Your health and wellbeing deserves quality care. Make sure to discuss any concerns you may have directly with your preferred physiotherapist, so that you can receive the appropriate guidance for your unique situation.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

Photo by Dr. Manuel González Reyes from Pixabay

Under normal conditions, the bursa need not swell up to protect the tendon, but if the tension in the tendon increases beyond the acceptable norm, swelling in the bursa physically pushes the tendon away to avoid friction over the bone. Bursitis is therefore often caused by repetitive motion or excessive pressure by the muscle and may on rare occasion result from a traumatic event. The symptoms may vary from local joint pain and stiffness to a sharp, stabbing pain surrounding the area, and the pain peaks during and after provocative activities, while joint stiffness can be a common symptom in the mornings.

Addressing the underlying cause of the increased risk of friction is ultimately what is needed.

• Surgeons may offer to remove the bursa but this leaves us wondering what would then act as the barrier and the early warning sign to protect the tendon from damage when repeatedly rubbing against the bone? So rather than shooting the messenger…
• We recommend determining why the tendon or muscle is tensioned beyond what the bursa deems safe.
• Home remedies in the interim could alleviate the symptoms and at times, allow for the condition to resolve, but if you do not see a marked improvement within 3 days and an ultimate resolution through use of a home remedy or any formal treatment, we recommend a change in your approach.

The goal with any treatment for bursitis should be to correct the bio-mechanical imbalances which caused the increased tension in the muscle and the initial irritation for the bursa, and unless proven otherwise, our experience says to look at altered joint mobility or altered nerve control for the muscle in question, as the primary suspect.

Your health and wellbeing is deserving of quality care so be sure to discuss any concerns you may have directly with your preferred physiotherapist, so that you can receive the appropriate guidance for your unique situation.

DOMS is one variety of muscle damage caused by exercise but is typically nothing sinister; the other occurs during and immediately after exercise and this is ‘acute muscle soreness’.

What are the symptoms of DOMS?

Apart from short term loss of muscle strength, reduced range of motion and possible swelling of the muscles, the most significant symptom of DOMS is a dull muscular ache. Passive stretching increases the symptoms, which explains the feeling of stiffness.

What are the causes of DOMS?

The primary cause of DOMS is muscle strains or ‘Myofibril tears.’ Small scale damage results in an inflammatory response with intramuscular fluid and electrolyte shifts. Blood tests can confirm this micro-trauma though the detection of markers like ‘creatine kinase’ and ‘lactic dehydrogenase’.

Muscle strength, motions and functions are impaired in someone experiencing DOMS due to swelling, altered muscle firing patterns and pain.

How do I know if I have DOMS or an injury?

Innocent soreness (as in the case of DOMS) is a tender, tired or burning feeling, usually an achy, stiff or tight feeling, typically occurring bilaterally and has a delayed onset.

An injury on the other hand causes deep, sharp, stabbing pains, typically only on one side and starts less than a day after activity, if not during. These are the signs that there may be a more serious injury and one should not assume that it’s just DOMS. Additionally, an injury will typically last longer than just a few days. General soreness from DOMS should peak at 24 to 48 hours after activity and last only up to 3 days. If symptoms are not subsiding after that, something more serious is possible.

What is my best course of action?

DOMS responds well to light activity of a similar nature to that which cause it …E.G. if you’re stiff from running, taking a leisurely walk should help. If symptoms linger beyond 3 days, or if any improvement seems negligible, schedule an appointment directly with your Physiotherapist, as you may be suffering DOMS or an injury. Try to remember what could have caused your pain and what it feels like, as this can help in your diagnosis. Contact us to ascertain the specifics of your condition and create an individualised plan to get you back on track with advice on how to avoid DOMS going forward.

What are the symptoms of Fibromyalgia?

Each individual can experience different symptoms, but the most common are:

• Fatigue that is disproportionate to the level of the individual’s activity and sleep
• Stiffness, tenderness and a high level of pain in the muscles and joints
• Anxiety, depression and possible bowel function problems
• Poor sleep patterns or waking after long bouts of sleep, but still feeling tired all day.
• Poor memory and alertness. A ‘foggy’ feeling in the brain.

The symptoms of Fibromyalgia are cyclical and each symptom can create the onset of another. The typical cycle would be:

An injury or disease leads to limited physical activity – which leads to muscular tension or stiffness – leading to stress/depression/anxiety – which leads to poor sleep – leading to pain – which leads to disease etc …and so the cycle will resume and continue. Breaking this cycle is essential to the recovery of a Fibromyalgia patient.

What are the causes of Fibromyalgia?

Far more prevalent in women than in men, there is really no known cause of this disease. It is extremely difficult to diagnose and treat, as it is neither an inflammatory, degenerative, nor an auto-immune disease.

What is known is that Fibromyalgia appears to manifest itself after:

• A stressful event like a motor accident or the death of a loved one
• A traumatic injury
• Repetitive poor sleeping patterns
• The sudden onset of an unexpected or chronic illness like Lupus or Rheumatoid arthritis

What is my best course of action?

Alleviating any of the symptoms of Fibromyalgia, even temporarily, can enable the sufferer to break the chain of symptoms and experience some relief or potentially break the cycle altogether.

Because it is difficult to diagnose and other conditions like an underactive thyroid, Vitamin D deficiency, or Rheumatoid arthritis can mimic this disease, extensive testing by a doctor or Rheumatologist may be necessary to eventually establish that you have Fibromyalgia.

Through alleviation of the pain, even for a few days, your Physiotherapist can assist you in finding, starting and maintaining comfortable and regular exercises, in addition to providing guidance on sleeping more comfortably. The combination of a reduction in pain, improved sleep and regular exercise provides a massive leap towards snowballing back in the right direction. Contact us for advice, referral to the correct specialist if necessary and positive treatment of this complex, yet but not necessarily incurable, disease. 

What is a ‘Ligament sprain’, as opposed to rupture?

To elaborate a little, ‘Ligament sprain’ occurs when its inelastic fibres are stretched through too great a range and tearing of the ligament takes place. The tear can be just a few fibres and classed as mild or grade I, but when classed as severe or grade III, a complete ‘rupture’ of the ligament has taken place, leading to joint instability.

How do ligament sprains happen?

The most common type of sprain is a sprained ankle, usually occurring amongst runners and sports people in general but it could happen to anyone. To give an example, in the USA alone, 25 000 ankle sprains occur daily. A runner going over a curb, catching the foot and twisting the ankle is a typical example. Knee and ankle sprains also happen in stopping and turning sports like hockey or soccer or in baseball where a player slides into the plate and twists the knee. The whipping arm action of the baseball pitcher and swing of the Golfer can also cause shoulder and elbow sprains and thumb, finger and wrist sprains happen in sports like skiing where one falls with an outstretched palm, or netball and cricket through catching injuries.

What are the symptoms of sprains?

Pain, inflammation and bruising are all common signs and symptoms of a sprain. At the time of injury, you may hear or feel a “pop” in your joint. With a mild ankle sprain, the pain may not be too intense and you may just have a limited ability to move the affected joint, but with a ruptured ankle ligament one may not be able to bear any weight on the foot.

What is my best course of action?

Mild sprains can sometimes be successfully managed at home with relative rest, compression and elevation but if the symptoms aren’t improving significantly each day over any 3 consecutive days, it’s likely that the management at that time is not sufficient. For your own peace of mind, to assure that the treatment is being correctly administered and to reduce the recovery time, it is advisable to consult a Physiotherapist directly to get started on the correct rehabilitation program, in addition to the management of your symptoms. It is essential to contact your Physiotherapist if you can’t walk more than a few steps, move the affected joint, or if you feel any numbness in the injured area. Severe sprains or ruptures may even require surgery, but you can save time and money if you contact us first, as Physiotherapists are the specialist for this type of injury, trained to have you back in action ASAP and refer immediately should that be required.

What is a ‘muscle strain or tear?’

Muscle strains are the most common source of muscle pain and are also known as muscle tears in the more severe cases. They vary greatly in severity from mild up to a complete muscle rupture. Muscle sprains that occur in the ankle, calf, thigh and biceps usually happen at high speed when the muscles are overloaded. When occurring in the back, shoulders and neck, it is more commonly as a result of muscle fatigue from postural strains.

What are the symptoms of muscle strain or tear?

Naturally, pain is experienced in the affected area and the pain can vary according to the severity of the tear. One can also experience:

• Weakness of the muscle – an inability to perform normally
• Bruising of the muscle
• The muscle feels tight and strained
• You cannot fully stretch the muscle

What is my best course of action?

If you experience these symptoms and the injury appears to be fairly mild your immediate course of action should be to apply a compression bandage on the affected area. It’s also a good idea to elevate the area if it’s swollen by, for example, raising your leg above your body. If you are still able to perform, then reduce training to a level where pain is no longer experienced.

Should your home treatment be ineffective and the injury continues to niggle, or if you are experiencing severe pain, or are unable to move normally, then it is advisable to immediately contact your Physiotherapist, who is trained to accurately diagnose the exact nature of the injury, advise on and carry out the best treatment for you. If the injury is sports related and waiting/resting is not an option you’d like to consider, you can save time (and often money too) by contacting your Physiotherapist directly to get back into action ASAP.

The more common types of musculoskeletal pain are lower back pain (LBP), whiplash, headaches, tendonitis (tendon inflammation), myalgia (muscle pain) and fractures. These could result from trauma, repeated movements, sports/exercise, poor posture or being immobilised (keeping still) for a prolonged period of time.

The symptoms differ from person to person and depend greatly on the cause and the duration of the injury. Common symptoms include: Pain that is aggravated by movement and remains after movement; Stiffness or aching with or without any movement; Sharp, stabbing pain with movement that resolves greatly after movement; Fatigue, Sleep disturbances or the inability to get comfortable; Burning sensations and Twitching.

My rule of thumb for any musculoskeletal pain is to have an assessment and treatment done by a Physiotherapist if you have not seen a drastic improvement within 3 days of the onset of the pain. Patients commonly try to cope by using medication and only turn to Physiotherapy after a few months having tried numerous remedies (or trying to ignore the pain). The problem here is that even an acute injury has then become chronic. The muscles have tightened more, the joints have sustained further damage while moving differently (in an attempt to avoid the pain during function) and the medication has not only cost a lot (while simply hiding your symptoms), but they have usually also started damaging your stomach lining.

The effect of all this is that you may have problems with ulcers, you have spent money and you have had no actual healing of the injury. In fact, the injury has most probably progressed and the number of treatments you may need to help the injury heal is now substantially more.

Very few people know just how simple it could be to rid you of the niggles you deal with on a daily basis. AND in South Africa, you do not even need a referral from your GP as Physiotherapists are first-line practitioners which means that we can assess, diagnose and treat the problem while being fully aware of other possible conditions outside the scope of Physiotherapy for which we will refer you to the relevant practitioner if need be.

Treatments for musculoskeletal pain may include splinting, rest, heat or icing, myofacial release, joint mobilisations or manipulations, dry needling, strengthening/conditioning/stretching exercises and anti-inflammatory/muscle relaxing medications. These treatments will vary depending on the findings on assessment, your diagnosis and the nature of the condition.

Why do we get Neck–Arm pain and Abnormal Neural Tension?

Both Carpal tunnel and Thoracic outlet syndromes, pinched nerves, abnormal Neurodynamics and even common Tennis elbow and repetitive strain injuries can be causes of normal Neck–Arm pain. Neural tension is the strain on a resting or moving nerve and so ‘Abnormal neural tension’ is when the nerve becomes restricted, like with restricted neck movement, muscle spasm around the nerve, or inflammation of soft tissue.

What are the symptoms of Neck–Arm pain?

• Stiffness, soreness or pain suffered in the neck
• A dull, sharp or even a burning pain running down the arm or arms
• Weakness, numbness or pins and needles.

What do I do if I experience these symptoms?

To save time and money, see your Physiotherapist as a first port of call, because Physiotherapists are specifically trained to clinically diagnose these conditions without sending you on a wild goose chase as the first step. Being nerve specific, it is important that they know the location and degree of your symptoms and the nature thereof to differentiate between Neck-Arm Syndrome and other possible causes of your arm pain. Physiotherapists are also trained to be able to identify Abnormal Neural Tension by moving your arm into certain positions which tests the movement of each nerve individually as it travels down the arm. 

How long will it take for me to be healed?

The length of recovery is often dictated by how long you have had the symptoms and we’d therefore advise that you contact us sooner rather than later. The good news is that Neck-Arm Pain is generally healed completely when the main problem has been identified and treated and in most cases, you can expect a noticeable decrease in your arm symptoms after only the first session. If there is a local dysfunction in the arm, like Carpal Tunnel Syndrome or Tennis Elbow, then these areas would also need to be treated before a full recovery can be achieved.

1. Discomfort that disappears through warming up
2. Discomfort that disappears when warming up, but re-occurs at the end of the activity
3. Pain or discomfort that occurs and worsens during any activity
4. Pain or discomfort that is there all the time.

Stages 1 and 2 allow for moderate continuation of activities/training (while starting rehabilitation with your physiotherapist to combat the cause), but in stage 3 or 4, aggravating activities/training should immediately cease and your Physiotherapist consulted to assess the injury and begin a rehabilitation program in conjunction with treatment to reduce pain and promote healing. Merely resting is rarely a solution and may not only delay your recovery but could in fact set you back further.

What are the common symptoms of Overuse injuries?

Symptoms are not always picked up in the beginning, because the first symptoms of stiffness and soreness for example, can disappear during warm ups. Other symptoms are swelling, redness, feeling warm to the touch and if the part is just not functioning well. The strongest symptom of overuse though, is when pain is experienced during an activity and continues even beyond cessation of such activity.

What Causes Overuse Injuries?

Repetitive usage itself is not necessarily harmful, but Overuse injuries can occur when combined with some of the following:

• Incorrect training, techniques, or equipment in the case of sports injuries.
• Simply not having sufficient endurance or muscular strength.
• Poor core stability and inflexibility.
• When strong tight muscles work against weak stretched muscles, this causes muscle imbalance.
• Any Misalignment or Biomechanical issues – like flat feet for example.

How can I try to prevent Overuse injuries?

The most common cause of Overuse injuries is incorrect training or preparation, so here are some helpful tips for prevention…

• Warm-ups with dynamic stretching before and cool-downs with static stretches after training are essential.
• Correct equipment (like the handle size of your bat or racquet) and footwear can make a big difference.
• Correct technique and slow building of intensity (max 10/% per week).
• Pain is a warning that there is a problem – Be aware of what your body is telling you AND LISTEN TO IT!

Remember that early identification and treatment will allow you to continue your activity, so contact your Physiotherapist as soon as any warning symptoms appear. We can not only identify the cause of your pain/discomfort but assist in correcting any poor biomechanics while addressing the symptoms, allowing you to say goodbye to your overuse injury!

What are the symptoms of Rotator cuff syndrome?

Each rotator cuff injury has its own symptoms, but they typically include at least one of the following:

• Aching pain on the outside of the shoulder/arm, or a sharp pain in a small spot in the front of the shoulder.
• Pain extended from the top of the shoulder to the elbow
• Aching during/after lying on the shoulder.
• Pain when putting your hand behind your back or your head
• Pain when reaching for a seat belt or typically when changing to 2^nd gear
• Pain or a clicking sensation/sound when the arm is overhead or at shoulder height
• Pain that feels like it’s actually Tennis or Golfer’s elbow
• Pain or weakness when attempting to reach for, or lift something.

What causes Rotator cuff syndrome?

It is often believed that the bones around the joint are responsible for pinching the small tendons and in this way causing dysfunction, damage and  pain, but this is seldom (if ever) the case. Rotator cuff tendons break down from inactivity rather than pressure. As the saying goes “Use it or lose it!” This alone is a very good reason to rehabilitate the joint before considering surgery to remove/reshape any bony elements, even if there is excessive growth reported (more often this is also a symptom of the dysfunction rather than the cause of the pain).

What is my best course of action?

In order to restore pain free and stable mobility, one needs adequate control and strength in all 4 of the rotator cuff muscles. Directly consult with your Physiotherapist who can diagnose a Rotator cuff injury in accordance with your clinical history and tests. Only if a complete tear is suspected will an ultrasound be requested before commencing rehabilitation.

The good news is that high speed, power, agility and a return to sport and work are all possible, but prior to that we would need to achieve relief from pain and inflammation; restore scapular control, normal neck and shoulder function and Rotator cuff strength …and regain your full range of motion and comfortable sleeping ability. Contact us to get your diagnosis, treatment and recovery plan underway immediately.