A Joyous and Active Festive Season

To all my loyal readers, I would like to wish you a wonderful festive season and a prosperous new year. Thank you for your continued support.

Remember to keep active during the festive season!

Merry Christmas and best wishes for a happy and healthy 2015!!!

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Achilles Tendon Rupture

Achilles tendon rupture refers to the complete tearing of the Achilles tendon. It is among the most severe muscular conditions of the lower leg and is extremely painful. Usually, the rupture occurs as one pushes off the front of the foot, as in any propulsive activities, such as running and jumping.

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Prevalence

This injury is most prevalent in individuals between the ages of 30 and 50 years. The rupture most commonly occurs between 2.5 and 5 centimetres above the heel bone, anatomically known as the calcaneus.

Signs and Symptoms

One can feel and hear a “pop” in the back of the ankle and there is extreme pain, often described as being shot or kicked in the heel. The following will also be present:

·         Visible defect in the tendon itself

·         The inability to stand on tiptoes or balance on the affected leg

·         Swelling and bruising around the ankle

·         Excessive range of motion when pulling the forefoot upwards

Treatment

In a complete Achilles tendon rupture, surgery is required to reattach the tendon to the calcaneus, especially in younger, more active individuals. A cast is required to ensure the foot remains immobilized while the tendon heals. Physiotherapy is then required to regain range of motion in the ankle joint. Finally, biokinetic therapy is essential to provide stretching and strengthening exercises in order to regain full function. This process usually takes at least 6 months.

References

Foundations of Athletic Training: Prevention, Assessment and Management

Motor Neurone Disease (MND/ALS)

With the recent craze of ice bucket challenges, I thought I’d write about Motor Neurone Disease (MND), so that those of you who did the challenge and made a donation can learn more about the condition.

Motor neurone diseases refer to a group of conditions that affect the motor neurones in the body. One of the most common of these conditions is Amyotrophic Lateral Sclerosis (ALS). Here in South Africa, ALS and MND are used interchangeably, generally referring to the same condition.

What is MND?

MND is the degeneration of the motor neurones in the body, causing muscle wasting and stiffness. Motor neurones control essential voluntary muscle activity, such as breathing, swallowing, speaking and walking. As the muscles get weaker, these movements become increasingly difficult.

What causes MND?

At present it is not known what causes MND; however, the following factors are believed to have an impact on increased risk of developing MND:

·         Exposure to toxic environments

·         Trauma

·         A virus that lies dormant in the system for a long period of time

·         A genetic predisposition to degeneration of the motor neurones

Prevalence

MND is more commonly diagnosed in adults age 50 years and older, but can be present in younger individuals. It also tends to be more prevalent in males.

Symptoms

Symptoms vary, depending on which motor neurones are affected first. Muscle wasting and stiffness usually occur first in the limbs, resulting in dragging of one or both legs and limiting the use of both the arms and hands. Speech gradually becomes slurred. As the disease progresses, the more crucial muscles of the face and lungs are affected, causing problems with breathing and swallowing, eventually resulting in death. Intellectual ability is not affected by MND.

Treatment and Prognosis

Currently, there is no treatment that will alter the progression of MND. Medications and therapies are used to manage the symptoms. Individuals with MND are usually given between 1 and 5 years to live after diagnosis, but there are cases where people have lived longer.

Management

Because there is no treatment for MND, it is crucial that the symptoms are managed appropriately, so that one can still enjoy quality of life. Physical therapy and exercise are essential in maintaining as much muscle strength and movement as possible, keeping an individual as independent as possible, as well as improving mood and self-worth.

References

http://www.ninds.nih.gov/disorders/motor_neuron_diseases/detail_motor_neuron_diseases.htm

Shoulder Impingement Syndrome

In my last blog, I discussed rotator cuff injuries, which develop as a result of chronic tears of the four rotator cuff muscles, which is caused by repetitive microtrauma to these muscles as a result of overuse.

Impingement syndrome of the shoulder occurs when the supraspinatus muscle or tendon becomes impinged, or trapped, under the acromion process during overhead movements. The condition can also be referred to as “painful arc” syndrome or “swimmer’s shoulder”.

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Symptoms

Depending on the severity of the impingement syndrome, the following symptoms may be present:

·         Pain and weakness in and around the shoulder joint

·         Limited range of movement in the shoulder joint

·         Clicking in the shoulder during movement

·         Increased pain when the arm is lifted up to the side between 70 and 120 degrees (called the “painful arc”)

Risk Factors

The following factors may increase the risk of developing impingement syndrome:

·         Excessive overhead movements (for example, swimming and cricket bowling)

·         Anatomical limits that result in limited flexibility of the ligaments around the shoulder

·         Anatomical shape of the acromion process

·         Increased thickness of the supraspinatus and biceps brachii tendon

·         Lack of flexibility and strength of both the supraspinatus and biceps brachii muscles

·         Weakness or tightness of teres minor and infraspinatus

·         Hypermobility of the shoulder joint

·         Imbalances in the strength, coordination and endurance of muscles supporting the shoulder joint and scapulae

·         Training devices, such as hand paddles in swimming

Management

·         Rest, ice and non-steroidal anti-inflammatory drugs

·         Physiotherapy to reduce inflammation and increase range of movement

·         Modify activity to movements that do not cause pain

·         Biokinetic therapy to correct imbalances in muscle strength and coordination and to assist in returning to normal activity, including sport activities

References

Foundations of Athletic Training: Prevention, Assessment and Management

Rotator Cuff Injuries

The shoulder is a complex ball-and-socket joint, which is able to move in many different planes. It is, therefore, susceptible to numerous injuries, two common types being injuries to the rotator cuff and impingement syndrome. In this blog, I will discuss rotator cuff injuries; in the next blog, I will discuss impingement syndrome.

The rotator cuff is made up of four muscles that surround the shoulder joint, providing stability to the joint. These muscles are supraspinatis, infraspinatus, teres minor and subscapularis. Chronic tears of these muscles can be caused by repetitive microtrauma to the muscles as a result of overuse.

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Prevalence

Partial tears are more commonly seen in younger individuals, whereas complete tears are usually seen in adults over 30 years of age. The risk of a complete tear increases with age. Partial tears are treated conservatively, whereas complete tears may require surgical treatment.

Symptoms

·         Dull ache deep in the shoulder joint

·         Pain in the shoulder joint that can wake one when lying on the affected side

·         Difficulty with actions such as combing ones hair and putting on a jacket

·         Weakness in the arm and shoulder may also be present

Causes

·         Traumatic injury, such as a fall

·         Lifting something that is too heavy for the muscles to cope with

·         Repetitive overhead movements, such as swimming, bowling and serving in tennis

·         Bone spurs, causing rubbing of the tendons

Risk Factors

·         Age – the risk of developing a rotator cuff injury increases with age

·         Sporting activities requiring repetitive overhead movements, such as swimming, bowling and serving in tennis, increase the risk of developing a rotator cuff injury

·         Jobs that require repetitive overhead movements, such as construction jobs, increase the risk for rotator cuff injuries

Management

Conservative treatment is usually adequate to treat a rotator cuff injury:

·         Rest, ice and non-steroidal anti-inflammatory drugs

·         Physiotherapy to reduce inflammation and increase range of movement

·         Biokinetic therapy to improve muscle strength and stability around the joint

Surgical treatment may be required in the case of a complete tear.

References

Foundations of Athletic Training: Prevention, Assessment and Management

http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/basics/definition/CON-20031421

Newsflash!!

Please note that I am moving premises.

As of 1 August 2014, Nicole Lay Biokineticist will be practicing at:

95 Boeing Road East

Bedfordview (entrance on Marais Street)

Tel: 011 454 0232

Achilles Tendinitis

With the Comrades Marathon taking place on Sunday, I thought it appropriate to look at another injury that commonly affects runners, namely Achilles tendinitis, or inflammation of the Achilles tendon. This is the most common type of tendinitis, affecting the Achilles tendon, which connects the two main calf muscles to the back of the heel.

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Risk Factors

The following factors may increase one’s chances of developing Achilles tendinitis:

·         Tight and weak calf muscles

·         Foot deformities affecting the alignment of the foot

·         A recent change in running shoes or surface

·         A sudden increase in training intensity, either distance, speed or hill work

Due to its position in the body, the Achilles tendon bears a significant amount of force, subjecting it to injuries such as rupture and tendinitis.

Signs and Symptoms

Acute signs and symptoms include the following:

·         Burning or aching in the back of the heel

·         Increased pain when stretching the calf muscles or rising up onto ones toes

·         Tenderness to the touch on the Achilles tendon itself

Chronic signs and symptoms include:

·         Pain that is exacerbated by exercise

·         Pain that becomes constant

·         A thickened tendon

·         Pain only on the back outer part of the heel

·         Muscle spasms and tightness, combined with reduced flexibility in the calf muscles

·         Radiographs may show bony deformities and calcifications

Management

Acute treatment includes ice, non-steroidal anti-inflammatory drugs and activity modification. Complete rest for up to three weeks may be necessary in more severe cases. Surgery may be necessary in chronic cases where conservative treatment does not alleviate symptoms.

An appropriate stretching and strengthening programme is essential to prevent recurrence of this injury. Once the acute pain has subsided, consult a Biokineticist to assist you with this programme.

References

Foundations of Athletic Training: Prevention, Assessment and Management.

Fibromyalgia and Exercise

Fibromyalgia (FM) is a complex, multidimensional, rheumatological disorder. It is the third most common rheumatological disorder in the United States. It affects both men and women; however, a higher prevalence is seen in women, with 80% of people affected being women between the ages of 20 and 55 years.

FM is characterized by the presence of chronic pain and tenderness at specific anatomical sites, known as “tender points”. Other symptoms may include:

·         Sleep disturbance

·         Chronic fatigue

·         Morning stiffness

·         Paresthesia (tingling sensation) in the hands and feet

·         Enhanced perception of physical exertion

·         Depression

·         Anxiety

As a result of these symptoms, those affected with FM may also suffer from:

·         Impaired functional ability

·         Low self-esteem

·         Poor physical fitness

·         Social isolation

·         Poor quality of life

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The exact cause of FM is as yet unknown; however, the following factors are believed to increase the risk of developing FM:

·         Muscle abnormalities

·         Neuroendocrine and autonomic system regulation disorders

·         Genetic predisposition

Due to the multidimensional nature of FM, a multidisciplinary approach to the management of FM patients has been shown to provide the best results. This includes appropriate medications to manage symptoms, client education, cognitive behavioural therapy, hypnosis, acupuncture, and an appropriate exercise programme.

People with FM will reap the same benefits of exercise that individuals without FM receive; however, the main goal of a regular exercise programme for individuals with FM is to restore and maintain functional ability. The benefits of exercise that are more specific to those with FM include the following:

·         Reduced number of tender points

·         Reduced pain at the tender points

·         Decreased general pain

·         Improved sleep and therefore less fatigue

·         Improved self-esteem

·         More frequent and meaningful social interactions

·         Improved functional ability

Because of their symptoms, people with FM often become sedentary and, therefore, very deconditioned. They often complain of morning stiffness, exaggerated delayed-onset muscle soreness, poor recovery from exercise, and difficulty using their arms when elevated above their shoulders. High-impact, vigorous activities are also not well-tolerated. Therefore, low- to moderate-intensity aerobic activity is recommended for people with FM. One must begin the exercise programme slowly and progression should be slow and controlled. Supervised exercise therapy sessions with a biokineticist will ensure appropriate progression and will potentially increase exercise adherence.

References

ACSM’s Exercise Management for Person’s with Chronic Diseases and Disabilities

Shin Splints

Medically know as Medial Tibial Stress Syndrome (MTSS), shin splints are an overuse injury of the lower leg, which causes pain and inflammation along the tibial bone in the shin, as a result of small tears in the muscles attaching to the shin bone.

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Causes

Shin splints are most commonly related to running activities. A change in running surface, speed, distance, technique, stretching or footwear may contribute to the development of pain.

Signs and Symptoms

·         Dull pain which occurs along the shin bone (tibia) at any stage during physical activity

·         Pain may occasionally be sharp and penetrating

·         Pain is usually relieved with rest, but can recur hours after physical activity has stopped

·         In beginners, pain may be caused by doing too much too quickly

·         In more experienced runners, pain may be caused by mechanical abnormalities in the runner’s technique

·         Pain is aggravated by actively pointing the toes

Treatment

·         Rest is essential to relieve pain – at least 5-7 days

·         Ice, compression, elevation and non-steroidal anti-inflammatory drugs may be useful to relieve acute symptoms of pain and inflammation

·         See a physician to rule out any other conditions, such as a stress fracture or compartment syndrome

·         Re-evaluate any contributing factors, such as running surface and footwear

·         See a podiatrist to assess any foot abnormalities

·         See a biokineticist to assess your running technique and correct any weaknesses contributing to the problem – appropriate stretching and strengthening exercises for the lower leg will probably need to be done

References

Foundations of Athletic Training: Prevention, Assessment and Management.

Signs You Should Not Exercise

With everyone’s New Year’s resolutions to get fit and healthy hopefully still in place, I thought I’d give a little insight into when one should not exercise. Despite all my efforts to encourage individuals to keep active, there are times when a little rest is more important.

·         Illness – currently on an anti-biotic or anything related to the chest. If you have a fever or are on an anti-biotic, this means you have an infection. Your body does not need the additional stress of exercise on top of fighting off the infection. Exercise increases both your heart rate and breathing rate, putting additional strain on the lungs, which is unnecessary and not advised if you have a chest cold or infection.

·         Injury and been told by a practitioner to rest. Often with acute injuries, one is told to rest the affected limb. However, you can still train your arms if you have injured your ankle, for example. You only need to rest the injured limb.

·         Overtraining – symptoms of overtraining:

o   Exhausted instead of energized after exercise

o   Get sick easily

o   Feel down

o   Unable to sleep

o   Extreme tiredness

o   Mood changes – short temper

o   Extreme muscle fatigue and soreness

Take a break from the gym for a week or so to give your body a chance to recover.

·         Recent concussion – you must have clearance from your doctor before you participate in any exercise or sporting activity following a head injury.

·         Recent asthma attack – you may need to adjust your exercise routine to allow your lungs to recover from the attack. 

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Your immune system resistance decreases with stress, which includes the stress of exercise. Therefore, you are likely to get sicker or simply keep getting sick if you train while you are not well, as your immune resistance is already low. The bottom line is: if you don’t feel well, take it easy. Rather get completely better and then go back to training.

If you suffer from a chronic illness or injury, consult a Biokineticist to assist you in prescribing appropriate exercises to maintain your fitness and manage your condition.

References

http://www.webmd.com/fitness-exercise/features/when-not-to-exercise

http://fitness.mercola.com/sites/fitness/archive/2012/12/28/7-hidden-signs-of-overtraining.aspx

Cancer and Exercise

Cancer has unfortunately become a reality in many people’s lives. It may be life-threatening, but very often is not. When one is diagnosed, one must make a decision whether to fight the cancer or let it take over. How you decide to tackle the condition will determine your journey.

                         

Virtually all people with cancer can benefit from exercise therapy. Because cancer is such a complex condition and there are so many different forms of cancers, each individual case must be carefully considered. The type of cancer present, the stage of therapy or remission in which the individual is in, and the type of anti-cancer therapy being received together with their side-effects need to be assessed when prescribing exercise. Both the goals of and the response to exercise therapy will differ from one individual to the next depending on the above-mentioned factors. Exercise prescription is, therefore, complex and must be carefully individualized according to a person’s specific needs and abilities.

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Tumours can be found anywhere in the body and their effect on exercise ability is directly related to the tissues that are affected by the tumour. The following exercise responses must be considered for specific cancers:

·         Tumours of the musculoskeletal system – pain is common in the affected tissues.

·         Tumours in the lungs – shortness of breath.

·         Tumours in the brain or central nervous system – neural deficits and seizures.

·         Tumours involving the bone marrow – anaemia (low red blood cell count).

Fatigue is frequently experienced by most cancer patients; however, exercise has been shown to reduce fatigue and improve mood, functional ability, and quality of life. The following benefits of exercise have been found in cancer patients who participated in regular, moderate-intensity, aerobic exercise during their cancer treatment:

·         Reduced fatigue

·         Greater body satisfaction

·         Maintenance of body weight

·         Improved mood

·         Improved tolerance to side-effects of anti-cancer medications

·         Improved quality of life

Exercise therapy is safe and beneficial for those with cancer, provided the exercise programme is specifically tailored to an individual’s type of cancer, needs and abilities. The following goals should be considered depending on where an individual is in their treatment:

·         Currently receiving treatment for localized cancer – maintain strength, endurance, and current level of physical function.

·         Cancer survivors in remission or cured – return to prior level of physical function, with exercise forming part of an active lifestyle.

·         Recurrent or metastatic disease – maintain mobility and functional ability to perform daily activities.

The side-effects of anti-cancer treatments play a major role in how an individual feels from one day to the next. Thus, the general health of the individual should be assessed every day before starting exercise and appropriate adjustments made.

So, whether you are suffering with cancer, or you know someone who is, speak to your physician about starting a regular exercise programme. Then speak to a biokineticist to assist you in this process.

References

ACSM’s Exercise Management for Person’s with Chronic Diseases and Disabilities