swelling. You can apply compression to the area with an elastic type bandage. Be careful not to tie the bandage so tightly that you cut off your circulation. If one of your arms or legs is injured, you can elevate the extremity above the heart level.