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Fibromyalgia Syndrome: Benefits of Exercise Therapy

Fibromyalgia syndrome (FMS) has been described as a chronic pain syndrome with widespread pain, diffuse tenderness and joint stiffness typically lasting a period longer than 3 months (Cheatham 2013 and Busch et al 2011). Other characteristic symptoms include disturbed sleep, fatigue, headaches, concentration and memory problems (Bennett 2005). The aetiology of this condition is still unknown, however researchers have hypothesised that there may be a genetic disposition as well as neurochemical imbalances within the central nervous system (CNS) (Corrales 2011). This increased activity can heighten sensitivity to stimuli (allodynia) and also heighten response to a painful stimuli (hyperalgesia) (Brumitt 2013).

Fibromyalgia syndrome: Benefits of Exercise Therapy

 

 

Management of the Injured Tendon: Difficulties in Diagnosis and Treatment

Abstract

Background: Tendon injury is a painful and often debilitating affliction, which commonly presents to the sports medicine professional. Researchers have often struggled to determine the most appropriate way to manage this condition. Despite the plethora of literature on management strategies, there appears to be little stemming from sound scientific evidence. Objective: The aim of this is to identify studies that demonstrate a greater understanding of the pathophysiology of tendon injury and evaluate the most effective management strategies for this difficult condition. Methods: A systematic review of the literature was conducted. Results: The current review found support for the early use of corticosteroid injections, despite long term detrimental effects. The review also demonstrated exercise therapy designed to stretch and strengthen will be more effective in the long term. Conclusion: Individuals with tendinopathy should perform a regular strengthening and flexibility regime as early as possible. Patients with pain limiting daily activities may benefit from corticosteroids injections, to allow them to perform activities with reduced pain.

Management of the injured Tendon

Rotator Cuff Strain

What is It?

A rotator cuff strain is a sudden traumatic injury to one or a combination of the supraspinatus, infraspinatus, teres minor and subscapularis muscles and or tendons. prior history of impingement syndrome may be present, and can often be difficult to diagnose. injury to the rotator cuff musculature, typically follows a traumatic incident, which is usually a good way to differentiate between tendinopathy.

to determine the extent of muscle injury a grading system exists to assist in guiding the rehabilitation process:

  • Grade 1: Minimal fibre damage, slight strength loss, minimal pain and a reduction in the range of motion
  • Grade 2: Partial tear with moderate fibre damage, increased strength loss, the tear is often palpable.
  • Grade 3: Complete rupture, possibility of surgical management, individuals may have a complete loss of strength with marked dysfunction including the arm drop sign.

Causes

  • Unaccustomed overuse of the muscle/tendon unit following extended periods of home improvements (gardening, painting), sporting activity (Tournaments with multiple rounds), weight training.
  • A single violent blow to the shoulder, particularly in the mechanisms of abduction, external rotation and extension (pulling the arm back to throw) and or adduction, internal rotation or flexion (Empty can).
  • lifting or pulling something with significant weight.
  • Falling onto and outstretched hand
  • If you have suffered a previous impingement syndrome without adequate recovery.

Signs and Symptoms

An individual may experience immediate pain at the time of the injury, depending on the severity of the injury the individual may be able to continue the activity only for the pain to come back once activity has ceased. A popping or tearing sensation may be felt at the time of the injury. There will be associated pain and weakness felt in the shoulder with possible swelling and bruising.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the shoulder joint and rotator cuff musculature. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain and inflamation is present you may benefit from ice application and some non-steroidal anti-inflammatory medication (NSAIDS). initial immobilization of the shoulder joint may be necessary in grades 2 and 3.
  • Initiation of flexibility and strengthening programs for the shoulder muscles with particular focus on the rotator cuff muscles, focusing on building stability in the joint before looking at strength.
  • Evaluating any training errors, correct technique and checking use of appropriate equipment. posture education for desk based workers limit the risk of further weakness through faulty head and neck alignment.

*** Assessment of muscle damage by a qualified professional is essential to determine the extent of the injury and evaluate the best course of treatment, therapists at sports injury scotland will be able to evaluate your injury and guide you as to the best method of progression ***

What can Sports Injury Scotland do??

Correct diagnosis of a muscle injury will ensure the individual gains the most appropriate treatment strategy for their injury. management of a muscle injury will vary depending on the amount of tissue damage and also the individuals daily activities. Sports massage and mobilizations have been found to be an effective method of reducing the pain associated with rotator cuff tears, increasing the mobility at the joints and improving the muscles strength and flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure adequate recovery. Postural re education is essential to ensure correct movement patterns in the future. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Cervicogenic Headache

What is it?

A cervicogenic headache is head pain which originates from the cervical spine. A complex musculoskeletal syndrome thought to be caused by abnormalities in the joints, muscles, fascia and nerves. Research suggests that this type of headache often goes untreated due to its often intermittent nature.

Causes

  • Prior neck trauma: any previous injury to the head or neck may predispose an individual to this type of headache, for example whiplash type injury as a result of a car accident. Improper management following these injuries could result in long term movement compensation patterns which could lead to chronic headaches.
  • Movement compensations: sustained postures associated with sitting at a computer for extended periods, playing computer games for extended periods, improper desk set up leading to forward head postures which increases the stresses on the joints ligaments and muscles leading to over activity. Repetitive movements of the head and neck can also lead to head pain, especially in jobs requiring excessive cervical extension (eg. painters)
  • Cervical joint dysfunction: joint stiffness and muscle weakness as a result of faulty movement patterns at work or in daily life. Imbalances can be developed over a long period causing weaknesses and poor muscular endurance in the cervical flexors and extensors.
  • Stress and tension due to work or home life can increase the tension on the neck and back musculature, which can increase the risk of sustaining headaches.

Signs and Symptoms

Diffuse dull ache which is typically located in the neck and occiput region, however in more chronic pain further referral into the forehead can occur. Pain experienced is usually unilateral (single side) and typically of gradual onset. A reduction in neck and shoulder range of motion is usually apparent. Individuals typically wake with a headache which can ease once up only to return later in the day. In the more chronic patient pain in the shoulder and arm may be apparent, however it doesn’t follow a typical distribution pattern.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the cervical spine. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from heat application and some non-steroidal anti-inflammatory medication (NSAIDS). It may be beneficial (when appropriate) to lie down when you are suffering from a headache, this will allow the cervical muscles time to relax.
  • Initiation of flexibility and strengthening programmes for the cervical flexors and extensors
  • Correcting any posture issues, ensure your desk set up is unique to you to avoid any unnecessary postures.

What can Sports Injury Scotland do?

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with Cervicogenic headaches, increasing the mobility at the joints and improving the muscles strength and flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure adequate recovery. Postural re education is essential to ensure correct movement patterns in the future. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

The Humble Foam Roller

Soft tissue injury is a common presentation to the sports injury clinic, with studies reporting high percentages of athletic injury involving soft tissue. Dysfunction in the musculoskeletal system has been though to be initiated by acute and chronic mechanisms including:

  • Physical Trauma
  • Overuse
  • Structural Imbalance
  • Inflammatory processes

Soft tissue injury can lead to pain and dysfunction in the remaining tissues if not rehabilitated correctly. The kinetic chain consists of the soft tissue system (muscle, tendon, ligament and fascia), neural system (nerves and central nervous system) and the articular system (joints). The musculoskeletal system works as an amalgamated functional unit, where all components work interdependently.

When one of the systems fails to work then the other systems must compensate. This may lead to overload of the tissues, fatigue and individuals may develop faulty movement patterns. Movements are learned by the nervous system, whether these are correct or not, faulty movement can occur due to poor motor control, these faulty patterns are then learned by the central nervous system. Implications exist when the body is unable to compensate for these faults and symptoms finally surface. This then initiates the cumulative injury cycle (CIC) in which the body lays down dense thick scar tissue, which causes adhesions within the tissue, thus limiting free functional movement.

Common management strategies for treating Myofascial restrictions include sports massage, where various techniques can prevent muscle damage, enhance muscle relaxation, reduce muscle tension, reduce muscle soreness and improve performance. While there are many reported benefits to sports massage, the cost of such therapy can often be too much for some individuals. Recently self-Myofascial release with a foam roller has received a lot of attention. A foam roller is simply a cylindrical piece of extruded hard-celled foam, which typically comes in various densities. Initially introduced as an acupressure application method, it has recently been used for self-massage, adopting long sweeping strokes along the length of the muscle. Individuals would search along the muscle for tender areas or trigger points and use the roller to decrease such issues.

Below indicates some of the important questions regarding the use of the foam roller, some videos of correct technique and purchase options.

Uses

  • Injury prevention
  • Performance enhancement
  • Self massage

Benefits of Foam Rolling

  • Correction of muscle imbalances
  • Increases in joint range of motion
  • Decreased muscle soreness
  • Relieves Joint Stress
  • Decreased neuromuscular hypertonicity (Increased tension in the muscles which can impair function)
  • Increased extensibility of the musculotendinous junction
  • Increased neuromuscular efficiency
  • Maintenance of normal functional muscular length

Pros

  • Inexpensive price range from £15-£43 (Foam Rollers can be purchased at Run 4 It With stores in Glasgow, Edinburgh, Aberdeen, Inverness, Dundee and Bridge of Allen).
  • Can be done at home
  • Intensity controlled by the individual
  • Can be completed daily
  • Can benefit the development of core stability, which in combination with enhances mobility will improve overall performance.

Cons

  • Can’t replace hands on sports massage, the roller is unable to think and react like a therapist can.
  • Potential to cause further damage if used too often and too deeply, the roller should be uncomfortable, however not enough to cause bruising and further injury.

Considerations

The use of a foam roller should be hard work, and is often painful, however the pain should not cause injury and you should not incur bruising. The patient can control the depth and intensity. Ensure you start light and as you warm up you can deepen the pressure.

Choosing a Foam Roller

Foam rollers come in various lengths and densities, the traditional hard foam roller is suitable for beginners and individuals with low muscle mass/density, this will prevent any likelihood if injury. The more complex rollers i.e. the grid is suitable for experienced exercisers, including individuals who have used foam rollers in the past and are looking for that extra challenge. The more dense the roller the more it is suitable to individuals with higher muscle mass and body density.

For further information on the use of the foam roller and purchasing options please don’t hesitate to contact staff at Run 4 It or Sports Injury Scotland.

Back and Core Stretching

Lower Back Stretch

Stretching should form an integral part of any training regime. Research suggests the best time to stretch is after exercise, making sure the muscles are warm. stretching a cold muscle can lead to potential muscle damage.

Attached is some stretches focusing on the main muscles of the Back and Core.

Back Stretching Program

Core exercises

A strong core is essential to optimal performance and the reduction of injury.

Attached is a beginners program to strengthen the core.

Core training program

Medial Tibial Stress Syndrome

Medial Tibial Stress Syndrome: Common Cause of Shin Pain

What is it?

Medial tibial stress syndrome (MTSS), commonly referred to as “shin splints” has received a lot of attention within the literature, often found to be a difficult condition to manage. Shin Splints is a term which has been used to encompass all causes of shin pain including, compartment syndrome, stress fractures and MTSS. It is therefore understandable why such a term can become misleading as to the nature of such a complex and painful condition. The tibia (shin) is the larger of the two long bones located at the front of the lower leg.

Causes

MTSS is a chronic overuse syndrome, extremely common in activities, which involve weight bearing such as running. It has also been described as a common source of shin pain in military personnel. Pain associated with MTSS is often as a result of the following:

  • Over pronation: during the stance phase of gait the foot pronates to absorb shock and to adapt to uneven terrain, it is the soleus muscles job to resist unwanted pronation, therefore when the foot over pronates it places a repetitive stress on the tendons insertion on the tibia.
  • Training Errors: New training programs, sudden changes or increases to training, and inadequate recovery can all impact the repetitive overuse placed on the shinbone. Gradual progression and training increases will allow the musculoskeletal system to adapt to the loads imposed on them.
  • Muscle imbalances in strength and flexibility: It is all too common in runners to focus solely on their running and to neglect the strength and flexibility of their muscles. Tightness and weakness of the lower limb muscles can cause improper mechanics increasing the likelihood of developing MTSS.
  • Inappropriate footwear:  Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions.

Symptoms

  • Pain due to MTSS is typically of gradual onset, pain is typically only associated with activity which often goes away once warmed up, that can often return when activity has stopped. The longer the injury goes untreated the more chronic the issue becomes, individuals may begin to notice pain during normal daily activities.
  • Pain is usually diffuse felt along the medial (inside) border of the tibia (shin bone). When a more focal area of tenderness is felt there may be a possibility of a stress fracture.
  • The pain felt can often be quite sharp, which may often be too painful to continue activity

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the tibia and leg musculature. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from ice application (15mins every 2 hours) and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programmes for the gastrocnemius/soleus complex and the anterior shin muscles. Beginning a proprioceptive training program will assist in regaining stability in the foot and ankle.
  • Correcting any training errors, following a guided program may ensure you don’t take on too much too soon. Altering the direction of your routes to ensure you are not running on the same cambered pavements.
  • Self massage with a foam roller.
  • Wearing the correct footwear, visiting a specialist footwear store such as Run 4 It will ensure you are measured correctly for the most appropriate shoe for your running style.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with MTSS, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

 

Plantar Fasciitis

Plantar Fasciitis

What is it?

The plantar fascia is a broad band of connective tissue, which not only supports the arch of the foot, but also plays an important role in normal foot biomechanics. The fascia is designed to support the longitudinal arch of the foot. It attaches at the base of the heel bone and runs the length of the foot to insert into the bases of each toe. The plantar fascia is placed under tension during preparation for toe off during gait; the fascia is designed provide static support by tightening to stiffen the foot to allow affective propulsion.

Causes

Plantar fasciitis is a common overuse injury, particularly seen in runners with research indicating can account for 8-10% off all running injuries. This has been though to be due to repetitive microtrauma at the point of insertion. Some of the most common risk factors include:

  • Pes Planus (Flat feet): this causes excessive mobility in the foot, placing additional strain on the fascia due to increased stretching forces and reduced arch support. (Over pronation)
  • Pes Cavus (High arch): generally causing increased stiffness within the arch, and subsequently reducing the shock absorption properties of the foot. (Excessive supination)
  • Training errors: increases in mileage, changing terrain and inadequate recovery can place the individual at increased risk of developing plantar fasciitis, new runners who take on too much too soon are particularly at risk.
  • Muscle imbalances in strength and flexibility: research has suggested that tightness in the posterior muscles (hamstrings, gastrocnemius and soleus) may contribute to developing this condition. Poor strength and conditioning of the hip flexors, abductors and tibialis anterior muscles have been found to possibly contribute to the development of plantar fasciitis.
  • Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause excess stress on the plantar fascia. Wearing adequate footwear will enable the foot to function more effectively, which will subsequently reduce the impact on the more proximal structures.

Symptoms

  • Pain associated with plantar fasciitis is usually of gradual onset; it is typically painful at the beginning of activity, which often eases, only to return once activity ceases. If left untreated the pain increases to the point where weight bearing is painful and made worse with activity.
  • Pain is usually described as being worse in the morning, this is due to the foot being held in a plantarflexed position which when standing this movement is rapidly reversed.
  • Pain is typically felt on the medial (inside) aspect of the heel at the insertion to the calcaneus.

Management

As with any overuse injury, early management is essential, the longer it goes untreated the more difficult treatment would be.

  • In the initial stages it’s best to avoid any aggravating activities, any activity, which doesn’t cause pain, can be performed, for example swimming, cycling and cross trainer.
  • Anti inflammatory medication and ice may be beneficial in the early stages
  • Initiation of a strength and flexibility program, with particular emphasis placed on stretching the posterior muscles and strengthening of the hip flexors and abductors.
  • Wearing the correct footwear, visiting a specialist footwear store such as Run 4 It will ensure you are measured correctly for the most appropriate shoe for your running style.
  • Self massage to the plantar fascia with a massage ball.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with plantar fasciitis, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Iliotibial Band Friction Syndrome


Illiotibial Band Friction Syndrome

What is it?

The iliotibial band (ITB) is a thickening of the fascia that envelops the thigh, it acts as a lateral stabiliser of the knee and is an extension of the tensor fascia late and gluteus maximus muscles, which then travels down the outside of the thigh to insert into the front of the tibia (shin).

Causes

ITB friction syndrome has been described as a non-traumatic overuse injury, which is extremely common in runners. Injury to this structure in runners is most often due to:

  • Training errors: Generally when runners take on too much too soon, i.e. increasing their distance too quickly, doing more sessions than their bodies can handle and inadequate recovery periods between sessions can all contribute to pain at the ITB. New runners are particularly vulnerable to this as it is often easy to embark on a new running program without fully understanding the progressions.
  • Muscle imbalances in strength and flexibility: a common mistake in runners is the sole focus on improving their running, without focus on the strength and conditioning of the muscles and joints required. Adequate strength will give the joints stability which when running, which will reduce pressure on structures like the ITB. Recently researchers have discovered that poor conditioning of the hip musculature can increase an individual’s risk of developing ITB friction syndrome.
  • Surface and terrain: repetitive running on the same routes and surfaces with various cambers can cause alterations in an individual’s biomechanics, leading to imbalances.
  • Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions. Wearing adequate footwear will enable the foot to function more effectively reducing the impact on the more proximal structures.

Symptoms

  • Initially the pain is of gradual onset; often not sever enough to notice, which often goes ignored. Around the outside of the knee can become tender and may be warm and swollen.
  • The pain is typically described as coming on at a specific distance or time during a run.
  • Pain can increase when running down hill, coming down stairs and with any repeated flexion and extension exercise of the knee.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the ITB. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from ice application (15mins every 2 hours) and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programmes for the hip, and core musculature is essential to reduce the pressure of the ITB.
  • Correcting any training errors, following a guided program may ensure you don’t take on too much too soon.
  • Self massage with a foam roller.
  • Wearing the correct footwear, visiting a specialist footwear store such as Run 4 It will ensure you are measured correctly for the most appropriate shoe for your running style.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with ITB pain, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.