Neck Pain

Neck pain can arise from a direct accident, gradual onset, or from simply turning the neck.

How does it happen?

Neck pain results from damage to the structures of the neck and can often happen from relatively simple movement such as flexion or turning the neck.

Where Do You Get Pain?

Neck pain can be experienced on one side or both, occasionally feeling symptoms in the head and shoulders. The pain can be a dull ache or sharp pain which is made worse by movement. In some cases it can prevent full movement of the neck. Sometimes you can experience headaches and pressure behind the eyes. Pain can also radiate into shoulders and sometimes arms.

What Should You do?

If you experience neck pain from an accident, turning your head or simply waking with pain you should consult Thirroul Physiotherapy or medical practitioner for treatment.

Management

You should not ignore the problem as the symptoms may increase, leading to a prolonged recovery. You should also avoid activities that aggravate your symptoms.

Neck pain often does not produce any long term effects but it is important to get properly diagnosed to ensure an appropriate and effective treatment. Neck pain does have a tendency to come back so it is important to also know self management strategies to help in the acute stages.

When seeing a physiotherapist or medical professional they may recommend the use of imaging techniques such as x-ray, CT scanning or MRI. From this the physiotherapist or medical professional will be able to determine an appropriate treatment plan.

Forearm Pain

Elbow Pain - Tennis or Golfer's Elbow?

These common tendinopathy elbow complaints consist of two similar, yet different injuries. Both injuries are degeneration and/or inflammation within the tendons of the forearm.

Tennis Elbow (Lateral Epicondylosis) refers to the common extensor tendons that attach to the outside of the forearm at the elbow. These tendons connect to the muscles that extend your wrist and fingers.

Similarly, Golfer's Elbow (Medial Epicondylosis) refers to the common flexor tendons that attach to the inside forearm at the elbow. These tendons connect to the muscles that flex your fingers and wrist.

With both lateral and medial tendinopathy the pain typically will develop gradually. Beginning as pain and stiffness after exercise but often settles with heat. However, as you continue to exercise, the tendinopathy progresses and the pain increases, until you lose strength in the forearm with difficulty lifting or gripping objects.

Management

Both Golfer's and Tennis Elbow do not get better on their own. This is because microscopic tears have developed within the degenerative tendons and continuing exercise will only make the pain worse. It is important not to ignore the problem and consult your physiotherapist for a correct diagnosis. Diagnostic tools such as an ultrasound may be needed to determine the severity of the tears and this can further facilitate a specific individualised treatment plan.

To begin treatment, stop performing any heavy lifting or gripping activities and ice after any activity for 15-20 minutes over the sore area. Gentle regular stretches of the forearm may help in decreasing some pain symptoms.

Your physiotherapist can help with massage, stretching, guide you with self management strategies and demonstrate specific graded strengthening exercises to get you back on track. Resting the arm may decrease symptoms temporarily but as a sole treatment will not completely resolve the problem.

Common Ankle Sprains

Ankle Sprain of the Lateral Ligaments

A lateral ankle sprain may consist of one or more of the outside ligaments of the ankle. The lateral ligaments are most commonly strained when the foot is rolled inwards stretching the outer compartment of the ankle causing pain. There may be an audible 'snap', 'crack' or 'tear'. Depending on the injury there may be swelling around the ankle causing difficulty walking due to pain with swelling increasing immediately or over a period of a few hours.

What Should You Do?

The initial management of an ankle sprain is crucial in reducing swelling and decreasing bleeding in the surrounding tissue. The first 72 hours can aide in a faster recovery and return to function for work or sport.

To limit the severity of the injury, it is advised that you stop your activity immediately and begin your treatment. Swelling is a necessary step in the healing process but excess swelling can cause damage to surrounding tissue and delay the healing process. Initial management should be followed with R.I.C.E. Treatment.

REST

Stop your sport or activity, limiting the amount of weight you put through your ankle. If it is a severe ankle sprain, you may need to use crutches if you are having difficulty walking.

ICE

Ice should be applied to the injured site for 15-20 minutes every 1-2 hours.

COMPRESSION

Compression should be applied using an elastic bandage or 'Tubigrip™'. The compression should be firm but not tight enough to cause pain.

ELEVATION

Try to rest with your foot up above the line of your heart. This will prevent gravitational pooling of fluid and assist in decreasing the swelling.

Your R.I.C.E. regime should continue until you seek further professional advice from your physiotherapist or medical professional, preferably within 2 days.

Core Stability

What is core stability and how do you activate?

Achieving better activation and control of your lower abdominals will assist in supporting your lower spine and improve general strength and stability. If you have good control of your deep abdominal fibers you can decrease the direct load from your lower back and disperse the force throughout the entire trunk. Effectively controlling your abdominals can be integral in the ability to decrease low back pain.

The important aspect of activating your lower abdominals is to have minimal contraction for the activity performed. You should not have a full contraction of your lower abdominals, but a gentle contraction to stabilise the pelvis and lower spine.

Anatomy

You have four main abdominal muscles. At the front you have rectus abdominals, which are your six pack muscles. These muscles fibers are vertical, help you sit-up, are excellent to show off down the beach but are not very effective in supporting the lower spine. In addition you also have external and internal obliques more to the sides of your trunk with muscle fibers in both diagonal direction. These help you twist and side flex and offer some core stability. Your deepest abdominal muscles are your transverse abdominals. These attach to you lower spine and have transverse (horizontal) fibers that attach to the front to the abdominal facia. This muscle sits in a position similar to the corset women used to wear in the past. If these transverse abdominals are activated effectively it can aide is stabilising and supporting the lower spine.

How to activate

There are numerous prompts to activate your abdominals and each person will find different prompts more effective than others. Knowing your anatomy, where the muscles attach and how the muscles fibers contract can assist in getting the broader picture and a better understanding of your body.

If you place your thumbs just above your hips and slightly towards the front, take a small cough and you should feel the lower abdominals activate. This is a co-contraction of your abdominals as you use your breathing muscles (diaphram and accessory muscles). You will be trying to activate your lower abdominals WITHOUT activating your upper respiratory muscles and your ribs. If you are performing this activity properly, no-one should be able to see you turning your lower abdominals on or off.

Imagine you have a piece of string about 2 inches below your belly button and you are pulling the lower stomach in towards the spine and gently lifting towards your head, your lower belly should draw in about 1cm and your should feel the abdominals (where you are placing your thumbs) tense up gently. When contracting your lower abdominals you should be activating about 5-10% of a full contraction, not as hard as you can. Over-activation of your abdominals will lead to poor control and significantly increase intra-abdominal pressure. You should be able to hold your lower abdominals comfortably whilst breathing normally. It is important that you relax your upper chest. You should find it is easy to activate your lower abdominals when breathing in and they want to drop off when you breathe out. You will be practicing this to keep a gentle constant contraction of your lower abdominals whist breathing normally. Over time you should be able to activate your lower abdominals automatically, especially when bending down, changing positions or lifting objects.

Download Core Stability Handout