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| Acute injuries Acute injury occurs when a tissue (muscle, tendon, or ligament) is exposed to stress or strain beyond its anatomic limits. The individual can usually recall the exact moment which the injury occurred. Redness, pain, swelling, heat, and loss of function are the hallmark signs of inflammation which typically follow an acute injury. While it is a necessary process for tissue repair, prolonged or excessive inflammation leads to increased pain and prolonged healing time. Early and appropriate care can greatly improve healing time as well as minimize the chance of recurrence. Protection, rest, ice, compression, elevation, and modalities (PRICEM) should be implemented as soon as possible. In some cases, depending on the injury, the joint or muscle should be gently mobilized to reduce tissue congestion and prevent unwanted adhesions. Studies have shown that resting a joint too much following injury can have detrimental effects. Your doctor will show you the proper way to begin a rehab program. Repetitive strain injuries Repetitive strain injury occurs when the rate/amount of repetitive insult to muscle, tendon, ligament or bone occurs at a greater rate then the time it takes to heal. As a result, tissues can become inflammed and in some cases, degenerative. When not addressed, tissues may become tough and fibrotic, causing further injury and limited range of motion. Conservative management utilizing a combination of Active Release soft tissue work, therapeutic exercise, and activity modification is a safe and effective treatment option. Chronic injuries Chronic injuries are typically classified as those lasting longer then 3 months duration. Chronic pain should be differentiated with an exacerbation of an old injury. While this is typically referred to as a chronic problem, flare ups are usually treated in the office like acute injuries. Therapeutic rehabilitation exercises play a crucial role in reducing or eliminating acute flare ups of old, "chronic"injuries. True chronic pain includes long standing musculoskeletal back pain as well as pain syndromes such as fibromyalgia. Manual techniques combined with other types of treatment can be used to manage chronic pain. CONDITIONS Plantar fasciitis The plantar fascia is tough connective tissue originating at the calcaneus (heel) and splaying out towards the toes. The central portion is called the plantar aponeurosis. It plays a role in arch support during gait. Medial and lateral plantar fascia covers muscles on the sides of the sole of the foot. Training errors such as increase increased intensity, frequency, duration of an activity or a change in surface are typical culprits. Additionally, improper footwear, muscle imbalance, inflexibility, or previous injury can cause plantar fasciitis. Patients typically report pain in the arch of the foot and the heel. The first step out of bed in the morning, walking around after prolonged sitting, and walking around barefoot may be painful. as a heel spur. The spur itself is not typically painful. Soft tissues inflammation is the pain generator. Achilles tendon conditions The achilles tendon is one of the strongest tendons in the body, connecting the calf (gastrocnemius and soleus) muscles to the back of the heel. Not all achilles pain is tendonitis. Studies show that some achilles pain is more degenerative then inflammatory in nature. This is referred to as tendinosis. Tight calf muscles, training errors, poor footwear, and overuse are contributing factors. Ankle sprains The most common type is an inversion sprain, when one “rolls” the ankle. A sprain is at tear, to varying degree, of ligament tissue. Poor muscle coordination, weak peroneal muscles (muscles on the outside of the leg), poor balance, and improper footwear are common causes. The biggest risk factor for an ankle sprain is a previous sprain. It is therefore essential that ankle sprains receive early and appropriate rehabilitation to ensure proper healing. Treatment focuses on restoring range of motion, maintaining strength, and improving balance and muscle coordination. Shin splint is a vague term for leg pain, typically associated with running and running sports. A more accurate term is tibial stress syndrome which can occur on the front or medial (inside) aspect of the shin bone. Pain results from traction and irritation of the muscles attachment to the highly sensitive outer surface of bone. It is a classic repetitive strain injury where the insult to the soft tissue occurs at a greater rate then healing. Iliotibial band friction syndrome The Iliotibial band (ITB) runs from the outside of the hip, down the side of the thigh to the outside of the knee. It functions to stabilize the patella (knee cap) during movement of the leg. Friction of the band over the outside of the knee can cause lateral knee pain. This is common in cycling and running. Treatment includes correcting training errors, assessing footwear, and manually working on the iliotibial band. Patella-femoral tracking dysfunction The patella (knee cap) slides up and down in a groove on the femur as the leg flexes and extends. It depends on the surrounding soft tissues to maintain smooth movement. When there is a muscle imbalance, inflexibility, or knee injury, the patella may not track properly causing pain around the knee cap. Discomfort is typically present descending stairs or with prolonged sitting. The appropriate exercise routine and soft tissue work is essential to treating this problem of biomechanical origin. Muscle strains A strain is a tear, to some varying degree, of muscle tissue. Poor flexibility and improper warmup can increase risk for strain. With the exception of full thickness tears, early rehabilitation, therapeutic modalities, and manual care will not only expedite recovery time but will help decrease chance of recurrence. Although a strain can occur to any muscle, the calves, groin, and hamstrings are the most common. Low back pain is a multifactorial problem as there is rarely a singular cause. Low back pain varies in complexity ranging from a muscle spasm which subsides in 1-3 days to severe, pain and disability which can last weeks. Treatment must focus on empowering the patient take an active role in their recovery. They must be educated on home care, pain relieving positions and stretches, and how to return to normal activities of daily living. A passive approach to treating low back pain leads to prolonged disability and recovery time. If your doctor is not promoting spinal stabilization exercises and active care, consider consulting another health care professional. See the low back pain page for more information. Sciatica Sciatica has become the catch all phrase for leg pain. True sciatica is pain in the buttock (with or without low back pain) which runs down the back of the thigh and towards the outside of the knee. It occasionally shoots past the knee and into the calf and foot. Severe cases may include weakness in the foot and difficulty walking. The most common cause of sciatica is from disc inflammation in the low back. Occasionally, muscles deep in the buttock which surround the nerve can become tight or irritated, provoking sciatic nerve symptoms. Neck pain The most common type of neck pain is when one wakes up in the morning with a painful neck and limited range of motion. This is referred to as wry neck or acute torticollis. It may result from sleeping in the wrong position or when the neck is exposed to a draft. This type of neck pain usually goes away in 1-2 weeks. When this occurs frequently, the underlying cause (usually postural) must be addressed. Hands on soft tissue treatment, therapeutic modalities, ice, and heat can expedite healing time. While disc injuries are more common in the low back, the neck is also susceptible. The most common areas are C4-C5 and C5-6. The symptoms of a disc problem is pain in the neck which may travel down to the shoulder blade or out to the shoulder and upper arm. In some cases, pain travels past the elbow and into the forearm and hand and is occasionally associated with a sensation of numbness and tingling in the fingers. More severe cases will present with hand weakness. Tension headaches Many headaches have a muscular component. At the base of the skull, the suboccipital muscles are responsible for small motions of the head. They, along with muscles in the neck/shoulder blade region or TMJ (jaw), can refer pain to the head, temples, and even the eye region. Active Release Technique is effective in locating and relieving head pain of muscular origin. The shoulder is an Inherently unstable joint. It relies on the surrounding musculature to stabilize it and allow it to function through a wide array of motions. The rotator cuff is a series of four muscles whose tendinous cuff helps keep the shoulder joint stabilized during motion. The scapula (shoulder blade) plays an integral role in shoulder function. Weakness or poor coordination in rotator cuff and scapular muscles must be addressed in shoulder rehabilitation. Optimal muscle strength, endurance, and coordination takes pressure off the surrounding soft tissues, relieving painful conditions such as tendinitis and bursitis. Medial and lateral epicondylitis Pain in the inside and outside of the elbow are known as golfer's and tennis elbow, respectively. One does not have to play golf or tennis to get this. Anyone who performs repetitive activities of the wrist, hand, or forearm is prone to epicondylitis. The appropriate rehabilitation, activity modification, and manual therapies can control pain and strengthen the region to ensure proper healing and prevention of recurrence. Carpal tunnel symptoms Made of the small bones of the wrist and overlying ligament tissue, the carpal tunnel is a small region which contains tendons and a nerve (the median nerve). When the tendons become inflammed, it can cause pressure on the nerve resulting in pain and tingling/numbness in the hand and fingers. It is important to evaluate and treat other areas where the median nerve can be "pinched" along its path to the hand. This is often overlooked in traditional treatment. The above information is not intended to diagnose your condition. It should not replace a consultation with a health care professional. |
