Pain Management

Arthritis

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arthritis, arthritis in hands

Is there a cure for Arthritis ?

Arthritis can affect people of all ages and is a condition that is characterised by joint pain and inflammation. At present there is no cure for arthritis.

Arthritis – Benefits of Exercise

Many people do not feel like exercising due to the pain caused by arthritis, however, exercise can help to ease pain and improve joint mobility which can:-

  • increase muscle strength and
  • reduce stiffness.

If you are overweight, combining regular exercise with a healthy and balanced diet will help with weight loss. This will result in less strain being placed on the joints in the hips, knees, ankles and feet.

The Arthritis Foundation recommends the following exercises:

  • Try some deep, belly breathing for between 30 to 60 seconds to help relax and relieve pain and stiffness.
  • 30 second seated straight leg raises are good for pain in the knee joints.
  • To strengthen muscles in the hips and thighs, march on the spot for 30 to 60 seconds.
  • By moving your arms on a table top as if you are swimming the breast stroke for 60 seconds could improve the movement in the upper body.

arthritis, arthritis in handsIf you find you have arthritic pains in your hands and fingers try the following:-

Fist clenching

Beginning with your hands and fingers spread out, slowly clench your hand into a fist. Keep your thumb on the outside of the fist, being careful not to squeeze your hand too much.

Slowly unclench your fist into its original position. Repeat these 10 times, and then swap hands.

Knuckle bending

Keeping your fingers straight, bend your knuckles as far as comfortable, apply a stretch and straighten your fingers fully.

Thumb bending

Using one of your hands, hold the base of the other hand’s thumb.

Without moving the base of the thumb, bend the top half of the thumb, until you feel the stretch. Return the thumb tip to its original position, and repeat.

Finger lifting

Rest the palm of your hand on a table, with all of your fingers spread apart. One by one, slowly lift each finger off the table.

Hold the finger in the air for a few seconds, before slowly lowering it.

Make an ‘O’

This stretch will help relieve achy or stiff pains in the hands.

Start with your left hand out and fingers straight, then, curve all of your fingers inward until they touch.

Your fingers should form the shape of an ‘O’. Hold this position for a few seconds.

Then straighten your fingers again. Repeat this exercise a few times a day on each hand.

Play with clay

Playing with clay is a great way to increase the range of motion in your fingers and strengthen your hands at the same time — and it won’t even feel like exercise.

If you think you may be suffering from Arthritis you should consult your GP for advice. If you would like to talk to us about your pain, please do feel free to contact us.

Source ANI

Article from The Express Newspaper

Health Benefits Ginger

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Health Benefits Ginger

Health Benefits GingerHave you ever looked in to the health benefits ginger? It really has some fantastic benefits. Ginger can come in many forms

  • Fresh
  • Dried
  • Powder
  • Juice or as an
  • Essential Oil.

Health Benefits Ginger, Chinese MedicineHealth Benefits Ginger – Chinese Medicine

The health benefits of ginger can be linked right back to Chinese medicine and over 3,000 years ago. This plant was used for a multitude of reasons:

A range of digestive disorders

  • Muscular conditions
  • Life longevity

Health Benefits Ginger – Essential Oil

As an essential oil ginger can be used in many ways but must only be applied topically.

  1. When diluted in a base oil or
  2. Inhaled in very small amounts – ideally via a diffuser

As an ingredient ginger is quite harmless.   If you are thinking about taking ginger supplements internally you should consult your doctor.

In certain circumstances, with certain some conditions, taken orally could cause more harm than help.

Mostly the essential oil of ginger is non-toxic and non-irritant. Despite root ginger’s rather strong smell in its natural state, the essential oil smells rather warm and spicy, sweet and moody.

Health benefits Ginger – Sore Tummy

In The Complete Book of Essential Oils & Aromatherapy Valerie Ann Worwood, ensures that she always includes ginger in her Basic Travel Kit.

For travel sickness the book recommends applying two drops of oil to a handkerchief, to be inhaled during the journey.

Alternatively one drop diluted in a little vegetable oil can be rubbed gently on the tummy, which. This would work equally well for indigestion.

Health Benefits Ginger – Motivation

In aromatherapy, essential oil of ginger is believed to suit people who are full of the ideas and plans but find it difficult to motivate themselves.  It promotes a sense of well being and encourages the joy of achievement – amazing!

Health Benefits Ginger – Back Pain

Ginger is thought to be particularly beneficial for the lower back because of its association with the kidneys.

Chinese medicine has used ginger for years to warm and strengthen ‘yang’ energy of the kidneys, It is considered to be ‘hot & dry’ therefore helpful in treating ‘cold, damp’ conditions.

Blend a few drops of essential oil of ginger with the same quantities of lavender and eucalyptus oils in a carrier oil. This is great for massaging the lower back.

“It’s excellent for cold, debilitated individuals who have a pale swollen tongue”, Gabriel Mojay, Aromatherapy for the Healing Spirit

For more information about the therapy treatments we offer please feel free to contact us.

Slipped disc – can it be managed osteopathically?

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Slipped disc – can it be managed osteopathically?

Natalie Nicolas Osteopath at The Therapy Rooms

Spinal disc lesions are a very common occurrence, with an estimated 50-60% of the population having one or more bulging discs in their spine. However, only a small minority of these suffer symptoms, but these can be vastly disrupting and debilitating. Disc-related pain tends to mostly affect people between 30 and 50 years of age.

The diagnosis may be termed as a ‘slipped disc’, ‘ruptured disc’, ‘herniated disc’ and ‘disc prolapse’. Unfortunately, healthcare professionals cannot agree on a precise definition, and use these terms interchangeably, which causes confusion. Rather than searching for a precise diagnosis, it is more useful for patients to gain a clear understanding of what may be happening inside their bodies. So what are discs, what actually happens when they ‘slip’, and can an Osteopath help?

The intervertebral discs are structures found in between vertebrae all the way from the neck to the lower back. They are composed of two parts: a tough outer layer, similar to a tyre, and a soft inner core, of a gel-like consistency. Discs are somewhat pliant, acting as shock absorbers and allowing for spinal curves and flexibility. Over time, this shock absorbing capability reduces, as the disc wears and loses height due to natural fluid loss. Small cracks appear in the outer layer and, if put under undue strain, the disc can start to be pushed out of shape. If this strain is maintained, the inside gel-like core pushes through the outer layer causing what is called a disc prolapse (‘slipped disc’ is actually a misnomer as the disc doesn’t actually slip out of place).

Disc prolapses tend to be most common in the lower back, as it bears the most torque and force on a day-to-day basis. The prolapse can press on the spinal nerves directly, or cause an inflammatory response in the area, closing the space where the nerves exit the spine. This can cause pain (known as sciatica if the pain runs down the back of the leg), tingling, numbness, pain or loss of strength in the arms or legs depending on whether the problem is in the neck or low back. In some cases, severe prolapses can press on the spinal cord, which requires urgent medical attention.

Osteopaths are trained to recognise any of these signs and act accordingly – referring the patient as appropriate. Whether the prolapse is mild or severe, sitting, lying, standing, walking, sneezing, coughing and bowel movements can be difficult. Whatever the severity, the damage sustained requires time to repair. Osteopaths encourage this healing process by establishing why the particular disc was the one that had the problem in the first place (trauma, postural problems, or wear and tear for example), and then treating to ensure that the spine is straight and mobile, and the protective spasm around the area is eased. As self-management of a disc problem is key, advice will also be given including postural tips, hot or cold packs and stretching as appropriate, as well as promoting to continue with normal daily activities as much as possible. The traditional medical approach to a disc problem is often to offer a combination of painkillers and muscles relaxants, which can work in conjunction with osteopathic treatment to resolve the disc problem more speedily. If the problem persists or there are any worrying symptoms, the patient can be referred back to their GP for further investigations and, if all else fails, on to a specialist if surgery is required.

 

Natalie Nicolas graduated with a First Class Masters degree in Osteopathy in 2014. She has since worked among other osteopaths, chiropractors, physiotherapists and sports therapists.

Natalie has a keen interest in treating musculoskeletal pain from a holistic viewpoint, observing the body as an integral unit. She enjoys treating people of many different backgrounds, ranging from athletes to patients with chronic pain disorders. When approaching a case, she considers all associated physical dysfunctions as well as lifestyle behaviours, occupation, physical activity, and daily life stresses. Having worked as a ski and snowboard instructor, Natalie understands the balance between injury, rehabilitation and performance.

Natalie is registered with the General Osteopathic Council and is a member of the Institute of Osteopathy.

A telephone assessment can be made to check you are suitable before booking a course of treatment.

Call The Therapy Rooms  on 0191 2136232 to arrange an osteopathy appointment with Natalie Nicolas.

Shoulder Pain – 4 Simple Exercises

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Tracy at The Therapy Rooms Newcastle shows you how to get rid of shoulder pain

How many times do you catch yourself hunching your shoulders at your desk? Look around. How many of your colleagues have the tell-tale signs of shoulders pulling forward, their heads poking out like little turtle heads from their shells? How many of your family or friends ask you rub their shoulders at the end of the day to ease their shoulder pain?

It seems an epidemic, doesn’t it? So many people seem to complain of stiff sore shoulders even whilst they are sat at their desks, hunching over their lap top or tablet.

How To Help Your Spine Do Its Job

The thoracic spine consists of the 12 vertebrae between the neck (cervical spine) and lower back (lumbar spine). 12 pairs of ribs attach to it which forms the rib cage, acting as protection of some of our vital organs. As well as protection, the thoracic spine is vital for movement. It bends forward, backwards and twists to the right and left. Well it should! But lack of mobility in the thoracic spine is so commonplace that we don’t even realise that we could and should move more easily.

But what can you all do about it?

Try these 4 simple exercises to ease shoulder pain….

1. Towel Roll Stretch for shoulder pain

Take a large towel and place it on the floor or a firm surface. Lie on top of it so that the towel is lengthways along the spine. It shouldn’t be so low down that it lies below the ribs. Make sure you put a pillow behind the neck to support it. Lie there for 10 minutes and relax. You may be more comfortable if you lie with your knees bent.

2. Rotation of Thoracic Spine Using a Chair for Shoulder pain

This is a great one for when you’re sitting at a desk. Whilst sitting in firm upright chair, without wheels, turn to the right, as if you’re reaching for something behind you. Hold the back of the chair with the right hand, reach for the back of the chair with the left hand and pull yourself further round. Make sure you keep your bottom firmly planted in the chair as there’s a huge temptation to lift it off to get further round.

shoulder-pain-blog-chair-chest-rotation

3. Chest Stretch

It doesn’t, at first, seem to make sense to stretch the chest muscles, when quite clearly, it’s your back and shoulders that are sore and achy. But constantly sitting and standing with rounded shoulders, causes the chest muscles, particularly the pectoral muscles, to shorten. As a result, we need to stretch and lengthen these muscles, if we want to mobilise the upper back.

Lying on your back, hold a small weight in each hand, or if you don’t have weights, a bottle of water. Start by holding the arms outstretched with the hands above the shoulders. Slowly take the arms overhead at 45 degrees until you can feel a stretch across the chest. Bring the arms back to the starting position and repeat 8-10 times.

4. Thoracic Spine Extension for shoulder pain

Place a rolled up towel or a foam roller horizontally on a firm surface. Lie on the foam roller so that it is across the back, just below the shoulder blades. Take the arms up and over so that the upper back curls over the roller. If you’re comfortable stay in this position and enjoy the stretch. If not, come back into the starting position and repeat. The repetition will help to loosen the stiffness in the thoracic spine.

shoulder-pain-blog-thoracic-spine-extension

When should shoulder pain treatment be carried out by a professional?

If you take care of your shoulders with these exercises, you should feel much more comfortable. However, chronic shoulder pain may be due to underlying issues, which need to be investigated. Call Tracy Russell  at The Therapy Rooms Newcastle for a consultation on 07974 725546.

To book an appointment for remedial or sports massage with Tracy Russell call 0191 2136232 or 07974 725546 or email Tracy at tracy@thetherapyroomsnewcastle.co.uk   

Please make sure you connect with us on Facebook too.

Thanks to Jaime Moran Wilson, Sports Massage Therapist, for collaborating with me on this blog.

Total Hip Replacement – Part 1 Preparation for surgery

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My journey started about five years ago. As a massage therapist, I was increasingly aware that the range of movement in my hips was poor. But as a reduction in range of movement is often gradual, I was able to rationalise with myself that nothing was wrong except that I was getting older.  I was 45!

My poor range of motion was particularly noticeable on abduction (moving my leg out to the side) and medial rotation (twisting my hip inwardly).  I was also in some discomfort if I had to walk for any length of time. The crunch came when I was running down the stairs and a crippling pain in my left hip forced my hip to give way.  I was able to steady myself but I was unnerved. A subsequent trip to the doctor and then the X-Ray unit showed I had arthritis of the hip joints and hypoplasia. Hypoplasia is a condition when the hip socket hasn’t properly formed and can lead to advanced degeneration of the hip joint. As a result of this diagnosis, I was determined to keep as fit and active as possible, as that was my best hope of maintaining my quality of life. I didn’t know how inevitable a hip replacement was, but it wasn’t something I relished so I implemented a consistent regime of massage, chiropractic, acupuncture and exercise, as well as a healthy diet with the emphasis on unprocessed home cooked food packed full of nutriton and supported with supplements. I’d like to think that all my efforts to stay as fit and healthy paid off, but ultimately there isn’t a parallel universe where there’s a Tracy Russell, who doesn’t exercise, eats take-ways and munches on pain killers to compare my progress to!

Five years on and the cracks were beginning to show! I knew it was time to have my hips looked at again. This is a list of the classic tell-tale signs of arthritis of the hip, that I experienced. It is not a definitive list of all possible symptoms, simply a list of those symptoms I experienced.

  • pain in the joint on weight bearing, particularly going upstairs
  • difficulty flexing the hip to raise the foot, to climb over obstacles, with either a straight or a bent leg
  • walking with a limp
  • muscle aches on over left gluteals, ilio tibial band and lateral left knee on walking more than 100 metres
  • fixed flexion deformity making lying supine uncomfortable
  • leg length difference
  • sharp pain and stiffness when making the first step, moving from sitting to standing
  • exhaustion at the end of the day, but exhaustion in the context that I was still running my busy massage therapy clinic, as well as running a home with 2 beautiful but demanding children

So it was with resignation, as I couldn’t continue living like this, that I sought advice from my GP. He referred me to the musculoskeletal unit at the Freeman Hospital, Newcastle. So on 13th December 2013, after a short consultation, examination and review of my X-rays, I was told that both my hips would need to be replaced. A part of me expected to be told that the left hip needed replacing. But there was also a part of me that was living in hope that there was a quick and easy resolution to my problems which wouldn’t need drastic intervention such as surgery. I definitely didn’t see two hip surgeries coming!

The waiting list for surgery was about 18 weeks. So part of my strategy for coping with these overwhelming emotions, was to work out a plan to be as prepared, that is as fit physically and emotionally as possible, for surgery. The plan below covers the strategies I put in place to get me through the impending 18 weeks. But as Rabbie Burns so eloquently put it, ‘the best-laid schemes o’ mice an’ men, gang aft agley’. A letter arrived at the end of January informing me that my surgery had been pulled forward to February 13th 2014 – in two and a half weeks!

Regardless, the plan was important whether I was having the surgery in February or April. A date in February just gave it more urgency. Here is what I did. My plan covered three main areas:

  • to ensure that my muscles were as strong as possible. Not only the leg muscles but after surgery I would need strong core and upper body.
  • to ensure that my body, but particularly my hips, were as mobile as possible.
  • to ensure that my general health was as good as possible to cope with the surgery and help the recovery process
  • to ensure that I nurtured myself emotionally to cope with the roller-coaster of emotions, that were to come. I felt that looking after my emotions would aid the recovery process.

THE PLAN

The Physical

  • 1 swim a week. Starting at 30 lengths of front crawl and building to 50 lengths. Front crawl is a tricky stroke to get the hang of but so much better for your fitness and your hips than breaststroke. Check out  http://www.swimming.org/swimfit/health-front-crawl/ for some great tips. There’s also a useful training video, which really helped me.
  • 1 cycle a week on a stationery bike. Starting at 5 kilometres and building to 10 kilometres. As with the swimming, I kept an eye on the time to maximise the fitness benefits, but I wasn’t a slave to the clock. Some days I could hardly turn the pedals at first, so it wouldn’t have been sensible to push it too hard and then be in pain later. But there wasn’t a session when I didn’t feel better after getting off the bike than before I had got on it. This definitely helped with my mobility and with my strength.
  • 1 leg strengthening session. Leg strengthening exercises focused on isolating muscles using equipment at the gym to develop quadriceps (leg extension), hamstrings (hamstring curl) and calf muscles (seated calf machine).
  • 1 upper body strengthening session to strengthen chest, back and arms. As well as the feel good factor from doing these exercises, I was hoping that, with a good strong upper body, I would be more mobile using crutches, post-surgery.
  • 3 times a week Pilates to promote core strength and mobility. For this I used My Pilates Guru app. I have done pilates for many years so I would say I knew the basics but I found this app really helpful in structuring the sessions and saving me from too much repetition and getting bored.
  • Regular chiropractic treatments helped to minimise the discomfort in my back, which was compensating for the fixed flexion deformity in the left hip and the leg length difference.
  • Regular massage therapy with Isabel Mineyko , my lovely associate at The Therapy Rooms. These treatments helped to relieve the discomfort in the gluteals and lateral left knee.

The Nutrition

  • My basic principles for healthy eating were continued during this pre-op phase. I mainly eat home-cooked family friendly meals. I eat 6-8 portions of vegetables and fruit a day, with the biggest proportion being vegetables. Thankfully I love dark leafy greens and they seem to be one of the foodstuffs that is universally considered healthy. (Please don’t tell me there is some new research suggesting that dark leafy greens are bad for you!) I eat 2-3 portions of fish a week and keep red meat and smoked foods to a minimum. I find a diet low in carbohydrates, which is very popular at the moment, very difficult to maintain but try to vary the type of carbohydrate I eat and keep my carbohydrates as unrefined as possible. I try to include essential fatty acids daily in my diet from not only oily fish but also nuts and seeds.
  • I have also believed that whilst the majority of our nutrition should come from good old honest food, I have always found a good multi-vitamin and mineral supplement, a vitamin C supplement and a fish oil supplement very helpful to my overall general level of fitness. In the lead up to the operation, on the advice of my health practitioner, I added to this Solgar’s Ultimate Bone Support and Pharma Nord’s Bio-Glucan Plus, to support my immune system.
  • I was conscious of the fact that, as movement and exercise became more and more difficult, so was keeping my weight under control. And as everyone knows, carrying excess weight is detrimental to arthritic joints. I used My Fitness Pal to keep a check on my calorie intake. But, in all honesty, I didn’t have the time or the emotional energy to be too zealous with this one. I also wanted to ensure that my diet is packed with nutrients which isn’t always easily married to calorie counting. And I often use food as a comfort, so inevitably, during this stressful time I did resort to food. The good news is that despite becoming less active and eating occasionally to comfort myself, I didn’t gain weight during this lead up to surgery.
  • 24 hours prior to surgery I started taking the homeopathic remedy, arnica, which is thought to be helpful for bruised and traumatised tissue.

The Emotional Side

It’s often when faced with a big challenge that you realise how strong you are but it is also when you find out what your weaknesses are. Facing Total Hip Replacement was certainly one of those challenges that was going to highlight the chinks in my emotional self. After the diagnosis, I experienced various emotions not dissimilar to The Five Stages of Grief, described by Elizabeth Kubler-Ross  in her pioneering book, On Death and Dying.  The five stages of grief, is the series of emotional stages that someone experiences when faced with impending death or other extreme, awful fate. The stages are shock, denial, intense concern, despair and finally recovery. After the initial shock and denial that this was really happening to me, I got locked in to a loop of intense concern, where I couldn’t think of anything other than my impending surgery and despair. The following things helped enormously :

  • talking to people who had successfully undergone THR and being encouraged by their stories of how the surgery had transformed their lives.
  • I got the chance to speak with my surgeon, a week before the operation to discuss issues I had. This was invaluable as I had ‘technical’ questions about the surgery which only he could answer. The questions such as ‘what happens to the muscle attachments and ligaments that are attached to the bone that is removed?’ could only be answered by the surgeon. In doing so, he allayed my fears that key attachments would not be disrupted.
  • visualising myself post surgery, being fit, well and active.
  • taking Bach Rescue Remedy daily but also when waves of panic overcame me.
  • meditating on a regular basis. I particularly liked Complete Relaxation Lite: Guided Meditation for a Happy, Stress Free Life. I found his voice soothing. But as we are all different, I suggest doing your own investigation to find a CD or app that suits.
  • planning and sorting out so that my home life and my business would run as smoothly as possible whilst I was out of action. I won’t bore you with the details but, for me, part of the anxiety was about what was going to happen to The Therapy Rooms whilst I was out of action. By sorting this out (as much as you can, in advance) I began to be less stressed about the operation.
  • I used the help and support from a reflexologist, chiropractor and massage therapist, which not only supported me physically but also provided invaluable support emotionally.

So the big day is looming. I’ve done as much as I possibly can to prepare myself. The next stage is the surgery and the critical 6 weeks post operation!

Why Computer Posture May be Giving you Back Pain

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Good computer posture is something that we’re all aware of, but only when we remember it.

The computer: one of the most common tools in modern life…

Poor Computer Posture
Poor Computer Posture

… and a device which forces the user into a terrible postural position.

When our parents told us to ‘sit up straight’ at table, they actually had a good point. Correct (healthy) posture means to sit or stand with a straight back.  Why?

Simply put, this is the position of least stress for our bones and muscles – the position they are designed to work most effectively in.

The head should look forward, not down, hanging its weight from the posterior neck muscles.  The neck should be upright, not tilted forward or back and straining. The shoulders should be pulled back to open up the chest.

The problem with the laptop is that to use it, all these things cannot be true…  The arms tend to come forward, straining the mid back muscles and tightening the pectorals. The neck is permanently bent forward to study the screen.

If you’re suffering from back pain, check your posture!

Like many people you probably spend hours in front of a computer every day – so make sure you’re doing it right.

I’ve found a really great article you might like to read to learn more about what you’re doing wrong and how to put it right.

“Your job shouldn’t be a pain in the neck—at least not literally. Yet two out of three office workers have felt physical pain in the last six months, according to a new survey released by the American Osteopathic Association (AOA).

The survey compiled responses from about 1,000 office workers ages 18 and older across the U.S. The results also showed that in the past 30 days, 62 percent of respondents had felt pain in their lower backs, 53 percent in their necks, 38 percent in their shoulders, 33 percent in their wrists, and 31 percent in their upper backs. …”

If you’d like to read more, follow this link  http://blog.womenshealthmag.com/scoop/correct-posture/

Why Quadriceps Switch Off

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In my article about knees, I mentioned that knee problems can be associated with the quadriceps muscles ‘switching off’.  I wasn’t terribly happy with this state of affairs – as a big fan of how the body works, I didn’t understand why we would switch off our own muscles, when we quite obviously needed them.  It just didn’t make sense.  So I set about investigating and this is what I came up with.

1. It seems that fluid or swelling in the knee, reduces the ability of the quads to fire up (Fahrer H, et al.  Knee effusion and Reflex Inhibition of the Quadriceps. A Bar to Effective Retraining. Journal of Bone and Joint Surgery 70 – B 1988)

In this study, excess fluid was removed from the knee using a needle, and there was an immediate increase in the strength of the quadriceps.   The critical amount appears to be about 15ml of excess fluid (about a tablespoon) on the knee, which will reduce efficacy.  This would not equate to a huge swollen knee, in fact I doubt if most people could spot if their knee was carrying an extra 15mls of fluid.

2. A study by Young in 1980 found that people who had injured their knee had a certain degree of muscle wastage.  The injuries were various including fractures, torn cartilage, ligament damage.  All of the injuries had been repaired and the patients were considered to have recovered.

Evidence pointed to the fact that the leg with the damaged knee was significantly smaller than the non-injured leg. Ultrasound revealed that the smaller leg size was due to the wasting of the quadriceps.

(Young et al Measurement of Quadriceps Muscle Wasting by Ultrasonography. Rheumatology and Rehabilitation 19(3): 141-48, 1980)

3.   A significant amount of the research  supports the theory that knees which are osteoarthritic have substantially weaker quadriceps.  Various studies compare ‘good’ knee to ‘bad’ knee; pairs of osteoarthritic knees to pairs of non-arthritic knees.  Repeatedly, the evidence suggests that knees suffering from arthritis have smaller, weaker quadriceps.

4. The final sub-section of this line of thinking is the role of pain in the function of the knee.  Research points to the fact that the quadriceps will switch off if there is pain on movement.  Clearly this may be related to the three conditions above but Jim Johnson in his book, Treat your Own Knees, feels that it is worth mentioning separately.  I’m not convinced, as I think it is unlikely that there will be many cases where there is knee pain yet there is no existence of fluid, osteoarthritis or existing damage to the knee.  But muscle weakening may be in part to the pain, separate to the other conditions.

Johnson quotes a bizarre study by Bertil Steiner, who applied pressure on to the side of one patient’s knee.  (The patient had a tumour on the side of his knee). Pressure on to the knee and therefore the tumour caused excruciating pain and the quadriceps gave out.  For the purposes of completeness and to reassure anyone who was worried about this poor man (as I was), the tumour was removed, the patient made a full recovery and his quadriceps quickly restored to normal function. Hopefully enough so that he could run away from Bertil Steiner!!

So to summarise, quadriceps that are weakened and wasting may be due to :

  • swelling
  • having had injuries, fractures
  • trauma to ligaments
  • arthritis
  • knee pain

So this research points to why we lose the strength and capacity of our quads. But the indications are that with the right rehabilitative exercises, we can have strong quads and avoid this catch-22 situation, that swollen arthritic painful knees turn the quadriceps off and without fully functioning quadriceps we risk getting swollen, damaged arthritic knees.

Knee Pain and Possible Treatments

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knee photoAs massage therapists, we often see clients with painful knees. Professionals working with knees often bandy around the term VMO as the possible cause of the pain but what exactly does it mean. It stands for Vastus Medialis Obliquus but to most of us that makes us none the wiser.  The Vastus Medialis is one of four quadricep muscles that lie on the anterior of the thigh:

  • Rectus Femoris
  • Vastus Lateralis
  • Vastus Intermedius
  • Vastus Medialis

The main function of these muscles is to extend the knee, so it is fundamental in walking, running, squatting, etc but all of these muscles have unique roles in supporting and stabilising the knee.

The vastus medialis originates from the tendon of Adductor Magnus and inserts into the tibial tuberosity via the patella tendon (as do all the quadricep muscles). The oblique fibres of the Vastus Medialis have been singled out and therefore given special mention because they perform and important role in stabilising the kneecap (patella) and ensuring that it tracks properly.  Weakness and mis-firing of these muscle fibres mean that when the knee is straightened, the patella doesn’t track properly in the patella groove causing painful achy knees and, over time, long term damage to the surrounding structures.

But why is the VMO consistently showing up as weak and not firing properly and how can we ‘switch’ it back on.

First of all, you must determine whether your VMO is contracting :

  1. Sit with your legs out in front of you and a rolled up towel under your knee (the knee should be slightly bent)
  2. Put your fingers over the area of VMO (as shown above right).
  3. Push your knee down into the towel (so that your knee straightens and the foot lifts off the couch)
  4. You should feel a strong contraction under your fingers
  5. If the muscle does not contract, continue to practice whilst pressing down gently on the muscle and concentrating on contracting the fibres underneath your fingers.

If the muscle does contract, you can continue with strengthening exercises:

  • Sitting on a chair with the knees bent, palpate the VMO. Start to slowly straighten the knee and ensure the VMO contracts. Maintain the contraction throughout the movement as you fully straighten the knee and bend it again. Repeat this twice daily until you can maintain a strong constant contraction 10 times in a row.
  • Place a large ball (such as a football) in between your knees and squeeze it.
  • Try performing a squat against a wall by sliding your back down the wall until your knees are at a right angle (your shins should remain vertical).
  • Try Peterson step ups. This exercise is difficult to explain so this demo is helpful. http://m.youtube.com/watch?v=UUYBhnN6IJA

Trigger Points… and the role of Massage Therapy in recovery

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No, nothing to do with guns and aiming, although Trigger Point Therapy – as anyone who has experienced it will testify – is far from painless!

A Trigger Point is defined as

‘A hyper-irritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band’.

In essence, it is an especially tender spot similar to a muscle knot. Like a normal knot, it prevents the muscle from fully extending, and generally weakens its performance, but on top of this, a Trigger Point has the potential to send referred pain to other areas of the body.

The referred pains caused by a Trigger Point can be extremely acute, sometimes bad enough to send the sufferer to the doctor. The problem this causes is that while the pain might be in the upper arm, the Trigger Point, its source, might be at the base of the shoulder blade, and so the painful area itself would not be presenting any obvious lesions or tensions that could be causing the pain, and so the pain can either be misdiagnosed as other conditions such as Angina or a Migraine, or they might be simply told they are imagining it, or given pain killers and told it will no doubt stop at some point…

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Again, much like a muscle knot, a Trigger Point can develop through repetitive stresses on a muscle, such as the position, poor posture or a particular job puts it into. There can also be predisposing factors such as recent over-exercise, or an injury to the muscle.

The Signs
Sufferers from an active Trigger Point can experience a range of symptoms such as poor sleep, weakness in the affected muscle, numbness or even a noticeable feeling of depression.

The Treatment
A Massage Therapist will use a combination of palpation to find the exact point, pressurisation (the painful part) for up to 7 seconds at a time, followed by strokes to the surrounding area to encourage a ‘flow and flush’ reaction within the muscle.  Used together, these can dispel the point and thus relieve the pain in the affected area. This can often take more than one treatment, but once identified, the point can be pursued until it is smoothed. Treatment is more effective if the patient is motivated to self help as well – by exercising and stretching regularly and keeping to a good nutritional plan.