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"

Neck Pain Facts

Neck pain is a common ailment that affects 50-70% of people some time in their lives. There are a number of potential causes of neck pain ranging from poor posture to whiplash. Neck pain is commonly caused by repetitive strain from prolonged sitting postures. 85% of the time the pain is mechanical coming from either the muscles, joints or ligaments. Fortunately, it is rare for the pain to be caused by a serious medical problem and such causes can be ruled out by a thorough history and examination from your healthcare provider.

Repetitive strain from prolonged sitting posture

When should I see a doctor?
Often neck pain episodes will get better on there own as nature takes its course. It’s important to stay as active as possible as the old adage of bed rest and trying to completely avoid pain is not the best advice. Most people do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

You should see a doctor when

• when you experience sharp shooting pain into your arms with or without numbness and tingling into your fingers

• when the pain is too much for you to cope with or there are specific activities important to you that you are having difficult undertaking.

• When you have associated headaches, dizziness or nausea

• When you experience weakness in your grip or you find yourself dropping items.

Neck pain is a very common problem and the chances that it is caused by serious disease are very rare. Health practitioners can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. 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. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities.

Make sure you work with your healthcare provider to find ways to better manage and control the neck pain.

What can I do for myself?

Keep in mind that staying active with your normal activities is the best thing you can do to limit the effects of neck pain on your life. You may have to modify the way you perform certain activities to keep from aggravating the tender tissues. Examples may be having to adjust and modify your workstation so that you are not having to look up or down at your computer screen, using telephone headsets rather than repeatedly cradling the phone with your neck, Pain medication, hot/cold packs, massage, manipulation and other modalities may offer pain relief, but they are best used to getting you re-activated and moving on with your life. Keep in mind that the pain is your own and the manner in how you deal with it and return to normal activities is the greatest thing you can do for yourself. Try to stay working as only in cases of particularly severe pain do you need to be off work. You may need to find restricted duties or reduced hours, but staying active is important. Staying active helps prevent long-term problems. If it has been several weeks since you have been back to work, you really should be planning with your doctor or therapist and employer how and when you can return. Here are some ideas to keep your neck pain from becoming a more long-term problem:

• Keep moving.

• Do not stay in a position for too long.

• Move before you stiffen up.

• Move a little more each day.

• Take “mini” stretch breaks throughout the day.

• Don’t stop doing things-just change the way you go about doing them.

Ways to increase your activity.

First ask what is it that I want to do? Is it driving, sitting at your desk, etc.? Find out how long you can perform this activity without “flaring-up” your condition or making you worse off than when you started. This is individual to you. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point. Having a little discomfort is alright, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. It’s normal to have good days and bad days. It takes some patience, but it works.

Ways to Modify Your Activities

Sitting
Find a chair with arm rests, that is comfortable to you and supports your forearms. Get up and stretch often.

The computer workstation
Make sure the height of the chair fits the desk. Arrange the keyboard, monitor and phone so you do not feel strained. The keyboard should be at a height where your hands rest comfortably on it. You may want to experiment with a wrist pad. There should not be any glare on the monitor. Get up and stretch often.

Driving
Adjust your seat from time to time. Try some support in the small of the back or even between your shoulder blades. Be careful not to lean forward too much or to poke your chin out. Take regular stops and get out of the car for a quick break. Walk around and stretch.

Carrying and shopping
Try not to carry groceries bags or boxes too long. Avoid carrying awkward objects. Keep the load close to your body. It is better to carry 2 two even weighted bags, one in each hand than to have one very heavy on one side.

Daily activities/hobbies
Vary your activities.

Sports
Continuing to play your normal sports is fine, but you may need to modify your game or decrease your intensity.

Sleeping
Your pillow should support your neck, but not push your head up too high. Find one that is comfortable. You may need to experiment from time to time with a new pillow.

If your pain is not settling down or getting worse, you may need further assessment from your health care provider. Make sure you ask questions or voice your concerns about your pain to your healthcare provider.

Rehabilitation
If there are specific activities which you are having difficulty with, a rehabilitation specialist can help. Once serious causes are ruled out and the pain is under control, the rehab specialist examines where the dysfunction lies. First identify specific goals or limitations you wish to overcome that are agreed upon by both the practitioner and you. The rehab specialist will perform a functional evaluation to determine what you are able to do and what areas may be causing some trouble. Bridging the gap between what you are able to do and what you want to do is the essence of rehabilitation. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Make sure and voice your thoughts and concerns with your healthcare provider. Pain and “flare-ups” may happen from time to time. This is normal and should not be the focus in care. Rather, try to focus on the exercises that are bridging the gap to your goals and what activities you want to do.

A simple neck strengthening exercise is shown here. Tuck your chin in while you press-up from a sphinx position. Hold this for one or two breaths and then repeat 8-10 times. Perform twice daily.

It is important that you maintain contact with your healthcare provider. If the pain is not settling down or is getting worse, you may need further assessment. Follow up visits provide you the opportunity to obtain more information and address any fears or concerns you may have with your neck pain.

Sources fom : www.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"

Shoulder Pain Facts


Shoulder pain is a common ailment that affects 10% of the population at some time in their lives. Shoulder stability requires proper function of the rotator cuff and surrounding muscles which attach the arm to the torso. A properly functioning shoulder allows for excellent movement and proper stability when pushing, pulling or reaching overhead. Injury to the shoulder joint may limit movement and/or cause pain with activities. Since there is the capability for so much movement of the shoulder, problems can occur, leading to rotator cuff tendonitis or tears, shoulder impingement syndrome (pain while reaching overhead), shoulder bursitis, or complete loss of the shoulder’s range of motion (frozen shoulder or adhesive capsulitis). While many shoulder problems are frustrating and may take several months to heal, many spontaneously get better on their own. As much as 50% of all people with shoulder pain do not seek treatment at all with as many as 23% of the cases getting better in one month and 44% of the case getting better by three months. Trauma to the shoulder or recurring shoulder pain may be an indicator that there is a more serious problem and additional investigation may be required.


When should I see a doctor?

You should see a doctor when you can no longer cope with the pain or you can no longer perform activities which are important to you.

You should see a doctor when:

•When the pain is too much for you to cope with and there are specific activities important to you that you are having difficulty undertaking.

•When you have sharp pain shooting into the shoulder with or without numbness.

•You notice a shrinking (atrophy) of the shoulder and/or arm muscles or an increased weakness in the hand or arm as a result of the shoulder dysfunction.

•The shoulder pain is non-mechanical. It is painful and symptomatic when you are not moving it or it seems to arise from other areas of the body (i.e. chest).

Shoulder pain is very common and most people are fine coping with the pain as the condition slowly gets better. The chance there is serious disease causing the pain is rare, but it is important you tell your healthcare provider of any fears or concerns you may have or difficulties you may be experiencing at your workplace. It is normal to have feelings of worry. Often times there are ways to control the pain and ways of modifying your activities that help you get on with your life.


What can I do for myself ?

Keep in mind that by staying active with your normal activities is one of the best things you can do for yourself. If your job requires movements that aggravate your shoulder, try to modify the task or activity. You may have to speak with your supervisor to see if there are ways to modify the job or activity to let the shoulder heal. Often reaching or lifting overhead will aggravate shoulder problems. Workstations may have to be changed to limit the cumulative tension in shoulders.

•Remember to try to move the shoulder in the pain free range

•Move before the shoulder stiffens up.

•Do not stay in one position too long.

•Take “mini” stretch breaks while doing repetitive tasks (computer work, desk work, etc.) ·

•Don’t stop doing things, just change the way you do them.


Ways to increase your activity.

First ask what is it that I want to do? Is it reaching into a cabinet, washing your hair, carrying a jug of milk, putting on a coat, etc.? Find out how long you can perform this activity without “flaring-up” your condition or making you worse off than when you started. This is individual to you. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point. Having a little discomfort is ok, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. If you unable perform the activity at all, try to change the way you use the shoulder. You may have to use a step stool to reach the cabinet, or bring your head closer to your hands while washing your hair, or carry a jug of milk with two hands rather than one. Find out how to modify your activity so you are able to complete the task that’s important to you. It’s normal to have good days and bad days. It takes some patience, but it works.


Ways to Modify Your Activities

The computer workstation
Make sure your shoulders are relaxed as you work. You may have to lower your keyboard or raise your seat. Take frequent microbreaks before tension builds in the shoulder. Structure your desk equipment so you do not have to reach too far for it.

Putting on a shirt or coat
Place the bad shoulder in the sleeve first. Then use your good shoulder/arm to place the shirt overhead or the coat around your body. You may have to twist your body a bit.

Washing/styling hair
Stoop and bring your head down to your hands. You may have to change your hairstyle until your shoulder function improves.

Reaching into a cabinet
Use a stepstool so you do not have to reach overhead.

Carrying
Use two hands when carrying, even if the object is small.

Fastening your seatbelt
Use two hands to control reaching and fastening the seatbelt. You may have to twist your body a bit.

Driving
Take frequent rest breaks so you can get out of the car and move your shoulder. You may have to modify where you rest your arm in the car.

Sleep
You may have to try different positions or support your shoulder with a pillow.


Rehabilitation

If there are specific activities which you are having difficulty with, a rehabilitation specialist can help. Once serious causes are ruled out and the pain is under control, the rehab specialist examines where the dysfunction lies. Often muscle and joint dysfunction leads to faulty movement patterns of the shoulder. This may lead to specific tissues and shoulder muscles getting “beaten up” by continually being reaggravated. First identify specific goals or limitations you wish to overcome that are agreed upon by both the practitioner and you.

The rehab specialist will perform a functional evaluation to determine what you are able to do and what areas may be causing some trouble. Bridging the gap between what you are able to do and what you want to do is the essence of rehabilitation. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Sometimes manual therapy, soft-tissue therapy, medication, injection therapy and other modalities may also be used to further you towards your outcome goals.

Make sure and voice your thoughts and concerns with your healthcare provider. Pain and “flare-ups” may happen from time to time. This is normal and should not be the focus in care. Rather, try to focus on the exercises that are bridging the gap to your goals and what activities you want to do. Some shoulder conditions may require surgery. This is usually after non-surgical remedies have failed and the individual is unable to cope with the pain or dysfunction. Your thoughts and fears are important. Make your healthcare provider aware of any worries you may have with any procedure.


All 4's Rock




A simple exercise for frozen shoulder and shoulder impingement syndrome is the “All – 4’s Rock”. In this exercise start on all 4’s and push your back away from the floor without rounding it. Hold your back flat and rock side to side 8-10 times. You can repeat this for 3 sets. This exercise targets the deep “inner” shoulder blade muscles – in particular, the serratus anterior muscle – that are responsible for stabilizing your shoulder.



Brügger Relief Position

Another exercise for frozen shoulder and shoulder impingement syndrome is is the Brügger relief position. This exercise improves both shoulder and upper back posture. It erases the slump position and helps take pressure off the ball and socket shoulder joints. Perform this throughout the day as a “micro-break” to improve your posture when you have been sitting or working at a desk for long periods of time. One or two repetitions for every 20-30 minutes of sitting is ideal.

Source from : clinicalrehabspecialists.com

Knee Pain (Patellar Tendinitis)

What is Patellar Tendinitis (PT)

A common complaint of athletes is pain in the front part of the knee. The medical term for this pain is patello-femoral pain syndrome, runners knee, anterior knee pain, extensor mechanism disorder, or patellar tendonitis (PT).

People with PT frequently complain of dull pain, which is worse running, squatting, jumping, or walking up or down stairs. Pain may feel worse after bending your knee when sitting. Sometimes the knee clicks or locks. Sometimes it feels like it is buckling under you when you walk. Sometimes it is swollen. This pain is usually chronic in nature.

Occasionally, direct trauma to the knee can cause PT, but usually it is caused by repetitive strain from overuse during activities. Knee pain is typically secondary to foot or hip dysfunction. Flat feet alter normal muscle relationships, and can force the knee into the wrong position while you are walking, running, or jumping. Even wearing the wrong shoes may cause stresses on the muscles around the knee. Repetitive movements in sports or work activities may exaggerate these imbalances and lead to PT.

When should you see a doctor?

Even though PT may be caused by a wide variety of conditions, usually it can be treated 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. Use the R.I.C.E. formula:

• Rest: Avoid putting weight on the painful knee. Some athletes temporarily switch to a non-weight bearing activity, such as swimming.
• Ice: Apply cold packs or ice wrapped in a towel for short periods of time, several times a day.
• Compression: Use an elastic bandage such as a simple knee sleeve with or without the kneecap cut out that fits snugly without causing pain.
• Elevation: Keep the knee raised up higher than your heart.

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 sore leg. 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 athletic shoes. How long have your worn them. As a rule of thumb, frequent runners should change their running shoes about every 6 months.
• During the beginning of your healing process, it may help to use a knee brace or patellar strap while exercising.
• Check your posture and the rhythm of your movements. Are you moving in a coordinated and balanced way?

At work and home
• Try to change your activities frequently.
• When gardening, sit in a low chair to avoid repetitive squatting.
• Minimize trips up and down stairs.
• Take frequent breaks.

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. This is important. There may be restrictions in your foot, hip or low back, which cause you to put unnecessary stresses on the knee. These stresses make it difficult to successfully complete your desired tasks. 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 balance the muscles, correct your posture, and free the entrapped nerves. By increasing your function, these exercises become the key to your healing.
One of the most basic knee exercises to improve the “tracking” of the knee cap (patella) is called the pillow push. Simply push the back of your knee into the pillow and hold it there for 5-6 seconds. Then release. Repeat 8-10 times. Perform twice a day.

Pillow Push – start position Pillow Push – final position

If the exercises you are doing, increase your symptoms, do not continue them. Consult your rehabilitation specialist.
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 the 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 "clinicalrehabsepcialists.com"

Ankle Sprain Facts

Ankle Sprain Facts

An ankle sprain is one of the most common sports injuries and happens quite frequently in normal daily activities. Although painful, it usually does not cause any long-term problems, if treated properly. However, if untreated, even the simple, minor ankle sprain can produce longer lasting problems such as decreased strength, balance and flexibility and increase your risk of future injuries to the same side (like your knee). Following are a few guidelines to help you care for your sprained ankle, and decrease your risk of future injuries. This is why taking care of your sprained ankle the right way is important.

An ankle sprain means that one or more of the ligaments around your ankle have been stretched, or even torn. This happens when you land on someone’s foot, or land awkwardly, rolling your ankle. This usually occurs with the foot rolling inward, stretching the lateral (or outer) ankle ligaments.

When to see a doctor
If you just sprained you ankle, you don’t usually need to see a doctor, but a few simple tests can tell you if you should.
You should see a doctor:
• If you are unable to stand and put weight on it
• If you have intense pain above the ankle in your lower leg
• If the pain and swelling continue for more than a few days, despite treatment (see below)

What can you do for yourself

For the first 24 – 48 hours, your ankle will probably swell and might even show some bruising. Minimize this by using the R I C E formula:

Rest: This means not pushing the ankle to do too much, although some movement will help to get the swelling down. Try toe wiggling or gently moving the ankle up & down 10 – 15 times each hour. If you can stand on it without too much pain, then go ahead and walk as normally as possible. If not, you can use some crutches for a day or two. If even standing on it is very painful, you should see a doctor.

Ice: Ice the ankle frequently to decrease pain & swelling

Compression: Using a compressive bandage (like an Ace © bandage) can help support the ankle and reduce swelling; it should be wrapped from the middle of the foot to just above the ankle. Do not wrap too tightly!

Elevation: Keeping the ankle above your heart level will also help keep swelling down.

During the next 2 weeks, your ankle is busy healing. As long as it is tolerable, it is OK to stand and walk on it. As long as you don’t twist it again, movement will actually help it heal. In the beginning, movements will seem stiff & may be sore. Use ice to help with the pain and control the swelling. If it does not seem to be getting better within the first week, an evaluation by your doctor may be needed.

When you are inactive for longer periods of time (i.e. sitting at work), make sure to keep moving your foot / ankle periodically to keep it from getting stiff. Simple up and down movements of the foot can help, or you can try drawing letters of the alphabet in the air with your foot.

Ways to increase your activity

When the pain and swelling have subsided and you are walking without favoring your ankle, you can begin some balance exercise:
Try standing in a doorway on 1 leg for 10 seconds If you can’t keep your balance for more than a couple seconds then try standing with 1 foot in front the other (as if you were walking a tightrope!), then try the one leg balance again after a week or so. If you can, try it with your eyes closed (ONLY if you can balance steadily on one leg for at least 10 seconds with your eyes open!) Always reach out to the wall or door jam for support if needed.

Ways to modify your activity

In Sports Some athletes wear ankle braces to help with support during practice & competition. While this may be helpful in high levels of play, for most of us who don’t work on strength & performance every day as our job, brace use can effect us in a negative way by teaching our muscles bad habit & becoming dependant on the braces.

At Home Practice your balance training while doing everyday tasks. Try standing on one leg while you brush your teeth!
Also, make sure to keep moving your ankle when you are sitting for long periods of time by doing ankle pumps (simple up and down movements) or drawing letters of the alphabet with your foot.

Rehabilitation

A rehabilitation specialist will evaluate your foot and ankle to rule out more serious conditions, evaluate your strength, flexibility, and muscle balance. They will likely also perform a gait evaluation and have you do other functional tests to look at how your ankle, knee, hip and spine all work together. Then a complete program can be made for you to help you get back to your desired activities.

Citated from "clinicalrehabspecialists.com"