Plantar Fasciitis
 

What is it? Pain in your heel on the sole of your foot.

Who gets it? Almost anybody can get it, young and old. However, it is most common in people who do a lot of walking and standing.

When does it hurt? It tends to be very sore with your first few steps of the day, or when you have been standing or walking.

What could I have? Plantar fasciitis

Common name? Policeman’s heel
 

If the above seems to describe your pain then you may be suffering from plantar fasciitis. This is aggravation of a band of fibrous tissue in the sole of your foot called the plantar fascia.

The aggravation often occurs where the plantar fascia attaches into the heel bone however the pain can be further up the sole of the foot towards the toes.

The common treatment often includes direct treatments like massage, stretching and strengthening exercises to the plantar fascia and the calf muscle. Also, it is often good to look at your foot posture; if you have flat feet then you may benefit from some orthotics that give you some arch support. If you have good foot posture, then you could be better off with some heel pads that decrease the pressure on the heel when you stand and walk.

 

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Tennis Elbow

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What is it? Pain in the outside of the elbow.

Who gets it? Almost anybody can get it, young and old. However, it is most common in people who do a lot of gripping or lifting.

When does it hurt? It hurts when you have to grip or twist objects with the hand and wrist.

What is the medical name? Lateral epicondylitis

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If this seems to describe your pain then you might have tennis elbow. This is aggravation of the tendon attachments of the muscles that engage to lift your hand and wrist up.

The aggravation can start as a result of a one-off event like lifting a heavy object or as a result of doing a repetitive task like stacking boxes. This results in pain when you are gripping or twisting an object like pouring the kettle. It can ache at rest and sometimes keep you awake.

Common treatments include direct hands on massage, acupuncture and elbow joint mobilizations. Using a tennis elbow brace can also help.

BEST EVIDENCE treatment is a strengthening program that focuses on slowly building the strength of the tendon without aggravating it too much. This can take 6-12 weeks for most people to return to normal activities  or sport without pain.

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Sever's Disease

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What is it? Pain at the bottom of your Achilles tendon in your heel.

Who gets it? Children aged 9 - 13.

When does it hurt? After a lot of running or sport.

What is the medical name? Calcaneal apophysitis.

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If your child has pain at the base of their Achilles in their heel and they are between the age of 9 and 13 then it is likely that they have Sever’s disease.

Sever’s disease is where the growth plate of the heel gets inflamed by the pulling pressure that the Achilles tendon exerts on it. It often becomes painful after a growth spurt or with increased running activity.

Treatment mainly focuses on stretching and massaging the Achilles and calf muscle to decrease the pressure on the heel bone. Wearing good supportive trainers often helps as most trainers have a little bit of a heel that also helps to reduce the pressure. We can also try taping the leg to support the area and decrease the symptoms during sport. Often however, the child has to limit sport activity to manage the pain levels.

The good news is that your child will grow out of this condition. But in the meantime, physiotherapy can help you and your child manage it and reduce the impact it has on their life.

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Rotator Cuff Injuries

Does your shoulder or the outside of your arm hurt when you lift your arm up?

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What? Pain in the shoulder or down the outside of the arm

Who gets it? Mostly people in middle age. The pain often starts after doing something heavy or falling onto the shoulder, however can slowly develop over time.

When does it hurt? It tends to be when you lift your arm out to the side, lift your arm up and put your hand behind your back. Sometimes you have little pain but have decreased strength in the shoulder.

What could I have? Rotator cuff injury or tear.

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I see a lot of shoulder injuries here in Te Puke. Every year I get a breakdown of the different types of injuries I see from ACC and comparing this with all the other physiotherapists in the country, on average, I see more shoulder injuries that the average Physiotherapist every year. I put this down to the type of orchard work and other heavy manual injuries that I see in Te Puke. Often these shoulder injuries are rotator cuff injuries or rotator cuff tears.

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Lower Back Pain

Don’t let lower back pain get the better of you

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Sometimes it’s the most innocuous tasks that result in lower back pain. Bending over at a funny angle to pick up a pen, or simply sitting with poor posture at work are the sorts of activities that can see people wincing in agony.

Perhaps this is why lower back pain is the most common complaint that we see in physiotherapy. It can affect the young and old, with pain ranging from mild to extremely debilitating.

Fortunately, there are a number of different treatments available to ease lower back pain. Massage, mobilisation, posture correction, acupuncture, manipulation, injections and surgery are some of the treatment options that can have significant benefits for people. In physiotherapy we have the skills to deliver many of these treatments to people with lower back pain.

Interestingly, the treatment with the best scientific evidence is in fact exercise-based treatment. In physiotherapy we are perfectly placed to deliver exercise-based treatments. We tailor programmes to meet the specific needs of each person and treat the source of their pain.

So, if you are fed up with suffering from lower back pain, see a physio – they can help you manage your pain and ultimately get you better.

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Osteoarthritis

Don't stop moving

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Osteoarthritis is an ageing process of your joints – and it gets more common as we get older. Think of it as your joints wearing out - just like your 2004 Ford Falcon’s engine, once it has done a few hundred thousand kilometres, it is done!

For a long time, doctors and physiotherapists would think of your joints in the same way. We would urge people not to overuse their joints and if they had signs of arthritis they were encouraged to reduce their activity in an effort to preserve their joints for as long as possible. A bit like that classic car that only comes out the shed on sunny Sunday afternoons.

However, we were wrong. Unlike your 2004 Ford Falcon or your 1964 Mustang, your joints have the amazing ability to repair themselves. Use and movement encourages this process of repair to happen. Studies have now shown over and over again that the people who keep their joints moving have less pain, limitation and disability from osteoarthritis.

So, if you have an x-ray and it shows that you have some osteoarthritis in a joint, don’t think that you have to rest it to preserve it. What you need to do is keep moving and using it and you will get the best you can out of that joint.

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Chronic Pain

Pain is one of life’s necessary evils, but what can you do if you start to experience chronic pain?

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For most people pain is an unpleasant but necessary part of life. Pain gives you a warning sign that you may be causing, or are about to cause, harm to yourself so you can react and do something about it.

However, for some people the pain signals continue for longer than is required or is beneficial. If the pain goes on for over three months then this is called chronic pain. Chronic pain affects millions of people around the world and can have a dramatic and detrimental effect on people’s lives. The treatment is not simple and often requires looking at a range of factors like diet, exercise, your mood, thoughts and feelings about your pain, stress and anxiety within your life, and any medications you take. Treatment often follows a team approach with pain specialist doctors, physiotherapists, psychologists and dietitians often having a part to play in the treatment.

Health care systems are increasingly recognising the importance of this team approach and agencies like ACC are supporting such treatment for chronic pain. So, if you suffer from chronic pain and would like to see if we can help, please make an appointment.

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Posture

Why posture is important – a cautionary tale 

Te Puke Physiotherapy’s Neil Barback shares from personal experience why maintaining good posture is so important.

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We have a nice wooden outdoor dining table at home. Around two years ago, I made the decision to stain it dark brown, which I realised was a mistake when I was about halfway through! However, I plodded on with the staining regardless, saying a sad farewell to the rich earthy tones of the natural teak timber. Ever since that day I have often thought that one day I will get the time to sand that table back to the wood and reinstate the natural beauty of the teak once again.

Around three weeks ago I finally found that time. After hours of sanding, the table was looking fantastic - but I was not! I found myself in considerable pain - and it was my own fault.

When sanding I disregarded my own posture while bending over the table, resulting in mid back pain that has only now - a few weeks on - started to diminish, despite my own knowledge of treatment and management. 

So, let this be a cautionary tale and please learn from my mistake. When adopting a posture for any length of time or when lifting heavy loads, keep your spine in neutral - or in other words, keep it straight. Also, work close into your body and whenever possible work at a good height so you are not bent over.

                Otherwise, you might find yourself like me – in pain!

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Rolled Ankle

Rolled ankles are a common injury and need to be treated effectively to get you back moving freely.

The vast majority of rolled ankles are inversion injuries that result in a lateral ligament injury. This means your foot rolls inwards and stretches, injuring the soft tissue on the outside of the ankle bone.

Some injuries are minor, just giving a little tug to the ligaments. Others are more major causing tearing of the ligaments of the ankle resulting in difficulty walking on the affected leg, pain, swelling, bruising and stiffness.

If you do sprain your ankle you should stop the activity you are doing, apply an ice pack for 15 minutes every few hours, rest the leg, apply compression and elevate the leg. If you are having a high level of pain or are having difficulty walking on the affected leg you should see your GP or physio for assessment and treatment.

At this assessment it can be assessed if you need an x-ray, and a treatment plan can be developed to help you to return to normal work, life and sport as soon as possible. This can include treatment and exercises to help you regain your movement, strength and balance reactions.

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Frozen Shoulder

Frozen shoulders are quite a common, restricting and painful condition for middle-aged people: nothing to do with how cold the weather is.

 

A frozen shoulder is when the outer lining of your shoulder joint tightens up and becomes stiff. The medical name for this condition is ‘adhesive capsulitis’. They are more common in women and diabetics. They often start for no reason with the shoulder becoming painful and then progressively stiffer over the space of a few weeks. At times they can come on after a shoulder injury or as a complication after a shoulder operation.

If you feel that you are developing a frozen shoulder then you need to be reviewed by your doctor or physiotherapist to confirm this diagnosis and develop a treatment plan.

Pain relief, steroid injection and a gentle stretching programme can all help. Often however, the shoulder steadily improves over some time (often many months) and returns to normal. You would expect to get a full recovery following a frozen shoulder.

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Sitting with low  back pain

The McKenzie Method

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Almost everyone will be aware of some stiffness in their low back after a few hours of sitting in the car, office chair or simply relaxing on the couch.

If you already have back pain, this could increase the risk of further problems or perpetuate your existing symptoms.

Have you ever been sitting for a long time and then have difficulty getting out of your seat? Does it then take a few steps to fully straighten up?

This is a sign of a developing problem and a simple tip can benefit many.

Just sit down with your buttocks placed well back into the chair. Place a rolled up towel in the hollow of the back. Sitting up straight can go a long way to relieve pain and stiffness in the lower back. Selected exercises from your physiotherapist can further improve function and help manage your pain.

This simple advice is based on the work by Robin McKenzie who developed an internationally recognised system of patient self-care known as The McKenzie Method. This method is practiced in 40 countries.

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Achilles Tendonitis

Have you been in the supermarket and experienced someone bumping the back of your heel with a shopping trolley?

 

With a minor injury the pain and local swelling only lasts a few days to a week or so. In some instances an impact incident to the Achilles tendon can lead to debilitating mobility problems that take weeks and sometimes months to resolve.

However, by far the most common cause of Achilles tendonitis occurs as an overuse injury in runners who suddenly increase the intensity or duration of their runs. It is common in middle aged people who engage in sports such as tennis, netball, stair-climbing and tramping.

Symptoms include a persistent heel pain and lower leg stiffness which tends to be worse on rising from bed in the morning, and initially when walking following a time of inactivity. You may have trouble pointing your toes and pushing off when you walk. Sometimes a painful lump may be felt just above where the tendon joins the heel bone.

A physiotherapist can treat your Achilles tendonitis. Depending on your situation, treatment can include appropriate advice regarding rest or activity, gait training and localised treatment. This also includes a graduated programme of gentle stretching and strengthening combined with advice regarding appropriate footwear and supports.

A return to full activity is always the goal but watch out for those shopping trolleys.

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Carpal Tunnel Syndrome

Carpal tunnel syndrome, also called median nerve compression, is a condition that causes numbness, tingling and sometimes weakness of your hand.

This can happen because of pressure on your median nerve that runs to your hand through a passage at your wrist called the carpal tunnel. The median nerve controls movement and feeling of your thumb, hand and most of your fingers.

Carpal tunnel symptoms include a burning, tingling numbness of the thumb, index and middle fingers. You may experience weakness in your hand and trouble holding things. Some people also feel sharp shock-like pain into the hand with certain wrist positions. Other common symptoms are waking up at night due to your hand ‘falling asleep’. This usually happens because of how you position your hand while sleeping.

The cause of carpal tunnel syndrome is not always clear. Sometimes it is associated with pregnancy, obesity and certain medical conditions. Repetitive wrist movements in the work- place may also contribute to its onset.

There are several clinical tests that can be performed by your physiotherapist to help confirm the diagnosis, with various treatment options including being fitted with a night splint if needed. If indicated your GP can organise a prescription for anti-inflammatory medication. If your symptoms persist, a specialist can perform a nerve conduction study, or surgery if necessary.

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Headaches while working from home

Over the past 2 years many of us have been working from home, spending long hours at our computers at the dining table or some other makeshift office. Often working on a laptop while sitting on the couch or even in bed. This has been combined with lockdown periods of not being able to get out and exercise as much as usual, and sitting watching more tv.

This change of lifestyle can take its toll. Our bodies are designed for movement and not meant to remain in one position for too long. Prolonged relaxed sitting posture can produce a variety of musculoskeletal complaints. Back and neck pain is common and so is headache.

Many headaches are mechanical in nature and can be fixed easily. They can be referred from the upper segments of the neck and so can be accompanied by some neck stiffness, but not always. The prolonged relaxed sitting position can cause over stretching of the ligaments of the neck and referred pain into the head is common and preventable.

If you are getting a headache after relaxing or working at the computer for a while, simply sit upright and place a rolled-up towel behind you in the hollow of the low back. Once in this more upright position, place your hands on your chin and push backwards for a few seconds and repeat this a few times.

Further advice and progression of neck exercises, along with hands on treatment, can be provided by your physiotherapist.

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