A few weeks ago I attended a further education course on shoulder pain & dysfunction and how best to manage this from in a chartered physiotherapy setting. My aim in attending this course was to learn how to better treat shoulders, helping my clients recover more quickly from injury.
There are 206 bones that make up the skeletal body. Bone is a living tissue that is constantly being removed and replaced. Bones need normal sex hormones, calcium, vitamin D, proteins and weight bearing / strengthening exercise to keep them healthy. Peak bone mass is reached at 25-30 years old. After the mid-forties bone density is lost approximately 0.5-1% a year. As we get older and over 50, more bone is naturally lost than is replaced. This causes bones to become fragile and therefore, they can break easily.
What is Cognitive Functional Therapy in Physiotherapy and how may it help me?
What is CFT?
CFT is a pain management approach that focuses on the patient and targets their beliefs, fears and associated behaviours (both movement and lifestyle). This approach has been devised by Professor Peter O’Sullivan and his research team. Peter is a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2005) and Professor of Musculoskeletal Physiotherapy at Curtin University. Internationally recognised as a leading clinician, researcher and educator in Physiotherapy, he has published more than 100 research papers, been keynote speaker at 60 national and international conferences and taught in 22 countries on the diagnosis and management of persistent pain disorders
Have you ever noticed your pain becoming worse after having a stressful day at work? Have you ever felt your pain to be worse following a bad night’s sleep? Have you ever drawn a link between busy days or busy life periods and an increase in pain? Before we discuss life factors, let’s discuss how the body feels pain.
Nerve fibres in our periphery, i.e. on the outside of the body, allow you to feel pain. For example, if you stub your toe against a door your toe will feel sore. The nerve fibres in your toe will send a message up to your brain to let the body know it is experiencing pain.
Studies have shown that of the patients presenting with headaches to private practice chartered physiotherapy, approximately one third are neck related cervicogenic headaches, one third are muscular tension type headaches and another third are migraine headaches.
Cervicogenic headache is a headache whereby the cause of the headache is a neck disorder, usually felt on one side. In other words the muscles, joints and nerves of the neck may not be functioning correctly resulting in referred pain to the head region. Common causes are sustained faulty postures, certain neck movements resulting in injury to the neck for example while lifting or carrying and sometimes stress.Typically clinical findings with this type of headache include musculoskeletal impairments such as muscular trigger points, restricted neck movements and reduced strength and endurance in the deep neck flexor muscles.
Increasing numbers of ‘older’ people are performing regular physical activity including walking, swimming, lawn bowls, golf, Pilates and cycling. This is great news from a health and social perspective, leading in an improved overall quality of life.
But how do we define ‘older’? It has become more difficult to define by chronology due to the variability in health and functional status among those of similar age. The American College of Sports Medicine (ACSM) define the ‘older’ person as over 65, or between 50 and 64 with clinically significant chronic conditions and/or functional limitations. We must remember there can be a large discrepancy between how old you are and how old you feel and function.
Physical activity and exercise have an important role in successful ageing. Successful ageing involves longevity and survival free of chronic disease, impaired physical and cognitive functioning as well as incident related disability (e.g. following a fall).
What is knee osteoarthritis?
Osteoarthritis (OA) is the most common form of arthritis (Vioreanu, 2014). OA is a degenerative, ‘wear and tear’ type condition while largely effects the protective cartilage in the joint which may affect the the ability of the knee joint to take weight during upright activities like walking and climbing stairs. Symptoms can also include achy pains, sometimes sharp from either the inner or outer knee, sometimes both. You may also feel a stiffness or weakness in the knee which may affect your confidence. Other problems may include intermittent swelling, fully straightening or bending the knee as well as feelings of ‘crepitus’ or grinding (Vioreanu, 2014). The incidence of OA tends to increase with age, with over 50% of the population having OA by the age of 65 (Vioreanu, 2014).
What can be done to help – what do the medical experts suggest?
The National Institute for Clinical Excellence have published updated guidelines in 2014 suggesting:
Why is the warmup and cooldown so important?
The warm-up prepares the body for exercise and should be tailored for the specific exercise that will be undertaken. For football, both general and specific exercises should be performed.
The warm up may involve
- General exercise jogging or cycling for 5-10 minutes to warm the muscles and enhance circulation in preparation for stretching
- Gentle static stretching of key muscle groups such as the hamstrings, calves and hip flexors which are held for 20-30 seconds and repeated 2-3 times. It is also important to stretch/mobilise the spine gently, especially the ‘twisting’ movement.
- Low level resistance exercises to ‘wake up’ important core stabilising muscles which will help support the back, hips and legs during training.
- Once the muscles are well warmed up, more vigorous dynamic stretches can be performed carefully under supervision of the coach so as to avoid injury.
The cool down is important to safely restore the body back to its resting state. This may include:
As part of our new Pilates term in November, we are adding a weekly ‘Falls Prevention Class’ which will take the form of a 60 minute exercise class aimed at improving general strength, balance, mobility and physical activity. The class will be run by a Chartered Physiotherapist who is trained in tailoring therapeutic exercise for all age groups.
Why a Falls Prevention Class?
The proportion of the population over the age of 60 years is growing rapidly and is likely to continue to grow in the coming years . More than 33% of community-dwelling people aged over 65 years unfortunately will experience a fall at least once a year, while 50% of those will have recurrent falls [2,3]. As age increases, the rate of falls can increase up to 60% [2,4]. Falling can badly effect confidence, reduce a persons feeling of independence and possibly result in isolation, with around 1 in 10 older people who fall becoming afraid to leave their homes for fear of falling again .
What is a Point Stimulator?
The point stimulator is similar in appearance to a large pen, it is a handheld device. The model we use in the clinic is the Pointer Excell 11 which we have found to be very effective and reliable.
The tip of the point stimulator, similar to the tip of the pen, sends a gentle current through the needle and into the muscle. This may enhance the sensory effects of dry needling which promote blood flow, healing and have local analgesic effects. The point stimulator also causes small micro-contractions within the muscle which may have additional mechanical effects as well as allowing accurate confirmation that the correct muscle is being needled.
Benefits of using the point stimulator are:
It can be used to ensure that the needle is inserted into the correct muscle so it is useful as a diagnostic tool.
It can also be used as a treatment tool by directly stimulating the needle for 2-10 second bursts with a 5 second rest in between for approximately 1-3 minutes, depending on the treatment dose and client’s response. Clinically this is particularly effective for reducing muscular tightness and deactivating painful myofascial trigger points within muscles.