Sports Physiotherapy and Physio Articles – Balance Physiotherapy

Physio and Sports Articles

No Bones About Osteoporosis • This Way Up... • Golfers Elbow • Runners Knee • Avoid Ankle Sprains • Plantar fasciitis/Heel pain

No Bones About Osteoporosis

Osteoporosis is an extremely common condition. Osteoporotic fractures can be painful. But, osteoporosis itself has no symptoms. A person may not know that they have osteoporosis until their bones become so brittle that a strain or bump causes a fracture which would not have occurred in someone with healthy bone density.

What is osteoporosis?
Osteoporosis (which literally means 'porous bones') is a condition characterized by loss of bone density, and weakening of bones. In many cases, bones weaken as a result of low levels of calcium, phosphorous and other minerals in the bones. When weak bones are stressed or injured, they often fracture, commonly in the upper spine, the hip or the wrist. Although it is commonly considered to be a disease of old age, loss of bone density can begin at a much younger age, getting steadily worse year by year. That's why it is important to be aware of the condition, and take steps to prevent it.

Am I at risk of developing osteoporosis?
Ageing is the main risk factor for osteoporosis and associated fractures. Our bone density peaks at around the age of 25. After this, bone gradually loses density and strength. In women, the rapid reduction of estrogen during menopause can cause bone loss of up to two percent per year. Other increased risk factors include: being of Asian or Caucasian race, having a low body weight, recent weight loss, a history of fractures, low levels of calcium and Vitamin D in the diet, tobacco use, alcohol abuse, extended use of certain medications (such as corticosteroids or thyroid medication), and lack of exercise.

How can I take action?
Every comprehensive osteoporosis management plan should include physiotherapy. Bone is living tissue that can be built up through exercise, so a physiotherapist will work with you to design a personal exercise program that suits you. They will provide you with a range of exercises of physical activities to do at home, and give you advice on making exercise and everyday activity safe for you.

Weight bearing exercises have been shown to contribute to bone health, helping to improve bone mass or slow the rate of loss of bone density. Weight bearing exercise means any exercise that is done on your feet, so that gravity is exerting a force. Some examples of weight bearing activities include walking, dancing, tai chi, aerobics classes and weight training.

A physiotherapist can advise on the optimum 'impact' for you.

Balance training is also important to improve mobility and reduce the risk of falls. Personally tailored exercise programs, such as those set out for you by a physiotherapist, have been shown to be more effective than general programs at helping people regain good balance.

If you have already fractured a bone, physiotherapists can also give you specialized advice on pain relief and mobility.

This Way Up...

Falls threaten the health and independence of older people. But, falling is not an inevitable part of ageing. Unsteady walking, poor balance and weak legs have all been identified as key risk factors for falls.

It is common for people who feel unsteady on their feet to do less walking. Over time this actually increases the risk of falling because muscles get weaker, joints get stiffer and balance gets worse.

Staying active the best prescription
There is no doubt that the most important thing that older people can do to prevent falls is to maintain physical activity. Studies have shown that exercise significantly reduces the risk of falling when combined with other falls prevention methods (such as a review of medication and a safety evaluation of the home).

Research findings reinforce the role of physiotherapy prescribed exercise in reducing falls and injuries for older people living at home. The physiotherapist in our practice is highly skilled in prescribing home based programs of strength and balance retraining exercises.

Exercise helps posture & balance
People with better posture, better balance and stronger muscles are much less likely to be injured. For example, women who sit for more than nine hours a day are more likely to have a hip fracture than those who sit for less than six hours a day. Special exercise programs, prescribed by physiotherapists, can reduce the risk of falling by about 20% and can also decrease serious injury from falls. These are programs that are tailored to each older person's needs and include progressive muscle strengthening, improving balance and walking.

Tips to prevent falls and improve balance

The physiotherapist in this practice suggests:

It's never too late to start exercising! Balance is a skill you can keep or recapture at any age.
Exercise regularly – this keeps the balance 'tuned up' and bones and muscles strong.
Exercise within your limits. Your physiotherapist will tailor a specific exercise program for you.
Walking aids such as sticks and frames should be correctly prescribed and fitted.
Choose proper footwear – firm fitting, flat shoes improve your stability.
Take extra care on uneven ground – surfaces such as gravel and grass are more challenging to balance.
Good vision helps your balance. Be careful if lighting is poor and avoid walking in the dark.
Be aware of home hazards – slippery mats, dangling electrical cords and clutter can turn your home into an obstacle course.
Have a 'Falls Emergency Plan' – know how to summon help if you do have a fall. Ask your physiotherapist to show you the easiest way to get up off the floor.

Studies have shown that falls and injury rates in older people can be reduced by a program of strength and balance retraining exercises prescribed by physiotherapists.

Golfers Elbow

There is nothing like a round of golf on a beautiful summer morning; the smell of freshly cut grass, birds chirping and the sun coming up over the horizon. When you are suffering a sporting injury however, the joy of golf can turn into a less than joyful experience.

Known medically as EPICONDYLITIS, Golfers Elbow causes pain and discomfort at the inner elbow joint, spreading to the forearm and wrist. Golfer’s Elbow is not limited to golfers, however. Many activities can lead to Golfer’s Elbow, including racket sports and throwing sports. Similar to Tennis Elbow, Golfer’s Elbow is related to excess or repetitive stress, especially forceful wrist and finger motions, damaging the muscles and tendons that control your wrist and fingers.

Symptoms can include stiffness in the elbow, a weakness in hands and wrists and numbness or tingling sensation radiating to the fingers. If left untreated, golfer’s elbow can cause persistent elbow pain.

Rest is extremely important in the recovery process. Sneaking in a round of golf before you are fully healed will only prolong your recovery.

Most common in men ages 20 to 49, the pain of Golfer’s Elbow can appear suddenly or gradually and may get worse when you:

Swing a golf club or racket
Squeeze or pitch a ball
Shake hands
Turn a doorknob
Pick up something with your palm down
Flex your wrist toward your forearm

But don’t fret! Golfer’s Elbow doesn’t have to keep you off the course or away from your favourite activities forever! With rest and appropriate treatment from your physiotherapist, you will be back in the swing of things in no time.

RUNNER’S KNEE

Runner’s Knee, or Iliotibial band Friction Syndrome (ITBFS), is a painful overuse knee injury that affects the outer part of the knee.

Common in both runners and cyclists, pain usually starts as intermittent pain, sharp in nature and very focal. If this pain, is ignored, it can develop into a dull ache even when you are not running or cycling, becoming painful when climbing up or down stairs.

Physiotherapist Catherine McLean says that the two main causes of ITBFS are inappropriate training and abnormal biomechanics.

Weakness in the gluteus medius muscle, located the top of the buttocks can caused ITBFS in distance runners. If the muscle is weak, then the tension in the ITB is increased. Your physiotherapist can create a strengthening program to target this muscle, helping you gain strength and improve your running.

Catherine suggests that before cycling, you should check your bike setup, especially saddle height. Too high a saddle will increase knee extension and irritate the ITB. If the sadde if too far back, having to reach further for the pedal will also stretch the ITB and possibly lead to irritation.

Treatment from your physiotherapist will assist in the prevention and rehabilitation of Iliotibial Band Friction Syndrome.

Ask your physiotherapist for stretching and strengthening exercises to help you recover quickly and avoid further injury in the future. Remember to stretch before and after activity, use ice to decrease pain and inflammation and take the time to rest your body, allowing it to fully recover.

AVOID ANKLE SPRAINS

The ankle joint has three bones that are precisely shaped to interlock and give stability. Strong bands of connective tissue called ligaments reinforce the joint and help hold the bones together. These ligaments prevent too much movement of the joint.

A sudden movement or twist, often when the foot rolls in, can overstretch the supporting ligaments, causing ligament tears and bleeding around the joint. This is known as an ankle sprain.

This is a common injury, particularly in activities that require running, jumping and change of direction (such as basketball and netball).

Symptoms of Ankle Sprain

Swelling – the ankle can swell in minutes or over several hours.

Bruising – over the area of injury.

Pain – when trying to move the ankle joint and when walking, especially when the knee goes forward over the foot.

In more severe injuries there may be associated bone injury and it is wise to get an x-ray to determine whether there is a fracture.

First Aid for Ankle Sprains

Stop your activity and rest the injured joint. Use icepacks every two hours, applied for 15-20 minutes. Bandage the joint firmly, and extend the wrapping up the calf and down the foot. Raise the ankle above heart height whenever possible, preferably lying down.

Avoid exercise, heat, alcohol and massage in the first 48 hours after injury, as these can all exacerbate swelling. See your APA physiotherapist if your ankle injury does not settle in a day or two.

Recurring Ankle Sprains

Some people suffer from recurring ankle sprains. This can be caused by a number of factors working in combination including:

Ligament Scarring – excessive looseness, as a result of previous ankle sprains;

Insufficient Rehabilitation – leading to weak muscles around the ankle joint;

Proprioceptive Deficit – decreased capacity to judge where your foot is in relation to your leg – this can be resolved with appropriate physiotherapy.

Rehabilitation & Support

If the pain from a sprained ankle that you are managing yourself has not improved after a day or so, it is best to seek the advice of your physiotherapist.

Ankle sprains need thorough investigation and rehabilitation. As experts in functional movement, physiotherapists are ideally placed to assess and treat these common injuries.

Physiotherapy treatments may include:

Exercises to strengthen all muscles surrounding and related to the ankle;
Advice on taping and ankle braces for use during activity, if required;
The use of wobble board or trampoline, and other exercises, to encourage balance and improve the proprioceptive deficit;
Exercise programs to improve mobility of the joint, as necessary.

Stand Firm – Don’t Let Heel Pain Stop You

Plantar Fasciitis is a common overuse injury affecting the sole or flexor surface (plantar) of the foot.

A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

The classic sign of plantar fasciitis is heel pain (usually radiating down the inside of the sole of the foot) within the first few steps after getting out of bed in the morning.

After a few minutes, the pain may ease, as the foot warms up, then it may reoccur during the day, after extended periods on your feet.

You’re more likely to develop the condition if you are a woman, if you are overweight, or if you have a job that requires a lot of walking or standing on hard surfaces.

People with very flat feet or very high arches may also be more prone to plantar fasciitis. Your APA physiotherapist will evaluate the way you walk (gait analysis) to determine if there is a biomechanical cause of your condition. They may recommend insoles to support your inner arch and exercises to strengthen the muscles and/or stretch the muscles and fascia.

Your physiotherapist may reduce the pain and inflammation by using ice or heat, or electrotherapeutic modalities like interferential or ultrasound.

Stiff joints around the foot and ankle can be treated using mobilization, where the physiotherapist gently moves the joints manually to remove the stiffness and restore the normal range of movement.

Stretching the plantar fascia is very important for encouraging the tissue to regain its normal alignment.

Studies have shown that stretching the fascia is more beneficial than just stretching the muscles.

Your APA physiotherapist can show you techniques and a range of equipment for stretching at home.

They may also show you how to tape your foot to support the plantar fascia and relieve some of the strain.

If you don’t treat plantar fasciitis, it may become a chronic condition, which is much more difficult to treat.

You may not be able to keep up your level of activity and you may also develop symptoms for foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.

Preventing Pain

Ensure that you wear appropriate, supportive, well-fitting footwear when exercising, walking, or standing up for long periods.
If your weight is a contributing factor, consult a health professional for a healthy weight control plan.
Physiotherapists can provide you with a sensible exercise program, tailored to your needs and taking into account your foot problems so that it is not aggravated.
Stretching the Achilles tendon and plantar fascia, as demonstrated by your physiotherapist, especially before and after exercise, may help to prevent the problem from returning.