Calf Tear

The calf is a group of muscles that sits at the back of your lower leg. Acute calf tears result in sharp sudden pain that onsets most commonly whilst jogging, sprinting or forcefully pushing off the toes. Sports or activities involving running are the most common setting for these types of injuries, however, many people will report their injury did not happen during a period of maximal exertion. When the force generated within the muscle exceeds the muscles capacity, tearing of the muscle fibres occurs.

Calf muscle injuries usually involve either the gastrocnemius or soleus muscle, both muscles are active during the push-off phase of running and walking. Both these muscles share the Achilles tendon, which is why the Achilles, gastrocnemius and soleus are the most common structures injured within the calf region. Tears involving the muscle belly heal faster than tendon tears because of the type of tissue and large vascular supply. As a result, recovery time and treatment can vary largely and is also impacted by the severity of the tear.

Calf tears result in bleeding within the muscle, swelling and problems pushing off the toes when walking.

There are three grades of calf tears:

Grade 1; Mild strain resulting in 0-20% tearing of the muscle fibres, 2 week recovery

Grade 2; Partial tear, 20-50% tearing of the muscle fibres, recovery over 4-6 week

Grade 3; Full thickness tear, 80% tearing of the muscle fibres, surgery with 6 month recovery

SYMPTOMS:

• Sudden pain in the calf region • Difficulty walking • Difficulty raising up onto toes • Swelling • Bruising

CAUSES:

Calf tears commonly occur with acceleration or direction changes. Sports or activities involving running are the most common setting for these types of injuries, however, there are a small amount that occur by simply walking. When the force generated within the muscle exceeds the muscles capacity, tearing of the muscle fibres occurs.

TREATMENT:

An acute calf injury is treated initially with the RICE regime (compression, ice, elevation and compression). Crutches may be required for walking in some cases. Progressive strengthening exercises are given early. As strength and load tolerance increase a return to running/sport program is implemented. Surgery may be indicated for more severe tears.

RETURN TO FUNCTION/SPORT:

Return to sport/activity is dependent on the severity of the injury. Generally, 2 weeks to 6 months.

PREVENTION STRATEGIES:

• Stretch - keep muscles flexible • Allow enough muscle recovery time between activity • Warm up

All MyCare Physiotherapists are well versed in the management of calf tears. We will identify the driving factors of your problem and commence appropriate treatment to return you to optimum health. Call us on 3349 3000 (Upper Mt Gravatt) or 3705 7170 (Underwood) during business hours or book online anytime by clicking on BOOK ONLINE above to find the next available appointment.

Subacromial Impingement

Subacromial impingement is known by a number of names although it is commonly referred to as swimmer’s shoulder.

Subacromial impingement is where the tendons of the rotator cuff become irritated where they pass underneath the acromion (tip of your shoulder) before attaching onto the humerus.

This irritation can result in a loss of movement, weakness or pain at the shoulder.

Common symptoms of impingement are lateral shoulder pain with movements that ‘close down’ the space between the head of the humerus (ball joint) and the acromion (tip of the shoulder blade). These include reaching for objects, putting the arm in a coat or doing up a bra

Pain is commonly felt on the outside of the shoulder with often some referral down the arm.

In many cases patients report a "catching" feeling about halfway up as they move their arms above their head. The feeling eases off as they move past the point of catching.

Subacromial impingement is best diagnosed with imaging either with ultrasound (US) or magnetic resonance imaging (MRI).

Physiotherapists are able to diagnose/speculate subacromial impingement involvement based on the range and quality of movement + level of strength produced by the shoulder. If your physiotherapist suspects subacromial impingement, he/she may refer you for a scan to obtain a formal diagnosis.

All MyCare Physiotherapists receive extra training in the assessment and management of subacromial impingement. We will identify the driving factors of your problem and commence appropriate treatment to return you to optimum health. Call us on 3349 3000 (Upper Mt Gravatt) or 3705 7170 (Underwood) during business hours or book online anytime by clicking on BOOK ONLINE above to find the next available appointment.

Patello-Femoral Pain Syndrome

Patello-femoral pain syndrome is a term used to describe pain felt behind the knee cap (the patella). The patella lies within the femoral groove and normally slides up and down as the knee bends and straightens. When there is restricted movement of the patella it can become irritated as it slides across the surface of the femur. This irritation can result in pain and dysfunction during activities such as going up/down stairs, squatting, hopping and running. Patello-femoral pain syndrome normally has a gradual onset of symptoms rather than due to a traumatic event.

Many factors can contribute to the onset of patello-femoral pain including muscle imbalance, poor biomechanics, growth spurts and sudden changes in physical activity.

The quadriceps muscle is attached to the patella with the vastus medialis oblique (VMO) muscle component responsible for pulling the patella inwards and the vastus lateralis (VL) muscle component responsible for pulling the patella outwards. If there is an imbalance between these muscles the patella can slide incorrectly.

Weakness in hip muscles can also cause patello-femoral pain due to poor knee control and shock absorption patterns.

Poor foot and ankle mechanics may also contribute to patello-femoral pain due to poor shock absorption and excessive tibial rotation.

The most common symptoms associated with patello-femoral pain include:

- Pain under or close to the sides of the patella.

- Low levels of swelling around the patella.

- Clicking or catching under the patella as the knee bends and straightens.

- Pain with repeated bending of the knee (eg. squats or going down stairs).

- Pain with prolonged bending of the knee (eg. sitting)

- A reduction in pain when the leg is relaxed in a straighter position.

Research has shown that physiotherapy management of patello-femoral joint pain is very effective. A physiotherapy treatment program will be guided by the patient’s goals such as a return to sport and other functional activities and can incorporate many of the following strategies:

- Modified rest from activities that are aggravating.

- Muscle re-training to strengthen the quadriceps, hamstrings and hip muscles.

- Taping is often an effective short-term solution to reduce pain.

- Foot biomechanics will be addressed.

- Addressing tight structures with release techniques.

- Addressing biomechanical movement patterns specific to your activities.

All MyCare Physiotherapists receive extra training in the assessment and management of patella-femoral pain syndrome. We will identify the driving factors of your problem and devise a structured individualised program to return you to optimum health. Call us on 3349 3000 (Upper Mt Gravatt) or 3705 7170 (Underwood) during business hours or book online anytime by clicking on BOOK ONLINE above to find the next available appointment.

Nerve Root Pain

Nerve root pain is a common condition treated by physiotherapists. Also known as radiculitis, radiculopathy or radicular pain, nerve root pain is a complex condition that requires clinical expertise and individualised patient management.

There are 31 pairs of spinal nerve roots that exit the spinal cord through a hole formed between the vertebrae above and the vertebrae below, called the intervertebral foramen.

Nerve root pain in the lower limb is characterized by back pain, buttock pain, leg pain (sciatica) and tingling and numbness that can extend into the foot. In the upper limb pain commonly extends from the neck into the arm with tingling and or numbness which often extends into the hand. Severe cases may result in leg or arm weakness or paralysis.

The nerve root is subject to injury at the intervertebral foramen as it is a defined space. Degenerative changes such as the formation of osteophytes (bone spurs) cause narrowing of the foramen known as foraminal stenosis, this can compress or irritate the nerve root and cause pain.

Intervertebral disc (IVD) herniation is another common cause of nerve root pain due to compression of the nerve root. Research has shown that nerve root pain does not always result from nerve root compression. Contents of a leaky degenerative IVD can seap onto the nerve root and cause nerve root damage and result in nerve root pain and altered function.

Treatment consists of medication such as analgesics and anti-inflammatories, rest and avoidance of aggravating activities. Spinal traction has been shown clinically to be an effective form of treatment for nerve root pain. Manual therapy, taping, postural retraining, nerve stretches and muscle strengthening may be used by your physiotherapist to return you to good health.

In extreme cases, nerve root injections may be used. Surgery is considered in those who show progressive muscle weakness or deteriorating signs and symptoms. These signs will be carefully monitored by your physiotherapist.

All MyCare Physiotherapists receive extra training in the assessment and management of nerve root pain. We will identify the driving factors of your problem and devise a structured individualised program to return you to optimum health. Call us on 3349 3000 (Upper MT Gravatt) or 3705 7170 (Underwood) during business hours or book online anytime by clicking on BOOK ONLINE above to find the next available appointment.

Thoracic Outlet Syndrome

Symptoms arising from Thoracic Outlet Syndrome (TOS) are caused by compression of the blood vessels and nerves that pass through the thoracic outlet. This outlet is a pyramid shaped channel at the base of the neck that allows for the passage of the nerves and blood vessels from the neck to the upper limb.

Patients with this condition often complain of pain, tingling, numbness or weakness in the arm. Coldness and heaviness in the arm can also be present. These symptoms are often located along the inside of the upper limb and can extend to the little finger and ring finger due to irritation and compression of the ulna nerve.

Repetitive use of the arm in overhead positions, prolonged sitting and some neck movements are common aggravating activities.

Causes of TOS include:

* Cervical rib (extra rib in the neck)

* Overdeveloped neck muscles

* Anomalies of the first rib

* Spasm of the scalene muscles (muscles along the side of the neck)

* Poor posture, in particular the scapula

* Repetitive overuse in sports or occupations

Conservative treatment with physiotherapy is often the first line of management. Treatment is focussed on retraining poor postures, particularly the scapula, strengthening and re-training the scapula muscles to offload the irritated nerves in the neck. Other treatments may include neck and thoracic spine mobilisation along with taping the shoulder to retrain faulty positions.

All MyCare Physiotherapists have received additional training in the assessment and management of TOS. We will assess your condition and organise a structured management plan to return you to full function ASAP. Call us on 3349 3000 (Upper Mt Gravatt) or 3705 7170 (Underwood) during business hours or book online anytime by clicking on BOOK ONLINE above to find the next available appointment.

Scoliosis

A lateral deviation of the spine is known as a Scoliosis. This results in the spine rotating around the vertical axis giving the spine a twisted appearance. Radiologically a scoliosis is defined by a Cobb angle of greater than 10 degrees, which is basically an indicator of the severity of the curve.

The most common type of scoliosis is known as Idiopathic scoliosis, or no known cause. This type of scoliosis can present at three different development ages; 1) infantile (<2 years) 2) juvenile (2-10 years) 3) Adolescent > 10 years to the end of the growth spurt. Adolescent Idiopathic scoliosis (AIS) accounts for 80% of idiopathic cases.

Adolescent Idiopathic scoliosis (AIS);

* positive family history

* more common in girls than boys

* AIS in girls accounts for 90% of the curves seen in clinical practice

Physical Traits of scoliosis;

* lateral deviation of the spine

* spine has a rotated appearance

* one shoulder or hip may look higher than the other

* rib hump with bending forward

Detection is via an x-ray and the severity is assessed by a radiologist who determines the cobb angle.

Most curves can be managed with physiotherapy which consists of postural education, manual therapy to loosen stiff joints and strengthening/core exercises to strengthen areas of weakness. Scoliosis, where the cobb angle exceeds 25 degrees, may require bracing and curves over 50 degrees may require surgery. This consists of straightening the curve with Harrington rods.

All MyCare Physiotherapists have received additional training in the assessment and management of scoliosis. We will assess your spinal curve and may request an x-ray (EOS) to confirm the diagnosis. We will then devise a comprehensive physiotherapy plan to return you to optimum capacity. Call us on 3349 3000 (Upper Mt Gravatt) or 3705 7170 (Unde

during business hours or book online anytime by clicking on BOOK ONLINE above to find the next available appointment.

Ankle Sprains

A sprained ankle is one of the most common injuries presenting to physiotherapy clinics on a daily basis. The lateral ligament complex (outside of the ankle) is most commonly the injured structure; this consists of three ligaments: 1) Anterior talofibular ligament 2) Posterior talofibular ligament and the 3) Calcaneofibular ligament.

These ligaments are overstretched or torn with an inversion mechanism (rolling the ankle in) as the outside of the joint is opened. The inside of the joint is compressed with this mechanism and can be a cause for ongoing medial (inside) ankle pain.

Grades of Ligament sprains:

* Grade 1 - up to 10% of the ligament tearing

* Grade 2 - (partial tear) up to 50% ligament tearing

* Grade 3 - over 80% tearing of the ligament fibres.

Grade 1 sprains generally recover with 1-2 weeks and respond well to physiotherapy. The patient can often weight bear immediately after the injury and there is often mild swelling which settles quickly. A grade 2 sprain or partial tear is a more severe injury characterised by inability to weight bear, moderate to severe swelling and more significant pain. These patients often require crutches to walk and may take up to six weeks to fully recover. A grade 3 rupture can take up to 3 months to rehabilitate and in some cases may require surgery to repair the ligament.

Initial treatment for ankle sprains should include gentle pain-free ankle movement, compression and elevation. Ice has traditionally been used for management of acute injuries but all research since it was originally suggested in the 70’s has suggested that icing slows down the healing process, so icing is no longer a great option following an ankle sprain.

Once the patient is able to weight bear, rehabilitation commences with larger active range of motion, calf strengthening, balance re-training and sports specific training. Most patients who sprain an ankle will be back to full functioning within six weeks, however, there is a small group of patients who will have ongoing pain and swelling which may require further investigations such as an MRI.

All MyCare Physiotherapists have received additional training in the assessment and management of ankle sprains, including when it is appropriate for an X-ray. We will perform an accurate assessment giving you a diagnosis with a rehabilitation program to follow so you are back on the sporting field as soon as possible. Call us on 3349 3000 (upper Mt Gravatt) or 3705 7170 (Underwood) during business hours or book online anytime by clicking on BOOK ONLINE above to find the next available appointment.

Whiplash

Whiplash is a term used to describe the rapid hyper-flexion followed by hyper-extension of the neck involved in a motor vehicle accident. This results in overstraining of the joints, ligaments and muscles in the neck. Stretching of the nerves in the neck can also occur with Whiplash.

Multiple structures of the neck could be traumatized through the one event. As a result, an extended period of time may be required to heal the damage to multiple structures.

Whiplash can give rise to a wide variation of symptoms including; neck pain, shoulder and arm pain, headache, dizziness, arm tingling and weakness along with concentration and memory difficulties.

Patients presenting with Whiplash often have a combination of physical and psychological contributing factors. These may include; reduced neck movements, painful neck joints, altered neck reflexes, loss of arm reflexes and psychological distress.

Recent research has shown patients with chronic whiplash have marked changes in the deep neck muscles shown on MRI. This emphasises the role of physiotherapy to help re-train and strengthen these muscles in these patients.

Further evidence from the literature suggests that maintenance of normal activities and avoidance of wearing a neck collar as the most effective initial treatment. However, there are a group of Whiplash patients who develop chronic pain and disability.

Physiotherapy management in the first three months includes education to stay active and avoid bed rest, restoration of neck mobility with manual therapy, re-training of the deep cervical muscles, re-training neck and eye control along with general neck and upper limb strengthening.

All MyCare Physiotherapists have received additional training in the assessment and management of whiplash patients. Our goal is to assess your problem and devise a structured plan to return you to full functioning ASAP.

If you’ve been involved in a motor vehicle accident and experiencing symptoms, don’t wait when a solution may be available. Call us on 3349 3000 (Upper Mt Gravatt) or 3705 7170 (Underwood) during business hours or book online anytime by clicking on BOOK ONLINE above to find the next available appointment.

Acute Wry Neck

Neck pain is a common symptom with approximately 70% of the population experiencing neck pain at some time in their life. Several conditions can cause neck pain, one of the most common being acute wry neck. Acute wry neck is a condition that affects the cervical spine and causes neck pain and stiffness and is usually coupled by spasm of the surrounding cervical muscles.

It most commonly affects the younger population ranging from young children to people in their thirties. Most people will first notice their pain as they first wake up as acute wry neck can result in a disturbed sleep or an unsupportive pillow. In an older population, the acute wry neck is generally more of gradual onset and people can notice mild symptoms before the pain sets in.

Acute wry neck can be an extremely limiting condition causing high levels of neck pain with a simple turning of the head. Simple tasks like head checking before changing lanes can be painful and in some cases unachievable due to the restriction from the cervical joints.

Acute wry neck most commonly affects the facet joints of your neck which are designed to allow movement between the vertebra. The inflammation of the facet joints is the primary cause of acute wry neck symptoms, however, muscle spasm which occurs as a response to the facet joint inflammation is generally just as much the problem.

Our Physiotherapists, Acupuncturists & Remedial Massage Therapists at MyCare Physiotherapy have proven to have great immediate results with acute wry neck. Through the use of joint mobilization and soft tissue techniques, most patients will experience immediately in session differences to their pain and range of movement. Depending on the extent of inflammation to the facet joints, residual symptoms should resolve after a week with treatment and full neck

function should be attained. With the strengthening of the surrounding muscles and removal of causing factors, patients are less likely to have a reoccurrence of their symptoms.

If you’re experiencing neck pain symptoms, don’t wait when a solution is available. Call us on 3349 3000 (Upper Mt Gravatt) or 3705 7170 (Underwood) during business hours or book online by clicking on BOOK ONLINE above to find the next available appointment.