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. 

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.

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!

In which areas of the body do Pinched nerves most commonly occur?

Although you can pinch a nerve anywhere in the body, it is more likely to happen where the space around the nerve is limited, as is the case in the Carpal tunnel, a tunnel through which the nerve passes in front of the wrist. So, this is the area where the commonly known ‘Carpal tunnel syndrome’ occurs.

The most common however and best known pinched nerve is the Sciatic nerve, situated in the lower back. A symptom of ’Sciatica’ is referred pain in the leg, and could result from pressure due to an Arthritic spur, a ligament injury or disc problems.

If there is pain in the arm, weakness or altered reflexes, it is possible that you have a pinched nerve in the neck, the second most common area of occurrence. The medical term for Pinched nerve in the neck is ‘Cervical Radiculopathy’ and be warned that it can be far reaching and deceptive. Some conditions diagnosed as Carpel tunnel syndrome and Tennis elbow for example, turn out to originate from pinched nerves in the neck.

How do I know I have a Pinched nerve….and need to see my Physiotherapist?

Pinching of your nerve can result in a combination of nerve pain, sensory loss, muscle weakness or altered reflexes…and possibly even loss of bladder or bowel control, depending on the function of the affected nerve. Whenever there is this reduction in or loss of power, it is essential to have an assessment ASAP as this often indicates true nerve involvement! Short of this scary scenario, if you have discomfort and you merely suspect some nerve involvement, physiotherapy should still be your first stop to address the situation.

Rest assured though that in the hands of an experienced physiotherapist, the cause and symptoms accompanying pinched nerves can be greatly alleviated if not totally resolved. Contact us for advice or a consultation.

Sometimes called Calvé disease and juvenile osteochondrosis, the number of terms used for the condition, named after the doctor who first described it, can be confusing. Sometimes the name ‘Scheuermann’ is incorrectly used for other conditions, such as ‘Juvenile discogenic disorder’ when there are changes in the disc spaces of the lumbar spine rather than the bones and joints of the thoracic spine.

What Causes Scheuermann’s Disease?

Scheuermann’s disease is not hereditary, nor gender or age specific (but more prevalent in young boys) and no absolute cause is known, but several factors are considered i.e. Juvenile osteoporosis; infection; malabsorption; endocrine disorders and biomechanical factors, including a shortened sternum.

What are the symptoms of Scheuermann’s disease?

Scheuermann’s disease is one that generally affects the young with symptoms that usually develop between the ages of 10 and 15 when the spine is growing rapidly. The following are usually experienced:

• Tired and stiff muscles, especially after long spells of sitting.
• Pain experienced with twisting, arching backward or bending. The pain is exacerbated therefore when sports and activities like gymnastics, dancing, or figure skating are participated in. There may be difficulty exercising in general.
• Muscle cramps or spasms and tight hamstrings.
• Red skin where the pronounced curvature rubs against the back of a chair.
• Intermittent back pain .
• Feeling un-balanced.

Serious damage is rare, but it’s not impossible for the spinal cord or internal organs to be harmed. If the lungs become compressed by a severe forward posture it could lead to breathing problems.

What is my best course of action?

Save yourself time and money by seeking advice from a registered Physiotherapist first. After diagnosing the condition, treatment typically starts by using various treatment modalities, such as soft tissue release, electrotherapy, dry needling and off-loading strapping to reduce the pain and inflammation.

During these relieving treatments, we also start to work on restoring and improving the control of the muscles involved in your back movements which will assist in attaining good posture. The muscle recruitment pattern and the appropriate exercises for your specific needs will be prescribed.

Your Physiotherapist will aim to restore optimal, pain-free function and minimize future dysfunction. Contact us for further advice and to make an appointment to set off on the road to resolution.

What are the symptoms of Scoliosis?

If any of the following are present in children under the age of 8, parents should be alerted to the possibility of Scoliosis:

• One shoulder blade is more prominent than the other
• Uneven shoulder heights
• Pitching or bending to one side
• Uneven hip heights
• Pain above the imbalanced areas

What causes Scoliosis?

Although it is not always caused by poor posture, Scoliosis can progress to a more sever curvature through poor posture or weak spinal muscles.

There are three primary types of Scoliosis, which are not necessarily isolated and one can have a combination of all three:

Structural Scoliosis occurs spontaneously mostly in woman and its cause is not always known.  There is a false belief that there is nothing a Physiotherapist can do for Structural Scoliosis. The effects of structural scoliosis can largely be treated and in fact, if left untreated the curvature of the spine can regress and develop into an additional Functional Scoliosis.

Functional Scoliosis can develop at any age, as a result of an injury response or excessive activity where an imbalanced motion of the spine occurs as in tennis or golf. Here the curvature is a result of the overuse of muscles on one side of the spine and the underuse of muscles on the other side. This too can be treated by a Physiotherapist and can typically be reversed completely.

Pathology related Scoliosis is usually predisposed by a neurological condition such as Muscular dystrophy, or in response to a severe injury to the spinal cord, like those which result in Quadriplegia. Maintaining optimal function is still of utmost importance to preserve long-term function for individuals suffering from these debilitating conditions but we acknowledge that it will be a long-term management plan rather than a quick resolution.

What is my best course of action?

Contact your Physiotherapist who, in the course of a clinical examination, will access the spine, shoulders, rib cage, pelvis, legs and feet for abnormalities, asymmetry and weakness.  X-rays will be recommended if a significant Scoliosis is detected but this usually not needed.

A program of pain relief, strengthening and stretching, restoring full function and preventing a regression of the curvature of the spine will be embarked on. Scoliosis can be managed and often reversed, so book a consultation and let us help you again optimal function and comfort as soon as possible.

The function of each pair of facet joints is to guide and limit the movement of each spinal segment. There are 3 sections to the spine and their facet joints are referred to as the cervical or neck, the thoracic or upper back and the lumbar or lower back facet joints. Facet joint pain is one of the most common causes of neck or back pain.

What are the symptoms of Facet joint pain?

An injury to the neck facet joint will cause pain to the neck or possibly the shoulder and upper arm. A back facet joint injury will cause pain to the back and possibly referred pain around the chest wall or to the buttock or thigh.

A Locked facet joint is when movement away from the pain is severely limited. When a locked facet joint becomes acute, muscle spasm will attempt to protect it. This results in pain, which may initially be felt in a very small area, worsening as the muscles become fatigued. As the body compensates for locked joints by moving neighbouring joints more than they usually would, pain is often experienced on the opposite side of the locked facet joint and may lead to other conditions. Decreased movement and difficulty stretching are also symptoms.

What causes Facet joint pain?

Injury can reduce facet joint motion, known as hypomobility – or movement may become excessive, which is known as hypermobility.

Hypermobility is often (but not always) caused by trauma as with:

• Dislocations
• Fractures
• Generalised excessive flexibility – or what might be referred to as being ‘double jointed’
• Destructive diseases – such as Rheumatoid arthritis

Hypomobility is caused by slow degeneration or poor motion of the facet joints, as with:

• Locked facet joints
• Arthritic facet joints
• Joint capsule thickening, shortening or scarring
• Degenerative bone spurs.

Locked facet joints are caused by twisting, awkward or unexpected movements – like one experiences when stumbling. It’s when facet joint motion exceeds muscle control. It can easily be triggered through a previous injury or weakness of the facet joint supporting muscles. People who repeatedly have locked facet joints typically have weak stability muscles that fail to control spine movement adequately.

What is my best course of action?

The treatment of a locked Facet joint is relatively simple and your Physiotherapist can usually unlock it using a painless mobilisation or manipulation technique. Treatment to regain full mobility and prevent re-occurrence varies according to what your Physiotherapist has ascertained during your individual assessment and despite presenting as a condition of restricted motion, the long-term stability for these joints is typically gained from limiting excessive motion in future by restoring proper control, as will be the case with other Hypermobile conditions.

Stiff or Hypomobile Facet joints are treated very differently to those which are hypermobile. Arthritic joints and those with capsule or ligament scarring respond to repetitive loosening to restore full mobility. This may initially be done manually but for lasting results, a person needs to mobilise these joins actively during their normal activities of daily living and therefore, rehabilitation plays a vital role in resolving spinal pain. Contact us directly for an accurate diagnosis of your specific condition and guidance to get you back on a positive path to being pain free again.