Ankle Injuries – Sprain, Strains and Fractures

Common conditions, Exercise, Injury, Lifestyle, Pain

Ankle sprain main

An ankle injury is the most common type of injury that may involve the bones of the ankle and other soft tissue structures. Three are three types of injuries that are observed at the ankle:

  • Sprains
  • Strains
  • Fractures

Sprains are injuries to the ligaments that connect one bone to another. An ankle sprain may involve an injury to one or more ligaments that stabilize the ankle and the foot. 

Strains are injuries that involve musculotendinous (muscle and tendon) structures. Both sprains and strains can occur due to over-stretching or tearing of the ligaments and tendons due to sudden twisting of the ankle joint or when excessive forces are applied on them.

Fractures are injuries that involve bones of the ankle joint. It ranges from a simple break in one bone to several fractures, which causes your ankle to move out of place and puts you in great pain.

Who could be at a risk of an ankle injury?

Ankle injuries may occur among,

  • Dancers
  • Sports persons- Gymnasts, basketball players, players participating in jumping sports etc.
  • Women wearing unstable high heels
  • Hypermobile people who already have laxed ankle ligaments 

Types of Ankle injuries

  • Lateral ankle injury

This is the most common injury to the ankle. Often, an inversion sprain could be an associated with a fracture and a strain to the peroneal tendons.  

An inversion sprain happens when the ankle in twisted inwards with an inward rolled foot as shown in Fig 1.

inversion injury

Fig 1: Lateral ankle injury

  • The Medial ankle injury

This type of injury occurs at the inner aspect of the ankle. Like a inversion sprain, the eversion sprain may also be associated with fractures of lower ends of the leg bones and strains to the tibialis anterior muscle.  

Eversion sprain happens when the ankle is twisted out with the foot rolled outwards as shown in Fig 2.

eversion injury

Fig 2: Medial ankle injury

High Ankle Injury

This type of injury is very rare. A high ankle sprain happens when the tibia bone rotates injuring the ligaments that hold the lower end of the two leg bones (tibia and fibula) as shown in Fig 3.

Severe injuries may cause fracture to the lower ends of the leg bones.

syndesmosis injury

Fig 3: High ankle injury

Severity of an ankle sprain 

An ankle ligament sprain can be graded according to the severity of the tear in the ligaments as shown in Fig 4.
 
lateral ankle sprain

Fig 4: Grades of ankle sprain

Sign and Symptoms of Ankle Injury
 
    • Swelling: Increased fluid in the tissue due to inflammation and soft tissue damage.
    • Pain:  Depending upon the severity of the injury and the structures involved, pain intensity can vary. 
    • Redness/ Warmth/ Tenderness: Caused by increased blood flow to the area.
    • Unstable ankle: The affected side feels weak and difficult to weight-bear.
    • Deformity: Severe injuries can cause fractured bones to move out of place and make the ankle look deformed.
Causes of Ankle Injury
Trauma
  • Stepping in a hole or a stone
  • Running on uneven ground
  • Fall or slippage on wet floor
  • Contact injury during sports like basketball, when a player is accidentally hit by an opponent causing the foot to roll inwards as shown in Fig 5.
Basketball

Fig 5: Lateral ankle sprain during basketball

Muscle imbalances

Lack of flexibility in muscles can hamper joint movement. For example, if the calf muscles are very tight, it will affect the stability and mobility of the ankle joint. In such a state, if one engages in any physical activity like running there could be a potential risk of twisting an ankle. Sometimes even lack of warm-up and stretching could be the cause of muscle imbalances.

  • Lack of Postural control

Postural control is defined as the act of maintaining, achieving or restoring a state of balance during any posture or activity.

It helps to maintain a good base of support for balance so that the force of gravity can act on the center of mass (COM) of the body. Centre of mass is the point in the body where the entire body weight is concentrated (located in the lower end of the spine) as shown in Fig 6.

Figure_10_03_05

Fig 6: Line of gravity and base of support

During sports, sudden quick body movements or external forces like a push or a contact by an opponent will affect your balance. If you lack postural controlm you may lose balance and risk hurting your ankle. 

Diagnosis of an ankle injury

Most ankle injuries are usually straightforward ligament strains. However, the clinical presentation of subtle fractures can be similar to that of a ankle sprains and these fractures can be easily missed on initial examination. Fractures are usually detected via X-ray scans. If any fracture is left untreated, it may cause excessive pain and disability to an extent that you may not be able to bear weight on the joint. Therefore, an X-ray or an MRI scan is often recommended to understand the severity of the injury.

For example, a lateral ankle sprain showing fractured bones in an X-ray is shown in fig 7. 

ankle sprain with bone fracture

Fig 7: Lateral ankle sprain with fracture of the lower end of fibula bone

Ankle Injury management

Usually, ligament injuries heal in about 6-12 weeks and fractured bones take about 3-6 months to heal. This is however largely dependent on the severity of the injury and lifestyle of the individual so complete healing time frame may vary. 

Even after the healing process, ankle injuries may cause long term instability if not healed correctly. This may also be the cause of recurrent ankle sprains. An expert assessment of ankle mechanics is very important to decide on how long to protect and rehabilitate an ankle after an injury. The treatment plan will aim to restore the normal functions of the ankle and make return-to-play decisions based on the stability of the ankle thus preventing recurrent ankle injuries.

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Common Knee Ligament Injuries

Common conditions, Injury, Lifestyle, Pain

17vike0510.jpg

A ligament is a band of connective tissue composed mainly of collagen fibres. The knee joint ligaments connect the femur (thighbone) to the tibia (leg bone) at the knee joint to improve its stability and to limit the amount of mobility in the joint.

The four main ligaments of the knee joint are,

  • ACL: Anterior Cruciate Ligament
  • PCL: Posterior Cruciate Ligament
  • MCL: Medial Collateral Ligament
  • LCL: Lateral Collateral Ligament
knee ligaments

Fig 1: Ligaments of the knee joint

Functions of the knee ligaments

  • Stability to the knee joint

The ligaments of the knee are responsible for preventing the tibia (shin bone) from sliding out of the femur (thigh bone). During rotational movements, knee ligaments work together to prevent both valgus (knee moved inwards) or varus (knee moved outwards) stresses to the knee.

According to their attachments in the knee, the ligaments prevent tibial displacements. For example, ACL prevents forward displacement of the tibia while PCL prevents backward displacement of the tibia. Similarily, the MCL provides support on the inner side of the knee while the LCL provides support on the outer side of the knee.

  • Locking the knee during walking

Apart from supporting the bones, the knee ligaments contribute to the “screw-home” mechanism, a process that locks the knees during walking. For example, just before you strike the heel to the ground your knee is slightly flexed (about 20 degrees bent) then the screw home mechanism works to straighten the knee as your body moves over the planted heel as shown in Fig 2.

swing to stance

Fig 2: Screw-home mechanism

What does a ligament Injury mean?

A ligament injury is the over-stretching or tearing of the ligaments of the knee. A tear may be partial or complete.

mcl injury BY GRADES

Fig 3 Grades of  Ligament injury

What can cause a Knee Ligament Injury?

Extreme movements at the knee joint forcing the knee to move beyond its normal motion can injure a ligament. Most of the injuries occur during weight-bearing activities, as the ligaments resist against perturbations at the knee.

Types of people who usually get them

  • Sports people like football players, basketball players, skiers etc.
  • Hyper-mobile individuals who engage in high-impact sports may have an injury due to excessive laxity in the knee ligaments.
  • Accidental fall on the knees or hit on the knees during contact sports like rugby, football etc or automobile accidents (in which the knees can hit the dashboard)

Mechanism of an injury

hyperextension

Fig 4: Causes of knee injury

  • Hyper extension injury

Extending the knee too far by over straightening of the knee. This can happen when you stop suddenly while running.

  • Flexion and Hyperflexion injury

Jumping and landing on a flexed (bent) knee or falling on your knees with over overbent knees.

  • Rotational injuries

Valgum (inner) or varum (outer) stress on the knees due to twisting of your knee inwards and outwards. Sudden shifting of weight from one leg to the other.

  • Contact Sports

Accidental hit on the knee during sports as shown in Fig 5

PCL INJURY

Fig 5: Direct hit on the leg

Other Reasons that contribute to a Ligament Injury

  • Lack of force distribution

During movement, the body exerts a force on the ground and at the same time, an equal and opposite ground reaction force (GRF) is exerted by the ground on the body. This GRF is directed towards the center of mass (COM) of the body, a point in the body where the entire body weight is concentrated; in front of the tailbone.

If there is an imbalance, which means the athlete’s knee does not bend on landing and remains straight, the GRF creates a forward shear force that pushes the tibial forwards, stressing the ligaments. Hamstring muscles on the back of the thigh play a vital role in stabilizing the knee joint especially when the athlete lands. Normally, the knees normally bend slightly to absorb GRF as shown in Fig 6.

QUADS DOMINANCE

Fig 6: Hamstring action advantage for absorbing GRF

  • Lack of trunk control

Without trunk control, there will be greater movements in the trunk following a perturbation (disturbance) which could affect the distribution of the GRF.

Lack of control in the trunk motion happens because of diminished proprioception. In such a situation, if the trunk moves more on the side of the knee joint laterally, the GRF tracks the COG and follows the movement of the trunk. As the GRF tracks the COM, and if it progresses beyond the center of the knee joint, it results in a movement of the knee joint into a valgus alignment stressing the knee ligaments as shown in Fig 6.

Trunk dominance

Fig 6: Valgus alignment of the left knee

Signs and Symptoms of Ligament Injury

  • Popping sound at the time of injury can indicate a ligament rupture.
  • The knee swelling within the first 24 to 48 hours
  • Tenderness and possibly redness around your knee on touching. 
  • Knee feels unstable or may buckle during weight bearing. This may cause you to limp or feel wobbly at the knee during walking.
  • Bruising around the knee can develop. 

What to do if you think you have an injury?

If you are having any of the above signs or symptoms, seek immediate medical attention. What can appear to be a simple ligament or soft tissue strain may become something more if left untreated. Diagnostic tests such as an X-ray or MRI scan will be able to show any tears or rupture of the ligaments. According to the severity of the ligament injury, appropriate treatment care will be advised.

Temporomandibular (TMJ) Joint and its Disorder

anatomy, Common conditions, Injury, Pain

TMJ

What is the TMJ?

The temporomandibular joint (TMJ) or the jaw joint is a synovial hinge type of joint. This joint is responsible for the movements of our mouth that are needed for chewing, biting, talking and yawning.

To achieve the complex movements needed by the jaw, the TMJ has two articulating surfaces which include the head of the mandible (jaw bone) that fits in the articulating socket of the temporal bone of the skull. In order to prevent friction between the two bones, an articular disc sits between the articulating surfaces which moves with the head of the mandible as one unit.

TMJ disc

Fig 1: Normal TMJ when jaw closed

Apart from the disc and articulating structures, there are other supporting structures that provide stability to the TMJ:

  • Joint Capsule
  • Ligaments
  • Muscles

Joint capsule and Ligaments of the TMJ

The capsule is a fibrous cartilaginous membrane that along with the ligaments surrounds the TMJ and attaches all around the articular eminence of the temporal bone, the articular disc and the neck of the mandibular condyle. Both the capsule and the ligaments provide stability to the TMJ during movements. The four ligaments include (Refer Fig 2),

  • The Lateral Ligament (temporomandibular ligament)
  • Sphenomandibular Ligament
  • Stylomandibular Ligament
  • Stylohyoid Ligament
CAPSULE

Fig 2: Showing the attachment of joint capsule, lateral ligament and stylomandibular ligament.

Muscles around the TMJ

The are four main muscles (Refer Fig 3) of the TMJ are,

  • Temporalis
  • Masseter
  • Medial Pterygoid
  • Lateral Pterygoid
muscles of tmj

Fig 3: Prime muscles for TMJ movement

Movements at the TMJ

There is a combination of hinge and sliding motions that can occur in the TMJ due to the movements of the mandible.

  • Protraction (forward) and Retraction (backwards)
  • Elevation (upward) and Depression (downward)
  • Lateral deviation (Side to side movements of the jaw)
MOVEMENT PROTRACTION RETRACTION

Fig 4: The forward and backward movements of the jaw

ELEVATION DEPRESSION

Fig 5: Upward and downward movements of the jaw

lateral deviation

Fig 6: side movement of the jaw

Temporomandibular Joint Disorder 

  • Muscular problem: Pain and discomfort in the muscles of the face during jaw movements.
  • Disc problem: Usually comprises of displaced disc, dislocated jaw, or injury to the mandibular condyle.
  • Joint problem: Degenerative inflammatory joint condition like Arthritis at the temporomandibular joint.

Reasons for TMJ Disorder

  • Genetics

Individuals who have misaligned jaw or teeth which are hereditary can be affected with TMJ disorder.

  • Functional mandibular overload

Normally the jaw is free to move and make contact with the teeth in the right position, (centered occlusion), in anatomical and functional harmony.

Mandibular overload occurs when one sleeps in a wrong position (face down) where the load of the head pushes the mandible to compress the TMJ on one side and attenuation of the ligaments on the other side. Compression obstructs the blood circulation and moves the teeth to a lateral bad occlusion position. In such a situation, swallowing causes the masticatory muscles to overwork to centre the jaw and bring the teeth from forced lateral malocclusion to centred occlusion. This causes a disharmony between the upper and lower teeth. An imbalance of the jaw that can cause bruxism in an attempt to re-position the teeth.

The term bruxism is defined as an involuntary rhythmic or spasmodic non-functional gnashing, grinding or clenching of teeth. The rubbing causes tooth facet to wear out, structural and function damage to the capsulo-ligamentous and muscles around the TMJ. Stress and psychological problems could worsen the condition.

Sudden trauma

Whiplash injury occurs any time when the head is suddenly and unexpectedly distorted from the neck, causing overstretching of the muscles and ligaments that hold the neck and head in alignment. During a whiplash injury, there is also a potential secondary injury of whiplash in the jaw. Jaw dislocation in severe cases can also occur.

  • Inflammatory diseases 

Sometimes infection in the teeth or adjacent structures can cause a spread of infection in the TMJ leading to infectious arthritis.

TMJ could also be affected by osteoarthritis that causes damage in the articular cartilage of the joint and disc degeneration leading to friction between the bones causing inflammation and pain. It usually affects individuals above 50 years of age and is associated with trauma and other muscular and teeth problems.

TMJ disorder could also be present among individuals who are already diagnosed of rheumatic arthritic disease.

Symptoms of TMJ

  • Jaw pain: Pain and tenderness in the jaws. Increasing pain during chewing in the TMJ and in the muscles, radiating pain is also felt in the face, jaw, or neck.
  •  Limited or painful jaw movement: Swelling due to the inflammation lead to joint stiffness and limited movement, wear and tear of the disc leading to locking of the jaw and impaired jaw function.
  • Headache, Neck pain or stiffness: It is generally assumed that headache, neck pain, or painful jaw movement is suggestive of muscular problems. Masticatory and neck muscles may show muscle spasm and myofascial trigger points in the masseter or sternocleidomastoid muscles that refer pain to the head.
  • Clicking or popping: This occurs within the joint during mouth opening and may indicate displacement of the intra-articular disk during mandibular movement.
  • Ear pain and tinnitus (Ringing of the ear): Middle ear muscles have a common embryological and functional origin with masticatory (Chewing muscles) and facial muscles.Having said that, problems with muscles in TMJ disorder could affect the middle ear. In case, other ear problems are not the cause of ear pain and tinnitus a temporomandibular joint dysfunction may be the reason of these symptoms.

Prevention and Treatment

In order to relieve pain and restore the function of the TMJ, a thorough assessment is required to correctly determine the causative factors and to treat the involved structures. Personalized care interventions at an early stage that includes behavioural change and reassurance are important steps for prevention of TMJ disorder.

Rotator Cuff Injury

Common conditions, Injury, Pain

shoulder

Our shoulders are the most movable joints in our body. Most activities whether simple or strenuous engage both our shoulders. That is the reason why with a little bit of pain in our shoulders, we find it very difficult to do even the simplest of tasks like putting on a coat or carrying groceries. Sometimes there is a crunchy sensation or you may hear clicking and popping sounds while you move your shoulder or do weights. This pain can worsen making you feel frustrated, leaving your shoulders feeling weaker than normal and stiff to move. There could be many reasons for the cause of your shoulder pain but the most common injury that could possibly show these type of symptoms would be a rotator cuff injury.

What is the rotator cuff and how does it get injured?

Rotator cuff injury

The Rotator cuff is a group of muscles coming from the shoulder blade and ending in tendons that attach to the arm bone. These muscles cup the shoulder and are responsible for its stability during movement. The muscles of the rotator cuff muscles include:

  • Supraspinatus
  • Infraspinatus
  • Subscapularis
  • Teres Minor

“Centralisation”- Your rotator cuff is important

The function of the rotator cuff, in addition to generating torque, is to dynamically stabilize the shoulder joint. It keeps the ball of the shoulder centred over the small glenoid socket. Thus, stronger rotator cuff muscles result in the better glenohumeral joint stabilization and hold the humeral head into the glenoid by depressing it. This prevents impingement and decreased chances of shoulder dislocation when the deltoid abducts(arm sideways up) the shoulder. Without an intact rotator cuff, particularly during the first 60 degrees the ball of the shoulder would migrate up the glenoid cavity causing the rotator cuff attachments to get compressed by the acromion leading to impingement of the rotator cuff. In patients with large rotator cuff tears, the humeral head is poorly depressed and can migrate cephalad during active elevation of the arm.

Rotator cuff injuries

Sometimes sudden fall or high impact sports could be the cause of injury but in most cases, it is due to the repetitive injury over the tendons as they being pulled beyond their capacity to stretch. This gradually worsens causing partial or full tear of the tendons. Due to the way these tendons cup the shoulder by being closely spaced, they are more at risk of friction. Especially when you turn your shoulder or lift any weight at the end range of shoulder movement, the tendons in this tight space become taut and rub against the bony knob (acromion process of the scapula) above them or against a ligament at the front of the shoulder. This causes friction, pain and as a normal response, inflammation sets leading to pain, swelling and movement restriction.

Physiology of rotator cuff damage

1. Tendonitis (acute Inflammation)

Tendonitis can occur in a particular rotator cuff tendon causing pain, inflammation and irritation. If this condition becomes more chronic, more tendons can become involved or it may progress to a tendinosis (degeneration).

2. Impingement Syndrome (compression of the tendon)

The most common site of impingements is within the “supraspinatus outlet”. This outlet is a space formed by the acromion process of the scapula, the coracoacromial ligament and the upper rim of the humeral head. Subacromial outlet

Impingement within the outlet can be caused by:

  • Thickened Coracoacromial ligament: This can cause impingement by becoming thickened due to excess calcium deposits that will compress the supraspinatus tendon.
  • Hooked acromium: In repetitive overhead activities, the tendons rubs against the acromion process of the Scapula and gets damaged. When the inflammation spreads into the pocket of fluids (subacromial bursa) that lubricates the rotator cuff tendons under the acromion bone. This causes subacromion bursistis and the pain gets even worse on movements.
  • Abnormal Scapular Movement: With normal shoulder movement, the scapula moves outward and upwards helping the shoulder to move up

scaphumerorhythm movement

  • In the case of an unhealthy shoulder, the scapula does not move in the same fashion as the healthy shoulder and gets “stuck” in a lower position. This could lead to abnormal movement of the scapula during shoulder movement. Poor scapular movement will cause compression of the tendons in the supraspinatus outlet increasing the chances of impingement of the rotator cuff tendon that goes under it.
  • The picture below shows an unhealthy right shoulder at a risk of impingement, showing improper movement in the scapula.

chances of impingement

3. Rotator cuff tears

A tear is a result of the worsening of the tendon damage. Although an acute fall can tear the rotator cuff tendon, chronic inflammation and degeneration due to impingement is the major cause of tears. This tear can start small and get larger over time due to repetitive use or a re-injury. When a tear occurs, there will be severe weakness and atrophy(loss of muscle mass) of the muscles around the arm and loss of movements of the shoulder. impingement

How is Rotator Cuff Injury Diagnosed?

Pain in the shoulder could be caused by various other reasons like joint injury, capsule injury, nerve problems and many more. A thorough examination of the shoulder should be done to distinguish the injury type. If a tear is suspected in the rotator cuff an MRI or an arthrogram (X-ray of the shoulder joint after injecting a contrast dye) can be taken.

normal

Prevention and Management

A proper diagnosis and plan of management is necessary for the treatment and prevention of rotator cuff damage. Initial treatment would be pain relief, rest and avoiding any activity that aggravates pain in order to enhance the healing process. Further treatments will be decided upon the individual’s condition. Thorough assessment and planning by the experts with an application of knowledge of the condition and correct methods of treatment will promote recovery and prevent injury reoccurrence.

Joint Hypermobility – Beyond the Normal Range of Movement

Common conditions, Geeky stuff, Lifestyle

Hypermobility pictures

Our joints are responsible for movements and stability (e.g ability to maintain and control movements in your knees). Different joints have varying degrees of inherent stability considering its function, the way it articulates, anatomical position, load-bearing capacity, strength and flexibility of the soft tissue structures (muscles, ligaments, and fascia).  

Joint mobility, on the other hand, refers to the range of movement in a particular joint. Like stability, it is dependent on the strength and flexibility of the surrounding soft tissue structures. This means that any problems with the soft tissue structures would affect the stability and mobility, making the joint susceptible to injuries and dislocations.

Hypermobility

You are said to be ‘hypermobile’ when you have the ability to move your joints beyond the normal range of movement. Sometimes it’s also called ‘double-jointed’. This condition is fairly common in the general population and might sometimes become an advantage for athletes or dancers.

Having said that, there are different problems related to hypermobility. The most important being the lack of stability in the joints.  One may be predisposed to soft tissue structure injury and experience excessive muscular stiffness.

‘Hypermobility’ – How did I get so flexible?

  • Genetics – Connective Tissue Disorder

The exact cause is unknown. Due to genetic problems, it can be seen among infants at birth with sometimes a possible decline in hypermobility during childhood, teens and adulthood. An improper gene resulting in joint laxity is due to the lack of collagen, elastin and fibrin proteins which usually help with the stability of joints, tendons and ligaments.

  • Acquired hypermobility 

Without having inherited laxity in the joints, many ballet dancers and gymnasts get hypermobile as they push the joints to the hypermobile range while working to get the flexibility to perform. Intense and excessive stretching of the muscles and soft tissue structures can also lead to hypermobility.

When do we say you have a Hypermobility Syndrome?

Joint Hypermobility Syndrome (JHS)

Individuals who suffer from chronic joint pain and other symptoms related to their hypermobility have a condition called joint hypermobility syndrome (JHS). As the name suggests the most affected part is the musculoskeletal system.

Due to hypermobility, the risk of injury to the joint structures, ligaments, tendons and other ‘soft tissues’ around joints are increased. In addition, the structure of the collagen fibres and the shape of the bone (articulating surfaces) both play a major role. Even a lack of neuromuscular tone and proprioception could be the contributing factors to this condition.

Aggravating factors, Symptoms and Common conditions associated with JHS

There is no specific activity that can trigger pain. For some individuals, repetitive movements, overuse, excessive weight bearing or even simple activities of daily living can cause pain.

  • Incorrect posture and alignment of joints: During daily or sports activities incorrect movements due to faulty posture can affect the hips, shoulders, knees, and elbows joints. For example, hyper-extending the elbows can injure the tendons on the sides of the elbow causing conditions like “tennis elbow” and “golfer’s elbow.”
  • Laxity in the soft tissue structures: This leads to increased strain, tearing and spasm causing pain and stiffness around the joint. Due to over extending and twisting flexible joints, partial dislocations or complete dislocation can also occur.
  • Muscle imbalances: Pain due to injury causes adhesions withing the soft tissue structures (Muscles, ligaments and fascia) of one joint leading to imbalances in the mobility of other joints and surrounding structures. Pain and spasm of the hip muscles can pinch the sciatic nerve resulting in pain called as sciatica which can be felt radiating down the back to the leg. Sometimes it could also be because of the inter-vertebral discs (made of collagen) that has become too soft than normal and has impinged the nerve.
  • High-impact exercises: Sports that involve running, jumping or physical contact predisposes lax joints to dislocate.
  • Stretching: Incorrect technique or type of stretching that involve grabbing a joint and pulling or pushing on it to loosen it up.
  • Heavy lifting, pulling and pushing: Odd-shaped weights and unusual angles often lead to injury due to excessive load on the joints.
  • Recurrent Ankle sprains: Sprains may take very longer to heal because they tend to get injured repeatedly while trying to heal.
  • Knee pain: This is most common in hypermobile. People because the cartilage between the kneecap and the knee get lax. Due to excessive mobility, the cartilage underneath the kneecap starts to wear down (a condition referred to as chondromalacia), causing pain and sometimes a crunching or grinding noise – while kneeling, squatting or climbing the stairs.
  • Chest pain: A condition called costochondritis or inflammation of the rib cartilage causing pain and tightness.
  • The jaw, or temporomandibular joint (TMJ): This is often affected because of loose structures.

Although pain and fatigue are the common complaints, the range of symptoms could be wider considering that cardiovascular and endocrine system could also be affected.

Are my symptoms related to Pain and Fatigue syndromes or is it because of Joint Hypermobility Syndrome?

Hypermobility predisposes people to developing Chronic fatigue syndrome (CFS), Fibromyalgia (FM), Chronic Regional Pain Syndromes (CRPS), Chronic Widespread Pain (CWP). In simple words, someone with hypermobility may have other pain and fatigue syndrome. However, people with pain and fatigue related syndromes may not be hypermobile. Thus, a careful diagnosis is necessary.

Hereditary Syndromes associated with JHS

  • Marfan’s syndrome or Ehlers-Danlos syndrome, Osteogenesis Imperfecta: These are usually inherited disorders that are passed on to children by their parents. Often, children with Down syndrome will also be hypermobile.

Diagnosis of Joint Hypermobility Syndrome and Management

In some cases, people may have inflammation in their joints but no presence of abnormalities of their blood tests (so called seronegative inflammatory arthritis). Similarly, confusion is very common among clinicians to come to a particular diagnosis with the number of pain and fatigue syndromes associated with the joint hypermobility syndrome.

Most clinicians use the Beighton score which is a nine-point scoring system that looks for hypermobility. In the thumb, elbow and knee on both sides of the body and the ability to bend forward and place the palms of the hands flat on the floor without bending the knees. Hypermobility is often found at the jaw, neck, shoulders, other small joints of the hands and feet, hips, ankles and mid-foot, sticking to the Beighton scoring method is not enough in clinical examination. A high degree of applied musculoskeletal expertise and knowledge of the condition will be required to address all the problems.

If someone has been diagnosed with hypermobility and symptoms of pain, it is advisable that particular care should be taken with physical treatments. Avoiding activities that would strain the hypermobile joints.

Treatments should focus on improving the functional stability and mobility of the soft tissue structures. Awareness such as perception of correct posture with neuro-muscular proprioceptive training. Maintaining an active lifestyle with lifestyle modification. Even simple things like nutrition and balanced diet to maintain optimal body weight will be beneficial.

What is Tennis Elbow

Common conditions, Exercise, Lifestyle, Pain

tennis player massaging elbow

You just upped the load of your weight training or might have recently engaged in an activity which was strenuous and involve repetitive movements of the wrist and elbow. This later results in a burning sensation on the outer aspect of the elbow which is painful, sore and very sensitive to the touch. All this describes a condition called  ‘Tennis elbow’ which is more commonly known as lateral epicondylitis among clinicians.

Tennis elbow was thought to be common only among tennis players. However, this condition has been affecting more than just sports people as it is actually common in occupations which involve repetitive forearm rotational activities.

It has been estimated that only 5-10% of cases occur in tennis players. More often than not, recreational players are more susceptible than elite tennis athletes due to improper stroke technique or faulty equipment use.

Pain in the elbow was first described as ‘writer’s cramp’ by Runge in 1873 and later was called ‘Lawn Tennis Arm’ now known as Tennis elbow or lateral epicondylitis. Nirschl and Pettrone in 1979, described the pathoanatomy of the area as tendinosis.

Though the acute stages of tendon injury can have an inflammatory component, chronic tennis elbow is considered as a degenerative pathology rather than a tendonitis. Degenerative in this sense as it is more a failed reparative process of the tendon with associated cellular changes rather than active inflammation causing the pain. Therefore, terms like “tendinopathy” and “epicondylalgia” are more often being used by professionals to describe this painful condition which affects both office workers and sports people alike.

All about Lateral Tendinopathy (‘Pathy’ meaning non-inflammatory disorder) or Lateral Epicondylalgia (‘algia‘ meaning pain)

  • What is the lateral epicondyle of the Elbow? 

The elbow joint consists of three long bones which meet in the middle portion of the arm. The upper arm bone (humerus) meets the two inner bone of the forearm (ulna) and the outer bone of the forearm (radius) to form a hinge joint. The radius and ulna bones are responsible for rotational movements of your forearm.

Lateral epicondyle

The elbow functions to move the arm like a hinge (forward and backward) and in rotation (twisting outward and inward). The outer bone of the elbow is referred to as the lateral epicondyle and is a part of the humerus bone.

  • What are the tendons that attach to the lateral epicondyle?

A tendon is a part of the muscle. Tendon function by joining the muscle to the bone providing leverage to perform a movement.

At the lateral epicondyle, the tendons of the extensor muscles start and runs along the forearm. Extensor muscles again end into tendons that pass over the wrist and attach to your fingers. These tendons cause upward or outward movement of the wrist and fingers.

extensor muscles

Extensor Carpi Radialis Brevis (ECRB) – Commonly affected muscle

When performing movements at the wrist or by holding the wrist downwards with the forearm in pronation (Palm facing downwards). The extensor muscles especially extensor carpi radialis brevis is at its maximum length.

ECRB

As the origin of ECRB muscle lies proximal to the axis of rotation for bending and straightening the elbow, it is subjected to shearing stress and most commonly affected in movements of the forearm and wrist.

extensor_carpi_radius_brevis

What are the causes of lateral tendinopathy or epicondylalgia?

  • Overuse injury

The repetitive motion of the wrist or any activity that requires excessive constant gripping/squeezing can cause injury to the extensor tendons.

Individuals who perform multiple sets of dips, push ups and chin ups can also develop pain and injury. Repetitive exercises that involve excessive wrist extension and forearm rotation stresses the extensor tendon. Especially beginners who are trying to perform exercises which their bodies are not used to. They may be executing these exercises with improper posture, incorrect body alignment or bad technique, which predisposes them to painful symptoms of lateral tendinopathy.

  • Weak Scapula Muscles

In a research study published in Journal of Orthopaedic & Sports Physical Therapy (2015), impairments of scapular musculature strength and endurance in individuals with tennis elbow was found. This suggested that muscles of the shoulder and scapula play a role in movements in the forearm and improving the strength and endurance of these muscles will prove beneficial.

  • Faulty techniques

During Racket sports, the overload occurs at the extensor tendons especially in the backhand stroke that is hit with improper technique. The key is to use the body weight and strength from the shoulder than overloading the forearm extensor muscles alone. In a faulty stroke, the elbow is straightening doing the racket motion. 

In the game of tennis, the following maneuvers can lead to tennis elbow:

1. One-handed backhand with poor form and increased load on extensor tendons.

AIG Open Day 7

2. A late forehand swing resulting in bending the wrist significantly stressing the extensor origin.

BNP Paribas Open - Day 10

3. Snapping and turning the wrist while serving with full power

twisting

  • Faulty Equipments

Racket 

A rigid and small size racket causes more compressive forces on the extensor muscles. Even though a stiff racket gives the player more power and control, a lot of compressive forces affect the forearm. The grip of the racket if too small or too large may require more strength to hold the racket. In both cases, the player may have to grip the racket too tightly to prevent it from twisting, and high grip force may increase the risk of injury.

Strings

High thicker string tension is problematic for the forearm because it reduces the dwell time of the ball on the strings. The lesser contact time of the tennis ball means that the shock of the ball impacts more to the forearm muscles.

Tennis ball

Old, wet and soft tennis balls affect the impact and contact point on the racquet requiring more effort from the forearm muscles during impact.

 What happens if you have an injury?

Tendinopathy is the result of overuse activity of the extensor muscles causing the tendons at the lateral epicondyle to have micro tears and reduce its blood supply. The tendon tissue develops large nociceptors that cause severe pain. Pain substances (substance-P and CGRP) irritates the surrounding nerve fibers to possibly inflame which further adds to the chronic nature of the painful condition. With the amount of pain, stiffness sets in causing weakness in the extensor muscles of the forearm affecting grip strength and daily activities. Chronic degenerative changes are seen in the collagen tissue of the extensor tendons that further worsens the condition.

Considering its severity from mildly irritating to a debilitating chronic painful condition, it can have a significant impact on social and occupational life.

How can you prevent tennis elbow?

If your injury is caused by an activity that involves placing repeated strain on your elbow joint, such as tennis or repetitive push-up workouts, changing your technique may alleviate the problem. Identifying and learning correct techniques, postural awareness and feedback for an experienced coach would be beneficial.

The best advice is to avoid too much stress on the muscles and tendons surrounding your elbow engaging in overuse activities. Mostly the condition is reversible with rest and treatment which will help prevent the condition getting worse.

Having said that, if it’s just an irritation, there are some precautions you would need to consider immediately while playing tennis. Watch out for faulty strokes or a playing situation which seems to exacerbate the problem. Get more information on the racket dynamics, tennis ball type and strings so that you can avoid injuries due to faulty equipment use.

Due to the insidious nature of the condition and a wait-and-see approach by many individuals, this condition becomes more chronic and debilitating. If pain persists and restricts the movements of the elbow, it will be best for you to get your elbow examined by experts to prevent any further damage.

Functions of the Patella – Knee Cap

anatomy, Common conditions, knee, Lifestyle, Pain

knee cap

The only time feeling weak at the knees would be a normal phenomenon is when you are standing at the edge of a cliff or doing a bungee jump.

Experiencing weak knees with joint pain can be quite debilitating. We can sit, stand, walk, run and move about easily because of our knees. What we should know is that our kneecap is a part of the knee joint and it should remain ‘in the groove’  for optimal function.

The kneecap, also called the patella bone, is a sesamoid bone in the front of your knee. It’s called the sesamoid bone as it has the shape of a sesame seed. The sesamoid bone is a bone that grows within a tendon. The patella has many biomechanical functions which are responsible for the protection, support and movements at your knees.

Anatomy of the knee cap

anatomy

The knee joint (Patellofemoral joint) is comprised of the three bones. The thigh bone (Femur), the shin Bone (Tibia) and the patella (Kneecap). The patella  lies in a groove at the lower end of the femur and acts as an attachment point for the four main muscles of the thigh (quadriceps). The lowest part of the patella continues on as a tendon that attaches to the tibia. The muscles pull on the patella and the patella pulls on the tibia allowing you to straighten your knee from a bent position.

knee extension action

Cartilage of Patella

articular cartilage of patella

The cartilage is a taut protective structure underneath the kneecap. It found to be among the thickest cartilage in the body providing cushioning for the patella bone. The cartilage helps to prevent friction and acts as a shock absorber protecting the bony surfaces.

Why is the patella so important?

  • Patella functions as a natural pulley

The kneecap plays an important role, it increases the leverage of the quadriceps tendon (thigh muscle tendon) and protects the front of the knee from direct trauma.

lever arm quads

The quadriceps muscle is providing the force like the man in the picture, the patella bone acts as a fulcrum to provide more leverage for lifting the stone.

In real life though, the patella is a little more complicated by not only providing increased force, but also by aiding in balancing forces as well as providing a direction for the forces.

  • Prevents excessive weight-bearing compressive stress 

As weight bearing stress falls on our knees, the patella acts as a spacer protecting the quadriceps tendon and bone from coming into compression and creating a frictional force. The patella also allows for smoother movements when bending and straightening the leg.

  • Maintaining the Quadriceps Angle

Q angle

The quadriceps angle or the Q angle is determined by drawing one line from the hip bone (anterior superior iliac spine) through the center of the patella and a second line from the center of the patella through the leg bone (tibial tuberosity).

normal Q angle

As the Q angle increases above 15 degrees, it potentially could cause the patella bone to move out of its groove. This is as if the Q angle is increased, forceful contraction of the quadriceps muscle can cause the patella to move outwards and possibly dislocate. Slight changes in the Q angle would cause imbalances in the muscle forces causing compression stress, symptoms of pain and inflammation at the knee joint.

Knee Pain related to the Patella 

Although patellar dislocation, fracture, and patellar tendon inflammation are the common sports-related injury. Many patella related problems may also occur during daily activities.

  • Runner’s knee/ Patellofemoral pain syndrome 

Patellofemoral joint pain is a condition seen in runners causing pain during running or while at rest. Pain usually occurs in the front of the knee.

  • Condromalacia Patellae (“soft cartilage under the knee cap”)

This often affects young, otherwise healthy athletes. Chondromalacia patella is one of the conditions that cause pain in front of the knee. When pain exists in the absence of cartilage softening, it can be referred to as patellofemoral pain syndrome (Runner’s knee). Although it’s common to sporting individuals, it can also affect individuals with weak quadriceps muscles. It is common among individuals engaging in activities like football, cycling, tennis, weightlifting, runners. In other words, any sport that involves running, jumping, squatting and landing on the knees.

  • Prepatellar bursitis (between patella bone and skin)

Prepatellar bursitis has historically been referred to as “housemaid’s knee”, which is derived from a condition that was commonly associated with individuals whose work necessitated kneeling for extended periods of time. Prepatellar bursitis is common in professions such as carpet layers, gardeners, roofers, and plumbers.

  • Infrapatellar Bursitis (Below the Kneecap)

This is common among individuals who engage in activities that involve kneeling down for long hours causing inflammation of the bursa below the patellar tendon. It can also occur conjunctively with a condition called jumper’s knee.

  • Suprapatellar Bursitis (Above the kneecap)

Injuries such as direct trauma and overuse injury to the bursa beneath the quadriceps tendon cause inflammation of this bursa.Overuse injuries caused due to running on uneven surfaces or doing jobs that require crawling on the knees.

  • Osteoarthritis 

Patellofemoral arthritis occurs when the articular cartilage on the underside of the patella wears down causing friction between the patella and the end of the thigh bones. It gets extremely painful during weight bearing with swelling, inflammation around the knee. It is generally a degeneration condition which requires immediate medical attention to manage the condition.

  • Patellar Dislocation 

This type of injury happens when the kneecap (patella) moves out of its groove due to the sudden change in direction engaging in high impact sports. It most commonly occurs among young girls or hypermobile individuals due to laxity and increased hip angle. Direct trauma to the kneecap could also cause dislocations.

As a precautionary measure, using knee pads during sports and regular exercises of your knee muscles will have great benefits for your patella. Generally, most of the injury conditions can be managed with appropriate treatment and rehabilitation.

However, if you’ve only begun to feel pain while doing activities or just by standing, you might like to seek medical attention to prevent long-term pain or further damage to your patella.

 

Management and Treatment of Scoliosis

Common conditions, Lifestyle, Scoliosis

Spine osteoporosis. Spinal cord problems on woman's back

Early management of scoliosis is the key to more successful treatment and improvement of body function. We don’t guarantee that scoliosis can be cured but we sure as hell will do what we can to influence the body in the right direction.

The body is like a garden. You can use the best soil, water regularly and provide ample sunlight but nobody can guarantee that the seeds will sprout. Our aim is to give your body the best environment and let nature work its magic.

Focused Muscle Retraining to Prevent Scoliosis Progression

Your brain is the boss. It is the ultimate centre that controls your muscles and nerves. No matter how long you hold your body in the correct position, it is of no good if your higher centre is unable to learn and organize your movements

Use a Mirror

Get visual feedback and awareness to do simple exercises for your brain to learn muscle control. It is important that you also focus on your legs, arms, head and hips as well as the body works as a whole unit.

posture

Improve Spinal Mobility

Focus on moving your back in varying positions while standing. It’s important you do small and gentle movements for constant brain signals. You should use your imagination to visualize the movements if trying to do it is too difficult and slowly work your way to incorporating them.

Twist and turn

tuck twist turn

When lying down, sitting or standing, place your arms with elbows bent to 90 degree with your thumb out. Then, gently twist your back and spine in the direction that is the easier one for you and rotate to the other side.

After you repeat this movement a few times, notice whether your back begins to move more easily if your spine begins to feel more mobile.

Stimulate the stretch reflex

The stretch reflex helps to control posture. When you bend slightly to your right, it causes a stretch in the spinal, hip and leg muscles on the left side. This activates the stretch reflex. What the reflex does, after the muscle is lengthened, is that there will be an immediate reflex contraction of the same muscle. Thus bringing your spine back to normal by adjusting and maintaining.

In most scoliosis cases, the muscles on one side of the spine are elongated while the muscles on the other side are shortened. Some might think stretching the shortened muscles will be the solution but that will actually stimulate the stretch reflex and cause further contractions.

Instead of stretching the short muscles, gently move to the side of your curve stretching the elongated muscles and let go to activate the stretch reflex.

Bending to lengthen

Correct Nutritional Imbalances

Improve the function of neurotransmitters in your brain in order to improve muscle contraction and control of posture.

Eggs/ Liver – They are rich in choline that forms acetylcholine a neurotransmitter for concentration and focus. It also plays a role in muscle coordination.

Brown rice: Serotonin, a calming neurotransmitter, plays an important role in brain activities such as learning and memory.

Spinach: Increase in folic acid that ensures your body synthesizes norepinephrine and serotonin.

Fish: Helps increase dopamine levels that are important for healthy nervous and immune system functioning

Dairy products: Increases norepinephrine a neurotransmitter that facilitates alertness, concentration and motivation.

Common Treatment Methods

  • Improving chest mobility

chest mobility

Mobilization and stretching techniques relieves the tight structures of the chest and back, helping your chest to expand.

  • Breathing exercises

diaphragm breathing Practicing diaphragmatic and deep breathing exercises will expand your chest and stretch the muscles of your chest, improving the oxygen uptake and lung function.

  • Foam roller for Myo-fascial Release

foamrolling

Scoliosis can cause chronic muscular strains, most commonly seen as trigger points in the muscles in the back, hips and abdomen. Using the foam roller will help loosen these muscles and potentially increase mobility.

  • Traction Therapy

scoliosis traction

Decompression traction therapy is another method used to treat back problems. This method is often used to treat mild scoliosis by giving the spine a chance to decompress and possibly influence it in the correct manner through stretching, exercises and manual therapy.

  • Correction exercises

exercises

Improving the muscle strength (especially in the abdominal muscles) and flexibility in the spine. To correct spinal curvature and stabilize scoliosis angle.

scoliotic curve heel

  • Insole Support

Scoliosis stemming from leg-length discrepancy due to a low arch and excessive inward position of your feet, can be corrected and stabilized using orthotics. Some may need a permanent heel lift due to an anatomical difference in leg length.

When there are differences in the alignment of your hips, you may be advised to use an insole to lift the lower side which will in turn, correct your posture.

  • Kinesio Taping 

RockTapeKinesio taping can be used to correct muscle imbalances and posture. This tape supports the muscles in their optimal length without restricting movements in your joints. It helps to adjust your posture correctly and reduce muscle strain. Due to the tape being an external support structure, it also provides proprioceptive feedback to the body when applied.

  • Forget about a perfectly straight back.

Instead, focus on having a strong healthy spine. It is natural to want a straight spine but opting for treatments that unnaturally forces your spine to be straight might leave you in unnecessary discomfort or pain. Even using braces or surgery have their limitations. A healthy spine would be one where you’re able to move in and out of different positions with ease.

It is still recommended to monitor the scoliosis twice a year with or without treatment.

Watching Out for Functional Scoliosis

Common conditions, Lifestyle, Scoliosis

Scoliotic curve

Have you ever seen it yourself or been told by someone that one of your shoulders is not in line with the other? Most people would have seen it but probably have no idea what it is. The condition is called scoliosis. It causes abnormal curving of the spine making your hips and shoulders appear uneven.

scoliosis

When do experts define scoliosis as functional scoliosis?

Functional scoliosis:

You most commonly see an exaggerated curve of the upper back (thoracic spine towards right or left side) and an excessive curving of the lower back (lumbar spine hyperlordosis).

Functional scoliosis involve compensatory curves which develop due to:

  • Leg-length differences or pelvic tilting
  • Incorrect postural response (muscle imbalance)
  • Transient or temporary, often due to painful response of your back pain

scoliotic spine

Can you get it sorted?

The curve of the spine is a consequence of faulty lifestyle or injury and often can be corrected .The curve does not twist and can be corrected by changing position and postural correction.

Look at your posture in the mirror.

  • Does your head tilt and do not line up over the hips?
  • Do you have protruding a shoulder blade?
  • Is one of your hips or shoulders higher than the other, causing an uneven hem or shirt line?
  • Any uneven neckline?
  • Are you leaning more to one side than the other?

Does scoliosis cause pain? What is so bad about it?

Most scoliosis is painless and more often than not, it goes unnoticed. However, with more advanced curves, pain arises due to other problems.

Common symptoms caused by scoliosis:

  • Excess fatigue – Fatigue is common while sitting or standing for prolonged hours but with the addition of scoliosis, extra strain is put on the body.
  • Poor body mechanics – Shortened muscles on one side of the curve causes spasms, tightness and incorrect movement patterns.
  • Respiratory problems – Restrictive rib structure may cause lung problems due to lack of full expansion of your chest. This may cause difficulty in breathing and the body may have trouble getting enough oxygen in more severe cases.
  • Inflammatory joint conditions – Arthritis is seen in the spine. The joints lose their cartilage that cushion the spinal discs. They get inflamed and bone spurs are formed. If spinal disc presses on the nerves, severe pain can develop which may require immediate medical attention.
  • Disc degeneration and low back pain – Due to degeneration, the disc between the vertebrae may become weakened and rupture. Treatment may involve removal of the old rods and extension of the disc fusion into the lower back.
  • Emotional Effects in Adults – Due to the increase in adults developing scoliosis, there is also an increase in problems of general health. Social, emotional and possibly mental health due to the physical appearance and social stigma of scoliosis.
  • Height loss – Fusion of the spinal disc in severe cases may cause height loss. However, much of the growth takes place in long bones, which are not affected.

How bad it can get?

scoliosis angle measure 

Mild Spinal curves less than 20 degrees is seen in about 80% of people with bad back or uneven hips. Experts recommend that curves beyond 20 degrees should be monitored in the event the condition worsens. These measurements of the length and angle of the curve are usually measured from a recent x-ray for optimum accuracy.

Why did you develop Scoliosis?

Physical stress or injury

Maintaining a wrong posture throughout the day puts an uneven load on the spine causing tight muscles of the body. This muscular changes compresses the joints and can cause injury over time.

exaggerated posture

In such conditions, if you engage in sports like tennis or dragon-boating where often it involves only one side of your body. One side will become overloaded and tend to be dominant. The imbalance causes muscles to be overused and the injury can worsen due to joint stress. The spine will adapt to this new posture as it’ll follow the path of least resistance causing a functional scoliosis to occur.

posture in tennis

Your spinal curves changes when after an extended period, some muscles get tightened and shortened on one side while lengthened and weakened on the other side of your body. This gives an uneven appearance even standing up straight. Problems like lack of muscular control and coordination while engaging in high impact activities may also cause injury and muscle imbalances. Scoliosis is most common among dancers, gymnasts, swimmers and single-handed sports enthusiasts.

Do you have weak bones?

Bone problems can be caused by a lack of estrogen (during menopause), Vitamin D (sunlight), calcium and impact (exercise). These can cause a decline in bone density. Experts recommend measuring bone mineral density and seeking ways to improve your lifestyle to prevent further damage.

Detection and Correction

Early observation and intervention can help correct your curves. Most scoliosis curves are mild and are mainly due to incorrect postural conditions. All you need is a little input on lifestyle changes in order to improve the mobility in your spine and maintain good health.

The truth is, our body has an extraordinary capacity to self-correct and adapt.

High Heel Pains – Getting it sorted!

Common conditions, Lifestyle, Pain

painful heel conditions

It’s very tempting to wear that pair of stilettos on party night but going through the same excruciating pain every time you wear high heels could be a sign that you need help. The “long legs” effect is temporal, where the damaging effects of high heels on your back, hips, knees and feet may be long term.

The common complaint is pain. Its source could be from your bones, ligaments, tendons, muscles, fascia, toenail beds, nerves, blood vessels, or even skin.

Considering where the location of your pain and with a thorough assessment of your body, experts can understand and nail the root of your problems.
 

There are various treatments you may want to consider in favour of high heels. Postural correction exercises, joint mobilisation, stretching and strengthening exercises may prove beneficial for your back, hips, knees and ankles.

Types of treatment:

  • Achilles tendon pain

Applying ice on Achilles’s tendon, massaging your foot will increase blood circulation and reduce swelling especially at the back of your heel or the ball of your foot. Ice pack should be applied for a maximum of 10-15 minutes otherwise the effect will be reversed. Ultrasound therapy can also help enhance the healing process of your inflamed tendon by improving circulation.

icing

  • Joint Mobilization

Mobilizing the joints of your body addresses any limitations in movements. This helps short and tight muscles, soft tissue restriction, joint capsule restriction, motor control problems, joint range of motion dysfunction and nerve-related issues.

Ankle joint mobilization therapy of doctor man to woman

  • Tight Calf muscles

Extended wear of high heels may shorten your calf muscles. Therefore, the best way to address calf tightness is to use a heat pack on your calf muscles to reduce pain, soothe and improve its blood supply. You could also use a foam roller to relieve tightness.

wall stretch

Simple calf stretches against the wall would also help, hold each stretch for at least 30 seconds.

Take the support of the wall, with the leg to be stretched kept straight at the back. Bend the front leg leaning into the wall causing a stretch to the calf muscle of the back leg. Hold position and repeat for at least 3 sets.

  • Orthotics for Arch support and Cushioning

bunion splint

You could see a podiatrist and invest in customised insoles if you have heel pain. Otherwise, off-the-rack silicone metatarsal pads will also help to protect your forefoot. You basically want to provide as much cushion to your feet as possible to reduce and absorb impact.

  • Bunions

Applying a cold compress over the bunions will reduce pain and swelling. Padding over the bunion will help prevent friction. Corrective orthosis footwear will straighten the toe and put it in its correct alignment during recovery.

Toe alignment correction

  • Treat Metatarsalgia

Rest, ice and avoid weight bearing. Ultrasound therapy can be used to reduce pain and enhance healing. Metatarsal mobilisation is also recommended for improving the range of motion. Use metatarsal pads for relief of pain while standing.

metatarsal pads

  • Prevent Haglund’s Deformity (the bumps at the back of heel)

Avoid wearing strappy heels. Soft-backed shoes or going barefoot helps reduce the friction around the area. Use heel pads to cushion the heel or underneath the heel to lift it up and reduce pressure when walking. Applying cold compress, doing calf stretches and trying ultrasound therapy over the Achilles tendon attachment will help.

US for bumps

  • Support your foot with Kinesio taping

Kinesio taping is a technique used to support your foot structures and promote the natural healing process without restricting the joint range of motion. It lifts the skin to help with drainage and prevent circulatory swelling.

high heels KT tape

  • Knee and Back Pain

Pain in the front of the knee and low back pain is common due to postural adjustments caused by high heels. A rest from high heels, pain relief treatments, mobility exercises, stretching and posture correction would be necessary. It is best to get professional advice and assessment of your back and knees to help determine the severity of your pain and its causes.

Although there are several techniques to treat the cause of your pain, prevention is always better than cure. In fact, it’s always good to get your pain managed before it gets disabling and cripples your lifestyle.