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Trigger points are hypersensitive areas within a muscle belly, commonly called “knots” that when stimulated, usually refers pain in areas around and away from the actual trigger point. They MIMIC pain in predictable band(s) away from the trigger point and also cause contractions in muscles that form taut bands… A trigger point is simply a small contraction within a muscle that can be excruciatingly painful.

Common ways in which trigger points mimic other conditions:

Weight-bearing on one leg more than the other (usually when we’ve had an injury to one side, we bear less weight on that side for example), can cause trigger points to develop in the gluteal muscles. Looking at this pain pattern, we could assume this to be sciatica. Sciatica is the description of a pain pattern and not a true diagnosis. (Fig.A below)

Another scary referral pattern is when a patient complains of severe pain in the left side of chest and down into the left arm. After appropriate testing for a possible heart problem is found to be negative, trigger points in the pectoral (chest) muscles are a likely cause for the chest and referred pain down into the arm. This pain referral pattern closely mimics that of a heart attack…and more often then not, they’re just as painful and stressful.

Severe headaches have become all too common. More often than not, after conducting many scans and tests, the muscles in and around the neck and jaw are found to be harbouring trigger points that are causing the headaches. These muscles contract strongly and can compress nerves and blood vessels causing muscle and nerve pain.

Other severe presentations that may involve trigger points as their cause are the 6-pack abdominal muscles mimicking appendicitis and other abdominal pains.

A wide range of sports injuries including: Tennis Elbow, Shin Splints, Biceps Tendonitis and Bursitis, may involve muscles that mimic and these conditions.

There may be various causes that flare-up trigger points, these may include:

Long term or very sudden overuse of muscles, activation by other trigger points usually in neighbouring muscles, disease, psychological distress (via systemic inflammation), post-surgery, direct trauma to the region, when nerves do not function properly along their path (radiculopathy), infections and chronic health issues such as diabetes, arthritis, smoking, etc.

Common treatment modalities we would use at PhysioPRO to treat trigger points could include:

• Proper diagnoses of trigger points and appropriate referral if serious pathology is suspected.
• Myofascial release techniques and ischaemic pressure.
• Dry-needling.
• Muscle energy techniques.
• Posture correction, Strapping and Taping techniques.
• Proper muscle activation, muscle and movement re-education.

For thorough assessment and comprehensive treatment kindly contact us….

Mitesh@PhysioPRO

I’m sure you’ve heard of the term “tendonitis” before, and you probably know of someone who has (or had) “tendonitis” of the elbow I.e. Tennis or Golfers’ elbow. Technically they are wrong, and it could be hampering their recovery!!

In actual fact, tendonitis is a very short lived and infrequent tendon condition. What they most likely have is actually TENDINOSIS, or otherwise known as a tendinopathy.

So what’s the big difference you ask? Well, medical terms that end in “itis” usually indicate inflammation and swelling, however in these tendon conditions, no inflammatory cells are present. This then has a direct impact on the way in which we treat the condition. So if you or your friend has tendinosis, taking anti-inflammatory medication is actually having no effect, and you may as well be taking Smarties instead…

If its not inflammation, then what is it exactly?
Without getting too technical, the substance that makes up tendons (collagen) is in a big tangled mess instead of a nice, neat and tight parallel bundles of fibers. There is also increased fluid around the fibers and lots of small, poor quality blood vessels. This can occur in various tendons, but the most commonly affected are those of the elbow (Golfers’ and Tennis Elbow), knee (Jumper’s knee), hip and ankle (Achilles Tendinosis).

So if you shouldn’t take anti-inflammatories, what should you do?

Tendinosis is usually as a result of repeated OVERloading of the tendon and therefore the CAUSE of your problem needs to be addressed. It could be as simple as a lack of rotation at the shoulder that could be causing your tennis elbow, or over-pronation at your ankle causing Achilles tendinopathy. Your physio should evaluate all likely factors and address these to prevent re-occurrence of your injury.

Where previously we were concerned not to inflame the tendon, treatment now focuses on actually CAUSING an inflammatory reaction, thus increasing blood supply and stimulating healing. Although painful, eccentric loading exercises are the “gold standard” of treatment to improve these conditions.

Nitric oxide donor patches and Shock wave therapy have some evidence to suggest they work, and a relatively new technique known as PRP (platelet rich plasma) injections (a topic we will discuss in future posts) are showing positive short term results at reducing pain and improving function.

I would highly recommend wearing a counterforce brace or getting strapped, as this will reducing the mechanical load on the tendon and alleviate pain.

One last thing you need to know. Tendon injuries usually take a long time to heal, especially if you’ve had it for months, so be prepared for some rehab and don’t wait till your pain is excruciating before you seek medical advice.

Ric@PhysioPRO

The most annoying of all injuries is probably knocking your little toe into a piece of furniture or door frame… However the most common everyday injury is the Ankle sprain…

The ankle joint, which connects the foot with the lower leg, is often injured in an unnatural twisting motion that occurs when the foot is planted awkwardly, when the ground is uneven, or when an unusual amount of force is applied to the joint. Ankle sprains are common sports injuries but can also happen during everyday activities such as walking or even getting out of bed.

The ankle joint is complex and comprises of several bones, many ligaments and tendons.

Ligaments are injured when a greater than normal stretching force is applied to them. This happens most commonly when the foot is turned inward or “inverted”. Outward or “eversion” sprains are less common, but usually more severe. Both results in tissue injury and inflammation. Blood vessels become “leaky” and allow fluid to ooze into the soft tissue surrounding the joint. White blood cells responsible for inflammation migrate to the area, and blood flow increases, all causing signs of inflammation: swelling, pain, tenderness, redness and warmth…

Urgent medical attention should be sought if signs appear more serious than this, for e.g., pain is excessive, despite the use of medications, elevation, and ice; the person cannot walk at all or cannot walk more than a few steps without severe pain, and/or the foot or ankle is excessively swollen. Fractures can also occur during severe sprains, and your physiotherapist can advise you when an x-ray is necessary.

Less severe sprains can be handled by self care at home by aiming to reduce and prevent inflammation…Remember PRICE: protect, rest, ice, compression and elevation (see Acute Injury Management blog).

Simple ankle sprains usually resolve between 6-8 weeks, however people often experience residual pain and stiffness in the ankle without proper rehabilitation. The chance of re-spraining the same ankle is said to be close to 80% due to a lack of, or improper rehabilitation.  To avoid this and gain complete recovery, seek expert care and rehabilitation of the ankle from a physiotherapist.

Physiotherapy treatment options for ankle sprains

Depending on the results of your ankle evaluation and examination and your specific needs and goals, your physiotherapist will create a comprehensive treatment plan specifically made for you. Physiotherapy treatments may include a combination of the following

• Patient education
  • About the condition
  • Precautions and injury prevention
  • Work or activity modification
  • Home treatments for symptoms
  • Home exercise program
• Recommend bracing or immobilization
• Recommend walking device (e.g. cane, crutches)
• Kinesiology Taping, Sports taping/Bandaging
• Ice / Heat application
• Electrotherapy & Ultrasound (US)
• Joint mobilization
• Graded Physiotherapy exercises including Balance, Proprioception and Gait re-education
• Formulate a work or sport-specific ankle rehabilitation program

The physiotherapy treatments for ankle sprain listed above will not be provided to you in one visit. Your physiotherapist is your best source for which interventions are best for you, based on your specific problems, overall level of fitness and your goals.

So if you have sprained your ankle already, or would just like to prevent this injury from occurring, pop in to your nearest PhysioPRO today.

Mitesh@PhysioPRO

Many patients come to my practice having heard something about inner core stability, but the majority have a very skewed perception of the core muscles and how to exercise these.

As an example, I asked a patient of mine (a provincial rugby player) if he does core exercises. “Yes”, he replied, “I do 100 crunches every day!”

You may think that this is the ideal response, but in fact he had very poor core stability when tested, and by the end of this article you should realise that he was in fact not training his core muscles.

To understand the concept of the “core”, one first needs a basic understanding of the muscles that make it up. The core can be related to a cylindrical can.

• The lid of the can is the diaphragm
• The bottom is the pelvic floor
• The front and  sides are made up of a deep stomach muscle (you’ve probably never heard of it) called Transversus abdominis
• Lastly the back is a muscle called Multifidus

These muscles all act together to increase the pressure inside the stomach cavity, and in so doing increase stability around the mid-section. A good way of visualising this is to try imagine squeezing a new tube of toothpaste with the cap on. The tube keeps its basic shape and is quite difficult to compress. Now remove the cap or make a hole in the side of the tube and suddenly the tube collapses.

The deep stomach muscle and Multifidus also have connections to the spine itself and when contracting, prevent excessive movement at the spine during activity.

So why was the rugby player not training his core you ask?

Well, most people only train the top three layers of stomach muscles during regular stomach exercises. Crunches, sit-ups and similar exercises all involve movement of the torso and so you tend to only train the “mobilising” muscles. These may look good when your shirt is off, but do very little for your back.  The deep stomach muscle is a “stabilising” muscle, so in order to train it, you need to challenge your bodies’ stability.

This is where Physio-balls, Bozu-balls (half a physio-ball) and Pilates come in. Using this equipment under the supervision of a trained Physio or other health professional will help you train your core correctly by challenging your balance and stability. Most of the exercises that use this equipment will be static exercises (i.e. holding a certain position with as little movement as possible) and then at a more advanced stage, movement can be added. Ever seen a person doing a full squat whilst standing on a Physio-ball? These people have phenomenal core stability and its quite amazing to watch.

One last thing worth mentioning is that if you do go to Pilates, PLEASE make sure your instructor shows you how to isolate Transversus Abdominis before you commence any exercises. If you have not been shown how to do this, you could do more harm than good. For this reason, Pilates classes at the gym down the road is probably not the best place to start this form of exercise unless you can get individual attention.

There is so much more to be said about core stability and its importance, but I hope this short explanation will help you to better understand your body.

If you need more info or would like to check and train your core, give us a call and let us bulletproof your back.

Ric@PhysioPRO

This month we welcome Riccardo Vacccaro, co-owner of PhysioPRO, to the world of blogging.

Riccardo Vaccaro received a BscPhysiotherapy (with Honours) from Wits University in 2007. He has always had a keen interest in sports medicine and rehabilitation.

Riccardo is a Fully Accredited Sports Physiotherapist registered with the South African Sports Medicine Association (SASMA). He is also a member of the Sports interest group of The South African Society of Physiotherapy (SASP).

Hi everyone,

Recently there has been a lot of interest shown in Elastic Adhesive Taping (EAT) as this multi-coloured tape has become a common sight in the sporting population. You only have to look as far as our National Rugby team to see how this tape has changed the taping world.

At our practice, patients are often amazed with the results they achieve using this tape. It is used to reduce pain, decrease inflammation and allow improved function.

It was created with the intention of “getting therapy between therapy sessions”. So let’s look at how and why it works.

There are currently many brands of this tape on the market and according to the brand, it may be referred to by different names, for example Kinesio tape, Kinesiology tape or K-tape etc.

Whatever the brand, they all work on the same basic principles, however not all tapes were created equally and there are differences in the adhesive properties of the different brands.  What about the different colours you ask? Well apparently this was done as colour therapy for patients, so for example blue should be used to try “calm down” tense patients. In my opinion, that’s about as usefull as wearing a hologram around your wrist to improve balance…but let’s leave that topic for another day.

So why does it work? Well, think of when you bump your head/knee/elbow or any other body part. What is your first instinctive reaction? After shouting ouch, you will most likely rub the area with your hand to help relieve the pain. This is because you are stimulating the skins mechano-receptors (which respond to touch) to send signals to the brain and in so doing, you close the “gate” on pain signals being sent.

This effect is known as The Pain Gate Mechanism and by applying tape over the skin, we are able to stimulate these mechano-receptors over a prolonged period thus reducing the body’s’ perception of pain.

Through this sensory stimulation, we are also able to effectively “switch” a muscle “on or off” depending on the direction of pull applied to the tape, and because the tape is applied over a prolonged time (3-5 days), this pull can be used loosen scar tissue.

It doesn’t end there though, because one of the other most valuable effects of this tape is the increase in lymph drainage, which is achieved through the tape microscopically lifting the skin, allowing fluid to flow easier and thus reducing inflammation.

I never get tired of seeing the expression on my patients’ faces when they see how a massive bruise is almost completely gone in 3-5 days after application of this tape.

As great as this tape may sound, it is really only as effective as the practitioner applying it. To get the best out of the tape, the practitioner has to assess each patient’s condition and then apply the appropriate taping technique, specific to the symptoms and cause thereof.

As with all great products, many companies are jumping on the band wagon, so please be wary of “do-it-yourself” taping, as you will probably be disappointed with the results and shocked at the price!

At PhysioPRO, our Physiotherapists are trained in the Kinesio Taping® Method and for more information on this subject please visit www.kinesiotapingafrica.co.za and click on the FAQ’s section.

“The new age sportsman or woman deserves a dynamic physiotherapist. Gone are the days of sticking someone on a machine for thirty minutes and massaging them for ten minutes. At PhysioPRO we pride ourselves on keeping up-to-date with current trends in Sports Medicine, to give you the patient, the best results possible.”

Riccardo