Back pain in new mums
Mother’s Day is just around the corner, so we wanted to dedicate this blog to all the mum’s out there. Being a mum is a tough job for anyone. Juggling work, keeping a home, family and friends, and of course caring for your little ones, can be draining both emotionally and physically. This is especially the case if you are a new mum, when life with your new addition is in its settling in period. Your body has been through a major change over the last 10 months, and it’s still changing now. Having a baby is a big deal, and you now have a recovery period ahead of you. But of course, you have a child to care for constantly, so there’s no time to worry about yourself, right? Wrong… it’s a difficult balance for sure, but looking after yourself means you’ll be able to look after your new recruit to the very best of your abilities.
My back STILL hurts 🙁
Pain is a common symptom experienced by new mums, with approximately 10% of women still experiencing pain two months post-delivery. Imagine being in pain all that time AND having a baby to look after – it doesn’t sound fun does it? Now, whether you’ve been through a natural birth or c-section, your body is vulnerable and weaker than pre-pregnant you, so it’s important to look after yourself to ensure you recover quickly and nip that pain in the bud!
The back is one of the most common areas of the body affected during and after pregnancy. Other areas include the pelvis and the wrists. The main reasons your back will complain in those early days boils down to the fact your posture won’t have a clue what has just hit it. Firstly, during pregnancy, ligaments become lax, muscles stretch or separate, which can produce imbalances or weakness. Even your breathing might change, depending on where bub is sitting in your uterus. Then of course your body is frantically trying to realign your centre of gravity to deal with your growing bump. Your body is working like crazy simply to keep you upright!
Then baby comes along. Of course, there’s the trauma you may experience with a vaginal or cesarean birth. Then, straight away, you will be feeding, changing, bathing and dressing/un-dressing your bubba multiple times a day. All these activities require you to have your baby lying down in front of you, with you bent over them, keeping them fed, warm, and happy. This continuous motion, combined with broken sleep, tiredness, and a recovering body, can lead you to over-work those back muscles. It’s also important to remember that your core muscles will have taken a big hit during pregnancy, so you won’t be as stable in the trunk as you were pre-pregnancy. Eventually your body will let you know things are not right by sending a few signals to the brain – hello pain!
What can I do to help?
Now you know why you may experience back pain, we want to let you know some of the things you can do from the very first day you bring your newborn home, to care for your back (and the rest of you of course), and reduce the risk of injury and pain. That way, you can dedicate 95% of your time to looking after your son or daughter. “Only 95%” we hear you ask – don’t worry, we’ll get to that!
To reduce the impact of feeding on your back, consider the following tips:
- Get a comfortable and supportive feeding chair: Avoid chairs that allow you to sink into them, such as a low arm chair or sofa. You will struggle to get yourself up from a slouched position, whilst holding your baby, without risking strain on your back and shoulders.
- Move regularly: Enjoy the one on one time, it’s magical! But, when you sit for long periods, your back and neck muscles will eventually feel it. Try some light neck stretches, and gentle spinal movements like rotating side to side and extending to open out the chest.
- Try a feeding pillow: As your baby grows, they will get heavier and heavier. A feeding pillow will take the weight of your baby so your arms, shoulders and back don’t have to bear the brunt of it all.
- Get your partner involved: If you’re a bottle feeder, then spread the load and ask your partner (or another family member) to feed when possible to give you a break. If you are breast feeding, they can still help by taking the baby from you when you have finished so you can get yourself up off your chair, minus the weight of your baby.
Oh so many nappies! “I didn’t sign up for this!” Ahem, sorry, yes you did! Just embrace the poo… It gets easier ;). The following tips also apply for dressing your baby:
- Get a change table: Whether it’s a nappy change or outfit change, do it at a height where you can stand comfortably and not be bent over for long periods.
- Following on from the above point… Avoid changing your baby on the floor. It’s not only your back that might complain, but your neck, shoulders and knees also!
There is no easy solution to this one. Most baths are low to the ground and require you to kneel and lean right over to get to where you need to be. However, we have found that baby baths can be useful as they are small, mobile, and can be placed at a height that suits your back better. Some change tables even double up as baby baths. Obviously be careful about carrying a heavy bath of water though – as long as it’s safe, try to bath your baby near a sink where you don’t have to carry the bath to fill and empty it.
So, you mentioned 95%?
You’re right, we did! And this is very important. Your baby is going to need lots of attention. But you also need attention. So, the remaining 5% is just for you. The following tips are aimed to address other areas of your life that often get neglected when being a new mum:
- Sleep when the opportunity arises: Whether this is when your baby is sleeping, or when your partner or family member are looking after your baby, getting sleep is very important. You need time to restore energy levels and allow the body to repair and recover. Who cares if the housework gets left for an extra day or two – it will still be there when you are ready to do it. Better still, get a family member to help. Team work!
- Eat well, stay hydrated: Don’t forget about the importance of a good diet. Eat lots of fresh, nutrient rich food, such as fruits and vegetables. And keep a bottle of water on the go constantly. It’s easy to forget and become dehydrated. If you are breast-feeding, remember where the water in the breast milk comes from… YOU!
- Have a bath: Of course, this doesn’t have to end at bathing. Read a book, do a crossword, go and sit in the garden with a cuppa… Our point is, make time for yourself regularly. These little breaks will keep you sane during a chaotic time of life. If help is at hand, use it. It is OK to have a break from it all. We cannot stress this point enough.
These last points can also help in the fight against back pain. Sleeping, eating and relaxation will help to reduce the risk of fatigue. Fatigue will compromise your ability to hold your posture in standing, sitting, and other positions such as bending. So, you can see why the 5% is so important.
At some point, you will need to address the physical changes that have occurred as a result of pregnancy and giving birth. These may include abdominal and pelvic floor muscle dysfunction, as well as spinal and other joint restrictions and dysfunctions. Every woman that has given birth needs to rehabilitate and strengthen their core again. Unfortunately, many don’t get around to it or it isn’t high on their priority list. However, (see points above) it needs to be! And of course, if you’re reading this and are pregnant, or thinking about having a child, there is so much you can do pre-birth to aid your recovery after having your baby, so come and see us!
If you’re a new mum or have had a child in the last few years, we can’t recommend enough to come and see one of our women’s health focused physios. We’ll assess you, and advise you on the best course of treatment and exercise to get you ‘back’ (excuse the pun) fighting fit and who knows… Another baby anyone?!
Stress urinary incontinence – what causes it, how to treat it and how to prevent it
Running, sneezing, jumping, laughing – they should be normal activities, but for some women they bring embarrassment or anxiety. Bladder weakness, incontinence and urinary leaking are common problems, especially in women after giving birth or going through menopause. There are many causes of bladder weakness, but today, we’re focusing on one of the most common: Stress urinary incontinence (SUI).
What is stress urinary incontinence?
SUI is where the bladder leaks a small amount of urine during activities that put pressure on the abdomen and push down on the bladder, like coughing, running or laughing.
What causes it?
Stress incontinence in women is often caused by pregnancy,
childbirth and menopause. In a quick anatomy lesson, your urethra transports urine from your bladder out of the body, via a muscular structure called the urethral sphincter. The sphincter contracts to hold urine inside your body until you’re ready to go.
During pregnancy and childbirth, your pelvic floor muscles can stretch and weaken. The muscles normally support the urethra, so when they, or the sphincter muscles, are weak, they can’t do their job properly and hold your wee in. During menopause, the female hormone, oestrogen, is produced in lower quantities. Oestrogen helps maintain the thickness of the urethra lining, so sometimes with decreased oestrogen, the lining is affected, and some women experience SUI.
It’s most common with activities such as coughing, sneezing, laughing, walking, running, lifting or playing sport. Other factors that can contribute to SUI include diabetes, obesity, constipation, and a chronic cough (often linked to asthma, smoking or bronchitis).
How to treat it?
Every single person is different, so it’s always best to see your Pelvic floor physio so we can assess you and work out the best treatment plan for you. However, some common treatments we recommend to our patients include:
- Pelvic floor exercises (see below for more information!).
- Changes in fluid consumption: This could include drinking certain amounts of fluids at certain times of the day. Or it could involve cutting down caffeine or alcohol to see if they irritate your bladder.
- Healthy lifestyle changes: Quitting smoking, losing excess weight or treating a chronic cough will decrease your risk of SUI, as well as improve your symptoms.
- Bladder training: We may recommend a schedule for toileting, depending on the type of incontinence you have. This is more so used when it’s a mix of SUI and another type of incontinence.
- Manual therapy: You may have some muscular imbalances that are inhibiting your pelvic floor from working properly or are impacting on other parts of your body. We’ll assess you, and then put together a treatment plan, which may include soft tissue massage, other musculoskeletal therapies, strengthening or stretching exercises, or more.
How do I prevent it?
Remember your physios, nurses, doctors, female relatives, mum friends (and the list goes on) telling you to do your pelvic floor exercises or Kegels when pregnant? Well, that’s one piece of advice you should listen to! In fact, it doesn’t matter whether you’re pregnant or not, you should always do your pelvic floor exercises to help strengthen those important muscles. Some basic pelvic floor exercises include:
- Draw your pelvic floor muscles in and up, like you are trying to stop urinating mid-flow. Hold for 10 secs. Relax for 5-10 secs between each tightening and repeat 10 times. (Don’t actually do your pelvic floor exercises on the toilet – trying to stop while actually urinating can cause other bladder issues)
- You can add faster pelvic floor lifts to the exercise by holding for 1-3 secs and relaxing for 1-3 secs. Repeat 10 times.
- Progressing the long holds to 20 secs and then 30 secs may be a goal to reach for.
Try and make pelvic floor exercises part of your routine. For example, do them when you brush your teeth each morning and evening, and when eating lunch. There are also many more exercises to help you, including core exercises such as Pilates.
Pelvic floor exercises should not cause any discomfort or pain. If you have a history of pain with intercourse, vaginal exam or using tampons, or if you have trouble emptying your bladder or starting a wee, you should see a Pelvic Floor Physio prior to starting pelvic floor exercises.
If you’re experiencing urinary leaking, are pregnant, have given birth (at any point in your life!), or if you want help with a preventative program, please come and see us. It is always best to see a Pelvic Floor Physio to get an individual program and to be confident on correctly tightening your pelvic floor muscles. We have helped thousands of women with stress urinary incontinence over the years and would love to help you live a happier, less-anxious life, so you can laugh all you want without having to worry about incontinence!
Your 2019 self-care bucket list
“New Year, new you” is often the slogan thrown around at this time of year, but we’re changing that. We think you’re pretty awesome, so it’s not about a new you, it’s about taking the time and becoming a better version of you.
Women, traditionally, are the care givers – the women’s role used to be looking after the house and children (and husband), while hubby made the money. Of course, over time, the world has progressed, and we do it all. And while there are absolutely amazing husbands and fathers out there that are hands on, women still tend to feel the pressure of working (however you’d like to define it), running a house and looking after children. And with everything going on around us, we put ourselves and our wellbeing at the end of the priority line. And that has to change, so for 2019 we’ve created a short self-care bucket list, for you and all the women in your life!
- Accept that self-care is not selfish
Taking time for you needs to be a priority. Whether that’s booking a hair appointment, reading a book in the bath (without interruptions), or going for a walk or swim, you need to do it – for your wellbeing, and the wellbeing of your family! When you schedule in you-time, it gives you the ability to relax, reflect and Zen-out. It gives your mind a break from the daily rigmarole of life. Don’t think of it as selfish – it’s actually the opposite. Taking self-care time makes you less stressed, more relaxed and happier – it makes you a better version of you, and therefore a better mother, wife, daughter, sister and friend.
- Practice positive posture
Think about the way you sit, stand and go about things in your daily life – even holding your baby! Correct posture not only helps with aches and pains, and reduces the risk of injury, it can also help with improving oxygen and blood flow.
Also try to avoid sitting for long periods – research shows that sitting for long periods can have a negative effect on your body and can lead to lower back pain, as well as the onset of chronic diseases such as obesity, diabetes and cardiovascular disease. Avoid sitting for longer than 30 minutes at a time, and when sitting, change positions regularly.
If you sit at a desk for the majority of the day, check out our diagram and make sure you’re set up correctly. Also make sure you break every 30 minutes – this could simply be standing up and doing a simple chest stretch, walking to chat to a colleague instead of phoning, or invest in a standing desk so you can alternate between sitting and standing.
- Move more
Doing physical activity is not at the top of everyone’s priority list but staying active is so important – it is recommended that we do a minimum of 30 minutes per day. But now here’s the twist!
If the word ‘exercise’ makes you cringe, start small. Start by counting your ‘physical activity’ minutes. Vacuuming, park your car at the back of the car park to walk to the shops, do squats while you brush your teeth. If you can start including incidental activity while you’re doing your daily tasks, you’ll find it much easier to increase the amount of physical activity you undertake. You’ll start to have more energy, and then all of a sudden that 15 minute ‘me-time’ walk becomes a blissful idea, then an action. A couple of weeks later it has turned into a half-hour ‘me-time’ walk, because you simply have to finish that podcast! So, move more but start small!
- Make meditation moments
Keeping healthy isn’t limited to food and exercise – it’s also about your emotional and mental health. When you’re swept up in the craziness of school drop-offs, work, events, and children’s extra-curriculars, a great way to calm the mind is meditation. Meditation helps reduce stress, strengthen your ability to focus and can assist in getting a good night’s sleep.
You don’t have to be a yogi or hippy, nor do you have to sit cross-legged on the floor. Meditation attracts many people because it’s flexible and versatile – you can do it anywhere at any time. Try deep breathing for 10 mins before you sleep, have a relaxing bath, or even sit in your car while your child is at dance lessons or football practice, close your eyes and let your mind slow down for ten minutes – bring your mind to the present moment and just breathe.
You are important, so this year, let’s make a pact that we will put self-care as a priority. If we take better care of ourselves, we’ll be better versions of us, and a better mum, wife, sister, daughter and friend. Start small and commit to your self-care bucket list!
If you’re taking steps to implement this bucket list, we’d love to know what you’ve done, and with your permission, share it with our clients to inspire and encourage others to prioritise their self-care journey. Please send your stories and/or photos to us at firstname.lastname@example.org or post them on our Facebook page www.facebook.com/physiotherapyforwomen.
Women, headaches and stress
The idea of Christmas usually fills us with joy, but as we start thinking of logistics and ticking things off our mental to-do list, it can become quite overwhelming and stressful. With stress often comes headaches, so we’ve listed the most common headaches women experience at this time of the year, and what you can do to help.
These are the most common types of headaches, and about 42% of women experience these (men are 36%). On average, they start in teenage years, peaking in your thirties and then decline.
These can be triggered by:
- Poor posture
- Bright lights, prolonged reading, loud noise
- Medication overuse
- Stress, anxiety
- Fatigue, emotional upsets, depression.
You can help relieve a tension headache by:
- Reducing stress, or being in a state of mental and physical relaxation
- Leading a healthy life: Get the right balance of work, fun, rest, sleep and exercise
- Psychological treatment to help with anxieties or emotional pressures
- Manual therapy treatment, such as massage or dry needling
- Other physiological treatment such as heat pads, compress and deep breathing
- Over-the-counter medication such as aspirin, paracetamol or ibuprofen.
Migraines can be pretty severe, and there are many types. They are usually one-sided and often accompanied by sensitivity to light, sound or smell, nausea, vomiting or cold hands. Some people also experience migraines with ‘aura’ which may include visual disturbances or numbness in the arm or leg. They can last from part of a day to three or four days and affect about 15% of Australia’s population.
It’s shown that your susceptibility to migraines is normally inherited (now which side of the family do you blame?), and there can be certain triggers (different for everyone), which include:
- Dietary triggers: Some common ones include missed, delayed or inadequate meals, caffeine withdrawal, certain alcohol, chocolate, citrus fruits, aged cheese and cultured products, monosodium glutamate (MSG) and dehydration.
- Environmental triggers: Common ones include bright or flickering lights, bright sunlight, strong smells, travel or flying, weather changes, loud sounds, going to the movies or overuse or incorrect use of computers.
- Hormonal triggers: Three times more women suffer from migraines than men, with the difference being most apparent during reproductive years. Some common ones include your last menstrual period, menstruation, ovulation, oral contraceptives, pregnancy, hormone replacement therapy and menopause. We’ll go into more detail about this below.
- Physical and emotional triggers: Common ones include lack of sleep, oversleeping, illness, back and neck pain, sudden, excessive or vigorous exercise, emotional triggers such as excitement or arguments, and relaxation after stress (known as a weekend headache).
There is no cure for migraines, but medication or alternative therapies might help. Alternative therapies include physio and massage, as well as many other areas like aromatherapy and meditation.
Hormones and headaches
Women get more headaches than men, with the difference noted most during the reproductive years, as mentioned above. There are three main areas to hormones and headaches:
- Migraine and menstruation: The ratio of migraines in children is 1:1 female to male. During reproductive years that ratio changes to three females to every one male. While there are many opinions as to why this is the case, most experts do agree that it’s mainly to do with a fall in oestrogen that triggers a migraine. Migraines associated with PMS (pre-menstrual syndrome) may improve with over-the-counter medications such as evening primrose oil, vitamin B6 or magnesium supplements. Always check with your doctor before taking vitamin B6 as it can have toxic side effects. Doctors can also prescribe other medications. Think about keeping a headache diary so your doctor can better understand the relationship between your cycle and headaches/migraines.
- Migraine and contraception: The effect of hormonal contraception on migraines is varied – some women get migraines when they start contraception, sometimes it makes them worse, and sometimes it has no effect. Generally speaking, a high dosage pill tends to increase the frequency and intensity of headaches, however a small number of women reported an improvement when they started taking the pill. Talk to your doctor about the best way forward.
- Migraine and pregnancy: Migraines don’t put pregnancy at risk, but they can be a concern, especially if it occurs for the first time. Studies suggest that 60-70% of migraine sufferers feel an improvement in their migraines during pregnancy – especially during the second and third trimesters. If you’re getting migraines during pregnancy, consult your doctor as many manufacturers don’t recommend their medication. After giving birth, many new mother’s (3-40%) suffer from headaches, migraine re-starts, or may get a migraine for the first time. However, if other headaches occur, see your doctor, as they could be related to a number of other medical issues that may need investigation.
- Migraine and menopause: Many women find that their migraines worsen leading up to their last period, and shortly after. Those who may not have noticed a link with their menstrual cycle might start developing regular monthly migraines. Some women choose to undergo Hormone Replacement Therapy (HRT), which replaces oestrogen that the ovaries can no longer produce. In theory, this should help migraines, but alas, the reality might not reflect this! HRT can both relieve migraines and aggravate them. Research suggests oral HRT is better for women who suffer migraines, but always talk to your doctor.
There are so many different types of headaches, and treatment varies from medication to manual therapy and physio. Whatever you’re experiencing, consult your doctor, or get in touch with us – we help many women with their headaches, and would love to help you too.
5 reasons why your shoulder is hurting
Our shoulders are pretty awesome, but they are indeed a complex little network of muscles, tendons, ligaments and bones. And an injury or imbalance can cause anything from a niggle to excruciating pain. Here’s a list of five common shoulder injuries to help you figure out why your shoulder is hurting.
Do you have severe stiffness in your shoulder, unable to move it the way you normally would? You might have frozen shoulder. Its medical name is Adhesive Capsulitis, and it happens when the connective tissue that lines your shoulder joint becomes thickened and inflamed. It’s most common in middle-age women, and there are certain factors that put you more at risk. For example, up to 20% of people with diabetes develop frozen shoulder, and those with thyroid problems or Parkinson’s disease may also be more at risk of developing it.
If you think you have frozen shoulder, see your physio. It’s often a long road to recovery, and while frozen shoulder might fix itself eventually, a physio helps speed that process up.
Rotator cuff tendonitis
There are four rotator cuff muscles in the shoulder joint. They are responsible for keeping the ball of your upper arm bone (humerus) in the shoulder socket (scapula – or shoulder blade), and they help you rotate, lift and drop your arm.
If you perform repetitive movements using this joint, it could lead to inflammation of the rotator cuff tendons, which can cause pain. Tendonitis usually begins as a mild weakness or pain when moving the joint, but if left untreated, can become more severe and constant. To help it heal, avoid doing the repetitive activity, use ice or heat, and see your physio for manual therapy and strengthening exercises. Anti-inflammatory medication, like ibuprofen, may help with the pain.
Rotator cuff tear
You can partially or completely tear a shoulder tendon from excessive repetition or direct trauma, like a fall. If you have a sudden tear, your pain can be severe, however if you have a chronic tear, your pain, weakness or stiffness can worsen over time – so much so that you may not realise it’s even torn due to the gradual onset.
Rest from aggravating movements, ice or heat are helpful in recovery from tears. Anti-inflammatory medication may help with pain, but usually physio will be recommended to strengthen muscles and improve the mechanics of the shoulder joint. In some cases, a cortisone injection or surgery may be required.
Any of the tendons or bursa (a fluid-filled sac that provides a smooth surface for your bones and muscles to glide over) that run through the small space in your shoulder joint can get impinged or pinched between the bones if inflammation occurs. You usually experience pain when moving your arm, especially when reaching overhead or backwards, or lying on your sore side. Many impingements are the result of repeated overhead activity, like when cleaning windows and bathroom tiles or when swimming.
Impingements may eventually weaken the rotator cuff, so if you think you have one, visit your physio. It’s important that you get treatment to alleviate pain, strengthen appropriate muscles and make sure your muscles are balanced so it doesn’t occur again.
Often known as ‘OA’, Osteoarthritis stems from wear and tear on the shoulder joint. Your cartilage acts as a cushion between your bones, helping them to glide easily. OA destroys this cartilage, so that your bones rub against each other, instead of over the cartilage. This is painful and can cause swelling as well, making it difficult for you to move your arm. People sometimes say they hear a grinding or clicking sound when moving the shoulder.
Movement is medicine when it comes to OA, although there may be times when rest or modification of movement from aggravating activities is required. You can also use heat or ice, and anti-inflammatory medication might help. Your physio will also treat your shoulder, giving you exercises to both stretch and strengthen the muscles in and around the shoulder joint. In some cases, steroid injections might also be recommended.
These are just five common reasons your shoulder might be hurting – there are many more. Other reasons could include neck pain which presents in the shoulder, or a labral tear. If you experience any of these, reduce or stop the activity that is causing pain, and book in to see your physio for treatment. Trauma to the shoulder may lead to dislocation or a bone fracture, which will likely require an initial emergency department visit. Also keep in mind that pain in your left arm/shoulder (accompanied by chest pain) can also be a sign of more severe conditions, such as a heart attack. If you think you’re experiencing symptoms of a heart attack, ring 000 or go to the hospital immediately.
What does Tennis Elbow mean?
Tennis elbow is a painful condition affecting the outside part of the elbow. This area is called the lateral epicondyle and so the medical term for this condition is lateral epicondylitis. Tennis elbow is usually caused by overuse of the forearm. The outer elbow tissues become inflamed. This involves wrist and elbow extensor muscles being overused in repetitive movement and/or sustained postures. Many forearm muscles attach at or around the lateral epicondyle so when they are overused they pull too much on the elbow and make it sore. Patients typically develop this condition in association with activities involving repeated wrist extension against resistance or from activities involving repetitive or forceful gripping of the hand. This includes sporting activities such as tennis and squash, manual work such as gardening, painting, cleaning, sewing and knitting or working at a computer.
What are the symptoms of Tennis Elbow?
Symptoms of pain, stiffness and inflammation are common with tennis elbow. Pain can be constant or it just comes and goes with particular wrist and elbow movements. The elbow and forearm pain is often aggravated with grip activities. Even a simple activity of holding a pen and trying to write can be uncomfortable.
Pain and tenderness is usually felt on the outside of your dominant elbow and into the upper forearm. The pain is often aggravated by wrist movements such as gripping, where the use of inflamed forearm muscles and tendon tissues near the outer elbow hurts.
Most cases of tennis elbow settle well with appropriate physiotherapy. This requires careful assessment by the treating physiotherapist to determine which factors have contributed to the development of the condition. The assessment findings determine a treatment plan which will focus on correction of the factors causing the pain.
Physiotherapy Treatment for Tennis Elbow
Physiotherapy treatment for lateral epicondylitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Physiotherapy treatment may be a selection of the following:
- Soft tissue massage and myofascial release
- Joint mobilization
- Dry needling
- Ice or heat treatment
- Progressive exercises to improve flexibility and strength
- Activity modification advice
- Technique correction
- Anti-inflammatory advice
- Devising and monitoring an appropriate return to sport or activity plan
How long will my tennis elbow
With appropriate management, most minor cases of tennis elbow that have not been present for long can usually recover within a few weeks. In more severe and chronic cases recovery can be lengthy process and may take up to 6 months in those who have had their condition for a long period of time. Early physiotherapy intervention is therefore vital to hasten recovery and enable you to use your arm in everyday activity with comfort.