Back 2 Health - Hull

19/07/2022

🔈 TIBIALIS ANTERIOR TENDONITIS - SYMPTOMS, CAUSES, TREATMENT OPTIONS

▶️ WHAT IS TIBIALIS ANTERIOR TENDONITIS?

The tibialis anterior is a muscle which lies at the front of the shin and attaches to several bones in the foot via the tibialis anterior tendon. The tibialis anterior is primarily responsible for moving the foot and ankle towards the head (dorsiflexion – figure 1), and, controlling the foot as it lowers to the ground during walking or running.

Whenever the tibialis anterior muscle contracts or is stretched, tension is placed through the tibialis anterior tendon. If this tension is excessive due to too much repetition or high force, damage to the tendon can occur. Tibialis anterior tendonitis is a condition whereby there is damage to the tibialis anterior tendon with subsequent inflammation and degeneration.

▶️ SIGNS AND SYMPTOMS OF TIBIALIS ANTERIOR TENDONITIS

Patients with tibialis anterior tendonitis usually experience pain at the front of the shin, ankle or foot during activities which place large amounts of stress on the tibialis anterior tendon (or after these activities with rest, especially upon waking in the morning). These activities may include walking or running excessively (especially up or down hills or on hard or uneven surfaces), kicking an object with toes pointed (e.g. a football), wearing excessively tight shoes or kneeling. The pain associated with this condition tends to be of gradual onset which progressively worsens over weeks or months with continuation of aggravating activities. Patients with this condition may also experience pain on firmly touching the tibialis anterior tendon.

▶️ CAUSES OF TIBIALIS ANTERIOR TENDONITIS

Tibialis anterior tendonitis typically occurs due to activities placing large amounts of stress through the tibialis anterior muscle. These activities may include fast walking or running (especially up or downhill or on hard or uneven surfaces) or sporting activity (such as running or kicking sports). Patients may also develop this condition following direct rubbing on the tibialis anterior tendon. This may occur due to excessive tightness of strapping or shoelaces over the tendon.

▶️ TREATMENT OPTIONS

Treatment for patients with tibialis anterior tendonitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Treatment may comprise:

- soft tissue massage
- electrotherapy (e.g. ultrasound)
- anti-inflammatory advice
- stretches
- joint mobilization
- dry needling
- ankle taping
- bracing
- the use of crutches
- ice or heat treatment
- exercises to improve strength, flexibility and balance
- education
- activity modification advice
- biomechanical correction
- footwear advice
- a gradual return to activity program

▶️ EXERCISES

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the advanced and self massage exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.

🔑 Foot and Ankle Up and Down

Move your foot and ankle up and down as far as possible and comfortable without pain (figure 2). Repeat 10 – 20 times provided there is no increase in symptoms.

🔑 Foot and Ankle In and Out

Move your foot and ankle in and out as far as possible and comfortable without pain (figure 3). Repeat 10 -20 times provided there is no increase in symptoms.

Reference: Physio Advisor

15/07/2022

Often confused with back pain sciatica

🔈 RELATIONSHIP OF SCIATIC NERVE TO PIRIFORMIS

(A) The sciatic nerve usually emerges from the greater sciatic foramen inferior to the piriformis.
(B) In 12.2% of 640 limbs studied by Dr. J. C. B. Grant, the sciatic nerve divided before exiting the greater sciatic foramen; the common fibular division (yellow) passed through the piriformis.
(C) In 0.5% of cases, the common fibular division passed superior to the muscles where it is especially vulnerable to injury during intragluteal injections.

12/07/2022

Interesting

🔈 MERALGIA PARESTHETICA - FRONT THIGH PAIN

Meralgia paresthetica is a condition characterized by tingling, numbness and burning pain in your outer thigh. The cause of meralgia paresthetica is compression of the nerve that supplies sensation to the skin surface of your thigh.

Tight clothing, obesity or weight gain, and pregnancy are common causes of meralgia paresthetica. However, meralgia paresthetica can also be due to local trauma or a disease, such as diabetes.

In most cases, you can relieve meralgia paresthetica with conservative measures, such as wearing looser clothing. In severe cases, treatment may include, physical therapy, medications to relieve discomfort or, rarely, surgery.

Symptoms
Pressure on the lateral femoral cutaneous nerve, which supplies sensation to your upper thigh, might cause these symptoms of meralgia paresthetica:

* Tingling and numbness in the outer (lateral) part of your thigh
* Burning pain on the surface of the outer part of your thigh

These symptoms commonly occur on one side of your body and might intensify after walking or standing.

Causes
Meralgia paresthetica occurs when the lateral femoral cutaneous nerve — which supplies sensation to the surface of your outer thigh — becomes compressed, or pinched. The lateral femoral cutaneous nerve is purely a sensory nerve and doesn't affect your ability to use your leg muscles.

In most people, this nerve passes through the groin to the upper thigh without trouble. But in meralgia paresthetica, the lateral femoral cutaneous nerve becomes trapped — often under the inguinal ligament, which runs along your groin from your abdomen to your upper thigh.

Common causes of this compression include any condition that increases pressure on the groin, including:

* Tight clothing, such as belts, corsets and tight pants
* Obesity or weight gain
* Wearing a heavy tool belt
* Pregnancy
* Scar tissue near the inguinal ligament due to injury or past surgery
* Nerve injury, which can be due to diabetes or seat belt injury after a motor vehicle accident, for example, also can cause meralgia paresthetica.

Risk factors
The following might increase your risk of meralgia paresthetica:

* Extra weight. Being overweight or obese can increase the pressure on your lateral femoral cutaneous nerve.
* Pregnancy. A growing belly puts added pressure on your groin, through which the lateral femoral cutaneous nerve passes.
* Diabetes. Diabetes-related nerve injury can lead to meralgia paresthetica.
* Age. People between the ages of 30 and 60 are at a higher risk.

04/07/2022

Another upper back consideration

🔈WHAT IS T4 SYNDROME?

T4 syndrome, also known as Upper Thoracic Syndrome refers to the pain in the upper back and is a much under-recognized or diagnosed condition. The spinal cord is divided into 5 segments: Cervical, thoracic, lumbar, sacral and coccyx. The cervical segment has 7 segments (C1-C7), the thoracic has 12 segments (T1-T12), the lumbar has 5 segments (L1-L5), the sacral also has 5 segments which are fused (S1-S5), the coccyx has only 1 segment.

T4 syndrome typically indicates pain in the 4th vertebrae of the thoracic segment of the spine. T4 syndrome is 3-4 times more common in females than in males.

💡 The Typical Symptoms of T4 Syndrome or Upper Thoracic Syndrome Include:

➡️ Diffused pain in arms
➡️ Paraesthesia in whole arm or the fore-arm
➡️ Extreme hot or cold temperatures of hand
➡️ Heavy feeling in the upper extremities
➡️ Non-dermatomal pains or aches in the forearm or arm
➡️ A crushing or tight band like pain
➡️ Recurrent complain of discontinuous pain in and around the scapular region or posterior thoracic pain
➡️ Sensations like tingling of pins or needles or numbness of the arm.

💡 What Can Cause T4 Syndrome or Upper Thoracic Syndrome?

The reason for the development of T4 syndrome depends on injury to the T4 segment of the spinal cord due to repeated bending, arching, lifting or twisting type of movement thus causing injury to the facet joints in that area. It can also be caused due to poor posture like protruding the head forward while sitting or standing, and slouching. It is common in people with cervical lordosis or cervico-thoracic kyphosis.

Women are more prone to develop the syndrome due to their structural differences from men. As the breasts develop, there is an increase in the amount of weight in the frontal part and to maintain that many would bend a little forward. The heavier the breast, the chances are more to develop T4 syndrome in women.

Treatment for T4 Syndrome or Upper Thoracic Syndrome
The treatment of T4 Syndrome solely depends on physiotherapy. An experienced physiotherapist will provide manual therapy with an impairment based approach. The sessions would start with manual therapy and slowly would progress to home exercise. The sessions would include some or combinations of the following techniques:

➡️ Joint manipulation and mobilization of the thoracic and cervical spine
➡️ Soft tissue massage
➡️ Taping or bracing
➡️ Electrotherapy viz., ultrasound or laser
➡️ Dry needling
➡️ Training in Pilates
➡️ Postural correction
➡️ Stretching
➡️ Exercises for flexibility and stabilization of the core

22/06/2022

🔈 SYNOVIAL SHEATHS AND TENDONS OF HAND

A. Observe that the six synovial tendon sheaths (purple) occupy six osseofibrous tunnels formed by attachments of the extensor retinaculum to the ulna and especially the radius, which give passage to 12 tendons of nine extensor muscles. The tendon of the extensor digitorum to the little finger is shared between the ring finger and continues to the little finger via an intertendinous connection. It then receives additional fibers from the tendon of the extensor digiti minimi. Such variations are common. Numbers refer to the labeled osseofibrous tunnels shown in part B.

B. This slightly oblique transverse section of the distal end of the forearm shows the extensor tendons traversing the six osseofibrous tunnels deep to the extensor retinaculum.

13/06/2022

Check this out

🔈 MERALGIA PARESTHETICA - FRONT THIGH PAIN

Meralgia paresthetica is a condition characterized by tingling, numbness and burning pain in your outer thigh. The cause of meralgia paresthetica is compression of the nerve that supplies sensation to the skin surface of your thigh.

Tight clothing, obesity or weight gain, and pregnancy are common causes of meralgia paresthetica. However, meralgia paresthetica can also be due to local trauma or a disease, such as diabetes.

In most cases, you can relieve meralgia paresthetica with conservative measures, such as wearing looser clothing. In severe cases, treatment may include, physical therapy, medications to relieve discomfort or, rarely, surgery.

Symptoms
Pressure on the lateral femoral cutaneous nerve, which supplies sensation to your upper thigh, might cause these symptoms of meralgia paresthetica:

* Tingling and numbness in the outer (lateral) part of your thigh
* Burning pain on the surface of the outer part of your thigh

These symptoms commonly occur on one side of your body and might intensify after walking or standing.

Causes
Meralgia paresthetica occurs when the lateral femoral cutaneous nerve — which supplies sensation to the surface of your outer thigh — becomes compressed, or pinched. The lateral femoral cutaneous nerve is purely a sensory nerve and doesn't affect your ability to use your leg muscles.

In most people, this nerve passes through the groin to the upper thigh without trouble. But in meralgia paresthetica, the lateral femoral cutaneous nerve becomes trapped — often under the inguinal ligament, which runs along your groin from your abdomen to your upper thigh.

Common causes of this compression include any condition that increases pressure on the groin, including:

* Tight clothing, such as belts, corsets and tight pants
* Obesity or weight gain
* Wearing a heavy tool belt
* Pregnancy
* Scar tissue near the inguinal ligament due to injury or past surgery
* Nerve injury, which can be due to diabetes or seat belt injury after a motor vehicle accident, for example, also can cause meralgia paresthetica.

Risk factors
The following might increase your risk of meralgia paresthetica:

* Extra weight. Being overweight or obese can increase the pressure on your lateral femoral cutaneous nerve.
* Pregnancy. A growing belly puts added pressure on your groin, through which the lateral femoral cutaneous nerve passes.
* Diabetes. Diabetes-related nerve injury can lead to meralgia paresthetica.
* Age. People between the ages of 30 and 60 are at a higher risk.

09/04/2022

Fascia, the cause of many issues!

🔈 MYOFASCIAL RELEASE VS. CRANIOSACRAL THERAPY

What is Craniosacral Therapy?

Craniosacral therapy is a method of alternative medicine used by massage therapists, naturopaths, chiropractors and osteopaths, who manually apply a subtle movement of the spinal and cranial bones to bring the central nervous system into harmony. This therapy involves assessing and addressing the movement of the cerebrospinal fluid (CSF) which can be restricted by trauma to the body, such as through falls, accidents, and general nervous tension. By gently working with the spine, the skull and its cranial sutures, diaphragms, and fascia, the restrictions of nerve passages are eased, the movement of CSF through the spinal cord can be optimized, and misaligned bones can be restored to their proper position. This therapy is said to be particularly useful for mental stress, neck and back pain, migraines, TMJ Syndrome, and for chronic nervous conditions such as fibromyalgia.

What is Myofascial Release?

Myofascial Release is a gentle therapy that consists of a mixture of light stretching and massage work. During a session, the therapist will apply hands-on massage strokes in order to release tension from the bands of the muscles, bones, nerves and joints, by unblocking any scar tissue or adhesions due to injury in the muscles and surrounding tissues. The theory of myofascial release requires an understanding of the fascial system (or connective tissue, which is not to be confused with the word facial). The fascia is a specialized system of the body that has an appearance similar to a spider's web or a sweater.

03/04/2022

YOU'RE SHOULDER SHAPE CAN PLAY A ROLE IN YOUR PAIN

The shape of the acromion process can play a significant role in shoulder impingement. There 4 types of acromion shapes, which can be seen on Y-view x-rays 💀 or MRI.

Type 1 (12%) is flat and gives you plenty of room to move your shoulder around.

Type 2 (56%) is curved downwards. It gives slightly less subacromial space than a Type 1 and is the most common shape.

Type 3 (29%) is shaped like a hook in the front, greatly reducing the space and is correlated with the highest incidence of rotator cuff 💥 tears.

Type 4 (3%) isn't significant clinically but actually curves up and creates more space.

What can you do with this info? 😕 If you have worked on the factors that you can control, like rotator cuff strength, posture, and scapular mobility, and still aren't seeing results, consider that there may be an anatomical limitation playing a role. Talk to your doc about getting an image to find out for sure.
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https://healthystreetlondon.wordpress.com/

29/03/2022

Good to know

🔈 HEADACHE AT THE BACK OF THE HEAD

There are many different types of headaches. One of the more common headaches is the suboccipital headache.

At the base of the skull there is a group of muscles, the suboccipital muscles, which can cause headache pain for many people. These four pairs of muscles are responsible for subtle movements between the skull and first and second vertebrae in the neck.

When the suboccipital muscles go into spasms they can entrap the nerves that travel through the suboccipital region. By compressing the suboccipital nerves they set off a series of events that lead to either a tension or a migraine like headaches.

CAUSES

The suboccipital muscles commonly become tense and tender due to factors such as

- Eye strain, wearing new eyeglasses.
- Sitting at a computer with our head forward and our head slightly tipped these muscles are doing a significant amount of work. This poor posture eventually causes the muscles to become tired, fatigue, and injured.
- Grinding the teeth, slouching posture, and trauma (such as a whiplash injury).

SYMPTOMS

Common signs and symptoms of a headache stemming from the suboccipitals include

- Pain, stiffness, and a dull ache in the upper neck and base of the skull
- Pain on the back of the head, and pain in the forehead and behind the eyes.
- Sometimes there may be visual disturbances or nausea, but those tend to be more common in migraine type headaches.

TREATMENT

People often feel relief when icing, stretching, or rubbing the suboccipital muscles. In the early stages rubbing the suboccipital region can reduce or eliminate a headache.

When the headaches progress often palpating the suboccipital muscles intensifies the headache. Some people feel a tension band or headache that moves towards the eye. When pushing on the suboccipital muscles, it may increase the intensity of eye pain.

Suboccipital headaches are improved with over-the-counter NSAIDs, ice, stretching, therapy, electric, ultrasound, and cold laser treatments. Goals of treatment are to decrease muscle spasms of the suboccipital muscles and trapezius. The poor posture of slouching forward and tipping the head up causes additional injury and spasms to the trapezius and upper back muscles. Treatment always looks at improving these muscles as well.

Treatment will focus on improving posture when standing and sitting, to relieve stress and strain on the muscles. In addition massage therapy is excellent at decreasing muscle spasms, pain, tenderness, and tension in these muscles. Stretching will be utilized to enhance flexibility. Strengthening exercises will be utilized for the weak muscles of the neck and shoulder complex.

Graston Technique is a very effective tool at decreasing the scar tissue and spasms associated with poor posture, headaches, and suboccipital spasms. Often people with suboccipital headaches have had poor posture for many years, and Graston helps decrease the fascial adhesions and scar tissue from years of poor posture.

27/03/2022

🔊 CALCIFIC TENDONITIS OF THE SHOULDER

🔔 INTRODUCTION

Calcific tendonitis of the shoulder happens when calcium deposits form on the tendons of your shoulder. The tissues around the deposit can become inflamed, causing a great deal of shoulder pain. This condition is fairly common. It most often affects people over the age of 40.

🔔 ANATOMY

Calcific tendonitis occurs in the tendons (tendons attach muscles to bones) of the rotator cuff. The rotator cuff is actually made up of several tendons that connect the muscles around your shoulder to the humerus (the larger bone of the upper arm).

Calcium deposits usually form on the tendon in the rotator cuff called the supraspinatus tendon.

There are two different types of calcific tendonitis of the shoulder: degenerative calcification and reactive calcification. The wear and tear of aging is the primary cause of degenerative calcification. As we age, blood flow to the tendons of the rotator cuff decreases. This makes the tendon weaker. Due to the wear and tear as we use our shoulder, the fibers of the tendons begin to fray and tear, just like a worn-out rope. Calcium deposits form in the damaged tendons as a part of the healing process.

Reactive calcification is different. Why it occurs is not clear. It doesn't seem to be related to degeneration, though it is more likely to cause shoulder pain than degenerative calcification.

No one knows what triggers the body to reabsorb the deposits. But once this occurs and the tissue begins to be remodeled, the pain usually decreases or goes away altogether.

🔔 SYMPTOMS

While the calcium is being deposited, you may feel only mild to moderate pain, or even no pain at all. For some unknown reason, calcific tendonitis becomes very painful when the deposits are being reabsorbed. The pain and stiffness of calcific tendonitis can cause you to lose motion in your shoulder. Lifting your arm may become painful. At its most severe, the pain may interfere with your sleep.

🔔 REHABILITATION

Even if you don't need surgery, you may need to follow a program of rehabilitation exercises. It is recommend that you work with a physical or occupational therapist for four to six weeks. Your therapist can create an individualized program of strengthening and stretching for your shoulder.

It is very important to strengthen the muscles of the rotator cuff, as these muscles help control the stability of the shoulder joint. Strengthening these muscles can actually decrease the pressure on the calcium deposits in the tendon. Your therapist can also evaluate your workstation or the way you use your body when you do your activities and suggest changes. Simple changes in the way you sit or stand can ease pain and help you avoid further problems.

24/03/2022

🔈THORACIC OUTLET SYNDROME

Thoracic outlet syndrome is a disorder characterized by pain and paresthesias in a hand, the neck, a shoulder, or an arm.
Pathogenesis often involves compression of the lower trunk of the brachial plexus (and perhaps the subclavian vessels) as these structures traverse the thoracic outlet below the scalene muscles and over the 1st rib, before they enter the axilla.

Compression may be caused by:
• A cervical rib
• An abnormal 1st thoracic rib
• Abnormal insertion or position of the scalene muscles
• A malunited clavicle fracture
• Thoracic outlet syndromes are more common among women and usually develop between age 35 and 55.

Symptoms and Signs of TOS
Pain and paresthesias usually begin in the neck or shoulder and extend to the medial aspect of the arm and hand and sometimes to the adjacent anterior chest wall. Many patients have mild to moderate sensory impairment in the C8 to T1 distribution on the painful side; a few have prominent vascular-autonomic changes in the hand (e.g., cyanosis, swelling). In even fewer, the entire affected hand is weak.

Rare complications of thoracic outlet compression syndromes include Raynaud syndrome localized to the affected arm and distal gangrene.

Exercise:
• Pectoralis stretch: Stand in a doorway or corner with both arms on the wall slightly above your head. Slowly lean forward until you feel a stretch in the front of your shoulders. Hold 15 to 30 seconds. Repeat 3 times.

• Thoracic extension: While sitting in a chair, clasp both arms behind your head. Gently arch backward and look up toward the ceiling. Repeat 10 times. Do this several times per day.

• Arm slide on wall: Sit or stand with your back against a wall and your elbows and wrists against the wall. Slowly slide your arms upward as high as you can while keeping your elbows and wrists against the wall. Do 3 sets of 10.

• Rowing exercise: Tie a piece of elastic tubing around an immovable object and grasp the ends in each hand. Keep your forearms vertical and your elbows at shoulder level and bent to 90 degrees. Pull backward on the band and squeeze your shoulder blades together. Repeat 10 times. Do 3 sets.

22/03/2022

Love the reality pic

ANATOMY OF FEMORAL TRIANGLE

The femoral triangle, a subfascial formation, is a triangular landmark useful in dissection and in understanding relationships in the groin. In living people, it appears as a triangular depression inferior to the inguinal ligament when the thigh is flexed, abducted and laterally rotated. The femoral triangle is bounded.

Surface anatomy of femoral triangle

A. Surface anatomy
B. Underlying structures

✅ Superiorly by the inguinal ligament that forms the base of the femoral triangle
✅ Medially by the lateral border of the adductor longus
✅ Laterally by the sartorius

The muscular floor of the femoral triangle is formed by the iliopsoas laterally and the pectineus medially. The roof of the femoral triangle is formed by the fascia lata and cribriform fascia, subcutaneus tissue and skin.

The inguinal ligament actually serves as a flexor retinaculum, retaining structures that pass anterior to the hip joint against the joint during flexion of the thigh. Deep to the inguinal ligament, the retro-inguinal space is an important passageway connecting the trunk/abdominopelvic cavity to the lower limb.