What causes De Quervain’s Tenosynovitis?

• Squeezing, pinching and grasping are all hand and thumb motions that, when repeated too often, can lead to Tenosynovitis inflammation. So, it is generally overuse and poor hand postures that are the main causes.
• Holding the hand at right angles to the wrist can also rub the tendon.
• Old scar tissue can encumber the tendon fluidity and Arthritic diseases, like Rheumatoid Arthritis, can also be the cause.

How do I know I have De Quervain’s Tenosynovitis?

You may well have De Quervain’s Tenosynovitis if you experience any of these symptoms:

• Grasping things with the thumb and hand becomes increasingly painful
• Pain in the forearm on the thumb side by the wrist
• Pain spreading up the forearm or down into the wrist and thumb
• You hear a type of ‘creaking’ noise (Known as Crepitus) as the tendons move through the blocked tunnel.

What is my best course of action?

It is best to see your physiotherapist as soon as possible and you can save time and money by going directly to them. No extensive testing is required to accurately diagnose De Quervain’s Tenosynovitis. A test known as The ‘Finklestien test’ is usually used and is one of the best. You will be advised on what hand and wrist movements to rest and restrict or possibly to wear a ‘thumb-spica’ splint which stops the wrist and lower joints of the thumb moving, thereby allowing the APL and EPB tendons a chance to rest. Contact us for an accurate diagnosis and treatment that will get you back to normal as soon as possible.

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.

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!

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.

Stress Fractures occur in 2 distinctive ways:

• Through excessive force in normal bone, as described above
• Through normal use of a weakened bone as in Osteoporosis.

Stress fractures can occur in anyone who simply under estimated their limitations at the start of a new exercise program. This may occur when not allowing for recovery between exercise days or suddenly training harder during individual sessions.

What are the symptoms of Stress fractures?

Localised pain associated with activity, which usually subsides with rest, is the only real symptom of Stress fractures. It is difficult to be sure of the presence of Stress fractures as they seldom show themselves in initial testing. X-rays taken 2-3 weeks after the initial injury should however show a white area indicating the body’s efforts to heal the bone. Upon seeing this callus formation, a definitive diagnosis can be made.

What is the cause of Stress fractures?

Usually the result of increasing the amount or intensity of activity too rapidly, Stress fractures are caused by fatigued muscles, unable to absorb added shock. Transference of this overload from the muscle to the bone causes the tiny cracks.

We all walk or run a bit differently, so your individual biomechanics can play a significant role. Those who run with poor biomechanics, may place additional stress on the bone via impact going through the leg.

Other causes are:

• Greater surface impact, like switching from grass to concrete
• Improper equipment, like running shoes that don’t suit your biomechanics
• Increased force with or duration of the activity, escalating muscle fatigue.

What is my best course of action?

Rest is important, but rest alone is not a long-term solution to the problem. It is necessary to rest from the direct cause of the problem (but you can’t just do nothing!) and to have your Physiotherapist asses your specific biomechanics to work on optimising the way that you run. They will also diagnose and decide on the exact cause of your problem, before possibly referring you to other medical professionals needed to assist in a complete recovery and prevention of recurrent episodes. Save time and money by making direct contact with your Physiotherapist, who can manage your diagnosis, treatment and recovery from start to finish, while keeping you fit for the next event!

What is Tendonitis?

The commonly know term for a tendon injury is Tendonitis which indicates inflammation in a tendon, but inflammation is actually a good tendon healing response. When there is collagen degeneration in the tendon due to repetitive overloading though, the tendon enters a state of disrepair and is more accurately described as Tendinosis or Tendinopathy. These Tendinopathies are best treated with functional rehabilitation by a Physiotherapist.

How do I get tendon injuries?

Tendon injuries may seem to happen suddenly, but are usually the result of poor muscle control and strength as well as overuse over time and ageing. Although tendons are designed to withstand strong pulling and repetitive movement, when the load is too great for the tendon to withstand, they sustain small micro tears and become stressed and inflamed.

When these tears exceed the rate of repair due to overloading on the Tendons, this is where disrepair occurs and Tendonitis becomes Tendinosis or Tendinopathy.

What are the symptoms of Tendinopathy?

Pain, stiffness, and loss of strength in the affected area are all potential symptoms of Tendinopathy. You should look out for the following:

• Pain and stiffness during inactive periods like at night or when you rise in the morning.
• You feel more pain from use of the tendon.
• The tendon area may feel tender and warm, and look red or swollen in the case of inflammation.
• You can hear or feel a clicking or ‘crunching’ sound when you use the tendon.

Be aware that the symptoms of a tendon injury are in fact not unlike and can be mistaken for those of Bursitis.

If I have Tendinopathy what is my best course of action?

As it goes through various phases from being very manageable to very serious, it’s essential to have a suspected Tendinopathy professionally assessed to identify the extent of your injury. Tears, depending on their severity may initially be addressed conservatively, but if the response is poor, surgery may be needed. In the absence of a tear and before having a scan, physiotherapy would be the more direct route to resolve the condition. Contact your Physiotherapist directly for consultation and expert advice. Like many other conditions, early diagnosis and treatment together with an effective rehabilitation program can render Tendinopathy manageable if not curable.