KEEPING ACTIVE AND WELL

It is important for the patient to stay both physically and mentally healthy while they wait for their surgery as this will help them get the best results from their treatment in the long term.  There are many online tools and resources available to help them keep active and to support their mental health.  Some specific treatments that might help patients include:

Pain Medication and anti-inflammatories          Painkillers and anti-inflammatories can help significantly in terms of allowing people to cope with their daily activities, remain mobile and getting a good night’s sleep. Use of any pain relief medication should be carefully controlled.  Steroid injections can help to ease the pain of osteoarthritis but the likelihood of a steroid injection working can be highly variable depending on the damage to the knee or hip.  Steroids also mask a patient’s symptoms but without addressing the actual underlying cause of the symptoms, thus fooling the patient  into thinking that their knee or hip is better, when it is not resulting in further damage occurring to the joint.

Physiotherapy and Chiropractic            Physiotherapy or chiropractic are recommended by NICE as part of the treatment pathway for knee and hip arthritis.  Appropriate treatment prior to surgery can improve a patient’s mobility and build strength and fitness levels and increasing the likelihood of a successful outcome from the replacement joint surgery.

Non-impact cardio fitness exercise       Exercise programmes can be helpful providing the patient with specific exercises and hands-on supervised guidance.  Cardio fitness exercise is something the patient can do for themselves.  The best exercises for patients with arthritis are those that are light and gentle on the joints such as walking, cycling and swimming.  Performing regular cardio exercise causes the body to produce endorphins helping to raise the patient’s natural pain threshold.

IN SUMMARY

With NHS waiting lists for knee and hip replacement surgery getting longer,  there will be a greater need for patients to consider alternative treatment options in order to delay the need for surgery,  to help them cope while waiting for surgery and to ensure that they are in the best possible shape when they undergo their operation.

USEFUL LINKS

whileyouwait.org       Provides additional information, support and resources to help patients while they are waiting for hospital care.

escape-pain.org  Provides a group rehabilitation programme for people with chronic joint pain that integrates educational self-management and coping strategies with an individualized exercise regimen.

Biotensegrity offers a unique way of examining the human body in the light of new understanding about functional anatomy. It is an overriding concept that describes a relationship between every part of the organism and the mechanics that integrate them into a complete functional unit.
This concept can be attributed to the work of Orthopaedic surgeon, Dr. Stephen Levin MD who says that the body is made up of many bones and structures and that, if one applies an external force, the entire shape “adapts” or changes according to the applied force, up until a breaking point is reached. The level of force applied to individual joint structures will affect the function of the joint or how it moves. Too much force may a restrict a particular movement or cause pain and too little force can make a joint unstable or prone to injury.  As the body adapts to poor movement at individual joints, pain can manifest in locations distant from the source of dysfunction

Individual Joints

The tensile structures surrounding each joint hold the joint surfaces apart, so that in a well-functioning joint there is no pressure on the bones as they move. This has significant implications for joints such as the hip and knee which are well known to wear out and need replacement. It is also important in spinal care; traditionally the discs in between vertebrae are thought of as shock absorbers, but in the Biotensegrity model, when the spine is well aligned with correct tension in the surrounding muscles and ligaments, there is no pressure on the discs. As you can see in the picture, the red and blue cords, which represent spinal ligaments, are tensioned so that the vertebral box are held apart from each other.

Biotensegrity and Pregnancy

A particularly good example of Biotensegrity at work is during pregnancy due to the change in the centre of gravity. During pregnancy, the hormone relaxin is released which results in a loosening of ligaments and joint structures throughout the body. These changes are gradual and occur over the entire nine months of pregnancy. Structure and function are inextricably linked as the skeletal frame has a direct impact on joint function. Differences in tensile and compressive forces throughout pregnancy can often lead to aches and pains as the body adapts. However, after the baby is delivered, there is an instantaneous change in forces affecting both structure and function. Relaxin stops being secreted  causing ligaments to start tightening up again. This is a good time to assess the functioning of the musculoskeletal system to avoid misalignments.

Biotensegrity recognizes that interactions between different components of the body follow basic principles of self-organisation and it recognizes the wholeness of the human body.

The first thing you should do, if you are experiencing recurring pain, is to get it checked out professionally. If you have nothing seriously wrong, and the problem is mechanical (i.e. bones muscles and joints) a visit to the chiropractor will probably sort it out.

However, many people find that the pain may recur in the future. Why? There can be many reasons. Here are some of them:

1.       Repetitive stress at work.
2.       Poor posture.
3.       The tissues become weakened and prone to re-injury.
4.       Stress or anxiety cause ongoing muscle tension.
5.       Loss of tissue resilience due to ageing.

A combination of these and other factors often lead to tissue damage. It may take a course of treatment and rehabilitation exercises to heal, but it can be difficult to remove all the causes of the problem. For example. You may be putting a lot of stress on your shoulder because of your job as a builder. Or you may be sitting for hours on end over the computer. You cannot just quit your job so the strain on your body is going to continue.

I teach my patients exercises and tricks to help avoid the worst excesses of posture, but with the best will in the world… this might not be enough; For some people, the painful symptoms will return and there is nothing they can do about it.

Well, actually there is; You can reframe pain.

As I have said, if the pain is severe and ongoing, you need to see a professional. Let’s assume you have done this. You have had some treatment the pain has gone away. But now you feel it starting to come back. This can be frustrating and upsetting especially if you thought you had got on top of it.

Firstly, you need to stop the negative thoughts, let go of the frustration and upset, and think about what you can do. You must do this because negative thinking will make the pain feel worse. Remember the pain is not as bad as it was originally; it is just starting to return, don’t catastrophize; it is not going to be as bad as it was before because you are going to take control.

See the pain as a reminder to take special care of yourself. It is like the oil indicator light in your car; There is no need to panic if the light comes on; It comes on long before your engine has run out of oil. You have plenty of time to top it up.

By the time you have been through a course of treatment you will have learnt the main causes of your pain. So you know what to do. Have you been working too hard, are you under a lot of stress, have you been sitting round in poor posture? It is simple, change what you have been doing and the pain will go away. The original injury will not return.

This is the reframe then: Originally pain was your enemy; it ruled your life and it was unbearable. Now the pain is your friend. It is your warning light. You can say “thankyou” to your body for giving you this warning before injury comes. Do what you need to take the strain from your body, and the pain will go away.

Therapeutic ultrasound is a common treatment practice in Physiotherapy and is sometimes confused with diagnostic ultrasound. Chiropractors tend to use spinal therapy as their main method of treatment, however, some do implement therapeutic ultrasound as well.

What is therapeutic ultrasound and how does it help with the treatment?

Therapeutic ultrasound is a method that uses sound waves to relieve and/or treat muscle spasms, inflammation, and pain.

Non-Thermal

Ultrasound brings energy into the body resulting in the microscopic gas bubbles around the tissues to expand and contract. The fast expansion and contraction of gas bubbles improves healing of the affected tissue as it helps improve the speed of the cellular processes.

Deep-Heating

Ultrasound is mainly for deep heating the body’s soft tissue structures. Deep heating the tendons, ligaments, and/or muscles helps to speed up the healing process by increasing the circulation to the soft tissues. Ultrasound increases the tissue temperature and decreases pain. The deep heating helps to loosen tight muscles and tendons. A chiropractor may use ultrasound therapy to improve the extensibility of the affected tissues in your body.

Ultrasound therapy helps treat various kinds of conditions and injuries including muscle tears, muscle strains, sprains and ligament injuries, joint tightness or contracture, bursitis (inflammation of the bursa), tendonitis (inflammation or irritation of a tendon), and frozen shoulder.

Using Therapeutic Ultrasound

Firstly the chiropractor will apply a small amount of ultrasound gel on the body part requiring treatment and this helps to reduce friction. The ultrasound head is placed on the affected area and then slowly rotated in a small, circular direction. The ultrasound equipment uses a variety of settings to control the intensity of the ultrasound. The settings used will depend on the stage of healing.

Ultrasound therapy is a completely painless treatment though some patient’s may feel a slight warming sensation and a little tingling on the treated area.

This particular patient had a corn in his left foot and he felt that this was causing the referred pain in his back; the fact that he was avoiding walking on the edge of his left foot caused an abnormal pull on the muscles in his legs, affecting his pelvis and low back.

He asked me “ Is that how it goes, from the left foot to the right side of the low back?” I had to answer that I did not know. In fact no-one can know. The body is a very complex moving “machine”. There is a whole science build around complexity, analysing complex systems such as weather patterns or economics. In most cases if you make a small change in some part of the system you cannot predict the outcome. This brings to mind the well known butterfly effect where a butterfly flapping its wings in the Amazon rainforest can cause a storm somewhere else in the world. So a corn on the foot could cause a migraine (but it probably won’t!)

Predicting Outomes

Basically things affect other things and we cannot exactly predict outcomes. However, what we can say is that if you alter your gait due to a problem in your foot, it is likely to have a knock on effect that moves up the body, putting pressure on tissues in different places. We can also say that the points of stress on tissues often swap sides of the body. So, a corn on the left foot might put excess stress on the right knee, the left side of the pelvis, the right side of the mid back and the left side of the neck…. Or you may find that the opposite happens; strain is put on the right side of the pelvis, the left side of the mid back and right side of the neck. Or some other strain pattern may emerge.

We can ascertain the pain/strain pathway by simple observation;  where the strain and pain is experienced, where the muscles are tender and where you can see subtle bends and twists in the body.

A problem in one part of the body can reflect and cause referred pain in other parts via a number of different mechanisms. The chiropractor’s skill lies in diagnosing the root cause(es) of a problem, and working out what effects this has had on the body. When you know the cause and the effect the treatment is straightforward.

The most common symptoms of hip arthritis are stiffness and pain which become worse over time. The pain will start off as mild but will worsen and become more persistent if not treated.

Movement will usually relieve stiffness in the hip joints though they can get worse during periods of rest. Cold weather usually exacerbates the pain. Patients may also suffer from morning stiffness, which may typically last for 30 minutes. Some patients will experience localised pain to the groin area as well as the thigh. The hip can also have limited range of motion and pain with weight-bearing. If the condition worsens the symptoms may become more persistent and painful.

How to Diagnose Hip Arthritis?

Pain in the hip region may refer from the low back, the pelvis or the knee. The first thing a Chiropractor does is take a full medical history.  They will identify the exact location of the pain and find out what makes it worse and what relieves it.  They will also investigate the possible causes. The Chiropractor will complete a physical examination of the patient and perform several tests, including orthopaedic and neurological assessments, muscle strength/tone and postural analysis.  Of course the best way to diagnose hip arthritis is with an x-ray.

Options for Hip Arthritis Treatment

In treating hip arthritis, it is best to first consider  non-surgical and non-drug treatments. Physical therapy is recommended for strengthening and stretching the muscles.  Some aerobic exercise will further benefit rehabilitation.

Treatment for hip osteoarthritis has two main goals – to reduce pain and inflammation and rehabilitation. Once pain and inflammation are under control the chiropractor and patient work together to prevent the problem from reoccurring. This rehabilitation process may include:

• Adjustment and mobilisation of the hip and other involved areas.
• Active soft tissue therapy.
• Education on home exercises, which includes stretching and strengthening exercises.
• Lifestyle changes to prevent aggravation of the injury.
• Orthotics or shoe inserts

A course of Chiropractic treatment can improve hip mobility. By using hands-on treatment techniques and combining these with home exercise, it is possible to restore hip function if the arthritis is not severe.

A lot of women are self-confessed shoe lovers, and with the growing popularity of high heels in the fashion industry, with a lot of colours and styles and to choose from, more and more women have jumped into the bandwagon, as wearing high heels gives the illusion of taller height, and apparently makes them stand and walk with poise. That is if they are used to wearing them.

But did you know that those “killer heels” are actually killing your chances of staying pain-free for life? Wearing high heels can do a lot of damage to your feet, calves, knees, hips, back, and tendons. Habitual wearing of these shoes can cause permanent physiological damage.

How the Damage Starts

The moment you wear your stylish stilettos, you tend to elevate your heel and your entire weight is placed on the ball of your foot. This compromises your posture and stability as it throws your hips, shoulders, back, and spine in out of alignment. To compensate for the instability, you unknowingly arch your back and you tend to walk with shorter strides.

High Heels and Pain

The longer your back is bent, the more pressure you put on the nerves of your back. This can cause sciatica. It is a nerve entrapment condition which can cause numbness from the back down the feet.

Long-term use of high heels can also cause pressure to your Achilles tendon, causing it to tighten and shorten. Wearing high-heeled shoes on a daily basis can cause permanent damage to the tendon.

Other damages that develop with long-term use of high heels are ankle injuries, Haglund’s deformity (a bony enlargement at the back of the heels), metatarsalgia (pain in the balls of the feet), hammertoes (a condition where the toes become permanently bent), bunions, and Morton’s neuroma.

Whether you are a teenager or an adult, if you wear high-heeled shoes for an extended period of time, and on a daily basis, or if you have the type of job that requires you to wear high heels, you are at risk for these injuries, especially when you spend your entire day standing up or walking.

If you are already suffering from these injuries, chiropractic care will definitely be beneficial for you. Staying in style, for most women, is important but is it worth the health risk?

Sources:

High Heel Horrors
High Heels: Worth The Health Risk?
The Real Harm in High Heels

As we continue our topic on Iliotibial Band Syndrome, this article includes an additional stretching technique. Several other supplementary treatment options will also be discussed .

Simple stretching exercise 

1. Stand in front of a wall with feet together.
2. Extend one arm and place a hand on the wall.
3. Slowly and carefully stretch the hips toward the wall and hold the position for a few seconds.
4. Return to a standing position.
5. Turn around and place the other hand on the wall and repeat the process.

This stretching exercise can help regain the suppleness of the iliotibial band and is effective if done regularly.

If a patient does these stretches regularly and find they are not getting any relief, there are other ways to relieve iliotibial band syndrome. Using a foam roller will help to stretch out and relieve the tightened iliotibial band. Place the foam roller on the floor and roll the affected area on top of it back and forth.

Additional Treatment Options

Should these techniques still not improve the condition, this could indicate that the patient has extremely tight connective tissue. Incorporating chiropractic manipulation as part of the rehabilitation process can benefit the patient hugely.  A full evaluation by a chiropractor is important in treating iliotibial band syndrome. A patient’s muscle balance must also be assessed in order to better identify all the contributing symptomatic factors. This includes a full biomechanical examination too. 

The chiropractor may recommend the patient to rest and take time off all activities that could aggravate their symptoms, including any sporting activities. Further recommendations may require the patient to ice the area and take anti-inflammatory medications to help relieve the pain. Unless the problems with muscle balance are resolved, rest on its own will not completely heal iliotibial band syndrome. A home exercise program designed specifically for Runner’s Knee may be prescribed.

Trigger point release therapy and soft tissue massage are also helpful in increasing the flexibility of the tightened tissue.

Choosing the correct running shoes is also extremely important and will depend on the patients particular running style. During a running activity, the iliotibial band stretches and contracts when the foot is in the air. Prescription orthotics or arch support for shoes will be helpful to correct the movement of the foot. Because overpronation (flat feet) is a common issue, shoes must be able to support the movement of the feet to prevent further injury.

Runner’s Knee: An Overview
Iliotibial Band Syndrome: Treatment Options

What is Runner’s Knee?

Runner’s knee is a common condition among runners and other athletes who do activities that require repetitive bending of the knee. These include football players, basketball players, ballet dancers, and even walkers. 

Runner’s knee is also known as iliotibial band syndrome and ITB friction syndrome. Iliotibial band syndrome is mainly an irritation to the band that connects the iliac crest (hip) to the tibia (shin). A patient suffering from this condition may feel a sharp pain to the knee or the hip after an intense training session.

The iliotibial bands may get irritated if they are tight. Tight ITBs will cause friction when rubbing against the outer portion of the knee, which will result in pain that may only be troublesome when you are about a couple of miles into your activity. A bony projection on the outer portion of your knee and/or a greater trochanter of the hip may contribute to runner’s knee if your iliotibial bands are tight.

There are a number of factors that could cause iliotibial band syndrome; two of them are biochemical abnormality and training error. Most patients state that the pain started after a sudden increase of activity intensity. Some describe pain after running downhill. Runners and other athletes usually have biomechanical issues (i.e., iliotibial band tightness and/or gluteal weakness). When running downhill, the knee angle at footstrike (when the foot hits the ground) is reduced, thus the symptoms occur. Running on an even terrain is less likely to cause runner’s knee, as the knee flexion when the foot hits the ground is not as limited as compared to when running downhill.

Here are the instructions for the simple stretching to alleviate the pain caused by runners knee.

1. Lie flat on your back.
2. Raise your left knee up to your left shoulder and push it over to your right shoulder using your palm.
3. Hold position for about twenty seconds.
4. Repeat five times.
5. Follow the same instruction for your right knee.

You can do this stretching three times a day or more. This can also be a part of your pre-exercise routine. You will see improvement in your condition in a week’s time with regular stretching. Whether you naturally have abnormally tight iliotibial bands or they got stiffened by running, regular stretching is recommended for faster improvement of your condition. The more you do this, the better.

Taking an oral anti-inflammatory and placing ice on the affected area can also help alleviate the pain. 

We regularly treat people with runner’s knee at our chiropractic clinics in Chester and in North Wales.

For more stretches and treatment options, if you do not get better, see part 2 of this article.

Runner’s Knee: An Overview
Iliotibial Band Syndrome: Treatment Options

This article will discuss the causes, symptoms and available treatment.

What is plantar fascia?

The plantar fascia is a ligament that extends from the bottom of the heel to the front of the foot. Its function is to support and maintain the arch of the foot. The plantar fascia plays a very important role in movement. Thus, any injury associated with it can result in difficulty walking and severe discomfort.

Plantar fasciitis was initially classified as inflammation. However, since no inflammatory cells presented within the fascia when examined, this information is now considered incorrect. In some circles they believe this can be attributed to heel overuse which then causes the collagen fibres near the heel bone (calcaneus) to degenerate.

Plantar fasciitis is often compared with heel spur; however, these two conditions are not exactly the same as a heel spur is a bony growth at the calcaneus.

What are the causes of plantar fasciitis?

Plantar fasciitis is common in people with overpronated feet (flat feet or feet that roll inwards). They are the most at risk for this condition as overpronation of the foot results to added stretching of the fascia.

When the calf muscles are too tight, they tend to cause high velocity foot pronation. This leads to repetitive overstretching of the fascia, causing the tendon to thicken. This thickening then causes the plantar fascia to lose its strength and flexibility.

Using footwear that does not provide sufficient arch support is also a cause of plantar fasciitis. Wearing shoes with cushioning and adequate arch support e.g. flat, lace-up shoes is ideal.

People who engage in sports activities that cause great impact to the foot (e.g. dancing, jumping, or running) are also at risk. Excessive and repetitive foot activity, such as running or walking on hard, uneven terrains, can also result in symptoms.

Overweight people are also at risk as the excess weight causes high impact to the foot. Sudden weight gain is another cause.

What are the symptoms of plantar fasciitis?

Plantar fasciitis is usually felt on the inside of the heel, where the attachment of the fascia is located. The symptoms present when the inside of the heel or the arch is pressed. As the fascia tightens up overnight, the symptoms may be worse in the morning when you take your first few steps. The pain, however, gradually alleviates as the foot warms up. The symptoms may worsen throughout the day, especially after intense activity. Tenderness, tightness, or stiffness on the bottom of the foot may also be present.

Treatment

There are numerous treatments available to ease the pain caused by plantar fasciitis, but there is no cure. In order to get long term relief, it is best to know and correct the cause of the condition.

What can you do?

1. Using a cold or hot pack on the affected foot can lessen the inflammation. Cold therapy is recommended to be applied regularly until the pain is relieved.
2. Resting until the feet are not painful is recommended. Doing so would be difficult as many people’s work involves being on their feet the entire day; however, forcing the affected foot to walk will aggravate the condition and worsen the inflammation.
3. Reducing the inflammation may be helpful but it does not provide a long term solution. The fascia may tighten up more, causing the heel to become more prone to stress. Doing plantar fasciitis exercises, like stretching the plantar fascia, is a significant part of the treatment and therefore should be done.

What can your chiropractor do?

1. Your chiropractor can prescribe anti-inflammatory medication (e.g. ibuprofen) to relieve the pain and inflammation.
2. Gait analysis can also be performed for the chiropractor to know whether you overpronate or oversupinate, so the proper insoles or orthotics can be prescribed. If overpronation is the cause of the problem, an insole will be helpful in restoring the normal biomechanics of the foot.
3. Your chiropractor can also reduce the stress and tension on your foot by applying sports massage techniques and calf muscle stretching.
4. He can also prescribe and teach you the proper exercises to help stretch the plantar fascia. These exercises can also help strengthen the fascia.
5. Your chiropractor will perform a biomechanical assessment of the foot ankle, knee, hip and low back as dysfunction in any of these areas can put excess stress on the foot. He will treat the joints with mobilisation where necessary.

We regularly treat plantar fasciitis in our chiropractic clinics in Chester and near Llandudno in North Wales.