Fall Prevention Facts

Introduction

Falls can be catastrophic. The 2 year mortality rate for 75+ year old individuals who fall and break a hip is greater than for heart disease or even cancer! Yet, falls can be prevented. It doesn’t take any surgery or medication, just simple, safe, regular strength and balance balance exercises such as in a Tai Chi class.
A fall can deprive an older person of their ability to lead an active, independent life. Each year tens of thousands of older men and women are disabled, sometimes permanently, by falls that result in broken hips and other bones. Besides strength and balance exercise, simple changes at homes and in daily routines can prevent such falls.

When should I see a doctor?
Any person over 65 years of age should have their balance tested. Diabetes, arthritis, and poor vision can each contribute to diminishing agility, coordination and reflexes. Certain medications may also have side effects such as dizziness or light-headedness.
Osteoporosis is a particular risk factor for a fracture due to a fall. Bone density declines in women after menopause and in older people in general. For someone with severe osteoporosis, even a minor fall may cause fractures to occur. Thus preventing falls is very important for all older persons.


What can I do for myself?

Falls and accidents don’t “just happen.” There are steps that can be taken to reduced our chances of falling. Here are some things you can do to prevent falls and fractures.

Check with your pharmacist if dizziness or light-headedness is a side effect of any of your medication

Be evaluated for diabetes

Have your vision and hearing tested.

Wear a properly fitted hearing aid and eyeglasses if recommended by your doctor.

Don’t drink too much alcohol

Avoid become overheated or dehydrated

Don’t get up too quickly after sitting or lying down. Low blood pressure may cause dizziness at these times.

If your walking is unsteady or if you sometimes feel dizzy, use a cane, walking stick, or walker.

Be particularly careful when walking outdoors on wet or icy sidewalks.

Don’t wear just socks on stairs or waxed floors where you could easily slip.

If you are carrying something when going up or down a stairway, keep one hand on a handrail.
Ways to increase your activity.

Keep up a regular program of exercise.

Join a Tai Chi or similar type exercise class

A simple self-test for balance involves testing if you stand in a doorway on 1 leg for 10 seconds

If you can, try it with your eyes closed

If you can’t do it for more than a second or two then try standing with 1 foot in front the other.

Always reach out to the doorjam for support if needed

Here are some other examples of ways to modify your activity:

How to Make Your Home Safe Checklist:

Stairways & hallways should have:

good lighting and be free of clutter

secure handrails of all stairs

light switches at the top and bottom of stairs.

Bathrooms should have:
grab bars placed in the bath tub or shower and if necessary near toilets
nonskid mats, traction strips, or carpet on all surfaces that may get wet
nightlights.

Bedrooms should have:
night lights or light switches within reach of bed(s)
area rugs should be removed or firmly attached to the floor
telephones that are easy to reach, near your bed.

Living areas should have:
couches and chairs with arm rests and at proper height to get into and out of easily.
Loose cords should not be present in any walkways


Rehabilitation

When you see a functionally oriented health care provider they will give you a comprehensive functional assessment. This will include a battery of tests to assess your balance, agility, coordination, strength, and flexibility. One of the most important treatments will involve balance training.

Your health care provider will identify balance exercises which you can do for a few seconds, but are not too easy.


For More Information

The U.S. Consumer Product Safety Commission can send you a free copy of the booklet Home Safety Checklist for Older Consumers.
U.S. Consumer Product Safety CommissionWashington, DC 20207800-638-2772800-638-8270

(TTY)Website: http://www.cpsc.gov/CPSCPUB/PUBS/701.html

Source from "clinicalrehabspecialists.com"

Fibromyalgia Facts

Fibromyalgia (FM) is a common and complex chronic pain disorder that affects an estimated 10 million Americans, mostly women. FM is a syndrome rather than a disease. Unlike a disease, which is a medical condition with a specific cause or causes and recognizable signs and symptoms, a syndrome is a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause. FM is characterized by chronic widespread pain, multiple tender points, abnormal pain processing, sleep disturbances, fatigue and often psychological distress. Fortunately, FM is not a serious life-threatening illness and can be diagnosed properly by a physician who is knowledgeable about this condition.The National Fibromyalgia Association (http://www.fmaware.org/) is a nonprofit organization that provides educational information and support for Fibromyalgia patients and their family members; it is an excellent resource for gathering more information on this elusive disorder

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The tender point locations of fibromyalgiaMense S, Simons DG. Muscle Pain. Lippincott, Williams & Wilkins; 2001.


When should I see a doctor?
As with many other medical problems, proper diagnosis is half the cure. People with FM tend to look healthy on the outside but feel miserable on the inside, and therefore it is important that a physician knowledgeable about FM be the person to make the appropriate diagnosis. Many physicians are still not well educated about the diagnosis of FM and may be too quick to give a diagnosis of FM. It is important that you first have standard laboratory tests performed – before a diagnosis of FM is given – in order to rule out some other medical problems that could be the cause of widespread pain and fatigue.Many other medical problems can mimic the symptoms of FM including anemia, Lyme Disease, rheumatoid arthritis, low thyroid, diabetes, vitamin and mineral deficiencies, and other chemical imbalances. Sometimes the key symptoms of FM - widespread pain and fatigue – can be caused by reactions or side effects to common medications such as statins for high cholesterol, some blood pressure medications, and even some anti- depressant medications. Your doctor should be able to rule out these other causes of widespread pain and fatigue with standard laboratory tests. The diagnosis of FM should only be given after a thorough physical examination and laboratory tests fail to detect another medical problem. As noted above, FM is a complex pain disorder that requires a multifaceted treatment approach including the following components:

Pain management with various medications

Gentle exercises

Sleep management

Nutritional guidance

Psychological and emotional support

Complementary therapies such as chiropractic, acupuncture and massage.

There is no single cause or single treatment for FM, and each individual with FM requires an individualized treatment approach using a combination of the above therapies. It is normal to worry about the cause of your pain and the impact it may have on your life. Talking with your healthcare provider about these worries and concerns can be helpful. Although the pain of FM can be debilitating at times, you and your healthcare provider can find many ways to relieve the symptoms and get you back to your normal activities.


When should I see a doctor?

Keep in mind that staying active with your normal activities is the best thing you can do to limit the effects of fibromyalgia on your life. You may have to modify the way that you perform certain activities of daily living, slow down your pace and intensity of physical exercise. However, you need to keep moving and exercise within the limits of your abilities. Many FM patients find that gentler forms of exercise are better tolerated, such as Tai Chi and Yoga. Avoid intense or aggressive forms of exercise, such as high impact aerobics or heavy weight lifting.Proper sleep hygiene is an extremely important component to the successful management of FM. You should avoid excessive amounts of caffeine and alcohol, as these substances can alter your normal sleep cycle. Regular exercise can be a helpful aide in promoting good sleep. It is important that you try to maintain a normal bedtime and time to awaken in the morning; keeping to a routine sleep cycle is very helpful. Some patients will require certain medications for improving their sleep, which should be discussed with an appropriate licensed healthcare provider. Emotional stress and depression tend to afflict many FM patients. Taking classes in stress management, mindfulness meditation, yoga, and relaxation therapy may be very helpful in the self-management of these emotional states. Some FM patients will have severe depression and/or anxiety that need to be treated with therapeutic doses of anti-depressant or anti-anxiety medications often in conjunction with a licensed psychologist or psychiatrist. It is important to note that this does not mean FM is a psychiatric condition; patients will simply find it easier to cope with their FM symptoms when their mental health needs are addressed. Many FM patients experience specific areas of muscle pain, in addition to the overall sense of widespread pain and fatigue. For these discrete areas of muscle pain known as myofascial trigger points, various types of massage or manual therapy can be very beneficial. As a rule, most FM will not respond well to heavy or aggressive types of deep tissue massage. Instead, FM patients should consider lighter forms of massage that do not involve deep friction or stripping of the tissues. Deep breathing and relaxation, along with massage, can aide in the relaxation of tight painful muscles.

Rehabilitation
The FM patient can benefit from the assistance of a trained rehabilitation specialist who understands that FM must be addressed with more gentle types of exercise than other patients with musculoskeletal pain. It is important for both the FM patient and their rehabilitation specialist to understand that “hurt does not mean harm”. FM patients can expect to experience a modest amount of post-exercise soreness, but this should not be excessive or debilitating. As a rule, exercises should be performed at a very low intensity and gradually increased to a level that is tolerable for the FM patient. Mild aerobics and strength training are indicated for the treatment of FM, with many patients reporting that yoga and tai chi exercises are excellent adjuncts to a standard rehabilitation program.One simple way to get started with an exercise program is begin a daily walking program. You could start by walking just 5 minutes the first day, and gradually keep adding 2-3 minutes per day until you are walking 30-40 minutes a day. When the weather is bad, you can substitute the use of a stationary bicycle indoors. Keep track of your time on the bicycle and set a goal of reaching 30-40 minutes. Some fibromyalgia patients prefer to exercise in the water, by treading water, swimming a few laps, or taking a beginner’s water aerobics class. One benefit of pool based exercise is the fact that the buoyancy of the water takes a lot of pressure off your joints.The type of exercise you choose is up to you. It's important that you start exercising and keep doing it. Exercise relieves much of the pain fibromyalgia causes. Some people even find that exercise makes all their pain go away. You will also feel better if you have some control over your own care and well-being, by doing things to help yourself get better.

Sources from Clinicalrehabspecialist.com

Herniated Disc and Sciatica Facts

Introduction

Herniated discs are probably the most common diagnosis for severe back pain and sciatica (leg pain). Discs are large cushions that lie between the individual vertebrae of our spinal columns.

The disc is composed of layers of ligaments (annulus fibrosis) arranged in a criss-crossing matrix that hold in a gel-like substance (nucleus pulposus), giving the disc its "shock-absorbing" ability. Sometimes the gel swells (which is called a disc protrusion or bulge).




A more problematic situation occurs if the gel pushes through its ligamentous wall (which is a disc prolapse or extrusion). Both situations can led to pressure or irritation of the vulnerable spinal nerve roots. This can lead to sciatica - an abnormal sensation felt anywhere from the buttocks to the feet.

For more that 70 years, orthopedists have believed that most lower back pain and sciatica were caused by herniated discs. The "dynasty of the disc" led to the typical medical advice of bed rest and medication. Gordon Waddell, a renowned British orthopedic surgeon, wrote in the journal Spine, "There is remarkably little scientific or clinical evidence to support the value of bed rest for low back pain or even sciatica." Bed rest is now known to cause prolonged pain, muscle weakness, joint stiffness, and depression.

If bed rest failed, surgery was the usual next step. Unfortunately, due to poor patient selection, many unnecessary surgeries were performed. Waddell said, "surgical successes unfortunately only apply to approximately one percent of patients with low back pain." According to Alf Nachemson, M.D., editor of the journal Spine, bulging discs are found and taken as an excuse to do a lot of surgery and percutaneous discectomy. Discs are made to bulge; that is a normal finding."

Edward Carragee, M.D. the Dean of Neurosurgery at Stanford University reported that disc bulges are present even in 20 year olds, BUT by age 30 there are more episodes of back pain in individuals whose spines had no abnormalities when they were 20 than in those with the bulges! He has also written in the journal Spine that the long-term results of surgery vs. conservative care for pinched nerves is no different.

Back and even leg pain can arise from the muscles, joints, or ligamentous structures of the spine. Whatever the cause, evidence is growing showing that rehabilitation not surgery is the treatment of choice for most lower back disorders.

When should I see a doctor?

Anytime a person has pain radiating down their leg they should see a doctor to find out the reason why. This is not something urgent unless there is buckling of one or both legs, incapacitating pain, progressive pain or numbness, loss of bowel or bladder control, or numbness around the genitalia or anus.

Pain Control/First-Aid

Goal: reduce pain, swelling and inflammation

• physical therapy (e.g. ice, electrical muscle stimulation)

• manual therapy (e.g. massage, traction) and manipulation

• anti-inflammatory/pain medication if necessary

What can I do for myself?

An important study from a leading orthopedic center in San Francisco demonstrated that more than 90 percent of patients with disc herniations responded to non-surgical treatment. Most of these patients had already been referred by neurologists for immediate surgery. Their treatment included simple pain control methods in combination with rehabilitation. According to Nachemson, "All the structures in the back fare better with early, controlled motion....if something is injured and you start to slowly move it under controlled conditions, then the structure heals quicker and better."

It is important to spare your spine if you have a pinched nerve. Slumping or bending forward from the waist are key sources of irritation of the disc. Prolonged sitting is another problem. Try not to sit for more than 20 minutes at a time without getting up and limbering your back. Because the disc is mostly water it swells at night when you are recumbent. Thus, the morning time is a critical time to keep your spine from bending forward while you brush your teeth, dry your feet and change.

Besides taking over-the-counter pain relievers of anti-inflammatories iceing your back at home is a key treatment. This can be performed for 20 minute intervals a few times a day.

Ways to increase your activity.

Walking is a safe exercise for pinched nerves due to herniated discs. If bending forward increases your leg symptoms, but bending backwards ONLY hurts in your back you may want to perform press-up and standing back extension exercises a few times a day. 10-12 slow repetitions are generally recommended. It is best to see a qualified health care provider to determine what exercise is best for you.


Rehabilitation

Goal: stabilize back through better flexibility, strength, and endurance

• education about lifting, sitting, etc.

• exercises to increase back and cardiovascular fitness

• encouragement to achieve and maintain a healthy back

Sources from : Clinicalrehabspecialists.com

Headache

Headache Facts

Introduction

Headache pain is a common problem which many individuals seek relief through health care assistance. While the pain is common, headache treatment and management can be an ongoing source of frustration for many individuals. There are many types of headaches with differing causes, presentations, durations and intensities. These may range from the common migraine, classic migraine, tension, cluster, temporal aritis, and sinus headache. While a headache’s presentation and symptoms may be similar or different from one patient to another, effective treatment strategies usually take an individualized approach to identify the cause for appropriate management.

The most common forms of headaches are tension and migraine headaches. Tension headaches are a non-specific headache which usually stem from overactive muscle tension in the head, shoulder and facial areas. Dull, achy, non-pulsating pain is often felt in the temples, TMJ, forehead and base of the skull. There is usually a correlation to daily stress and these headaches do not commonly associate with bouts of nausea, eye pain, facial numbness.

More than 28 million Americans suffer from migraine headaches which are generally more severe than tension headaches. Women are three times more likely to suffer migraine headaches than men. These headaches may be influenced by external factors such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near-daily use of medications designed for relieving headache attacks; bright lights, sunlight, and fluorescent lights; TV and movie viewing; certain foods; and excessive noise. Migraines often occur with nausea, visual pain or disturbances, facial and hand numbness, and sensitivity to light and sound. Migraine headaches usually last in bouts, lasting from a few hours to several days. Classic migraines differ from common migraines due to the aura (flashing lights, blind spots, or jagged lines in vision, smelling strange odors and difficulty speaking) that will precede the manifestation of the migraine by 10 to 30 minutes.

When should I see a doctor?

Understand that while headaches are quite common, they can greatly impact the quality of your life and limit your daily activities. Seek care from your healthcare provider when you are unable to manage or cope with your headache. Your healthcare provider will take a history to try and identify the cause of your headache and rule out sinister causes. Once “red flags” have been eliminated, treatment solutions are offered to control the pain and reduce future reoccurrence so you can get back to your daily activities. While serious pathology is a rare cause for most headaches, it is normal to worry about the cause of your headache pain. Often fears of more serious disease may be of worry to you. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the headache pain and that there are ways to relieve the symptoms and get you back to your normal activities.

What can I do for myself?

Since headache occurrence can be frequent, often there are ways to cope with an episode and limit its effects. Some individuals keep a headache diary to track headache triggers such as specific types of food or stressful situations that can be avoided in the future. In the event of a headache, avoiding certain types of light, finding a quite place to rest, reducing light exposure with sunglasses or sitting in a dark room may help ease the pain. Some people find sipping strong coffee helps with the headache pain. Others find alternating a hot compress for several minutes on the forehead followed by a cold compress helps reduce the pain and repeating this cycle several times. Try different coping strategies and see what works best for you. Some over-the-counter medications may help you control the pain. Prescription medications may also benefit some individuals. Speak with your healthcare provider about such remedies to determine if they are appropriate for you.

Rehabilitation

If your healthcare provider determines that your headache is from a musculoskeletal origin a rehabilitation program may be ordered. This may consist of short term trial of spinal mobilization/manipulation, soft-tissue treatment, neck stability exercise training and/or sensory motor training all used to reduce headache intensity and prevent reoccurrence. Workplace and lifestyle advice is often incorporated to improve management skills. The Brugger relief position is excellent stress “micro-break” which relaxes over-tense muscles.

Neck retraction is another exercise that helps to increase neck stability and stretch overactive muscles at the base of the skull.

Keep in mind that while headaches can be unpleasant and greatly affect the quality of our lives, there are emerging treatment strategies that can empower the patient to effectively control a headache’s intensity and frequency. Speak with your healthcare provider about any fears and concerns regarding your headache pain and discuss a management plan that works for you.

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What is ‘whiplash’?


‘Whiplash’ is what happens when someone’s head moves forwards and then backwards quickly. This quick back and forth movement may cause injury to the neck. This whiplash movement often happens in car crashes. People who have been in a crash often complain of neck pain and stiffness afterwards, sometimes even a few days after the accident. For most people the pain is mild, does not interfere with their normal activities and gradually gets better. Research indicates that people who carry on with their normal activities recover faster than people who stay at home and reduce their activities.

Some people have more severe neck pain. They may also experience:
• headaches
• pain in the shoulders and arms
• dizziness or altered sensation
• weakness in the arms.

These people should see a doctor immediately since they may have a Whiplash-Associated Disorder, or WAD as it also known.

What is WAD?

The term WAD stands for Whiplash-Associated Disorders. It covers a range of neck problems resulting from the whiplash motion of the accident. These can range from no discomfort at all to very severe injuries.

To help the doctor work out how serious your injury is and the most appropriate treatment, the neck problems from a whiplash have been grouped into four ‘grades’ of WAD.

Grade 0 no pain or discomfort. No physical signs of injury.

Grade 1 neck pain, stiffness or tenderness. No physical signs of injury.

Grade 2 neck pain, stiffness or tenderness and some physical signs of injury such as point
tenderness or trouble turning the head.
Grade 3 pain, stiffness or tenderness and neurological signs of injury, such as changes to
reflexes or weakness.
Grade 4 pain and fracture or dislocation of the neck.


When should I seek medical advice?

You should seek medical advice after an accident if you have:

• medium to severe pain in your neck
• neck pain plus stiffness (you have problems turning your head)
• arm numbness or weakness
• drowsiness, nausea, vomiting, confusion
• any complaints that are not getting better or are getting worse.

These symptoms may mean you have WAD.
It is important that you see your GP for a medical assessment.
A registered health professional such as your GP, physiotherapist or chiropractor is the best person to advise you about how to manage your whiplash injury.

It is also important that you tell your GP of other professionals who may be treating you.

How long will it take me to get better?

This will depend on the extent of your injury. Every injury is different.
Most people will be able to continue with their normal activities, but it may take weeks, or even months, for the discomfort to go away completely.
If you have had to reduce your normal activities, you should be able to return to them within weeks.
It may seem that it is taking a long time for you to recover. If you are worried about this, or if your pain gets worse, see your doctor immediately.


Treatments that are recommended

Act as usual: you may have pain but maintaining your normal activities is an important factor in getting better.

Exercise: specific exercises to restore muscle control and support your neck should improve postural control and prevent unnecessary postural strain. General exercise and activity are also important.

Pain relieving medication: pain relieving medication such as paracetamol can be prescribed. For more severe cases, anti-inflammatories can be prescribed in the short term to reduce pain and swelling. Use of medication should be limited as it may have side effects.


Treatments that may be used

Advice about posture: advice about how to sit and stand correctly can be helpful in addition to maintaining usual activities and exercising.

Joint Mobilisation: a therapist gently and repetitively moves the joints in the neck region to reduce pain and restore normal movement in the neck. This can be used if it reduces your
symptoms. It is important that your therapist is registered, qualified and trained to do mobilisation.

Spinal Manipulation: a therapist applies a gentle quick single thrust to the joint to the limit of its range of movement. This produces a clicking sound. The manipulation aims to reduce pain
and restore motion. It can be used if it reduces your symptoms. You should check that your health provider (medical practitioner, chiropractor, osteopath or physiotherapist) is registered, qualified and trained to do manipulation. Complications from manipulation are rare but include stroke and death.

Combination of Treatments: a combination of treatments such as exercise and mobilisation can be used. Traction: a machine gently stretches the neck. Traction can be used with other treatments. There is no evidence that traction works for WAD, so it should only be used if it reduces your symptoms.

Acupuncture: fine needles are inserted into specific points on the body. There is no evidence that acupuncture works for WAD; it should only be used if it reduces your symptoms.

Improving your environment: learning about the structure of your neck and how it works can be helpful. Improving your work practices can lessen unnecessary strain and allow you to function well in your normal daily activity. For example, the chair you sit on at work may need adjusting. It may also help to stand up for a break or change position every 20 minutes. If you have learnt relaxation techniques these may be helpful in managing pain associated with WAD.

TENS, heat, ice, massage, ultrasound, laser, short-wave diathermy: TENS (Transcutaneous Electrical Nerve Stimulation) is a low frequency, painless electric current sent through the skin to reduce pain.
This and other passive treatments/electrotherapies, if administered by trained professionals, are additional treatment options during the first three weeks. They are used with manual and physical therapies and exercise to help you return as soon as possible to your usual activity.

Rest: a period of bed rest is not recommended for people with WAD Grade 1. People with WAD Grades 2 and 3 should not have bed rest for more than four days.

Surgical Treatment: in almost all cases of WAD Grades 1 to 3 surgery is not required.

Collars: the use of a collar, sometimes called a neck brace, is not recommended for WAD Grade 1. If prescribed for WAD Grades 2 and 3, a collar should not be used for more than three days as it may slow your recovery.

Exercises that might help The following exercises should help to heal your neck.* Perform all exercises in a slow and controlled manner. The exercises are designed to restore the movement and muscle control around your neck and to reduce unnecessary postural strain and muscle pain.


When you are performing the exercises, stop and contact your doctor or therapist if you notice:

• dizziness, light headedness, blurred vision, fainting or disorientation
• sudden pain shooting down your arm, or numbness or weakness in your arm or hand
• unusually severe neck pain
• exercises consistently producing a headache, which persists.

For each exercise:
• move smoothly and slowly, without sudden jerks. The key is precision and control.
• keep your mouth and jaw relaxed. Keep lips together, teeth slightly apart and let your tongue rest on the roof of your mouth.
• gently hold your shoulders back and down so that they are relaxed while doing all exercises.
• in movement exercises, try to move the same distance to each side. If one side is stiffer, move gently into the stiffness. Move to that direction a little more often.
• expect some discomfort, but remember exercises should not cause severe pain.

Lie down with a soft pillow under your neck, and with your knees bent up.

The chin nod exercise

Gently and slowly nod your head forward as if to say ‘yes’. Feel the
muscles at the front of your neck.
Stop the nodding action just before you feel the front muscles hardening.
Hold the nod position for five seconds and then relax. Gently move your head back to the normal start position. Repeat up to 10 times.

Head rotation

Gently turn your head from one side to the other. Look where you are going. Progressively aim to turn your head far enough so your chin is in line with your shoulder and you can see the wall in line with your shoulder. Repeat 10 times to each side.


Correct postural position

Correct your posture regularly by gently straightening up your lower back and pelvis. Now gently draw your shoulder blades back and down (women towards their bra clip). Hold the position with ease for at least 10 seconds.

This position will prevent and ease muscle pain and tension in your neck and shoulder muscles. Repeat the correction regularly, every half hour during the day. You can do this exercise at work, in the car, train or bus and sitting at home.

Neck isometric (no movement) exercise

Sit in the correct postural position as described above. Make sure your chin is relaxed and slightly down. Place your right hand on your right cheek. Gently try to turn your head into your fingers to look over your right shoulder but allow no movement. Hold the contraction for
five seconds. Use a 10% to 20% effort, no more! Repeat with the left hand on the left cheek. Do five repetitions of the holding exercise to each side.

Sit in the correct postural position. Repeat all exercises below 10 times to each side.

Rotation: gently turn your head from one side to the other. Look where you are going, progressively aim to see the wall in line with your shoulder. This exercise is similar to the one you did lying down. This time you do it sitting.

Side bending: gently tilt your head towards your shoulder and feel the gentle stretch in the muscles on the side of your neck. Perform the movement to both sides.

Bending and extension: gently bend your head towards your chest. Lead the movement with our chin. Moving the chin first, bring your head back to the upright position and gently roll it back to look up towards the ceiling. Leading with your chin, return your head to the to the upright position.

Where else can I get help?

Specialist health professionals
Your GP can refer you to health professionals who are experts in treating WAD. These may include a GP who sees a lot of WAD patients, specialists, physiotherapists and chiropractors.

Pain management clinics
You would normally be sent to a pain management clinic only if your injury and/or pain is severe and long lasting.

Community resources
Evening and community colleges run classes in relaxation and stress management, but see your doctor before starting one of these. For the phone number of your nearest college look under
‘Evening & Community Colleges’ in the White Pages phone book.

Local hospitals may also run relaxation classes.
Web site The MAA web site www.maa.nsw.gov.au has general information on rehabilitation and other publications on Whiplash-Associated Disorders.

Claims Advisory Service
For information or assistance on a CTP claim contact the Motor Accidents Authority Claims Advisory Service on 1300 656 919.

Source from "clinicalrehabspecialists.com"

Carpal Tunnel Syndrome Facts

Introduction

A common medical complaint is pain and tingling at the wrist and hand. The bones of the wrist are called the carpal bones. Across the inside of your wrist is a ligament, which forms a supportive, protective shield for the nerves, tendons, and vessels supplying the hand. This tight space is called the carpal tunnel. If the size of this area is reduced (for instance by inflammation), and the median nerve, which goes from the neck to the index, middle finger and the thumb, is compressed, carpal tunnel syndrome may result.

People with carpal tunnel syndrome frequently complain of pain, numbness, or tingling, from the fingers to the forearm, elbow, and shoulder. They may feel clumsy, and find they are dropping things more often than usual. Sometimes it becomes difficult grasping objects or opening jars. Some people experience pain turning their hand up and down, while others find that the pad between their thumb and wrist has gotten thinner. It is common to feel worse during the night.

Carpal tunnel syndrome is caused by compression of the median nerve. This may be from direct trauma to the area such as a fracture or sprain, or due to upper extremity repetitive strain from working long hours at a computer, or on an assembly line. It is also believed that obesity, arthritis, diabetes, pregnancy, and hypothyroidism, may all contribute to this syndrome. Carpal tunnel syndrome is a condition related to inflammation around, and compression of the median nerve. It is made worse by poor posture.

When should I see a doctor?

Even though carpal tunnel syndrome may be caused by a wide variety of conditions, usually it can be treated without drugs or surgical intervention. If your pain so severe that you have difficulty with your normal activities, you should see a doctor. The healthcare provider you select will help you with ways to better control your pain and to improve your ability to perform desired activities.

What can I do for myself?

Even though you are in pain, it is important for you to stay active.

• Find exercises, which don’t require repetitive movements of the arm and hand.

• Examine which activities make your arm, wrist, and fingers feel better or worse. Try to limit those activities, which make you feel worse.

• Vary your activities frequently.

• Take “mini breaks” to rest arm, wrist, and hand, and to correct your posture.


Ways to increase your activity.

Evaluate what you can do, how long you can do it without increasing your pain, and what is too painful to do. Record how long you can participate in the activity without increasing the pain in your arm, wrist, or hand. Continue those activities you can do without pain. Temporarily avoid those activities, which are too painful to do at all. For those activities which cause “flare-ups” after prolonged use, try the following guidelines:

• Look at how long you can comfortably perform the activity, and reduce the time you do it by 20%. (In this way you should avoid the “flare-up”.)

• Over several sessions, gradually increase the time spent doing the activity.

• If another “flare-up” occurs, don’t panic! You may have tried to do too much too soon. Once again reduce your activity level by 20 %, and keep active.


Ways to modify your activities

· Simple changes to your workstation, such as the placement of your computer keyboard and mouse, the height of your desk or chair, or the direction you stand when doing repetitive movements, can significantly reduce your pain (see figure).


Ergonomic Work Station Checklist

Are you experiencing back pain? Complete the following checklist to find out whether you're doing all you can to help prevent and alleviate back pain.


Ergonomic Chair Yes No
1. Is your chair's height adjustable (i.e., higher for writing, lower for reclining)?

2. Does your chair have a tiltable seat pan that can be inclined forward for desk work, backward for reclining, and remain horizontal for erect sitting?

3. Does your chair have arm rests?

4. Do you have a lumbar support in the back rest?

Sitting
1. Do you sit with your buttocks back as far as possible on the seat?

2. Is the back rest firmly against your back?

3. Do you change positions in the chair frequently?

Computer Work Stations
1. Is the computer monitor at chin level?

2. Have you positioned the monitor so that glare is reduced?

3. Is the keyboard just above elbow level? (Your wrists should be relaxed.)

4. Do you have a document holder just below eye level?

Telephone
1. Do you use a head set if frequently on the phone?

2. If a head set is not used, do you alternate sides?


Rehabilitation

A rehabilitation specialist will perform a functional examination to rule out serious conditions, discover functional weaknesses, and help you identify specific goals of treatment.

Once your pain is under control, and your doctor has ruled out serious conditions, there are simple exercises for carpal tunnel syndrome, which may help you balance the muscles, correct your posture, and free the entrapped nerves. By increasing your function, these exercises become the key to your healing.

While carpal tunnel syndrome is often described as an isolated injury at the wrist, there may be a problem any where along the path of the median nerve. Because of this, it is important to rehab the entire affected upper extremity, neck, and shoulder, wherever the entrapment is found. Your rehab specialist may perform gentle mobilizations to the restricted joints and muscles, recommend exercises like the ones listed above, and recommend simple changes to your workstation. In order to lessen your discomfort at night, your healthcare provider may recommend using a night brace to support your wrist, and give suggestions on sleeping positions, which may decrease your pain.

Carpal tunnel syndrome may take several weeks to months to resolve. It is important to be patient and to continue the rehabilitation program. Try not to focus on pain. Throughout the treatment remember to focus on your functional improvements. It is these improvements, which allow you to increase your activity level, and return to your normal life.

Source from "clinicalrehabspecialists.com"

Tennis Elbow Facts

Introduction

Tennis elbow is a common complaint of athletes involved in racket and throwing sports. It involves pain on and around the outside (or lateral) part of the elbow. The formal name for the elbow is the epicondyle. If there is tendonitis around the lateral elbow, it becomes known as tennis elbow, or lateral epicondylitis. When there is tendonitis on the inside (or medial) part of the elbow, the condition is known as golfer’s elbow, or medial epicondylitis. Young boys also can develop little league elbow from pitching too much or hard without enough rest or recovery time.

People with tennis elbow frequently complain of pinpoint pain around the lateral elbow. The pain may travel around the elbow, down the forearm to the wrist, or up the arm to the shoulder. The pain is made worse during continued activities like practicing a backhand stroke in tennis, throwing a soft ball, or practicing handstands in gymnastics. Repetitive tasks, such as painting, hammering, inputting on a computer keyboard, or using a screwdriver also increase pain. As symptoms worsen, people complain of difficulty holding up a cup of coffee, turning keys in locks, shaking hands, doing needlework, or playing musical instruments.

Typically tennis elbow begins slowly over time due to repetitive movements using incorrect body mechanics. Continuing the activity after the initial injury occurs, overloads the tissues, causes inflammation, and complicates the injury.


When should you see a doctor?

Even though lateral epicondylitis may be caused by a wide variety of conditions, usually it can be treated conservatively without surgical intervention. If your pain is so severe that you have difficulty with your normal activities, you should see a doctor. The healthcare provider you select will help you with ways to better control your pain and to improve your ability to perform desired activities.


What can you do for yourself ?

Even though you are in pain, it is important for you to stay active. Being active can help prevent long-term problems.

• If your pain is acute, ice or anti-inflammatory medication may help.

• Rest the sore arm for a few days to a week, to give the tissues a chance to heal.

• Find exercises, which don’t require repetitive movements of the arm and hand.

• Examine which activities make your arm, wrist, and hand feel better or worse. Try to limit those activities, which make you feel worse.

• Switch to power driven tools, which allow you to limit repetitive arm turning motions.

• Vary your activities frequently.

• Take “mini breaks” to rest arm, wrist, and hand, and to correct your posture.


Ways to Increase your activity.

Evaluate what you can do, how long you can do it without increasing your pain, and what is too painful to do. Record how long you can participate in the activity without increasing the pain in your shoulder, arm or hand. Continue those activities you can do without pain. Temporarily avoid those activities, which are too painful to do at all. For those activities which cause “flare-ups” after some use, try the following guidelines:

• Look at how long you can comfortably perform the activity, and reduce the time you do it by 20%. (In this way you should avoid the “flare-up”.)

• Over several sessions, gradually increase the time spent doing the activity.

• If another “flare-up” occurs, don’t panic! You may have tried to do too much too soon. Once again reduce your activity level by 20 %, and keep active.


Ways to modify your activity.


In sports

• Check your equipment. Is it the right size or weight? If it is a racket sometimes the grip is too small leading you to grip it too tightly.

• It is also common for beginners in tennis to squeeze the grip too hard and forget to relax their forearm muscles in between strokes. Good coaching is a must to develop healthy habits.

• Check your posture and the rhythm of your movements. Are you moving in a coordinated and balanced way?


At work

• Evaluate your tools. Change from non-powered hand tools to power tools.

• Use a wrist pad when inputting on a computer keyboard.

• Be sure your computer keyboard is not too high or low so that your elbow is bent at a 90° angle
• Try to change your activities frequently.


At home

• Select lightweight pots and pans for cooking.

• Take frequent breaks from activities ranging from needlework to gardening.


Rehabilitation

A rehabilitation specialist will perform a functional examination to rule out serious conditions, discover functional weaknesses, and help you identify specific goals of treatment. There may be restrictions in your foot, hip or shoulder, which cause you to put unnecessary stresses on the elbow to complete your task. When striking a tennis ball 90% of the power is generated from your legs not your arms! Your rehab exam will uncover these hidden causes to your problem.

Once your pain is under control, and your doctor has ruled out serious conditions, there are simple exercises, which may help you to stabilize your elbow. By increasing your function, these exercises become the key to your healing. An example of these exercises follow:

Along with rehabilitation exercises, your rehab specialist may perform gentle mobilizations to the restricted joints and muscles, myofascial release, as well as recommend simple changes to your work or play activities. The goal of treatment is to relieve your pain and increase your function. Remember try not to focus on pain. Throughout the treatments, try to focus on your functional improvements. It is these improvements in what you can do and how long you can do it, which allow you to increase your activity level, and return you to your normal activities.

Source from " clinicalrehabspecialists.com"