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Both headaches and migraines are a surprisingly common problem affecting people of all ages. What makes migraines in particular so difficult to treat is the numerous ‘triggers’ that may initiate the migraine. These differ greatly from person to person and even from day to day – what triggers a migraine or headache one day may have no effect the next.

Some common triggers of migraine include: stress, hormonal fluctuation, weather changes, food and food additives, odours, light, medications, physical activity, caffeine and nicotine as well as changes in sleeping habits and even hunger. Other causes for recurrent headaches can be traced to dysfunction of cervical spine (neck), the temperomandibular (jaw) joint, sinuses and even visual deficiency.

The role of a physiotherapist is to work in conjunction with your doctor in determining a possible trigger of such attacks and modifying your lifestyle to eliminate or reduce your exposure to such triggers. Many headaches and migraines respond exceptionally well to manual treatment of the joints and muscles of the neck. Physiotherapy may include joint and manipulation or mobilisation (a more gentle means of loosening the vertebral joints) deep tissue massage and various forms of heat therapy.

Perhaps more importantly your physiotherapist will give you exercises and advice to reduce any excessive strain placed on the neck during the occurs of your day – yeas, that means advice on your posture whether it be how you hold your spine while you sit, sleep, stand or work. Ideally, we want to give you the knowledge and power to control your own headaches.

It is also important to remember that although many headaches respond very well to physiotherapy on the neck and upper back. This may not be the cause of the problems. Many of the triggers mentioned above are also responsible for tightening the muscle and joints of the neck and across the back of your shoulders. Unless you find your particular trigger (or triggers) you invariably end up treating the symptoms and not the cause of the problem.

The following symptoms may indicate that your headaches are originating from your neck:

  • Pain radiating from the back to the front of your head
  • Headache brought on or worsened by neck movement or by sustained neck postures
  • Headache with dizziness or light-headedness
  • Headaches that regularly affect the one side of your head or face
  • Headaches that are eased by pressure to the base of the skull


 

A sprained ankle involves damage to both ligaments and nerve fibres. With any injury an inflammatory response occurs at the injury site. Swelling in the area impedes repair and healing, therefore immediate treatment of any soft tissue injury is to minimise swelling and bleeding.

ACUTE STAGE - Immediate to 48 hours

R.I.C.E.R.

  • R – Rest. If weight bearing is painful, use crutches
  • I – Ice. Remove shoes and socks and apply ice in a moistened towel to the injury site for 15 to 20 minutes, repeating every 2 hours.
  • C – Compression. Using an elastic bandage. Compress the foot ankle and lower calf.
  • E – Elevate. Ideally it is best to raise to foot higher than the heart.
  • R – Referral. Refer the injured player on to a physiotherapist or doctor.

After the ‘Acute Stage’ treatment involves increasing the range of movement of the joint and regaining strength and co-ordination.

Progression should be gradual using non-weight bearing exercises, partial weight bearing exercises and then to gentle full weight bearing exercises. Movement should then become more functional until light training is possible.

When ligaments are torn, nerve ending which are important to the co-ordination and balance of the ankle joint are also damaged. Balancing exercises are therefore necessary in the definitive treatment.

Together all the exercises aim to increase strength, mobility and co-ordination and will help PREVENT further injury to the joint.

Remember that proprioception (co-ordination) and balance take longer to recover than strength and mobility so balancing exercises should be persisted with for several months.

 

Patello-Femoral Syndrome (PFS) is a condition caused by the patella (kneecap) not tracking properly over the femur (thighbone). The patella normally rides in a groove on the femur. With PFS, an imbalance of the quads muscles exists – usually the lateral or outside muscles over-powers the inner medial muscle – and this pulls the patella out of its normal groove. When the patella doesn’t track properly in its groove, it causes pain – usually around the inner margin, below or behind the kneecap.

Signs and symptoms of PFS include:

  • Pain under or around the kneecap
  • Pain is often worse after activity that involves keen bending – running, stairs (often worse walking up – stairs), squats, etc.
  • Knee ‘cracks’ or needs to be cracked to decrease pain
  • Patient cannot sit for long periods of time without straightening out the knee to make it crack
  • Often there is also tenderness and swelling below the kneecap on either side of the patella tendon

Treatment for PFS involves several steps to correct the positioning and tacking of the kneecap and biomechanics of the lower limb. It may involve stretching massaging the outer thigh muscles and illio-tibial band, strengthening of the inner quadriceps muscle (called vastus medialis obliques or VMO) and, if necessary, correction of foot pronation (rolling in) often with the use of orthotic shoe inserts. Orthotics may also be utilised if the problem is one that is persisting beyond a reasonable time or has subsequently returned.

Treatment usually follows an active rehabilitation program – meaning that athletes can often continue to participate in their sports provided they adhere to the exercise program and are able to either tape or brace the knee during activity. Bracing or taping involves manually position the kneecap in its proper position until the strengthening regime has taken effect.

Often biomechanical abnormalities of the pelvis need to be addressed, especially in female athletes or those people where excessive flexibility or instability in this area is an issue. This is possibly the most common knee condition affecting physiotherapy patients. It responds very well to treatment but requires some dedication and persistence from the patient. Left untreated, arthritis invariably ensues.

 

The term ‘whiplash’ describes the aetiology (cause) of a particular spinal complaint rather than a specific condition. It is caused when the neck (cervical spine) is flung rapidly into one direction before immediately ‘whipping’ back. Although it is a complaint we generally associate with the trauma incurred in a major vehicle accident, such forces can be placed on the neck in many other ways. Various physical sports (football, rugby and boxing for example) may also give rise to violent and rapid movements of the neck.

Although such movement can lead to very severe, precise spinal injuries including fractures, disc injuries or nerve entrapment, whiplash describes the injury to the soft tissues that support the cervical spine – the muscles, tendons and ligaments – and the muscle tightening (spasm) that results.

When treating the whiplash patient it is important to assess the cervical spine completely to determine the full extent of the injury and to rule out more serious underlying damage. Whiplash may cause pain immediately following an accident or in many cases may not develop until several hours later of even the following day.

Common symptoms include:

  • Muscular pain
  • Joint Pain
  • Headaches
  • Tingling, numbness or other nerve symptoms
  • Reduced range of motion
  • Decreased spinal strength
  • Nausea

Understandably therefore, whiplash may vary greatly in severity and there are a number of factors that can influence the injury:

  • The speed and nature of the motor vehicle accident – the angle of impact, the speed of collision, the type of vehicles involved.
  • The position of the neck at the time of the injury – was the head turned (or looking up or down) at the time of collision?
  • The integrity of the spine prior to the injury – is there any previous neck injury of degeneration and what is the general health of the individual?
  • Was the individual prepared/braced for the accident?

The muscle tightness that invariably follows a whiplash injury is a reflexive response to injury and pain. In many cases, it is the muscle soreness that proves most debilitating. Hence to reduce this there a few important steps that should be followed in the days immediately following an accident. Painkillers and non-steroidal anti-inflammatory drugs can be very effective in reducing the severity of symptoms and minimizing muscular tightness. It is important that a full assessment is given prior to the prescription of such medication.

Applying ice packs to the neck can often help in the first few hours although this too can cause muscular tightness and hence beyond the first 24 hours, it is advised that heat packs be used to help sooth and reduce the pain around the neck and shoulders.

Role of physiotherapy

Manual physiotherapy techniques include mobilisation, massage, heat and taping. All physiotherapists are skilled in applying these techniques safely.

The most frequently used mobilisation technique is oscillation. Oscillations are small rhythmic movements applied by the physiotherapist to painful, stiff or inflamed tissue. These tissues include facet joints, intervertebral discs, dura and spinal nerves. A comprehensive assessment enables the physiotherapist to identify which of these structures is the primary source of symptoms.

Various forms of heat treatment and electrotherapy may also be utilized during physiotherapy sessions. Your physiotherapist plays an important educational role in the treatment of whiplash. Symptoms associated with this type of injury can persist for several months or even years and are understandably frustrating to tolerate. Correcting the ergonomics of your workplace, fitness and postural ere-education programmes as well as lending a sympathetic ear play an important role in the management of this condition.

 

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Both headaches and migraines are a surprisingly common problem affecting people of all ages. What makes migraines in particular so difficult to treat is the numerous ‘triggers’ that may initiate the migraine. These differ greatly from person to person and even from day to day – what triggers a migraine or headache one day may have no effect the next.

Some common triggers of migraine include: stress, hormonal fluctuation, weather changes, food and food additives, odours, light, medications, physical activity, caffeine and nicotine as well as changes in sleeping habits and even hunger. Other causes for recurrent headaches can be traced to dysfunction of cervical spine (neck), the temperomandibular (jaw) joint, sinuses and even visual deficiency.

The role of a physiotherapist is to work in conjunction with your doctor in determining a possible trigger of such attacks and modifying your lifestyle to eliminate or reduce your exposure to such triggers. Many headaches and migraines respond exceptionally well to manual treatment of the joints and muscles of the neck. Physiotherapy may include joint and manipulation or mobilisation (a more gentle means of loosening the vertebral joints) deep tissue massage and various forms of heat therapy.

Perhaps more importantly your physiotherapist will give you exercises and advice to reduce any excessive strain placed on the neck during the occurs of your day – yeas, that means advice on your posture whether it be how you hold your spine while you sit, sleep, stand or work. Ideally, we want to give you the knowledge and power to control your own headaches.

It is also important to remember that although many headaches respond very well to physiotherapy on the neck and upper back. This may not be the cause of the problems. Many of the triggers mentioned above are also responsible for tightening the muscle and joints of the neck and across the back of your shoulders. Unless you find your particular trigger (or triggers) you invariably end up treating the symptoms and not the cause of the problem.

The following symptoms may indicate that your headaches are originating from your neck:

  • Pain radiating from the back to the front of your head
  • Headache brought on or worsened by neck movement or by sustained neck postures
  • Headache with dizziness or light-headedness
  • Headaches that regularly affect the one side of your head or face
  • Headaches that are eased by pressure to the base of the skull


 

A sprained ankle involves damage to both ligaments and nerve fibres. With any injury an inflammatory response occurs at the injury site. Swelling in the area impedes repair and healing, therefore immediate treatment of any soft tissue injury is to minimise swelling and bleeding.

ACUTE STAGE - Immediate to 48 hours

R.I.C.E.R.

  • R – Rest. If weight bearing is painful, use crutches
  • I – Ice. Remove shoes and socks and apply ice in a moistened towel to the injury site for 15 to 20 minutes, repeating every 2 hours.
  • C – Compression. Using an elastic bandage. Compress the foot ankle and lower calf.
  • E – Elevate. Ideally it is best to raise to foot higher than the heart.
  • R – Referral. Refer the injured player on to a physiotherapist or doctor.

After the ‘Acute Stage’ treatment involves increasing the range of movement of the joint and regaining strength and co-ordination.

Progression should be gradual using non-weight bearing exercises, partial weight bearing exercises and then to gentle full weight bearing exercises. Movement should then become more functional until light training is possible.

When ligaments are torn, nerve ending which are important to the co-ordination and balance of the ankle joint are also damaged. Balancing exercises are therefore necessary in the definitive treatment.

Together all the exercises aim to increase strength, mobility and co-ordination and will help PREVENT further injury to the joint.

Remember that proprioception (co-ordination) and balance take longer to recover than strength and mobility so balancing exercises should be persisted with for several months.

 
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