Bone Health and Exercise

Physiotherapy » Posts by Sun City Physiotherapy (Page 9)

Bone Health and Exercise

Optimal bone health is a serious consideration in people approaching mid-life. It is common knowledge that bones become more brittle as we age. What may be less recognized are the factors we can control through exercise and nutrition in the first half of adult life that have a direct effect on prevention of osteoporosis.

Osteoporosis is a disease characterized with a loss in bone mass and deterioration in the sturdiness of bone structure. This is associated with the increased risk of fractures, particularly in the hip, wrist and spine. It is prevalent in the older population. If you are a woman, you have a 50% lifetime risk of a fracture from osteoporosis.
Bone loss is an insidious process. In the early stages it is called “osteopenia” It can occur when an arm or leg is casted after a frracture. A loss in bone mineral density (BMD) can accelerated after taking steroid medications or with certain autoimmune disorders or diabetes.

Reduced levels of estrogen after menopause accelerate bone loss. However, it is well- established that if a woman in her 40’s and 50’s exercises regularly and has good nutritional habits, she can diminish her post-menopausal bone density loss substantially. Osteoporosis is optional!

How does exercise affect bone health?
Bone is a living tissue. Bone cells, called osteophytes, have the ability to act like strain gauges and adapt to the amount of stress placed on them. Regular weight bearing exercise or strength training is essential to maintaining healthy bone. Resistance training improves muscle mass and strength and can increase spine and hip bone density. It is essential that the exercises chosen are safe and appropriate for the individual. Physiotherapists assess posture, understand risk factors and can advise which exercises are best for those with osteoporosis.

As a preventative measure and for those with mild osteopenia, high and medium impact exercise such as soccer, tennis, activities such as skipping and step-ups can stimulate healthy bone cells to produce a stronger bony matrix and increase BMD.

For individuals with moderate osteoporosis, weight bearing exercise and moderate impact exercises are appropriate, high impact exercise is not. Strength training exercises should target the specific areas affected. Balance exercises and fall prevention awareness are important, as falls can result in fractures, which are painful and can take much longer to heal than with normal bone. Working with a physiotherapist with specific knowledge about osteoporosis to set up an exercise program is highly recommended. Check with your physician before beginning a strenuous exercise program.

Attention to postural alignment during strength training is important. Certain exercises place too much strain on the midback area and can increase the rounding, or kyphosis in this area. For example, repeated curl-ups for abdominal strengthening, or swinging kettle balls with arms extended should be avoided.

Why does nutrition play such an important role in prevention of bone mineral density loss?
Bones are important warehouses for calcium and other important minerals needed for cellular function. If our diet is low in calcium, the body borrows it from our bones. If it’s not restored, a net deficit in minerals can result in reduced BMD.
In order to maintain optimal bone health, sufficient amounts of Calcium, Magnesium, Vitamin D are recommended.

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Tennis Elbow

Elbow, Wrist and Hand

Tennis Elbow – you don’t need to play tennis to get it!

Tennis elbow is so called as one of the reasons you can get it is from faulty technique in a tennis shot. This is only one of the ways that you can get tennis elbow though, it can come on from many other activities that involve a lot of wrist and forearm use.

The medical name for this condition, lateral epicondylitis, gives us more information about where the problem occurs. The lateral epicondyle is a small bony prominence on the outside of the elbow and is the point of attachment for the tendons of the wrist extensor muscles. These muscles run up the top of the forearm and play a role in movements such as bending the wrist back, making a fist, and twisting the forearm.

Lateral epicondylitis occurs if these muscles are used more than they are used to, resulting in pain and damage to the tendon where it attaches onto the bone at the lateral epicondyle. If you have tennis elbow, you will likely report an increase in pain when gripping tightly or shaking hands, using a screwdriver or twisting a jar, or any activity that requires wrist and hand use. The outside of the elbow can be very sensitive to touch, and you may find it will get very stiff, especially first thing in the morning.

In order to treat tennis elbow, it is important to identify the reason why it became injured in the first place and correct that. Apart from stopping the aggravating activity, there are often other contributing factors that need to be changed in each individual case. These can be related to our own anatomy in the elbow and arm, movement patterns which are overloading and therefore damaging the tendon, or factors relating to the equipment being used.

A physiotherapist can identify the changes that need to be made in each individual case and implement these. As well as this there is specific treatment that can be done to the tendon to ensure optimal healing such as friction massage and laser, and a stretching and strengthening program should be implemented too to ensure the muscles and tendons are in good shape to be able to cope comfortably with being used in the future.

So even if you don’t play tennis, you can still be affected by tennis elbow. Taking the right action will take your pain away.

Classification of Whiplash Injuries

Shoulders

Physiotherapy » Posts by Sun City Physiotherapy (Page 9)

Classification of Whiplash Injuries

Motor vehicle accidents (MVA) are sometimes an unfortunate consequence of modern reliance we have on automobile transportation. Previous to the invention of the car, there was “railroad neck”, and also a whiplash variation termed “roller-coaster neck”. Motor Vehicle accidents are sometimes termed “motor vehicle crashes” to suggest the preventable nature of some accidents. When a crash does occur, there is usually a chain of events including visits to the auto body shops, ongoing communication with insurance claims agents, and visits to many different health care professionals.

Despite advancement in sophisticated safety equipment for cars, bodily injury can sometimes result from accidents. Although the impact can occur in less than a second, the resulting injuries can persist for weeks or months. The neck (cervical spine) is the most common area of involvement, however, the mid back or low back can also sustain trauma. The shoulder or chest area can also be bruised by the restraint effect of the seat belt.

Injuries to the cervical spine are termed “whiplash-associated disorder’ or WAD for short. As with most conditions and injuries, there is a spectrum of severity. Following much consultation, the Quebec Task Force on Clinical Classification of WAD developed a five point scale of severity in 1995, which is well recognized within the health care and insurance fields. With Grade 0, or WAD 0, there are no physical signs, and the person does not complain of symptoms or usually seek help. At the other extreme end of the spectrum is the most severe WAD IV injury in which X-rays indicate a fracture or dislocation and require urgent medical attention. WAD classification is determined by a detailed and comprehensive clinical examination. Fortunately, most of the whiplash injuries sustained in a crash are classified as WAD II or III, and are commonly treated in physiotherapy practice. Clinical features include pain, and limited range of motion due to muscle spasm, sprained ligaments, and inflamed joints. Irritation of the neurological system can manifest as symptoms of numbness or tingling extending into the upper or lower extremities.

Physical therapists are very familiar with performing a detailed assessment and can help with determining the degree of injury that a person has sustained. A physiotherapy treatment plan is determined based on the degree of injury and time since the accident. Early in treatment when the condition is still very acute, it is common to suggest use of ice to decrease inflammation and pain relieving physical electrical modalities can also be used. As the person’s symptoms decrease, gentle mobilization, range of motion exercises, and progressive strengthening exercises are commonly introduced. Progress with treatment is individual and dependent on many factors. There are numerous practice guidelines, however, which suggest a return to normal daily activities as soon as possible, and treatment that promotes return of function is most helpful. A physical therapist is well trained to help assess your whiplash condition and provide an individualized treatment plan.

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Don’t take a holiday from good low back posture.

Back

Don’t take a holiday from good low back posture.

Trains, planes and car rides to visit friends and family; sitting down for a big turkey meal; sledding or hitting up the ski hill on snowy days; lounging around on Christmas morning admiring the tree and wrapped presents – this all sounds like a perfect holiday. While it is a wonderful combination for good times and many smiles, it unfortunately for some can also be a perfect recipe for a sore back. Something that all of those activities listed above have in common is a forward bent – or ‘flexed’ – position of the low back.

With normal standing posture, the low back has a slight curve, which is known as ‘lordosis’. When we bend forward or sit, we lose the lordosis and our lumbar spine – the low back – goes into flexion. Spending too much time flexed, or performing heavy tasks in this position, can put a strain onto the lumbar discs. The ‘intervertebral disc’ is a structure that sits between adjacent vertebrae in the spine. It is composed of a tough, fibrous periphery with a gel-like nucleus in the centre. Repetitive or sustained flexion, as well as heavy lifts or bends, can injure the disc by causing tears in the fibrous rings. When this occurs, the gelatinous nucleus can bulge into the tear. In more severe cases, the gel can even push outside of the disc. It is most common for injury to occur in the back of the disc rather than the front.

To visualize what happens, imagine a jelly donut, where the dough is the fibrous outside of the disc, and the filling is the nucleus. Line up the hole that was used to fill the donut as being at the back/side of the imaginary spine. If you push on the front of the donut, the jelly will squeeze out toward the back, and can even push out of the donut (which would be the case in severe injury, or ‘prolapse’). Forward bending is similar to this – there is an increased pressure on the front, and a suction force at the back, causing the gelatinous nucleus to move posteriorly if the fibrous rings are not holding it in place. Even with just an outward bulging of the disc (so, the jelly in the donut has moved but hasn’t escaped through the hole) can cause inflammation, and irritation of surrounding tissues, including nerves.

There are several strategies that can be used to help in the prevention of lumbar disc injuries. A few are:

Use a firmly rolled towel, or a ‘lumbar roll’, in the curve of your low back if sitting. It is helpful to keep one in your vehicle
Avoid the slumped position when sitting. A lumbar roll helps with this, as does your leg posture. Having your hips and knees in a deep bend, such as in a low chair, increases the forward bend in your back
Take standing and walking breaks when traveling, or during long meals
Stay flexible – tight hamstrings (backs of the thighs) in particular can have an effect on low back posture
Keep a strong core to help support your back during activities. This doesn’t necessarily mean doing crunches or sit-ups, but exercises that target the deep core muscles
During the post-holiday clean-up, avoid stooping to bend down to pick things up. Instead, bend your knees and hips to get into a good squat position. It’s a good way to exercise your legs, too!

Even with taking precautions, injuries can occur either with a single incident or over time. When this is the case and you notice you are having back pain, it is important to seek care from a health provider. Lumbar disc injuries, along with other causes of low back pain, can often be treated conservatively (meaning, non-operatively). It is important to note that not all back pain is due to disc injury. A physiotherapist can help to determine what structure may be causing your pain, and give you appropriate exercises, stretches, hands-on treatment, and strategies for management, specific to your injury.

Carpal Tunnel Syndrome

Elbow, Wrist and Hand

Carpal tunnel syndrome is a common wrist and hand injury. It occurs when one of the major nerves called the median nerve is compressed within the carpal tunnel of the wrist. This may occur for a number of reasons but some of the more common reasons include: pregnancy, gout, trauma (repetitive or direct trauma), or infection. Carpal tunnel can happen at anytime, however it is more common between the ages of 40-60 and women tend to be affected more often then men.

This condition is characterized by burning wrist pain and numbness or tingling within the hand. This often occurs at night and the patient usually wakes up due to the symptoms. In some cases the pain can radiate to the forearm, elbow, and shoulder.

Some of the other symptoms reported by patients include poor sensation in the hand, weakness of the hand, cramping in the hand, reduced temperature in the hand, and sometimes shaking or flicking the hand relieves the symptoms. There may also be muscle wasting around the thumb. Movements of the hand are often pain free, however some resisted movements around the thumb can be painful.

Diagnosing carpal tunnel syndrome is often done based on the patient’s medical history. Your physiotherapist or physician will take you through a series of tests and if carpal tunnel syndrome is suspected a nerve conduction test may be ordered to confirm the diagnosis. Diabetes should be excluded, as it can be a risk factor for carpal tunnel syndrome.

Mild cases can be treated conservatively. This may include splinting, activity modification, diuretics, and NSAID medications. Techniques such as contrast baths, which are alternating baths of cold and warm water, may be used in some cases to control inflammation and swelling. A physiotherapist may give you specific exercises that can be helpful with a patient’s recovery. For more persistent or severe cases, corticosteroid injections or surgery may be required.

Wrist and hand injuries are often difficult to diagnose so if you are experiencing symptoms of this nature it is recommended that you see your health care professional to have it taken care of.