Osteoarthritis (“arthritis”) is a very common condition, affecting 25% of the population over the age of 65. Weight bearing joints in the lower limb are particularly susceptible to arthritis as the weight of the body adds to the biomechanical stresses affecting the joints. Two very common areas for arthritis are the hip and the knee.

What is Arthritis?

There are different forms of arthritis. Some are inflammatory, like rheumatoid arthritis. These types of arthritis are usually genetic and have less to do with “wear and tear”. Your body has decided to “attack” its own joints and inflame them. The more common type of arthritis is not an inflammatory type of arthritis, but rather a “wear and tear” type. This is osteoarthritis…the type that usually affects knees, hips, the lower back and neck (to name a few areas).

Risk Factors for Arthritis

There are various risk factors for the development of arthritis. If everyone in your family has experienced arthritis, there’s a good chance you will too. If you’ve had multiple traumas to a joint and have endured a lifetime of strenuous activity (sports or employment) there’s a good chance you’ll develop arthritis in that joint. Interestingly, some research has uncovered some more interesting, less obvious risk factors…

Knee Arthritis and Hip Arthritis…Risk Factors?

A recent paper published in Foot and Ankle International found a correlation between certain foot-types and joints where arthritis occurred. The authors found those with limited dorsiflexion (the movement of bringing your toe toward your shin) and a high arch in the foot had a trend toward arthritis in the hip. For those with a normal range of motion in the ankle but flat feet there was a trend toward arthritis in the inside of the knee.

Diagnosing Arthritis

Thankfully, another recent study has provided a reliable way for practitioners to measure patients and determine if their foot type and ankle range of motion is abnormal. We can combine this information with other risk-factors for osteoarthritis and tailor a treatment plan accordingly. In other words, if your measurement scores are poor and you already have some risk-factors for the development of arthritis (elderly, female, obese, osteoporotic, history of trauma to the joint, genetics etc.) there’s a good chance you’ll experience some pain at some point. X-rays and blood tests can also sometimes be helpful for the diagnosis of arthritis.

Treatment for Arthritis

There are various treatment options for arthritis. At our clinic in Burlington, we offer treatment through our physiotherapists and our chiropractors. Both practitioners offer laser therapy, which is perhaps the fastest way to get pain relief. For some, the pain doesn’t return for quite some time. For others, strengthening and stretching are the best options, which can be taught to you by our physiotherapist.

If you think you may have arthritis or at risk of arthritis, give us a call.  We can offer you advice, direction and a plan for the future.  Laser Therapy, Chiropractic, Physiotherapy…we can help!    

To learn more about our chiropractors, click here.
To learn more about our physiotherapists, click here.

For further information please contact us…905.220.7858 info@burlingtonsportstherapy.com

References
Bosomworth NJ. Exercise and knee osteoarthritis: benefit or hazard? Canadian Family Physician 2009; 55: 871-878.
Reilly K, Barker K, Shamley D et al. The role of foot and ankle assessment of patients with lower limb osteoarthritis. Physiotherapy 2009; 164-169.
Reilly K, Barker K, Shamley D et al. Influence of foot characteristics on the site of lower limb osteoarthritis. Foot Ankle International 2006; 27: 206-211.
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Carpal tunnel syndrome occurs when a nerve in the wrist (the median nerve) gets compressed between some bones and soft tissues. The symptoms usually consist of pain, numbness, tingling, weakness and deficits in sensation. Typically, carpal tunnel syndrome is more common in women and often occurs in both hands.

Carpal Tunnel Syndrome Treatment

There are many different treatment approaches for carpal tunnel syndrome. For those individuals with significant changes in the hand musculature, an unrelenting symptom pattern and objective confirmation of carpal tunnel syndrome surgery is often indicated. For most people carpal tunnel syndrome can be easily controlled with conservative treatment.  At our chiropractic and physiotherapy clinic in Burlington we recommend a combination of soft tissue therapy (active release techniques and graston technique) with night splinting. The purpose of the soft tissue therapy is to break-down scar tissue that is impeding the proper function of the median nerve. The night splinting is used to “unload” the nerve and allow it to heal.

Wrist Brace for Carpal Tunnel Syndrome?

Although there is significant evidence supporting night splints for carpal tunnel syndrome, the results of a 2007 paper published in the Archives Physical Medicine Rehabilitation suggest that there may be a right and a wrong way to do this. In this study the authors compared two different approaches for splinting the wrist in patients with carpal tunnel syndrome. Their findings indicated that a splint which keeps a specific segment of the finger extended is more effective, as several studies have shown that this position keeps certain muscles out of the carpal tunnel. Shortening these muscles at night therefore allows the median nerve to have more room in the carpal tunnel without being compressed.

Physiotherapy for Carpal Tunnel Syndrome

The combination of active release technique, graston technique and night splinting is an effective and evidence based way to conservatively control carpal tunnel syndrome.  Our clinic has also found laser therapy to be effective for this condition.  What is right for you?  It depends on a variety of factors; how long you’ve had carpal tunnel syndrome and what else you’ve tried are two of the more important factors.  Keep in mind that there are numerous causes of numbness, tingling, pain and weakness in the wrist and hand. There are other potential entrapment sites of the median nerve and there are other nerves that can create similar symptoms to carpal tunnel syndrome. Ensure that your condition is properly diagnosed by a qualified practitioner; feel free to contact our clinic and schedule an appointment with one of our doctors to see if you truly have carpal tunnel syndrome.

For more information about our Chiropractors, click here.

Fore more information about our Physiotherapists, click here.

References

Brininger TL, Rogers JC, Holm MB et al. Efficacy of a fabricated customized splint and tendon nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial. Arch Phys Med Rehabil 2007; 88: 1429-1435.

Goodyear-Smith F, Arroll B. What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management. Ann Fam Med 2004; 2: 267-273.

Miedany YE, Ashour S, Youssef S, Mehanna A, Meky FA. Clinical diagnosis of carpal tunnel syndrome: old tests – new concepts. Joint Bone Spine 2008; 75: 451-457.

Ugbolue UC, Hsu WH et al. Tendon and nerve displacement at the wrist during finger movements. Clinical Biomechanics 2005; 20: 50-56.

A Burlington Ontario Physiotherapy Clinic on Low Back Pain Exercise

As mentioned in a previous blog, the transverses abdominis muscle has been shown in the literature to play an important role in controlling the spine and therefore has an impact on lower back pain.  Although it has yet to be determined whether this muscle can cause lower back pain or whether it changes as a result of low back pain, it is relatively safe to say that the literature supports retraining this muscle as a potentially helpful approach to rehabilitation of lower back pain for some patients.

Transversus Strengthening for Lower Back Pain

A 2010 study published in the Journal of Orthopaedic and Sports Physical Therapy had similar findings to a 2008 study in that athletes with lower back pain could not perform the muscle test for the transverses abdominis as well as those athletes who did not have lower back pain.  So what does a finding like this mean? 

The Most Important Muscle for the Lower Back?

The transverses abdominis is not necessarily the most important stabilizing muscle of the lumbar spine.  It is not the only muscle that needs to be trained for patients with lower back pain.  Training the transverses abdominis will not guarantee elimination or total prevention of lower back pain.  These findings suggest that for some patients with lower back pain, retraining of the transverses abdominis can be helpful in re-establishing control of the spine.  This may result in decreased low back pain.  Identifying weakness of the transverses abdominis is paramount to the effectiveness of this approach, since we cannot expect targeting this muscle to be helpful if a person already has normal function in this area.

Treatment for Low Back Pain

At Burlington sports therapy, our chiropractors and physiotherapists make every effort to keep abreast of the most current, proven and progressive approaches to the treatment of lower back pain.  We don’t just choose stretches and strengthening exercises that look creative or clever.  We choose the appropriate exercises for our patients as dictated by the scientific literature.  Live in the Burlington area and looking for treatment?  Give us a call!  905.220.7858   info@burlingtonsportstherapy.com

References
Hides JA, Boughen CL, Stanton WR et al. A magnetic resonance imaging investigation of the transverses abdominis muscle during drawing-in of the abdominal wall in elite Australian football league players with and without low back pain. Journal of Orthopaedic and Sports Physical Therapy 2010; 40: 4-10.
Hides JA, Stanton WR et al. MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain. British Journal of Sports Medicine 2008; 42: 509-513.
Richardson CA, Snijders CJ, Hides JA et al. The relation between the transverses abdominis muscles, sacroiliac joint mechanics and low back pain. Spine 2002; 27: 399-405.

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“Sciatica” is a slang term often used to describe pain in the sciatic nerve distribution.  More often than not, this involves symptoms down the back of the thigh below the knee and into the foot.  This is caused by an irritation of the sciatic nerve.  As we’ve mentioned in previous blogs, sciatica is not actually a diagnosis but rather a slang term used to describe nerve irritation in the back of the thigh and leg.

Physical Therapy Burlington Ontario for Sciatica

Numbness, Tingling in the Leg

One of the more common causes of numbness, tingling, pain or aching in the lower limb (following a sciatic pattern) is lumbar disc herniation.  Many people refer to this condition as a “slipped disk”, a “pinched nerve” or a disc bulge.  Lumbar disc herniation is an area of considerable interest for researchers as the treatment options range from exercises, clinical treatment (like that from a physiotherapist or chiropractor) to surgery.

Treatment for Sciatica

There is ample evidence supporting each avenue of treatment for sciatica.  For example, a large 2006 study published in the Journal of the American Medical Association found no difference between patients who underwent micro-discectomy (surgery) to a group that were treated with physical therapy modalities and steroidal injections.  Another study, published in the Journal of Manipulative and Physiological Therapeutics found that lumbar spine traction, ultrasound and low intensity laser therapy were all effective in the reduction of sciatic nerve pain and the reduction of the size of the lumbar disc protrusion.

Sciatica Exercises…Do They Work?

A third example of research for sciatica treatment is a 2006 study published in the journal Physical Therapy.  The authors of this paper found that exercise-based management of a patient with lumbar disc herniation not only decreased symptoms after nine weeks, but demonstrated resolution of disc extrusion and relief of the nerve root compression on a follow-up MRI. So what is the best way to treat a lumbar disc herniation?

Treatment For Lumbar Disc and Sciatica

There are many variables that play a role in the decision making process for lumbar disc herniation management.  Our clinic usually recommends starting with the most conservative approach that is appropriate for an individual’s symptoms. Occasionally, in severe cases, surgical intervention may be warranted.  In the province of Ontario, your medical doctor or your doctor of chiropractic have the ability to diagnose this condition for you.  Obviously, a proper diagnosis is the first step for a successful treatment outcome!  Need help?  Give us a call! 905.220.7858  info@burlingtonsportstherapy.com

Want to meet our Chiropractor?  Click here.  Our Physiotherapist?  Click here.

References

Hahne AJ, Ford JJ. Functional restoration for a chronic lumbar disk extrusion with associated radiculopathy. Physical Therapy 2006; 86(12): 1668-1680.

Unlu Z et al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. Journal of Manipulative and Physiological Therapeutics 2008; 31: 191-198.

Weinstein JN et al. Surgical vs. non-operative treatment for lumbar disk herniation: the spine patient outcomes research trial (sport): a randomized trial. JAMA 2006; 296: 2441-2450.

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Shoulder pain is very common among active individuals.  Although there are many different causes of shoulder pain, many studies have been published in recent years which link scapular (shoulder blade) position and the activity patterns of the muscles around the scapula to many types of shoulder injury. Among the evidence is the consistent finding of delayed lower trapezius activity in dysfunctional shoulders. 

Lower Trapezius Exercises

A 2009 study published in the Journal of Orthopaedic and Sports Physical Therapy used EMG analysis to examine muscular timing in the trapezius muscles during various exercises. The results of the study indicate that the prone extension exercise and the prone horizontal abduction (with external rotation) both promote early firing of the middle and lower trapezius muscles (when compared to the other muscles that move the shoulder).  This is a good thing for those of you who might be confused…in other words, many shoulders have weakness in this area and we now have scientific evidence as to the best way to strengthen these muscles.

Shoulder Exercises – Lower Trapezius

In the prone extension exercise, you simply lie on your stomach (on a bench) with your shoulders flexed to ninety degrees. You then extend your shoulders to achieve the end-position pictured below. (Don’t use a stick as pictured below…it is recommended to use dumbbells).

In the second exercise, you start in the same starting position as the first exercise but you bring your arms out to the side (as pictured below).  Finish the exercise with your thumbs pointing up to the ceiling. 

Treatment for Shoulder Pain

As always, we do our best to bring you the most current and accurate information both in our clinic and on our website.  References are provided below.  If you’re experiencing shoulder pain we suggest that you have your condition examined by one of our doctors; jumping into a strengthening program without being diagnosed is not recommended.  Most cases of shoulder pain not only benefit from strengthening the right areas, but they also require focused treatment at the dysfunctional structures.  Laser therapy is one of our popular treatment methods for shoulder pain and can be applied by either our physiotherapists or our chiropractors.  For more information, call 905.220.7858 or email us at info@burlingtonsportstherapy.com. 

References

Cools AM, Dewitte V, Lanszweert F et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? The American Journal of Sports Medicine 2007; 35(10): 1744-1751.

De Mey K, Cagnie B, Van De Velde A et al. Trapezius muscle timing during selected shoulder rehabilitation exercises. Journal of Orthopaedic and Sports Physical Therapy 2009; 39(10): 743-752.

Hirashima M, Kadota H, Saraurai S et al. Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing. Journal of Sports Science 2002; 20: 310-310.

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