Injury blog: Gluteal tendinopathy

Do you have pain on the outside of your hip area? If so, this blog will be worth a read. This month we are looking at a common issue we see in clinic involving a group of muscles known as the gluteal muscles. These muscles are prone to developing sore tender spots in them, but we are going to focus more on the tendons of these muscles… Specifically on an injury known as ‘tendinopathy’.

Your glute anatomy

The gluteal muscles are found in the hip and buttock region of the body and consist of three muscles altogether. These are:

  • Gluteus Maximus: A large buttock muscle which helps to move the hip backwards and rotate it outwards.
  • Gluteus Medius: A fan-shaped muscle found on the side of the hip between the pelvis and the hard bony ball you can feel a short way down your upper leg on the outside. This muscle helps to move the hip out sideways, as well as rotate the hip and stabilise the pelvis when we walk or run.
  • Gluteus Minimus: Another fan shaped muscle which sits deep to the gluteus medius muscle and performs a similar role.

The tendons of the gluteus medius and minimus muscles, where they attach into the thighbone, are commonly exposed to high amounts of compression and loading, which over time leave them open to injury. We will be talking about the medius and minimus muscles here.

What is tendinopathy?

Tendinopathy is the name we give to an injured tendon, whereby the tendon has undergone physical change, due to excessive loads acting on them when we move incorrectly over a long period of time. An example involving the gluteal muscles is where imbalances in the relationship between the pelvis and thighbone (i.e. from weakness of the gluteal muscles) result in the hip moving in an abnormal and inefficient way. Over time this places excessive strain on the gluteal tendons as the hip moves when we walk or run.

Initially the tendons and other tissues around them respond by becoming thicker, due to chemical changes that are occurring inside the tendon. A thicker tendon is able to cope more with the compression it is under, but there is a downside. During the thickening process, the tendon fibres also become disorganised or deranged, leaving the tendon less able to cope with the force a muscle exerts on it when it contracts or ‘pulls’ on it. As the process continues the tendon becomes more and more degenerated and eventually the tendon is no longer able to adapt to the excessive forces acting on it and a tear can occur. A tear can be the result of an untreated tendinopathy.

Who does it affect?

In the active population, gluteal tendinopathy is commonly seen in athletes, like runners. It is also commonly seen in people who are inactive where the effect of de-conditioning leads to weakness and changes in the way we move. So, you are not safe from this injury even if you don’t regularly exert yourself!

Signs and symptoms

The main symptom is pain on the outside of the hip that comes on without any real obvious ‘injury’ or event. This pain then worsens over time and is usually brought on by weight bearing activities like walking, running and climbing stairs. As with many tendon injuries, you may feel pain at the beginning of an activity, with a lessening of pain as the activity progresses, and then a worsening of pain again after you finish. A common symptom of gluteal tendinopathy is pain experienced at nighttime when lying on the injured side. You may also feel pain that radiates down the thigh to the knee.

Treatment

The good news is if you seek treatment early in the injury process, you can avoid long term complications like tears, which are notoriously much harder to treat. Our advice to you is come and see us as soon as possible after you start to feel pain.

We are extremely well versed in treating gluteal tendon injuries and can get to work immediately. There is a good chance weakness in your gluteal muscles will have been a factor in the development of the injury, as well as a disengagement of the way the trunk, pelvis and legs act together as a unit. Strengthening exercises which focus on building muscle mass, as well as specific exercises to gradually re-load and strengthen the tendon to its full capacity will be key to your recovery. We will also have to re-train your movement patterns to ensure any abnormal movements are corrected. That way we can be sure when you return to your full training schedule, or whatever activity you want, we won’t be seeing you back for the same problem two months down the line.

We may use any number of treatment techniques to help you back to full fitness. These may include massage, joint mobilisation, dry needling and shockwave therapy. So, if you have hip pain, come and see us today – we can help.

Staying sane during isolation

Hello readers! We hope everyone is staying safe at this very crazy and uncertain time. We realise for a lot of our clients that life has changed drastically over the past weeks and months since COVID-19 has made its entrance to the world. Here at Physio For Women we have also been adjusting to some changes that have been instilled upon us in the healthcare world. We want you to know that we are still here and continue to work hard every day to ensure we uphold our high standard of care for all our patients.

This month we thought a focus on self-help advice during isolation was warranted. Trying to juggle working from home whilst looking after children and adjusting to being around partners and other family members 24/7 is a big task for anyone. We’ve highlighted a few key areas that are worth considering to keep on top of your health (and sanity) during isolation.

Home office set-up

If you are used to working in an airy and spacious office or other workplace, then being plunged into the world of working from home can come as quite a shock. Many of you won’t necessarily have the space or equipment at home to match your workplace, so taking some time to set up a space that works for you is worth it, to reduce the impact on your body. We suggest the following:

  • If you can make it work, set yourself up in a separate room like a study and designate the space for work only. If this is not possible, choose a corner of any room and make it your own. This will allow you the best chance to concentrate on work when you are there.
  • If you don’t have a desktop set-up and are working on a laptop, ensure it is on a table and avoid working on your lap. A table with a supportive chair is best, and try to break it up with periods of standing at the breakfast bar or kitchen work top. Boom… You have your very own sit-to-stand desk!

For a desktop set-up, follow these pointers to reduce stress on your body whilst working:

  • Ensure the top of your computer screen is level with your eyes, or just under
  • Sit upright with feet planted on the floor, arms relaxed by your side, and elbows bent at 90 degrees
  • Avoid cocking your wrists back during and between typing. Keep them relaxed.

Work routine

This is a must if you have children and other family members at home who you will be interacting with more than usual. Have some set times during the day when you try to focus on work. We realise this is not always possible with children, but have the routine in place and use it loosely. Children need attention and interaction (now we realise how much they get at school!), so set your expectations low and be fluid. Have the colouring pencils, craft box, toys and games at the ready and set the kids some tasks for when you are working. And if you really need to get some work done and it’s just not happening, it is OK to allow the kids to watch TV or a movie for a few hours. Unusual circumstances may mean unusual routines for a while. Children are resilient and will bounce back from these changes… Everything in moderation.

Ensure you give yourself regular breaks from screen time to have a stretch, move the body, and give the brain a rest. We recommend getting up from your workstation every 30 minutes.

Family routine

You might be finding it tough being around the family 24/7. This is natural and don’t feel bad about it. It’s a good idea to set out some ground rules, particularly if you have to work on a daily basis. Everyone has a role to play to make sure the household cogs keep moving smoothly. One family member can do the washing, another can stack the dishwasher, etc… On top of this, allow time to get out and exercise and make sure you have alone time as well. Being around family can be challenging, especially when you are used to being at work for eight hours a day normally.

Seek out physio when needed

This is an important one. We realise it has not been as simple with booking appointments and getting that face-to-face time with us. But if you have any aches or pains that are not responding to exercise, stretching and other self-help remedies, then please get in touch. We are still open but are working to limited hours. We also have strict screening and hygiene protocols in place, and this is to ensure the safety of both you and us. Call us today on 08 8443 3355.

We wish all our clients the very best during this difficult time. Please practice social distancing, good coughing and sneezing etiquette, and wash your hands regularly with soap or alcohol hand sanitiser. These are still the best measures in preventing the spread of COVID-19.

We will get through this!

Lower back pain and lumbar disc bulge

Hello readers! This month we are going to talk to you about a common low back complaint. Let us paint you a picture. You’re a busy mum that tackles the same daily challenges of getting the kids through their morning routine, school drop off, housework and a day job. It’s hard work, not to mention having this niggly, nagging low back pain to deal with at the same time. Sound familiar?

It’s a scenario we are all too familiar with here at Physiotherapy for Women. We see so many busy mums who are struggling with low back pain, but are just so caught up in the daily grind that they don’t find the time to come get checked out. Usually the pain carries on for some time, then one day they’ll bend down to tie up a shoelace and bang… Crippling pain! It’s often at this stage that people come to the clinic barely able to move and in a very distressed state.

So what has happened?

The scenario of long-standing low back pain followed by a single episode of acute pain (often following a seemingly trivial movement) is common with a lumbar disc bulge. Let us explain what it is, how it happens, and what we can do to help get you back to being super mum again.

The spine is broadly made up of bones called vertebrae and discs that sit between them. The discs are responsible for allowing movement, whilst being strong enough to hold the vertebrae together. They also act as shock absorbers for the varying forces that our body must withstand on a daily basis when we move. Each disc has an outer and inner section. The outer section is a tough and fibrous material (aka the ‘Anulous Fibrosus’ or AF), whilst the inner section is more gel-like (aka the ‘Nucleus Pulposus’ or NP).

A lumbar disc bulge occurs when the NP pushes through the AF and the disc material moves into a space in the spine that it would not normally reside in. This causes inflammation and depending on the severity of the bulge, can press on nerves that run down to the legs. It’s important to point out that discs don’t just spontaneously bulge for no reason. The NP will slowly push through the AF over a long period of time (hence the long standing niggly pain), usually because we have spent this time doing lots of bending and lifting (who doesn’t with kids, right?!), which places high amounts of stress on the discs. Then there is the ‘straw that broke the camel’s back’ moment when things turn worse suddenly (in the example above, it was the tying of shoelaces).

Signs and symptoms

The signs and symptoms of a disc bulge will depend greatly on the level of the spine that is affected. Most commonly, it affects the lowest two discs in the spine. The nerves that exit the spine at each level have a specific role and will run down to serve different parts of the legs. Broadly speaking, you may experience any or all of the following:

  • Low back pain (especially when bending and sitting)
  • Pain that travels down one or both legs
  • Pins and needles, tingling or numbness down the legs
  • Weakness with certain leg movements

A severe disc bulge can lead to more serious signs and symptoms which include problems with your bowel, bladder and sexual function. These are rare but can occur.

Treatment

Recovery from a disc bulge usually takes 3-6 months, depending on the severity. That doesn’t mean you’ll be in pain for that long. Generally speaking, the acute pain from a disc bulge will start to settle within a few days to a week. Inflammation is a process the body goes through when injury occurs and it is vital for our recovery. So the early stages will definitely be the worst, but the good news is things will start to feel better quite quickly with some treatment and by following some simple rules. Coming to see us early on is important because we can educate you from the word go. It is normal in the early stages of an injury like this for people to want to stop everything, including moving, through fear of injuring themselves further. However, it is very important to keep moving! The worst thing you can do is to lie down on a lounge and do nothing all day. They say motion is lotion, and that’s true when it comes to disc bulges. Doing things like heavy lifting and bending is off the cards to begin with, but walking and mobilising the spine regularly is allowed and encouraged.

The injury will have left you with restricted joints and muscle tightness. We will use massage and joint mobilisation techniques to free you up and get you moving again. We will also give you some exercises to start following which we will progress slowly. These will aim to restore full movement to your spine and limbs, muscle tension to normal levels, and strength to the trunk and limb muscles that have been affected.

Many mums we see with this issue have poor core stability, most likely stemming from pregnancy and poor movement and breathing over the years. Being unable to stabilise through the trunk and pelvis during movement will have been the main reason the disc has bulged in the first place. So, it is natural for there to be some core strengthening needed for full recovery and to reduce risk of re-injury in the future. Over time we will start to re-introduce full movement, including bending and lifting. But this time round you’ll be moving well and safely.

If you have low back pain, we recommend you come to see us at the earliest possible convenience. Don’t wait for the big bang as recovery will be longer. Give us a call today on 08 8443 3355.

Wrist and thumb pain after pregnancy?

young mother holding newborn babyIt has been a long journey and you’ve been through a lot over the last 10 months. You’re already exhausted and you’ve only just started your life with a new addition to the family. Life doesn’t get much busier than this, right?! How frustrating then that you’re having to battle through this new period with a sore wrist and thumb. If it’s any consolation, you’re not alone. One study from 2017 reported over 50% of women experienced wrist pain following delivery of their baby, and over 80% of those still had pain two months on. Read on to find out why.

The most common cause of wrist and thumb pain after pregnancy is a condition called De Quervain’s Tenosynovitis. That’s a bit of a mouthful so let us explain simply. There are a few different tendons which run from muscles in the forearm along the thumb side of the wrist, which act to move the thumb away from the hand when the palm is held out flat. The tendons are covered in a thin ‘sheath’ of tissue which provides important lubrication to allow for smooth movement. On their journey from the forearm, the tendons and their sheaths have to pass through a little tunnel, made up of bone and soft tissue. In De Quervain’s, the tendons and/or sheaths become thickened and this leads to problems with movement through the tunnel.

It is thought that new mums are at higher risk of developing this condition due to the repetitive nature of lifting and holding their baby. These movements put the hand, thumb and wrist into a compromised position and increases strain through those tissues. It has also been suggested that increased fluid retention and hormonal changes following pregnancy could also be involved in the development of this condition.

Another common cause of wrist and hand pain following pregnancy is Carpal Tunnel Syndrome. This condition involves the pinching of a nerve as it passes through the wrist. This is different from De Quervain’s in that a patient will experience pins and needles and/or numbness in the hand as well as wrist pain—a blog topic for another month!

Signs and symptoms

If you develop this condition you can expect the following:

  • Pain and/or swelling around the base of the thumb, and thumb side of the wrist
  • Pain increased by thumb and wrist movements
  • Pain associated with gripping, lifting and twisting objects
  • Popping/clicking with wrist movements (in severe cases)

If you are reading this and alarm bells are already ringing, then you may want to consider giving us a call to book an appointment. We can help you with this problem so read on to see what treatment we offer.

Treatment

As this is a busy time of your life, our aim will be to get you out of pain and functioning as soon as possible. After all, you have a little one to prioritise now and it’s not like you can just stop parenting to allow your body to heal. Fortunately, you don’t have to. Our treatment for De Quervain’s may include any or all of the below options:

  • Rest and splinting: In the initial stages, you may need to alter how much you do with your wrist and thumb. Getting some extra help around the house from friends and family may help to take the load off. Using feeding pillows to support the baby during meal times is another way to reduce your ‘holding’ time. Wearing a splint or brace can help to reduce aggravating movements in key areas of the wrist whilst still allowing you to move and perform your everyday We may fit you with one of these if we think it is necessary.
  • Massage and joint mobilisation: To release tight muscles and restore range of motion to the hand, wrist and forearm joints.
  • Taping: To support the wrist or aid with drainage of the wrist area back up the limb towards the heart.
  • Stretching: To combat any tightness of the hand and forearm muscles. You’ll also need to do some of these at home.
  • Graded strengthening exercises: Evidence is pointing more towards gradual loading exercises to rehabilitate the tendon and restore full movement and strength to the tissues.

Other treatment options include therapeutic ultrasound and corticosteroid injections for pain relief. For severe or persistent cases that don’t respond to a more conservative approach, a surgical opinion may be required. We will always work hard to ensure you don’t reach that point because the recovery is always longer and it means a time period where your function will be much reduced, which is always difficult when you have a little one.

Our advice to you is to not let it get to that in the first place. No matter how trivial you think it is, if you start to feel pain in your wrist in the early days of motherhood, please get in touch with us here at Physiotherapy for Women. We can put all of the above in place straight away to avoid your pain getting out of control. That means more time for you and your baby. What could be more important at this time?

See you next month!

How important are you to yourself?

Hello readers! We trust everyone had a superb festive season. Now that the fun and frolics are over for another year, it’s back to the routine of everyday life… This may mean many of life’s stresses that disappeared temporarily during the Christmas carnage will rear their head again. This can be a bit of a shock to the system and before you know it, you’re immersed in work, family, keeping your home clean and slaving over the hob. But what about you? Where do YOU fit in to all of this? It’s easy to get caught up in life and forget about number one. Here at Physiotherapy for Women, we always ask the question ‘How important are you to yourself?’. Let’s discuss why this is important and what you can do to ensure you make 2020 more about you.

note with positive care messageSelf-care is a vital part of life. We know it’s a bit of a cliché, but if you don’t look after yourself first, how can you look after others, or work, or do anything? You’d be surprised how little time many of our patients spend looking after themselves. It often takes being in pain for someone to realise that something has to give, and change is needed. It’s also regularly the case that someone is stressed, exhausted and moving poorly (and not enough too!), which all play a role in why they have pain. And this is where we ask the questions about self-awareness and attitudes towards themselves.

Let’s give you an example… A working mum comes to us for help with neck and shoulder pain. She has two children, one at school, one at daycare, and her and her partner work a job each. The week is full of running around organising the kid’s drop-offs and pick-ups, working, cooking, cleaning and washing. Weekends are full of kids sports and visiting relatives. Sound familiar? Where is the time for anything else? For many it’s a source of stress in itself. Being time poor is a huge factor in why people fail to look after themselves and end up in pain (and stay there). For this working mum, her pain is now affecting her ability to ‘do’ life. The really hard thing is, something has to give if the cycle is to be broken and for her pain to become a thing of the past. She needs to prioritise self-care and learn that it is OK to spend time on herself. It is pivotal that she does, so she can get back on track ‘doing’ life.

As her physiotherapist, our primary goal is to get her out of pain. Our second goal is to keep her out of pain. And this is where advice on lifestyle, exercise and moving well (and often) comes into play. One of the hardest jobs we have as a physio is educating people on how to change their lives, so they can work towards preventing injury rather than waiting for it to happen and then seeking help. In the case of the working mum, it involves helping her change her attitude towards self-care to ensure she is running at 100%, so she can give everything she needs to her family and work. Some of the topics we might discuss with her and suggest changes to may include:

  • Exercise — a must for all humans. Our important bodily functions rely on us moving regularly. Try taking a walk in the evening once the kids are in bed (get your partner/family member/friend to watch over them). It will allow you to unwind from the days’ events whilst giving your body some valuable movement. Alternatively, reserve one evening in the week or weekend to attend a yoga or pilates class. Or think about what you can do at home (incidental exercise while doing mundane tasks, or a nightly 20 minutes of exercise in the lounge room or on the deck!)
  • Diet — a sticking point for time-poor people, but eating a diet rich in fruits, vegetables and other nutritious foods will keep your energy levels pumping and ready for everything. Diets high in fast or nutrient poor food will leave you sluggish and tired. Try packing your own healthy lunch and snacks, when you pack your child’s lunchbox!
  • Meditation or mindfulness — a great way to have you time. It only requires 10-15 minutes a day and is a fantastic way to unwind and clear the mind. It takes practice but can be very beneficial to easing stress. We can advise on where to get started.
  • Keep a gratitude diary — every morning when you wake up, immediately write down 5 things you are grateful for. While you can pop it in the ‘notes’ section on your phone, try opting for a pad and paper on your bedside table. It helps give you focus on what’s important to you. This is great motivation for keeping yourself healthy, happy and grateful.

There are many other areas we may discuss with you. We won’t pretend it’s easy to make these changes, but we are here to help guide you through all of it one bit at a time. Our main message here is that whilst we appreciate you have many responsibilities and important things in your life, we would like you to make YOU a high priority. Yes, this is us telling you to read that book, take that bath and take up that hobby you’ve always wanted to! Be important to yourself and make 2020 a year for self-care.