Rehabilitation Pilates Classes are ongoing at Mid West Physiotherapy.  Each course runs for 6 weeks, one evening per week.  Classes are limited to 5 maximum.  All classes are supervised and run by a Chartered Physiotherapist and Pilates instructor.  For more information please see the Rehabilitation Pilates page.  To enquire about or enrol in a class, contact us on 061-201444.

Knee Pain

Healthcare providers usually call pain at the front of your knee or under your kneecap Patellofemoral Pain Syndrome.

Most often, this pain occurs after exercise, but you may also feel it if you sit too long. Over time, your knee may begin to hurt during exercise or throughout the day. You may feel a nagging ache or an occasional sharp pain. This pain may cause you to limp and may limit your activities. This can be very frustrating, but there is good news: exercises can reduce knee pain and allow you to return to normal activities without needing surgery. Although we have known the benefits of exercise for some time, we were not sure which exercises were best at quickly reducing your pain.

A study published in the August 2011 issue of Journal of Orthopaedic & Sports Physical Therapy provides new insight and evidence-based exercises to help answer this question. Click the following link for more informaton and to read the study in full Knee Pain: Strengthen My Hips? But Its My Knees That Hurt!

Golf-related injuries

This is an excellent article on golf related injuries written by Philip Reid in the Irish Times.

Our Chartered Physiotherapists can screen you and identify any weak points in your body which may be prone to injury. We can then provide an injury prevention and warm up exercise programme tailored to you.

Contact us at 061-201444 for further information.

Hydrotherapy Rehabilitation Limerick

Hydrotherapy is the use of water at an increased temperature for the maintenance of health, the treatment of disability, the relief of pain and the promotion of physical wellbeing. Hydrotherapy Rehabilitation is used by people who from chronic pain, such as fibromyalgia.

Benefits from Hydrotherapy include:

• Rehabilitation of Sports injuries
• Musculoskeletal conditions, like low back pain, soft tissue and ligament injuries
• Rheumatology conditions, such as arthritis and fibromyalgia
• Orthopaedic conditions, for example after hip and knee replacement
• Neurological conditions, such as stroke, multiple sclerosis and Parkinson’s disease, Spinal Injury, Head injury
• Recovery from road traffic accident injuries
• Chronic pain

Avail of Hydrotherapy Rehabilitation in Limerick

St. Gabriel’s hydrotherapy pool based in Dooradoyle, Co. Limerick is heated and maintained at 32˚ Celsius, which is approximately 6˚ higher than a regular pool. The surrounding poolside air temperature is maintained at 29˚ Celsius. The higher water temperature helps to lessen muscle stiffness, ease muscle spasm and reduce pain, which allows for a wider range of motion and more effective rehabilitation following injuries and surgery.

Hydrotherapy can also improve balance, motor skills, co-ordination, posture and gait. For wheelchair users, the warm water allows freedom of movement that they would otherwise find unachievable.

At Mid West Physiotherapy we can offer clients one on one Hydrotherapy treatment sessions. If you are interested in learning more about Hydrotherapy Rehabilitation and the service we offer please contact Mid West Physiotherapy on (061) 201444 or email info@midwestphysio.ie.

The Role of the Chartered Physiotherapists in Bone Health and Osteopenia / Osteoporosis

Bones are made from living tissue which renews itself continuously throughout life. If the skeleton is to develop and renew itself effectively and remain strong it needs, amongst other things, regular stimulation from effective physical activity. Bones need a variety of brief and frequent loading every day such as in normal activities like walking and climbing stairs to maintain their strength. They also need to be loaded a bit more than usual to build and improve their strength – the more the load the greater the strength possible. How long bones stay strong and healthy depends on how well they were made to begin with. Generally people have reached their peak bone density by their early 20’s. Therefore the early years, particularly the early teen years are vital in the life time of bone health.

What is Bone Mineral Density?

Bone mineral density (BMD) is a measurement of the level of minerals in the bones, which indicates how dense and strong they are. If your BMD is low compared to normal peak BMD, you are said to have osteopenia. More specifically, osteopenia is defined as a bone mineral density T-score between -1.0 and -2.5.

What is Osteopenia?

Osteopenia is a condition where bone mineral density is lower than normal. Low bone mineral density but not low enough to be classified as osteoporosis. It is considered by many doctors to be a precursor to osteoporosis. However, not every person diagnosed with osteopenia will develop osteoporosis.

What is Osteoporosis?

Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered.

The Irish Society of Chartered Physiotherapists (ISCP) set up a Working Party to promote the Physiotherapy role in all stages of bone health and the management of osteopenia and osteoporosis. The Physiotherapy Promotion and Management of Bone Health Throughout the Life-Span document was approved by the Society in 2008. Where there is compromised bone health, it is imperative that Physiotherapy management is included in the comprehensive physical and medical management of the osteopenia/osteoporosis condition.

Risk Factors for Osteopenia / Osteoporosis

Risk Factors for osteopenia/osteoporosis can be modifiable or non-modifiable. Risk factors include:

• Advancing age, female, positive family history of osteoporosis +/- low trauma fracture, smoking
• Physical inactivity, excessive exercise, eating disorders, low calciumin diet lowVitamin D levels/non-exposure to sunlight
• Low BMI, loss of height, malnutrition, endocrine disorders
• RA, corticoid-steroid therapy, late onset menarche , menstrual disturbances, early menopause
• Prolonged use of proton pump inhibitors, heparin therapy, hypogonadism
• Chronic renal disease, post all transplants, coeliac disease, malabsorption disorders, excessive/high alcohol consumption, chromosome disorders, malignancy, chemotherapy

Prevention is better than cure

Prevention is better than Cure

To maximise bone health it is necessary to undertake exercise/activity that is weight-bearing in nature and involves many areas in the skeleton. It has also been shown that the element of ‘surprise’ is what has the stimulating effect on a bone’s density – therefore while ‘every day walking’ helps maintain bone density in the lower limbs, it has no impact on further increasing bone density in the head of femur. In order to surprise the body, one needs to ‘hop, skip and jump’ or walk very briskly – just 10 minutes of this has been shown to be effective on the femoral head when carried out daily. Walking, which is weight-bearing on the lower limbs, will have no impact on the bones of either the upper limbs or spine however. A variety of many exercises/activities are therefore needed to influence bone health throughout the body. Variety also pertains to other factors such as duration, speed, repetitions, weights, levers and frequency. The specifics of the exercise/activity programme will also depend on a diagnosis of either osteopenia or osteoporosis and the person’s age-group/menopause status.

Physiotherapy Management of Ostepenia / Osteoporosis

The Chartered Physiotherapist has a large and comprehensive role to play regarding bone health and all other musculoskeletal issues. A Chartered Physiotherapist is the ideal source of expertise to prescribe and appropriately modify exercise programmes to help maintain bone density and promote good bone health for the future.

The Comprehensive Management of Bone Health Issues Is 3-Fold:

• Nutritional and life-style changes
• Weight-bearing exercise and activity
• Pharmaceutical medications and Calcium + Vitamin D supplementation

Physiotherapy intervention does not need to wait for results from scans. The Chartered Physiotherapist can do an ‘informal’ screening with searching questions, observations and measurements such as height loss and BMI. A suitable and beneficial Physiotherapy plan can be initiated with a ‘working diagnosis’ whilst awaiting the opportunity for a DXA scan. It is never too early for Physiotherapy intervention regarding a person’s bone health; equally it is never too late. It would be unusual for some intervention not to be of some benefit – and of course, as in all things Physiotherapy-wise, the sooner the better!

Muscle Tears

Muscle tears can happen to virtually any of the muscles in your body and the treatment approach to them is the same regardless of which muscle is involved.

What are muscles?

Muscles are made up of bundles of muscle fibres that contract and relax, which shorten the muscles (concentric contraction) or lengthen the muscles (eccentric contraction). They are attached onto your bones by strong cords, known as tendons. Your muscles are placed strategically over your joints so that when they contract and relax, the joint moves. So for example, your biceps (the bulky muscle above your elbow) bends the elbow, the quadriceps (the big muscle at the front of your thigh) straightens your knee and so on. In other words, your muscles are what make you move.

How do muscle tears occur?

Muscles get torn if you over stretch them or over-exert them by working them too heavily. In most cases, you feel the pain immediately but in the case of milder tears the pain can be obscured until after you stop. When a muscle tears, the fibres of the muscles literally tear apart. There are different grades of muscle tears, depending on how many fibres are injured. A complete tear can happen, when the muscle is literally torn in two. This type of tear usually requires surgery to stitch the ends together. Luckily, this is rare enough and most muscle tears are incomplete i.e. some, but not all of the fibres are torn. This is also termed a muscle strain.

Muscle tear recovery

When a tear/strain occurs, the torn fibres bleed. Then the area gets inflamed and hot. Inflammation is often thought of as being a bad thing, but in fact it is the body’s way of healing your injury. Extra blood flows into the area, and all kinds of complicated chemical reactions occur. This results in a ‘mopping up’ process, where the excess bleeding is cleared away and new muscles fibres are formed. This bridges the gap between the torn ends, like a scar. This ‘scar tissue’ is not as flexible as the rest of your muscle, and eventually needs to be stretched so that it doesn’t restrict your muscle and prevent it from working properly.

What can you do to assist muscle recovery?

So what can you do to help the process along? Initially when you feel the tear, you need to rest up completely until the internal bleeding stops – this can take a few hours. In the next 2 to 3 days, it may feel hot and sore, so icing it and putting on a compression bandage helps. Taking anti-inflammatory tablets can also help to reduce the nasty side effects inflammation 24-48 hrs after injury. Once the severe pain is gone, you can start to stretch the muscles gently, aiming for full flexibility. You can then start to exercise the muscles. Initially, the muscles will feel quite weak, but you can build them up gradually, making sure that the exercises don’t hurt the muscles. Your physiotherapist can advise you about the correct exercises to do. Once the muscle feels fairly strong, you can go back training. If you are in a rush to get better, then physiotherapy can speed up the whole process. If you find that the muscle is still ‘twinging’ on you when you do certain things, then you most likely have extra scar tissue in the muscles, which is restricting you. Often, you’ll be able to feel a hard nodule where the scar tissue is lodged. In this case, you should see a physiotherapist, who can work on the scar tissue, making it softer and more pliable.

Prevention of muscle tears

To some extent, muscle tears can be prevented. Always warm up before you run at pace and stretch your muscles regularly. In runners, the muscles most commonly strained are the calf muscle, Quadriceps (front of thigh) and Hamstrings (back of thigh) muscles. Be sure to stretch these before and after your run, particularly in cold weather. Remember to do dynamic stretching before you run i.e. walking lunges, walking quads stretches, walking sumos, walking calf stretch etc and sustained stretches after you run (30 second holds 3-4 times on your calves, quads, hamstrings, groin and hips).

IT Band

As we draw nearer to the Great Limerick Run, many of you will begin to ramp up your training in preparation for the big day. Today we will discuss one cause of lateral knee pain that is common in runners; Ilio-tibial Band friction syndrome (ITBFS).

About the Ilio Tibial Band

The ITB is a thick band of tissue overlying the muscles on the outside of the thigh. It stretches from the outside of the hip to just below the knee and helps to stabilise the knee particularly during running.

In bending and straightening the knee it passes from behind the lateral femoral condyle to in front.  When there is increased stress through this tissue the repeated friction caused as it passes over the condyle can lead to lateral knee pain. The ache that develops often appears at the same distance during subsequent runs and can limit an athlete’s ability to increase their distance.  Longer runs or courses with a lot of downhill sections tend to aggravate symptoms.

About Ilio-tibial Band friction Syndrome (ITBFS)

ITBFS may be due to inappropriate training or abnormal biomechanics. Inappropriate training ranges from progressing your distance too quickly to running on steep downhill or uphill courses.

Biomechanically, excessive pronation (inward rolling of the arches of the feet) can lead to increased stress through the ITB, this can be reduced by making sure you have good supportive footwear (ideally running specific). Poor hip control/stability and weak gluteal muscles can also lead to increased tension which exacerbates the friction caused at the outside of the knee.

Prevention

In a lot of cases it is the end result of doing too much too soon! This is especially true for people who are new to running or are returning from a long break in training. See the training link on the website for a guide on how to increase your mileage safely. As with any physical activity regular stretching can help reduce the stresses around the joint. Stretching of the hips and thighs in particular can help reduce the friction at the ITB.

Treatment

Initially it is essential to reduce any inflammation around the area with regular icing or simple anti-inflammatories if indicated*. Your Chartered Physiotherapist will work to restore normal length in the tight muscle groups in the hip and knee using a variety of manual techniques and by implementing a comprehensive stretching regime.

They will also assess you biomechanically for any lower limb abnormalities that may be causing or exacerbating this condition and may prescribe orthotics for your feet if appropriate. In some cases it may be necessary to assess your running technique to try to pin-point faulty technique or give you a targeted exercise protocol to address any weaknesses that may affect the hip and knee.

In any case, by gradually increasing your training schedule, regularly stretching all muscle groups and working on hip and core muscle strengthening exercises you can prevent this common problem from affecting your goal of completing the Great Limerick Run.

If you are experiencing any lateral knee pain or have any questions please contact us.

Good luck from all at Mid West Physiotherapy.

Pilates at Mid West Physiotherapy

Pilates is fast becoming a popular workout choice for many people. Black swan actress Mila Kunis is a fan, rugby players do it, Bruce Springsteen does it. Physiotherapists say older people can use Pilates to help manage pain and improve quality of life.

People with arthritis can benefit from Pilates. More and more doctors are recommending Pilates as the “arthritis diet” to their patients. It can be used to help people of all ages. According to research Pilates is now known to be very effective as an arthritis exercise. Pilates not only makes your joints strong, it also leaves you refreshed and energised. It was originally designed for rehabilitating patients and can be practised even if you are stiff and out of shape.

Pilates allows Physiotherapists to take treatment further. Focussing on basic activities like standing or sitting without pain so you are not just lying on a bed being treated. Pilates will not cure certain illnesses or conditions but it should relieve the pain, build your core muscles, giving you strength from within to support your joints.

Some people say they can’t do Pilates because of their age. But it’s very good for posture, for preventing joint damage or repairing wear and tear. If you have chronic arthritis, you can maintain your strength and fitness so you don’t get worse. Pilates can be modified to any level to suit any age.  People might need to retrain their basic posture, starting with breathing and only then adding in movement. In Pilates classes people concentrate on small movements and become aware of how parts of the body work together.

Pilates exercises can reverse years of deterioration, but there’s a catch, simply going to one session won’t cure ongoing illnesses but following instructions at home can make all the difference.

Many Chartered Physiotherapists in Ireland use Pilates as a form of treatment, it is like a tool to help people manage pain, move more freely and improve their quality of life over time. Pilates can help with many conditions including osteoporosis or spinal stenosis. It can involve a variety of equipment including elastic bands, foam rollers, gentle trapeze-like pulleys, gym balls to focus on areas of the body or groups of muscles which are not working smoothly.

Concentration, dedication and willingness to implement is all that is needed from clients. It takes patience, you have to give it your full attention while in the class.

When a patient enrolls in a Pilates class at Mid West Physiotherapy they will have an inital one-on-one consultation if they are not already a patient at the practice. Here we will discuss any existing conditions or injuries. We do a full physical assessment which includes spinal observation, checking range of movement plus flexibility in and around each major joint. During this consultation patients are educated on the principles of Rehabilitation Pilates and variety of level one exercises are taught.

There are enormous benefits to be gained through Pilates and Rehabilitation Pilates.  Find out more about our Rehabilitation Pilates Classes.

The following exercises can be completed by athletes, sports people at any stage throughout the year. If you have any questions please contact Mid West Physiotherapy on (061) 201444 or info@midwestphysio.ie.

Exercise # 1 | Overhead Squat

Click here to see a video of overhead squat

• As shown in the attached video stand with feet shoulder width apart, feet pointing forwards. Pull in the abdominals and keep them relaxed and breathe.
• Using a bar placed on your shoulders not your neck, descend into a deep squat as shown. If this is uncomfortable, you have poor form. You may need to work on improving movement patterns.
• Once in a deep squat, use mirrors to check body posture and position.
• Come out of the squat and return to the starting position.

Exercise # 2 | Step Ups

Click here to see a video of Step Ups

• Use a bench or step up box that is at the level of your knee or slightly lower , depending on ability. The higher the step the harder the exercise, Ensure you can perform this exercise on both sides before adding dumbbells.
• Step up onto the box with right leg first, then step down. The right foot should never leave the box and the left foot should never touch it.

Exercise # 3 | Side Plank Exercise

Click here to see a video of a side plank

• Adopt a side lying position. Depending on your form you can start with the underlying leg straight to make it easier, bend up the underneath leg.
• Side bridge up, taking weight throught the bent elbow. Maintain good shoulder, hip, knee alignment throughout the exercise. Hold this position for 30 seconds or more, and repeat three times.
• To make this exercise more difficult, abduct the top leg x 15 reps.

Exercise # 4 | Single Leg Squat (lateral view)

Click here to view a video of a single leg squat

Exercise # 5  | Single Leg Squat (frontal view)

Click here to view a video of a single leg squat frontal view

Exercise # 6 | Full Plank Exercise

Click here to view video of the full plank