The Myth of Core Stability

We have taken the excerpts below from the Lederman article in 2007. He explains the basic concept of core stability and the problems with it. Both the fitness and Physiotherapy industries adopted these concepts with the minimal appraisal, either as they appeared to offer a solution to a difficult problem (low back pain), or they made money out the concept (see Pilates and sales of small clinical ultrasound devices).

Introduction

Core stability (CS) arrived in the latter part of the 1990’s. It was largely derived from studies that demonstrated a change in onset timing of the trunk muscles in back injury and chronic lower back pain (CLBP) patients. The research in trunk control has been an important contribution to the understanding of neuromuscular reorganisation in back pain and injury. As long as four decades ago it was shown that motor strategies change in injury and pain [3]. The CS studies confirmed that such changes take place in the trunk muscles of patients who suffer from back injury and pain. However, these findings combined with general beliefs about the importance of abdominal muscles for a strong back and influences from Pilates have promoted several assumptions prevalent in CS training:

  1. That certain muscles are more important for stabilisation of the spine, in particular, transverses abdominis (TrA).
  2. That weak abdominal muscles lead to back pain
  3.  That strengthening abdominal or trunk muscles can reduce back pain
  4.  That there is a unique group of “core” muscles working independently of other trunk muscles
  5.  That a strong core will prevent injury.
  6.  That there is a relationship between stability and back pain As a consequence of these assumptions, a whole industry grew out of these studies with gyms and clinics worldwide teaching the “tummy tuck” and trunk bracing exercise to athletes for prevention of injury and to patients as a cure for lower back pain [4, 5].
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This refers to a tear of all fibres of the Achilles tendon. The Achilles tendon is the largest and strongest tendon in the body. It connects the calf muscle to the heel. It is placed under stress with every step we take and must withstand stresses of many times body weight when we run, push-off or jump. It is prone to degenerative changes which weaken it, and these can leave the tendon prone to tearing completely (or rupturing).

Achilles tendon ruptures are most common in people over the age of 40 but can occur in younger people participating in high intensity sports. The tendon will usually rupture through the mid-portion of the tendon.

achiles tendon rupture

Risk Factors

  • Genetic predisposition (collagen weakness) • Diabetes • High body weight • High body fat percentage
  • Age

Diagnosis

The diagnosis is usually made from the history and from clinical testing. Further investigations such as x-ray, MRI and ultrasound can be undertaken to confirm the diagnosis and to assess other structures.

Treatment

Treatment of the ruptured tendon is dependent on the opinion of an orthopaedic surgeon.

  • Non-Surgical – This involves immobilization of the area with a cast.
  • Surgical – This involves suturing the ends of the tendon back together followed by a period of immobilization.

Following either of these options a thorough strengthening program will be set up to help restore full lower limb function. This should be designed and guided by a Physiotherapist.

Recovery Time

Recovery time for this conditon is varible but most can regain full function within 6 – 12 months.

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Whether it’s elite level athletes or recreationalists, compression garments are in style, but is the squeeze on your body worth the squeeze on your wallet? The research says ‘probably yes.’ Graduated compression garments are tighter on the ends farther from your heart and looser on the ends closer to your heart. In some athletic designs, they are tighter over specific muscle groups. This design facilitates circulation in general. It has been used in medical situations such as lower leg edema for years. In athletic wear, the promise is that the garments will reduce fatigue and improve recovery.

compression_athletic_wear

The Journal of Strength and Conditioning Research has published a number of well-designed, placebo controlled studies conducted in Australia, Canada, and the U.S. The general consensus is that quality, well-designed graduated compression garments work well. Various studies have found results such as:

  • People asked to jump repeatedly showed less fatigue and averaged a higher jump, but the single highest jump did not increase.
  • People who biked 40KM two days in a row were 1.2% faster the second day, compared to a group of riders with placebo garments
  • Rugby players who worked out two days in a row, ran 3km 2% faster the second day.
  • Athletes who wear compression garments report feeling less sore
  • 8% greater distance covered in 45 minutes on a treadmill
  • Greater tissue oxygenation
  • Improvement of joint alignment, range of motion, and proprioception’

Most of the studies support one or more benefits of the compression garments, but not all. Despite the fact that there is an abundance of research on the subject, there may be a need for a bit more research to help determine which products work and which don’t. Some products may not provide enough compression to be effective. Some experts suggest that a compression garment needs to provide at least 18mmHg of pressure to benefit fatigue or recover. Ideally, a compression athletic garment would provide between 20mmHg and 40mmHg of pressure. Unfortunately, many garments do not print the amount of pressure they provide on the labeling. So it is also helpful to know that garments with a higher percentage of spandex typically have more compression.

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Ligaments are soft tissue structures that attach bones together, and in so doing support the join or joint between these bones. The term ligament sprain means that the ligament fibres are disrupted and is synonymous with ligament tear.

In the thumb most of these injuries occur at the metacarpophalangeal joint (or MCP joint). The ligaments that support this joint are the ulnar and radial collateral ligaments. These ligaments can either sustain a partial tear/sprain or sustain a full tear/rupture.

Ligament Injuries to the Thumb

It is important that this injury is diagnosed correctly and management is correct, as long term problems can result from incorrect management. Injuries to the ulnar collateral ligament are commonly referred to as ‘gamekeeper’s or skier’s thumb’, shown in the image below.

Clinical features

  • Pain will radiate around the base of the thumb.
  • There is usually swelling around the thumb and into the palm if it is a higher grade injury.
  • There may be bruising.
  • Patient may report a popping feeling when the injury occurs
  • It is often quite tender to touch at the base of the thumb
  • The joint may appear somewhat deformed, particularly when moved

 Diagnosis

Clinical examination will usually alert to suspicion of this injury. Certain x-ray views including stress x-rays may be useful in assessing the ligament.

Treatment

Non-surgical (conservative) management is considered for low grade injuries. Higher grade injuries and those involving fractures always require review from an orthopaedic specialist.

Conservative management is used for partial tears/sprains and will usually include the following:

  • Activity Modification/Rest – A period of activity modification is recommended to rest the injured area.
  • Immobilisation – The thumb can be braced or supported with tape
  • Strengthening – A Physiotherapist prescribed and guided strengthening program is required to help restore normal function to the thumb and hand

Recovery (this is a general guide only)

  • Mild – 1-4 weeks
  • Moderate – 4-12 weeks
  • Severe – Will require review with a hand specialist.
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This is an injury that affects the triangular fibrocartilage complex (TFCC) that sits between the ulna and radius in the wrist.

TFCC

Mechanism of Injury?

This injury occurs when there is a high compression force placed through the joint. This is usually seen with someone landing on their wrist. The other mechanism this injury can occur with is a golfer striking the ground.

Pain and Symptoms

Pain will usually be over the back of the wrist and towards the ulna side of the wrist. Often there may be some swelling over the affected area. It is usually tender to touch over the affected area. Patient may also report clicking and catching within the area.

Diagnosis

Diagnosis of this condition can usually be confirmed with the assistance of MRI.

Treatment

If there is a large tear through the TFCC this will require a review with a hand specialist and possible surgery to follow. Conservative management is used for this condition and will usually include the following:

  •  Activity Modification/Rest – A period of activity modification is recommended to help unload the irritated area.
  • Bracing – The wrist will be braced or taped in neutral to help unload the area.
  • Medication – There are several medications that are sometimes used to assist with symptoms. These should be medically prescribed.
  • Strengthening – A carefully designed strengthening program is required to help restore normal function in the wrist and forearm region.
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A Baker’s Cyst is swollen semimembranosus gastrocnemius bursa. Synovial bursae are sacs that generally occur near our joints and sometimes communicate with the joint cavity. They typically sit at sites of anatomical friction and are designed to reduce friction. A swollen and painful bursae is known as a bursitis or bursopathy and can result from a number of causes including:

  • Inflammatory arthritis
  • Gout Pseudogout Infection
  • Acute trauma Mechanical irritation through friction
  • Pathology in the joint or tendon in which the bursae communicates

In children Baker’s Cysts usually occur through irritation of the bursa. In adults they occur as the result of a chronic knee swelling, usually with a posterior horn medial meniscal tear.

bakers_cyst

Pain and Symptoms

Symptoms can include some or all of the following:

  • Pain if present will usually be around the back of the knee
  • It is usually tender to touch over the region
  • There may be a visual lump in the back of the knee

Diagnosis

MRI will confirm both the presence of the cyst and also will be able to identify the underlying pathology in the knee which is causing the cyst to develop.

Treatment

This often requires no treatment. If there is no pain or loss of function they can generally be ignored. If treatment is necessary it will consist of treatment to the underlying problem (eg the meniscal tear).

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ITB is an abbreviation for the “iliotibial band” which is a strong, flat tendon-like structure which connects the muscles of the hip to the outside of the lower leg. Friction occurs as the lower part of the ITB rubs over the lateral femoral epicondyle. If the ITB is tight and the rubbing becomes repetitive, increased friction will result causing irritation of the band and the bursa (a fluid filled sac) which sits between the band and the underlying surface. The band often rubs over the bony prominence at around 30 degrees of knee flexion.

Iliotibial Bandriction Syndrome

Who is affected by ITB friction syndrome?

ITB friction syndrome is very common in runners (both novice and elite) and becomes prominent after an increase in training volume. There are both modifiable and non- modifiable factors that can lead to this condition.

MODIFIABLE

  • Footwear
  • Training Volume
  • Excessive downhill running
  • Weak hip muscles
  • Tight hip muscles
  • Excessive Foot Pronation (flattening)

NON-MODIFIABLE

  • Naturally thick ITB
  • Naturally tight ITB
  • Prominent lateral femoral epicondyle
  • Increased Q angle (related to shape of the pelvis)
  • Symptoms of ITB Friction Syndrome includes
  • Pain at the outside of the knee
  • Pain with exercise especially running and riding
  • Pain with stairs (especially coming down)
  • A “snapping” or “catching” sensation of the knee

Advanced Physio treatment

Advanced Physio uses a combination of treatments dependent on the severity of the injury. We recommend initially treating the injury using Advanced Physio’s manual therapy, exercise prescription in combination with:

  • Rest from aggravating activity
  • Ice the area
  • Anti-inflammatory medication, as directed by referring doctor

Our physiotherapy treatment will be customised to suit the patient and may include:

  • Stretching of hip muscles (gluteus maximus and tensa fascia latae especially)
  • Strengthening of hip abductor muscles
  • Stretching of the ITB
  • Foot wear modification (if required)
  • Orthotics (if required)
  • Gait analysis and correction

 

 

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An acute wry neck is the sudden onset of neck pain accompanied by spasm of the neck muscles.

The main symptom is pain localized to one side of the neck. The pain can be referred to the head or shoulder region.  The neck feels “stuck” in one position and attempted movements to free it usually results in sharp spasms of pain. Think of these joints becoming jammed or locked, rather like a door jamming on its hinge. The result is a painful, protective muscle spasm.

wry neck

Anyone can get a wry neck but it occurs typically in young people between 12 and 30 years of age.

The precise cause of a wry neck is unknown. It may be the result of a
 minor injury or simply sleeping with the neck in an unusual position.
 For many years the theory was that a “slipped disc” caused a wry neck,
 but with the help of modern diagnostic imaging the cause seems to be an injury to the facet joints. Contrary to popular belif , a wry neck is not caused by a cold draught of the neck

Sometimes a wry neck can be caused by an inflammation of the lymph glands in children.

Fortunately an acute wry neck is a transient and self-limiting condition that can recover in a matter of days.  Advanced Physio’s therapists are skilled in treating most neck pain ailments and can effectively assist with pain relief and a rapid recovery.

Our Advanced Physio team use a variety of treatments, including manual therapy – a very effective treatment since it uses a combination of massage, joint mobilizations, stretches and strengthening exercises.

Patient support & self-help at home

To help relieve the pain and discomfort between treatment sessions, Advanced Physio would recommend that at home, patients do the following:

  • Heat and massage.  Applying a heat in the form of a hot face washer or heat pack to the painful area may help. Massage using an analgesic balm can also relieve symptoms.
  • Sleeping and pillows. Avoid sleeping on too many pillows. Pillows should support the head without bending the neck to an angle.
  • Tailored Exercise. Keep neck mobile within patient’s comfort zone. Advanced Physio can design gentle exercise that aids a more rapid recovery.
  • Posture. Keep a good posture during all tasks. As part of a patient’s treatment, our physiotherapist will demonstrate how to achieve this.
  • Driving. Driving during the initial period of a wry neck should be avoided; the inability to get full rotation of the head to view oncoming traffic is hazardous.

 

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 A SLAP lesion is as a result of an acute trauma due to overload, resulting in a degenerative lesion.

The most common mechanism of injury is repetitive overload (e.g. swimmers and throwing sports) or excessive inferior traction (e.g. carrying or dropping and catching a heavy object).

SLAP_Lesion

 Symptoms of a SLAP Lesion

A typical symptom of a SLAP lesion includes a catching sensation and pain with shoulder movements, most often overhead activities such as throwing. Patients usually complain of pain deep withinthe shoulder or in the back of the shoulder joint. It is often hard to pinpoint symptoms, unless the biceps tendon is also involved.

There a four (4) types of SLAP lesions. Conservative management for all, but the most minor SLAP lesions are usually unsuccessful.

Unstable (shoulder feels as though it will give way) SLAP lesions (types 2 and 4) should be repaired arthroscopically by reattaching the labrum to the glenoid. Stable SLAP lesions (types 1 and 3) usually respond to arthroscopic debridement to eliminate mechanical irritation is usually adequate.

Labral lesions are often associated with a shoulder that feels unstable; this will be addressed with a graded strengthening program for the shoulder and scapula stabilisers. This should be designed and supervised by your Physiotherapist. In some cases repair is not possible and a small portion of the meniscus may be trimmed or cut out to even-up the surface.

 

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If you have back Pain, read tour following tips to take care of your back.

Your whole body must keep active to stay healthy. It thrives on use.

Regular physical activity:

  • Develops your muscles
  • Keeps you supple
  • Gives you stronger bones
  • Makes you fit
  • Makes you feel good
  • Releases natural chemicals that reduce the pain

Even when your back is painful, you can make a start without putting too much stress on

it by:

  • Walking
  • Swimming
  • Exercise bike
  • Dancing/Yoga/keep fit

shutterstock_370613435

Exercise gets your back moving again by stretching tight muscles and joints, and stops the working parts seizing up. It also makes your heart and lungs work and improves physical fitness.

Different things suit different people. Experiment – find what works best for you and your back. Your goal is to get moving and steadily increase your level of activity. Do a little bit more each day.

Getting stiff joints and muscles working can be painful. Athletes accept that when they start training, their muscles can hurt and they have to work through the pain barrier. But that does not mean they are doing any damage. So don’t worry if exercise makes you a bit sore at first – that’s usually a sign you are actually making progress! As you get fully fit the pain should ease off.

No-one pretends it’s easy. Pain killers and other treatments can help to control the pain to let you get started, but you will still have to do the work. There is no other way. You have a straight choice: rest and get worse, or get active and recover.

Do not fall into the trap of thinking it will be easier in a week or two, next month, next year. It won’t! The longer you put it off, the harder it will be to get going again. The faster you get back to normal activities and back to work the better – even if you still have some restrictions.

 

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