Do you sit at a desk all-day long?
Are you feeling stiff with rising tension in the shoulders and neck?

Posture related tension in the upper back, shoulders and neck area is a common complaint for desk workers and those who drive a lot due to the prolonged periods of time in the same position. People who work in high-stress jobs will also be familiar with this type of neck tension.

Eventually this ongoing state of tension can lead to headaches and migraines which become more difficult to treat.

This 1-hour 'Neck Tension Release' session will provide you with effective relief at intervals which suit you and your lifestyle in order to prevent more chronic conditions from developing.

Who will benefit?

• Those who feel generally stiff through the upper back as well as tight in the muscles across the shoulders and up into the neck
• May occasionally get headaches which feel they start in the neck and creep up the back of the head, sometimes around to the front
• Desk workers and drivers
• Anyone in stressful working environments who do not get an opportunity to take regular breaks

The idea that the common back pain, specifically lower back pain, can be a result of our modern lifestyles does make some sense. In general people are sitting more for extended periods of time which contributes to lower activity levels. These factors alone can negatively affect posture which often lead to problems in the synovial joints of the spine, nerves and surrounding muscles which all play their role in causing back pain.

The medical history of any back pain sufferer is an important consideration for the Physiotherapist when understanding how best to help relieve the symptoms. There is not a single most effective approach for all conditions of back pain and in fact sometimes the seemingly sensible treatment only makes the symptoms worse. We wrote about such back pain confusion in a previous article.

Over-reacting to back pain can cause both patient and Physiotherapist to take unnecessary measures and potentially over-treat the condition. The most important factor is intervening early before the pain progresses to a more chronic state. An experienced musculoskeletal Chartered Physiotherapist will be able to suitably educate you on your type of pain, potential causes and other important considerations such as the risks of fear-avoidance behaviour.

Anterior knee pain or patellofemoral pain syndrome (PFPS) is a common complaint that we see in the clinic. What we are dealing with here is pain located to the front of the knee, usually over or around the kneecap. It can be vague and difficult to say exactly where it is sore. The pain may be constant and made worse by certain activities, otherwise only painful when doing certain things. The pain often starts gradually for no obvious reason and may be aggravated by walking, running, ascending or descending the stairs or prolonged sitting with the knee flexed. You may have severe difficulties continuing the activity that causes you pain and discomfort.

Who is likely to suffer from this condition?

PFPS is more prevalent in females, they are 1.5 to 3 times more likely to develop the condition than males in the athletic population. It can be a significant and debilitating complaint that can affect as many as 1 in 10 active adolescent girls.

What exactly causes PFPS remains a misunderstood and controversial topic. Knee muscle weakness especially of the vastus medialis obliquus (inner thigh muscles which supports the knee cap), abnormal foot biomechanics - in particular abnormal pronation, weakness of the hip stabilising muscles and poor functional control of the femur during weight bearing tasks can be common causes of the syndrome. So in other words if you have weak thighs and hips, wobbly knees, flat feet and generally poor balance you may be at risk.

Do you suffer from frequent episodes of Low Back Pain?

We offer a 1-hour physiotherapy 'Low Back Pain Maintenance' treatment session specifically designed to help reduce the frequency and severity of your painful episodes.

Who may benefit?

Frequent episodes of low back pain has many causes. These may include generally poor conditioning of the spine, muscle stiffness with ‘trigger points’, low levels of activity, stress and other lifestyle factors. Your low back pain may also be due to a degree of 'wear and tear' of the spine, what is medically referred to as spondylosis or osteoarthrosis of the spine.

Recurrent episodic mechanical low back pain can be well managed with intermittent 'maintenance' physiotherapy sessions.

Our team of Chartered Physiotherapists have designed this 1-hour treatment session to assist you in the management of this type of low back pain with the intention of reducing how often and how severely the episodes occur.

Calf pain is more often a muscular complaint and we regularly treat such conditions here in our Physiotherapy clinic. However, calf pain can indicate a far more serious and dangerous health concern as I have been cautiously reminded of by a recent experience.

As Chartered Physiotherapists we are first-contact practitioners where patients can schedule consultations directly with us without having to go through their GP first. We therefore see many patients presenting with what they believe is muscular pain and dysfunction. In a recent case where calf pain was the complaint the more serious symptoms of Deep Venous Thrombosis (DVT) were presenting.

The medical training of Chartered Physiotherapists equips us with the knowledge and ability to identify these "red flag" symptoms and immediately refer for further medical review and investigation. As medical practitioners it is important we keep the differential diagnosis in mind and refer on if necessary.

Its that time of year again when I am fortunate and privileged to offer my experience and clinical expertise at the UCD School of Physiotherapy. I am currently teaching as an external lecturer on the Musculoskeletal module with my main role to cover the more practical ‘hands on’ aspects of managing patients with spinal conditions.

There is a bridge to gap between the world of academia and course work as offered in the University setting, and the application of this knowledge in a real world clinical setting. This is where I come in as I try to help students learn the manual therapy, exercise and patient management skills to be able to help the patients they encounter as students and upon graduation.

This brings me to some criticism of the University system, which is that of attendance. Given that these skills are only taught once in this setting, I am concerned when the lecture and practical classes don't have a 100% attendance by the physiotherapy students. These are the basic skills anyone wanting to work in musculoskeletal physiotherapy requires to be effective, they are the bread and butter of our practice. The time to gain the knowledge is now, so why not make attendance a priority? The University are trying to address the issue by making practical attendance contribute to the final module grade, however as yet this has not quite made the full impact. I feel that students have to want to learn and that if the passion and enthusiasm is there, attendance would never be an issue.

It would appear that according to the research evidence anti-inflammatories are indeed effective for pain relief but have shown no proven benefit in actually reducing the signs of inflammation, such as swelling, in a sprained ankle for example.

So, the answer is yes, but not in the way most of us would expect.

In a recent British Journal of Sports Medicine podcast, the effectiveness, use and safety of these commonly used drugs are discussed. The research would suggest that Paracetamol may be as effective in alleviating pain so this should be tried first as it has a lower risk of side effects.

The best pain relief may be achieved by combining Paracetamol with an anti-inflammatory such as ibuprofen (Neurofen) and often a lower dose of the anti-inflammatories is therefore required, thereby reducing the risk of side effects.

What is osteoporosis?

Osteoporosis means porous bones. It is a progressive bone disease in which a loss of bone mass and density may potentially lead to fracture. It can affect all age groups and both males and females. Women are at greater risk of developing osteoporosis than men, mainly due to the rapid decline in oestrogen levels after the menopause.

Bone is a living tissue that is constantly being absorbed and rebuilt. As we get older more bone is naturally lost than is replaced. However In osteoporosis the bone mineral density is reduced even further. The structure of bone begins to deteriorate and the amount and variety of proteins in bone are altered. This causes bone to become more fragile and more at risk of fracture through a minor fall or bump. The spine, hip and wrist are most commonly involved.

What are the symptoms of osteoporosis?

Osteoporosis is often referred to as the silent disease as it may not be diagnosed until a fracture has occurred. Fractures due to osteoporosis can lead to changes in posture (such as developing a stoop in your back), muscle weakness, loss of height and bone deformity of the spine.

Some people may experience pain in their bones and muscles, particularly in their backs. If you do experience any such symptoms and have some of the risk factors of osteoporosis it is important to talk to your GP.

The list of risk factors is extensive. Here are some of the more commonly associated risk factors:

Low back pain continues to be a topical issue within society and one which all of us can relate to. Undoubtedly each of us have either suffered with low back pain ourselves or know someone who does.

While for some it can be an acute episode that resolves over a short period of time for others it becomes an ongoing issue that may develop into a much greater problem, that of chronic low back pain.

We recently listened to a very interesting podcast by Dr. Kieran O’Sullivan, from the University of Limerick, on chronic low back pain. He discusses how we as Chartered Physiotherapists can improve our approach in the care of these patients suffering low back pain.

Some highlights from the podcast include:

By the time someone with chronic (around 3 months or more) low back pain attends the physiotherapist he or she may already have been in contact with several healthcare practitioners and undergone extensive diagnostic testing. Each of these practitioners may have had a slightly different explanation as to the cause of this person’s pain.

Trigger points can be found anywhere throughout the body but often give us most trouble causing neck pain and low back pain, both regions which can be implicated in the development of ‘muscular tension’ headaches.

Trigger points are the tender almost nodular feelings in generally taut bands of muscle. They are very good at creating a sense of vague achy, deep dull or boring pain, even sometimes sharp and ‘nervy’. They also result in stiffening and weakening of muscles such that they cannot do their job in supporting an upright posture for example.

Have a feel of the muscles between the neck and the shoulder, those that may feel tense when sitting all day or stressed. If the muscles feel ropey, stringy or hard with one or two spots that are exquisitely painful to press on, these are likely to be trigger points in your upper trapezius muscle.