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