Call Methven: 03 3028 205 or Ashburton: 03 308 3004


Posture and Pain

  • By Kristin Gunn
  • 12 May, 2017

consider the position of the spines

Poor posture can cause muscle strain, stress on joints, discs and nerves and alter breathing patterns. This can lead to headaches, spinal pain and even increase stress and panic attacks.

Take a minute to look around and consider the position of the spines around you. A head position forward of the chest rather above our shoulders or slumped lower back are easy indicators that stress is being put on the body- which could result in pain.

Physio, massage or acupuncture can relieve symptoms in the short term… however consider how many hours a day we spend in a car, at a computer, watching TV or playing video games. The biggest change we can make is to sit upright, use a lumbar roll, set up a work station correctly, take regular breaks and move around and use recreational time to be active. And its FREE!

Consider how the bodies of the future are developing and how we are teaching them to look after themselves. Are your children sitting upright, keeping a low load on their spines and muscles? Are we leading by example?

CASE STUDY

A 34 year old teacher presented with pain in her mid back. She was fine during her working day but pain increased as she prepared her classes at her lap top after school and that evening.

She added a low-cost screen and wireless mouse to her work station set up so she could connect her laptop and sit more upright. Four sessions of physio mobilised her mid back, released muscles and taped her to assist in postural correction. She performed home exercises- stretches to relieve her pain and strengthening exercises for her postural muscles. Within six weeks her long standing pain of three years had gone and she was much more productive in her after school prep!

Take time to review your work station as outlined in last week’s article. Encourage postural awareness within the family. Plan time away from devices and be active. Seek early input for postural pain- it does not need to take long and can provide a postural wellness strategy for life.

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By Kristin Gunn 13 Sep, 2017

I love this study! You can google a short summary under FIDELITY- the Finnish Degenerative Meniscal Lesion Study.

 Signs of cartilage or meniscal degeneration in the knee are joint line pain with squatting or twisting with or without locking where the knee feels stuck.

 I cannot imagine any other Ethics Committee authorising “pretend” surgery but that is what happened in this Finnish research. They compared two groups-  keyhole knee surgery removing degenerative cartilage in the knee to keyhole surgery NOT removing the cartilage. Yes, they had the anaesthetic and the incision but no actual surgery was performed in the control group.

 In short the outcomes were pretty amazing. At two year follow up patients without knee arthritis but with symptoms of a degenerative medial meniscus tear were no different whether they had had the actual surgery or not. That means that their condition could have been just as well managed with no surgery.

 CASE STUDY

 I had an interesting example of this last year. A 32 year old woman had tweaked her knee squatting to lift a heavy pot out of a low cupboard. She showed all the clinical signs of a tear in her cartilage so we arranged a specialist appointment and had a few sessions of physiotherapy working on strength, range of motion and pain management. The specialist confirmed the diagnosis but in the interim the mother of one had conceived again and was unable to proceed for MRI or surgery.

 We continued with occasional physio visits and exercise and I was thrilled to see her and her beautiful baby pop in to the clinic at the beginning of the year with a fully functioning pain free knee.

 I am sure she would have proceeded for surgery had she not become pregnant. It was a great learning experience for me and a relief for her and her family!

Reference:

Sihvonen R, Paavola M, Malmivaara A , et al

Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial

Annals of the Rheumatic Diseases   Published Online First: 18 May 2017. doi:10.1136/annrheumdis-2017-211172

By Kristin Gunn 13 Sep, 2017


METHVEN CLASSES  

Start from Mon 2nd Oct - 5th Dec for 10 weeks


Monday Krissy   5-6pm     ADVANCED LEVEL 1&2  Continuing from level 1 at steady pace

                   Krissy  6-7pm     BLOKES LEVEL 1& 2 Continue Pilates for core strength and  flexibility.

Tuesday Isabel 6-7pm    BEGINNERS Wishing to start Pilates as a core strengthening, balancing programme and  

                                                   no specific condition limiting your movement.

Venue: Elim Church Rooms, above the cinema on Main St

 Price: Early Bird Rate of $150 - payable to confirm your place by Wednesday 20 th September .

After this, classes will be $180 for the term

 

STAVELEY CLASS

 

Wednesday Tania  9-10 am LEVEL 2 For those with Pilates experience who wish a more challenging session

                          Tania 1015-1115am LEVEL 1 continue Pilates as a core strengthening, balancing programme and

                                                                      no specific condition limiting your movement

 Venue: Staveley Hall  

Price: Early Bird Rate of $150 - payable to confirm your place by Wednesday 20 th September   2017 .

After this, classes will be $180 for the term

 

Payment for Methven & Staveley classes :

Can be made at the clinic Mon - Fri with cash, eftpost or cheque or via direct credit to the

Westpac bank, Tancred St, Ashburton, 03 0835 0400010 03 .

Use name and Pilates as a reference. Places are confirmed on payment and email confirmation only. Classes subject to minimum numbers to run. Contact: phone 03 3028 205, email amy@contactphysio.co.nz

   

ASHBURTON CLASSES

 

Start from 3rd Oct - 5th Dec 10 weeks

 

Tuesday Nina 530-630pm LEVEL 1&2 continue Pilates as a core strengthening, balancing programme and

no specific condition limiting your movement.

Classes subject to minimum numbers to run. Payment required to secure place.

 Venue: St Pauls Room, 65 Oxford Street Ashburton

 

Price: Early Bird Rate of $150 - payable to confirm your place by Wednesday 20 th September 2017 .

After this classes will be $180 for the term

 

Payment for Ashburton classses :

Can be made at the clinic with cash, eftpost or cheque or via direct credit to the Westpac bank, Tancred St, Ashburton 03 0835 0400010 00.

Use name and Pilates as a reference. Places are confirmed on payment and email confirmation only. Classes subject to minimum numbers to run.

 

Contact: phone 03 302 8205 to Methven clinic or email to amy@contactphysio.co.nz

 

By Kristin Gunn 03 Sep, 2017

When netball and Rugby seasons was in full swing we saw a lot of ankle sprains coming through.

It can be so tempting during a game to have a tweak and play on- clinically I often see this preceding a much more significant sprain and resulting in time off sport and work. So rule number one is even for a small sprain- stop and RICE rest ice, compress and elevate. Elevate above the level of the hip. Take the time to evaluate before returning to play.

 An ankle x-ray should be considered if there is pain around the malleoli – the bumps on either side of the ankle, bony tenderness along the bottom 6cm of the posterior edge of the tibia and fibula- either the inside or outside ankle bones, or an inability to weight bear for four steps- both immediately and once at the medical centre (Ottowa ankle rules).

 It is recommended to RICE for 48-72 hours and then progress to movement. This can be a good time to consider physiotherapy support to help manage pain, swelling, joint stiffness and gait re-education. Choosing the appropriate time to progress weight bearing and exercises can be very helpful to optimise recovery time and return to play.

 Taping and bracing are often used in the treatment and prevention of recurrent ankle sprains. Studies have shown both to have a preventative effect while having minimal detrimental effect on sports performance. There is no research evidence soundly supporting one more than the other.

 Bracing and taping are not replacements for rehabilitation to regain full range of motion, strength and balance. Recurrent sprains can occur off the sports field too!

Try assessing your ankle stability by using tape to mark the above shapes. 6 feet long and at 45 degree angles. Stand in the centre and reach the non weight bearing leg in each direction as far as possible. Reach should be equal on both sides. Reduction in reach all directions and specifically in direction 4 has been found to accurately predict people with chronic ankle instability.


By Kristin Gunn 29 Aug, 2017

Neck pain is a common condition and affects most of us at one time or another. It can be acute and last a few days or be a recurrent life time problem. Gradual onset is common associated with posture, driving or computer work. Whiplash, sports injury or concussion can be involved. It can also include a headache from the neck, arm pain, pins and needles, numbness and or weakness. 

Clients almost always benefit from a review of posture and provoking activities. Altering driving position, work station or even getting large mirrors for a vehicle can all make a huge difference to function. We spend a lot of time in the same position or doing similar activities. Spending some recreational time stretching or doing yoga or pilates can be very beneficial. 

Physiotherapy studies have identified joint mobilisation of the neck and upper back to be beneficial in the short to medium term. Specific strengthening exercises have also been found to be beneficial. Interestingly there was not evidence found in favour of manipulation- a more vigorous mobilisation of the joint outside of normal range of motion. There is convincing evidence for specific exercises for chronic neck pain and headache. 

In the clinic we assess each client individually and consider their joints, muscle length and strength and nerves in relation to their symptoms and daily activities. Our goal is to have both a treatment which eases symptoms and a longer term plan for the client to ease symptoms and prevent future recurrence. This way we are striving to build a future filled with doing the things you love without pain limiting you.

 CASE STUDY

 A 60 year old grandmother was having neck and shoulder pain causing her problems at work, preventing her lifting her grandchild and most importantly preventing her bowling.

 We provided a work station assessment; massage, joint mobilisations, acupuncture and taping to get her bowling again and in the longer term a programme of upper back stretches and shoulder neck strengthening exercises so she would be able to keep up with her ever growing grandchild!

 She is anticipating a championship win at bowling in the coming season!

By Kristin Gunn 24 Aug, 2017

Osteoporosis means porous bones and is a condition in which bones lose their strength. We reach our optimal bone density by about 18 years old and from then it is a case of slowing bone loss. 1 in 2 women and 1 in 5 men over the age of 50 will break a bone because of osteoporosis. This is not only relevant because of pain and loss of function but can also lead to long term disability and loss of independence.

 Adults over 50, who use steroids, have a history of falls or have had previous fractures with low level trauma are considered higher risk.

 The best way to address osteoporosis is prevention- high impact and strengthening exercise, plenty of calcium and vitamin D from the sun and reducing intake of alcohol and smoking are all critical. Starting as children and continuing all the way through life.

 A daily calcium intake if 700-1200mg a day is recommended (National Osteoporosis Guidelines UK 2017)- possibly higher in post-menopausal men and women. Supplements or prescribed medication should be considered for those at high risk. Consider your diet and calcium uptake. Foods high in calcium are milk or yogurt, kale, sardines, broccoli, water cress and tahini.

 Take a walk in the sun for 15 minutes a day. Try early in the morning so you can have the vitamin D benefits without the harsh UV rays.

 Numerous studies have found that bone density can be optimised at any age with exercise. Elderly hospitalized patients could improve theirs doing arm exercises with 0.5kg weights by the side of their bed.

 Physiotherapists can help provide an appropriate exercise programme. Your GP can consider the need for supplementing your calcium. Take action to maintain your bone density- it is so easy!

 

By Kristin Gunn 30 Jun, 2017

Tennis Elbow presents with pain in the outside of the elbow and spreading to the forearm. I rarely see it associated with playing tennis! Preserving jars, computer work and milking are some of the more common onsets I have seen this year. 

Pain is typically aggravated by gripping and lifting and gets worse with more activity. Pain is generated from the bony attachment, the tendon or the muscle which extends the fingers. Localised heat, ice, arnica or Voltaren gel and stretches may all help. It is vital to address the daily tasks which aggravate the pain and try to change them to be less provocative.  

Additional physio modalities are ultrasound, laser, bracing or taping, massage, acupuncture and various exercises to load the tendon and strengthen the muscle. It is also important to exclude contributing factors referring from the neck and shoulder.

CASE STUDY 

A busy 52 year old farmer had a six month history of increasing forearm pain. It improved a bit with rest but recurred as soon as he was active. It was limiting most upper limb activity- driving, managing the animals, fencing and opening a beer! 

On assessment he had positive nerve tests, reduced upper limb distal pulses, elbow joint stiffness and pain and pain on the common extensor tendon of the elbow. Rest was not an option. Eccentric exercises increased his pain to an intolerable level. 

We used neck mobilisations, release through the neck and chest muscles, elbow mobilisations, ultrasound, taping, massage and trigger points to reduce the pain severity and progressed to slowly introducing eccentric strengthening. It has taken a couple of months but he is finally back to work, cycling AND opening his beer!

By Kristin Gunn 19 Jun, 2017
                
Start from Mon 17th July  – 20th September  for 10 weeks

        METHVEN CLASSES
Monday  Krissy  5-6pm   ADVANCED LEVEL 1&2 Continuing from level 1 at steady pace            
                   Krissy 6-7pm   BLOKES LEVEL 1&2 Continue Pilates for core strength and flexibility.

                   Venue: Elim Church Rooms, above the cinema on Main St

                   Price: Early Bird Rate of $150- payable to confirm your place by Friday 7th July 2017.
                               After this, classes will be $180 for the term

          STAVELEY CLASS
Wednesday  Tania  9-10 am LEVEL 2 For those with Pilates experience who wish a more challenging session            
                          Tania  1015-1115am LEVEL 1 continue Pilates as a core strengthening, balancing programme and
                                                                   no specific condition limiting your movement
                          Venue: Staveley Hall
                
                          Price: Early Bird Rate of $150- payable to confirm your place by Friday 7th July 2017.
                                       After this, classes will be $180 for the term

Payment for Methven & Staveley classes: Can be made at the clinic Mon - Fri with cash, eftpost or cheque or via direct credit to the Westpac bank, Tancred St, Ashburton, 03 0835 0400010 03.Use name and Pilates as a reference. Places are confirmed on payment and email confirmation only. Classes subject to minimum numbers to run. Contact: phone 03 3028 205, email amy@contactphysio.co.nz

         ASHBURTON CLASSES
Tuesday Nina   530-630pm LEVEL 1 continue Pilates as a core strengthening, balancing programme and
                                                        no specific condition limiting your movement              
                   Nina   630-730pm LEVEL 2 For those with Pilates experience who wish a more challenging session

                    Venue: St Pauls Room on Oxford Street Ashburton

                    Price: Early Bird Rate of $150- payable to confirm your place by Friday 7th July 2017.
                                 After this classes will be $180 for the term
         
Payment for Ashburton classses: Can be made at the clinic with cash, eftpost or cheque or via direct credit to the Westpac bank, Tancred St, Ashburton 03 0835 0400010 00.Use name and Pilates as a reference. Places are confirmed on payment and email confirmation only. Classes subject to minimum numbers to run.Contact: phone 03 302 8205 to Methven clinic or email to amy@contactphysio.co.nz
By Kristin Gunn 29 May, 2017
The large tendon of the calf muscle is prone to injury when subjected to unaccustomed repetitive high loads. Typically onset is gradual and affects the midportion of the tendon. There is almost always morning stiffness and pain confined to the tendon which walks off after a short period of walking around.

Tendons love loading though and specific exercises have been studied in detail in the literature- finding that exercise is the most effective way to resolve the condition. The most up to date findings advise progressive loading to the muscle tendon unit- different exercises progressed during the rehabilitation process. Unfortunately findings also suggest that working in to the pain is most helpful!

There are a number of different injections which have been tried- steroid, blood and platelet rich plasma, sclerosing and cell based therapies. The efficacy of these has not been proven.

CASE STUDY
A 32 year old passionate recreational runner presented with a 4 month history of Achilles tendon pain. He was able to run it off but found it was getting increasingly frequent and severe.

The gastroc muscle in his calf was tight so we provided heel raises, massage and stretches. His sub talar joint was stiff in eversion and eased with joint mobilisations. We provided him with a home exercise programme: He performed 5 x 45 second isometric holds and full range heel raises over a step. He was managing these within two weeks and they were progressed to single leg raises. Due to the high distances he enjoyed running we worked specifically on endurance and energy storage exercises in the later stages.

Twelve weeks later is pain free and training towards his first marathon.
By Kristin Gunn 12 May, 2017
Poor posture can cause muscle strain, stress on joints, discs and nerves and alter breathing patterns. This can lead to headaches, spinal pain and even increase stress and panic attacks.

Take a minute to look around and consider the position of the spines around you. A head position forward of the chest rather above our shoulders or slumped lower back are easy indicators that stress is being put on the body- which could result in pain.

Physio, massage or acupuncture can relieve symptoms in the short term… however consider how many hours a day we spend in a car, at a computer, watching TV or playing video games. The biggest change we can make is to sit upright, use a lumbar roll, set up a work station correctly, take regular breaks and move around and use recreational time to be active. And its FREE!

Consider how the bodies of the future are developing and how we are teaching them to look after themselves. Are your children sitting upright, keeping a low load on their spines and muscles? Are we leading by example?

CASE STUDY

A 34 year old teacher presented with pain in her mid back. She was fine during her working day but pain increased as she prepared her classes at her lap top after school and that evening.

She added a low-cost screen and wireless mouse to her work station set up so she could connect her laptop and sit more upright. Four sessions of physio mobilised her mid back, released muscles and taped her to assist in postural correction. She performed home exercises- stretches to relieve her pain and strengthening exercises for her postural muscles. Within six weeks her long standing pain of three years had gone and she was much more productive in her after school prep!

Take time to review your work station as outlined in last week’s article. Encourage postural awareness within the family. Plan time away from devices and be active. Seek early input for postural pain- it does not need to take long and can provide a postural wellness strategy for life.
By Kristin Gunn 06 Apr, 2017
I am concerned by the increase of young people with postural neck pain and headaches presenting to the clinic. Children are starting to use phones and tablets at an increasingly young age and continue into school. There is NO posturally efficient way to sit and work at a phone, tablet or laptop.

Recently I did an ergonomic review for teachers at a school and it transpired they are also doing most of their evening work on laptops on the couch. What are you doing? How does your body feel after a couple of hours working at a device? What are we teaching children? Are we looking after them and ourselves and leading by example?

I thought I would start by outlining how to set up a workstation optimally.

WORK STATION SET UP

Start with your chair. Find out how to adjust height, angle, seat position and arm rests. Your chair should have good low back support which should sit snugly in your lower back. Alter angle of the seat pan and tilt backrest slightly back. There should be a fist size gap from the back of the knee and the bottom of the seat.

Set height relative to your desk first by raising or lowering the chair. Your desk should be 50mm above your thighs which should allow your elbows to be at 90 degrees and wrists resting in neutral at your desk.

Your keyboard should be 50mm from the desk edge with your wrists in a neutral position. Your mouse should be right next to the keyboard so you are not reaching.

Screen should be arm’s length in front of you and the top of your screen level with the top of your head. If there is the option tilt the screen slightly forward to reduce glare.

If your feet are not completely flat, consider a foot rest. This should tilt 15 degrees and height should allow hips at 90 degrees.

If you get these right your head should be relaxed above your shoulders in a neutral position, shoulders relaxed, wrists and neutral and hips and knees at 90 degrees with feet flat.

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