Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is a very common and often debilitating condition in which the shoulder joint becomes extremely painful and there is a loss of movement. There is no known cause for frozen shoulder; however, certain factors increase the risk of developing a frozen shoulder. According to PubMed Health, these risk factors include:

·         Diabetes

·         Shoulder injury

·         Shoulder surgery

·         Cervical disc disease (neck)

·         Open heart surgery

·         Overactive thyroid

The most common symptoms are pain, loss of motion in the joint and stiffness.

Frozen shoulder is caused by inflammation of the joint capsule, resulting in limited movement and pain. Generally, one gets pain in the shoulder without any known cause. This results in a person using the affected arm less because it is sore. Reduced movement results in increased stiffness. Depending on how long one waits to be treated, this cycle will continue until a person has next to no movement in that shoulder.

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Frozen shoulder is usually diagnosed by means of an examination of the shoulder and according to the symptoms a patient is experiencing. An x-ray may be done to rule out any other injuries in the joint and an MRI may be done to confirm inflammation; however, most of the time a medical practitioner will diagnose a frozen shoulder by examining the shoulder using various tests. Common movements that people suffering with frozen shoulders battle to perform include:

·         Reaching up to the front

·         Reaching up to the side

·         Bending one’s arm behind their back

·         Putting on a coat

·         Brushing one’s hair

If untreated, a frozen shoulder may take up to two years to recover, and one may never regain complete range of motion. Pain killers and anti-inflammatory drugs can be taken to reduce pain and inflammation. It is then vital that intense physical therapy with a Biokineticist is started early in order to speed up the recovery process. Because movement is often restricted by pain, which then results in stiffness, it is important that the arm is used and moved throughout its range of motion. Passive and active range of motion exercises must be performed on a regular basis. Depending on how severe the frozen shoulder is, recovery may take anywhere from a few weeks up to nine months. Surgical intervention may be necessary in severe cases. Here, the arm is moved through its full range under anaesthetic in order to release scar tissue in the joint.

Therefore, if you have any pain in the shoulder that is restricting movement in your normal daily activities, consult a medical practitioner as soon as possible so that you can start your exercise therapy with a Biokineticist early, thereby speeding up your recovery.

National Epilepsy Week

This week, 20 to 26 June, is National Epilepsy Week, so I thought it appropriate to give you some insight into this often misunderstood condition. I will also discuss considerations that must be taken into account when people with this condition participate in any physical activity.

Epilepsy is defined by The American College of Sports Medicine (ACSM) as: “a chronic, neurological condition characterized by temporary changes in the electrical function of the brain”. These changes in electrical function negatively affect the transmission of information between nerve cells, resulting in seizures. Awareness, movement and/or sensation can be affected during a seizure.

Most often, the cause of epilepsy is unknown; however, common causes include head injuries, tumours, infections, strokes, and lead poisoning (ACSM).

Besides seizures, the following symptoms may occur (ACSM):

• Headache
• Changes in mood or energy
• Dizziness
• Fainting
• Confusion
• Memory loss
• Babbling

Often, one experiences an aura, or warning, before a seizure occurs, which may include (ACSM):

• Dizziness
• Tingling
• Peculiar smell or taste
• A feeling of euphoria
• Auditory hallucination
• And/or painful sensations

Various forms of epilepsy exist; therefore, it is extremely important that this condition is accurately diagnosed by a neurologist, so that the appropriate treatment can be applied. Blood tests, a CT scan, EEG, MRI, and lumbar puncture can be used to diagnose epilepsy; however, a full physical examination must also be done to rule out any other conditions that may cause seizures.

Three main types of seizures exist: a grand mal lasts about 50-90 seconds and involves a loss of consciousness, collapsing, rigidity, and an increased heart rate. A person is usually very tired and sleepy after such a seizure. A petit mal generally last 3-10 seconds and presents as a blank stare or loss of focus. A person usually recovers quickly, but may have multiple episodes. A psychomotor or temporal lobe seizure usually lasts 1-5 minutes and includes a blank stare, lack of awareness, daze, mumbling, struggling, and being afraid. This state of confusion can last a while after the episode and individuals may not remember what they were doing.

According to ACSM, exercise has not been shown to cause seizures; however, it is important to be aware of certain precautions that must be taken when dealing with an epileptic. If seizures are controlled, epileptics can generally partake in any physical activity, including contact sports, although individual sports are generally preferred. High risk activities, such as mountain climbing and underwater activities, must be very carefully supervised and the supervisors must be made aware when an epileptic is participating and how to deal with that person if s/he has a seizure. Triggering factors, such as strobe lights, excessive fatigue, hypoglycaemia (low blood sugar) and alcohol intake, must also be considered.

ACSM states that regular physical activity can, in fact, reduce seizures, as there is improved mental alertness and suppressed electrical activity in the brain. Therefore, it is important that epileptics maintain an active lifestyle. Such individuals are often overprotected by their loved ones, resulting in them being less active and very unfit. This contributes to a sedentary lifestyle and the unfavourable complications that go with it.

Exercise to Manage Parkinson's Disease

What is Parkinson’s disease?

Parkinson’s disease is a progressive disorder that affects the central nervous system. According to MedicineNet.com, it is the most common movement disorder. This condition occurs when there is an insufficient production of the chemical – dopamine – in the brain. Dopamine is a messenger in the brain that is responsible for producing smooth, coordinated muscle movements. Thus, in people with Parkinson’s disease, this lack of dopamine in the brain results in limited and uncoordinated movement.

Causes

The cause of Parkinson’s disease is unknown; however genetic and environmental factors, such as exposure to toxins, are potential contributing factors.

Symptoms

The following symptoms may occur with Parkinson’s disease:

·         Tremors

·         Rigidity

·         Bradykinesia (limited movement of the extremities)

·         Poor motor control when rising form a chair

·         Stooped posture

·         Shuffled and stiff gait (walking pattern)

The figure below illustrates the typical standing posture of an individual with Parkinson’s disease.

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Treatment and Exercise

Parkinson’s disease is treated with medication. But, because it is a movement disorder, it is essential that people with this condition also receive supervised physical therapy on a regular basis, in order to maintain functional ability for as long as possible. The condition is progressive; however, exercise can help to slow the progression and maintain mobility.

Falls are a common problem in people with Parkinson’s disease because of the shuffled and stiff walking pattern. Individuals with this condition will tend to stoop forward, shuffling their feet along the ground instead of picking them up. This may result in them tripping over the smallest uneven surface and possibly falling. These people also often have a slower reaction time, meaning they are less likely to catch themselves if they lose their balance. Falls are very serious in elderly people, as their injuries become more severe, resulting in less mobility, thereby creating a vicious cycle.

So, the first and most important aspect to consider when working with a Parkinson’s patient is that of gait, or walking pattern. It is essential to make these people aware of how they walk and make the necessary corrections, explaining why these corrections are made. Also, practice walking in various directions and around different objects, so that they become comfortable with moving in different directions.

Fluid movements must be encouraged. These include walking, cycling and swimming, amongst others. If a person has already developed a tremor, one does not want to exacerbate this by getting them to lift excessive weights. Keep weight training to a minimum and rather do more repetitions, keeping the movements smooth and manageable. This will also create a feeling of achievement which is important for motivation.

Stretching and flexibility exercises are important to maintain range of motion. Therapists must be aware of how the person is feeling. If one overstretches a patient, they may respond by tensing up the muscles, thereby exacerbating rigidity. The patient must remain relaxed during stretching.

It is important to ensure that exercises are functional, thereby assisting patients to maintain their ability to perform the activities of daily living. Find out what an individual struggles to do at home and work on ways to improve those movements.

So, for those of you who may have been diagnosed with this condition, don’t sit back feeling sorry for yourself. Get up and keep moving! With the help of a Biokineticist, you can still have prolonged functional ability and quality of life!

Total Knee Replacement Surgery: Pre- and Post-Operative Rehabilitation

Total knee replacement surgery is a common means of treating degeneration and/or osteoarthritis of the knee joint. It requires the two degenerated articulating surfaces to be replaced, making it a highly invasive and traumatic procedure. It is, therefore, important that numerous measures are taken to ensure one is physically ready for surgery.

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In the case of an elderly person, the surgeon may require the patient to have a full medical examination with a physician prior to surgery to ensure the patient is physically strong enough to undergo surgery. In the past, total knee replacement surgery was done using a full anaesthetic. Nowadays, it is becoming more common to use sedation together with an epidural.

If possible, the patient should start a pre-operative programme to strengthen the knee. This will help to strengthen the surrounding muscles that support the knee joint, thus shortening the recovery process. One must also try to maintain or improve one’s general physical fitness, so that the physical state of the individual is adequate prior to surgery in order to improve recovery. Exercise may, however, cause further inflammation and discomfort, so care must be taken at all times. A Biokineticist plays a crucial role in this process.

Below are some guidelines with regards to exercises that can be done prior to a total knee replacement procedure.

Exercise to improve cardiovascular fitness:

Cycling – high saddle

Walking – tolerable to pain

Swimming or water aerobics – minimal impact and strain on the knee

Arm ergometry

Strengthening exercises for the rest of the body:

Arm strengthening exercises – machines or dumbbells – important for holding ones weight on the crutches following surgery

Abdominal and core strengthening exercises – to assist in maintaining good posture

Strengthening exercises for the muscles surrounding the knee:

Quadriceps setting

Straight leg raises

Heel slides

Calf raises

Foot pumps

Ball squeezes (between knees)

Hip raises

Glute squeezes with a theraband

Following surgery, the first step is to regain mobility and range of motion of the knee joint. One must see a physiotherapist regularly to assist in regaining range of motion. Once this has been achieved, one should see a Biokineticist to assist you in starting an exercise programme to again strengthen the surrounding muscles. Initially, the exercises will be similar to those done prior to surgery and they will become progressively harder with time. The exercises should be done at least 3 to 5 times per week. Cardiovascular and upper body strengthening exercises that were done pre-surgery should be restarted as soon as possible to regain general physical fitness.

So, don’t be afraid to start exercising as soon as you feel ready to do so. With the correct guidance and appropriate progression, the rehabilitation can be more successful and the recovery time can be shortened significantly.

Multiple Sclerosis

What is it?

Multiple Sclerosis (MS) is an autoimmune disease that affects the central nervous system, that is, the brain and spinal cord. All nerves are surrounded by a myelin sheath – a protective layer surrounding the nerves. This myelin sheath assists in the conduction of neural signals from the brain to the muscles, innervating the muscles and thereby creating muscular contractions. With MS, demyelination of these sheaths occurs, resulting in the neural conduction along the nerves being adversely affected. Speed of conduction is reduced and the result is a reduction in smooth, rapid and coordinated movement. The effects can range from little or no disability to severe disability.

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Various types of MS exist

The National Multiple Sclerosis Society identifies 4 types of MS: relapsing remitting, secondary progressive, primary progressive and progressive relapsing. The most common form is relapsing remitting MS (RRMS). In this case, one has relapses, where symptoms are present, and then periods of remittance, where symptoms subside or disappear altogether. The more relapses a person has, the more severe the symptoms become. Stress, both physical and emotional, is the main contributing factor causing a relapse.

Causes

MS occurs as a result of the myelin sheath surrounding the nerves being damaged. This can be due to inflammation, when the body’s own immune cells attack the nervous system (autoimmune disease). The reason for this is unknown, but is thought to be due to a virus or genetic defect.

Who is at risk?

MS is more common in women. It is generally diagnosed between the ages of 20 and 40, but can occur at any age.

Symptoms

MS affects numerous body systems, including the eyes, bowel and bladder, sexual function, speech and swallowing and, most noticeably, the muscular system. In this blog, I will discuss the muscular system only. According to ACSM, the physical symptoms include the following:

• Spasticity
• Incoordination
• Impaired balance
• Fatigue
• Muscle weakness, paresis (partial paralysis) and paralysis
• Sensory loss and numbness
• Cardiovascular problems
• Tremors
• Heat sensitivity

The role of exercise in managing MS

The progression or prognosis of MS is not affected by exercise. However, a person with MS will still experience the short-term benefits of partaking in a regular exercise programme, such as improved cardiovascular fitness, increased strength and flexibility, and improved functional ability. People with MS often lose function in their legs, resulting in them being unable to walk. It is important to strengthen and stretch the leg muscles in order to prolong function. One should also focus on balance and stability exercises to reduce the risk of falling.

Important things to remember

People with MS do not have the same ability to regulate their body temperature as those without MS, so it is important to keep the room temperature in which you are exercising cool.

If muscles are overworked or overstretched, this can cause an acute inflammatory response, which may exacerbate symptoms. So, take it easy! Rather use lighter weights and do more repetitions to improve endurance and muscle tone.