JT Physio

Large Rotator Cuff Tears

Tue, 13 Aug 2024 15:01:58 GMT

Large Rotator Cuff Tears

Large rotator cuff tears and physiotherapy

Shoulder injuries, particularly those involving the rotator cuff, can be both painful and debilitating. However, there is good news for anybody facing the challenges of a large to massive rotator cuff tear. Recent research has shown that exercise can be as effective as surgery in improving quality of life, disability, and pain for those with experiencing large to massive rotator cuff tears (Fahy et al. 2022). Given the costs and risks associated with surgery compared to exercise, it seems reasonable to try exercise-led physiotherapy in the first instance.

What is the rotator cuff?

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, playing a crucial role in stabilizing and enabling various shoulder movements. When a large tear occurs in these tissues, it can result in pain, weakness, and reduced range of motion. Although it’s important to note that tears of the rotator cuff are very common, and we start to see them more so in those over 50 years of age (Teunis et al. 2014).

Strength training: building resilience

The controlled and targeted resistance provided by strength training exercise contributes to the overall stability of the shoulder joint, which can aid a reduction in pain and restoring functionality to the shoulder joint. Your physiotherapist will be able to guide you through a gradual and progressive approach to strength training. Starting with gentle, controlled movements and gradually increasing resistance overtime can help rebuild muscle strength. This approach can also allow the shoulder to become more adaptable to the demands of everyday life.

Conclusion

By following a structured rehabilitation program under the guidance of a Chartered Physiotherapist, those with large rotator cuff tears can often develop a stronger, more resilient shoulder than ever before.

References

Fahy, K., Galvin, R., Lewis, J. and Mc Creesh, K., 2022. Exercise as effective as surgery in improving quality of life, disability, and pain for large to massive rotator cuff tears: A systematic review & meta-analysis. Musculoskeletal Science and Practice, 61, p.102597.

Teunis, T., Lubberts, B., Reilly, B.T. and Ring, D., 2014. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of shoulder and elbow surgery, 23(12), pp.1913-1921.

To book your appointment, contact us on 0749111010 or book online via link.

Author: Aiveen Lavery

Senior Physiotherapist

Pre/post-operative physiotherapy at JT Physio

Tue, 13 Aug 2024 14:42:55 GMT

Pre/post-operative physiotherapy at JT Physiotherapy

Introduction

Embarking on a surgical journey can be both a daunting and hopeful experience. At JT Physiotherapy, we understand the significance of pre- and post-operative physiotherapy in optimizing outcomes and ensuring a smoother recovery process.

Pre-operative physiotherapy

Before the surgery, it’s important to lay a strong foundation for a successful recovery. Pre-operative physiotherapy can play an important role in preparing you physically and mentally for the upcoming procedure. Recent research found that patients who underwent preoperative rehabilitation prior to their total knee replacement surgery had a significant reduction in pain, length of hospital stay and functional performance, compared to those who did not receive physiotherapy and exercise preoperatively (Vasileiadis, D et al. 2022).

Below are a few of the most common surgeries we would see:

ACL (anterior cruciate ligament) reconstruction
Total hip replacement
Total/partial knee replacement
Shoulder surgery i.e., Laterjet procedure, shoulder replacement
Spinal surgery i.e., microdiscectomy, lumbar decompression
Bone fracture

Post-operative physiotherapy

Once the surgery is complete; the focus shifts to rehabilitation and recovery. Post-operative physiotherapy is a personalized and progressive process designed to:

1. Minimize swelling and pain.

2. Restore mobility and function.

3. Prevent complications.

4. Progressive strengthening .

Throughout the rehabilitation journey, our physiotherapists communicate regularly with your consultant and clinical specialist physiotherapists to ensure the rehabilitation plan is aligned with the surgical goals and any adjustments are made quickly. At JT physiotherapy, we are lucky to have strength testing equipment that allows us to measure and track your progress over time. The ability to quantity your strength provides valuable insights throughout the rehabilitation process.

Summary

By addressing both the preparatory and recovery phases, we hope to encourage people to take an active role in their healing journey. Through personalized care, education, and ongoing support, we aim to improve the overall surgical experience, contributing to successful outcomes and improved quality of life for our patients.

If you or anyone you know are scheduled for a Pre/post-operative physiotherapy, it would be beneficial to contact a Chartered Physiotherapist for advice and exercise beforehand to help your recovery.

If you would like any further information, reach out to us on 0749111010 or via email at aiveen@jtphysio.com .

Thanks for reading.

Aiveen.

References

Vasileiadis, D, Drosos, G., Charitoudis, G., Dontas, I. and Vlamis, J (2022) Does preoperative physiotherapy improve outcomes in patients undergoing total knee arthroplasty? A systematic review. Musculoskeletal Care.

Author: Aiveen Lavery

Senior Physiotherapist

Dry Needling

Tue, 04 Jul 2023 11:14:09 GMT

Dry Needling

What is Dry Needling?

Dry needling is technique that involves inserting thin, sharp needles into your skin and into area of muscle that are either tight or irritable. It is used as part of your pain management plan alongside exercise and stretching. The needles that are used are the same as the ones used in Acupuncture, but the technique is different; Acupuncture will involve many needles along “meridians” or “energy lines,” whilst dry needling will only use a few needles in a concentrated area. The needles a thin and do not contain any medication, hence the “dry” needle.

What is does it do?

The aim of dry needling is to reduce tightness in the muscle, increase blood flow to the area, and reduce pain in the area/ an area of referred pain. There is some contention as to what effect dry needling has, and whether the depth/ technique matters. Some studies have indicated that the sensation of the needle going into the skin causes the most effect. When the needle goes into the skin, there will be an increase in blood flow to the area, but the substantial changes occur at nervous system. In a muscle that is tight or irritable, the nervous system will be working overtime, and when you get a change quick change in tightness or a muscle it is due to a dampening down/ calming of the nervous system. During dry needling you can get a “local twitch response” which is when the muscle goes rapidly in and out of spasm, this is a visual representation of the changes of the nervous system. If the grading of needling is high or is deep you can sometimes feel tender in the area for a day or two, but it will pass.

What conditions can Dry Needling be used for?

Dry Needling can be used as part of treatment plan for a multitude of conditions. It is important to remember that Dry Needling alone will cure/ treat your issues, and that it should always be used as part of your treatment/ rehab plan.

Experientially I have found it to be a useful part of my treatment of clients with neck and shoulder pain, headache and migraine symptoms, jaw and temporal-mandibular pain, lower back and hip pain, and various muscular injuries.

It can also be a useful treatment option for those with:

• Disc issues

• Joint issues

• Tendinopathies

• Migraine and tension-type headaches

• Jaw and mouth issues

• Pelvic pain

• Whiplash

• Spinal issues

• Repetitive motion disorders

• Phantom limb pain

Who should not have dry needling?

For safety reasons the people with the following conditions should not have dry needling performed:

· Pregnant

· People who suffer with epilepsy

· On blood thinners and those with haemophilia

· Immunocompromised

· Very afraid of needles

· Those unable to understand the treatment.

The Pointy End (Pun Intended)

In conclusion, dry needling can be an effective adjunct to treatment for a variety of conditions. It should always be used in combination with advice and education, as well as some home exercises for you to be able to continue with the therapy by yourself. If you have any questions or would like to know more about it, please feel free to contact us at JT Physio.

Author: Kieran Sasiadek

Senior Physiotherapist

If you would like any further information, reach out to us on 0749111010 or via email at kieran@jtphysio.com

Trigger Finger

Tue, 27 Jun 2023 11:43:20 GMT

Trigger Finger

Introduction

Trigger finger is a condition affecting one or more of the hand's tendons, making it difficult to bend the affected finger or thumb. It can make a finger get stuck in a bent position.

Research has found shockwave therapy to help reduce pain and increase functional capacity in those with symptoms (Dogru et al. 2020).

To book your appointment, contact us on 0749111010 or book online via link.

Author: Aiveen Lavery

Senior Physiotherapist

De Quervians Tenosynovitis

Fri, 23 Jun 2023 13:54:32 GMT

De Quervians Tenosynovitis

Introduction

De Quervians tenosynovitis is a common pathology affecting the tendons on the thumb side of the wrist. Possible causes include acute injuries, overuse and repetitive motion of the wrist and thumb.

Like many tendon pathologies, progress can be slow. Research has found shockwave therapy to be a safe and effective treatment for those with De Quervians Tendinopathy (Haghnighat et al. 2021). The mechanical stimulus provided by shockwave therapy is thought to help initiate tendon regeneration and increase blood flow (Wang et al. 2012).

To book your appointment, contact us on 0749111010 or book online via link.

Author: Aiveen Lavery

Rehab Journey and Setbacks

Thu, 22 Jun 2023 11:39:52 GMT

Rehab Journey and Setbacks

Being in pain and being injured is no fun. You have the physical effect of pain, stiffness, irritation, and reduced function, and you also have the psychological impact to deal with. The anxiety of how long it will take to get better, a reduction in your quality of life, and the fear of whether you are making things worse. Clients will also often blame themselves for their injuries, “I shouldn’t have done that” or “I’m sat for too long,” and although there can be some merit in these comments, it is important to realise that pain is a very complicated issue and rarely ever due to one factor. As such there is little value in beating yourself up for your injuries, and “being kind to yourself” is a phrase I will extensively use with my clients.

In my day-to-day work, clients will often ask if they should stop doing an activity, whether its golf, swimming or running. My answer will always be “No.” One of the worst things a physiotherapist could do, is to take away something that brings you joy and improves your quality of life. Often, I might ask a client to modify the activity or reduce it to more manageable levels for a brief time, then gradually increase their volumes as tolerable. An example being a client with elbow pain when playing golf, we can reduce their volume to nine holes instead of a full eighteen, then gradually building back up to a full eighteen as tolerable.

In an ideal situation when you are recovering from an injury, you would make continued linear progress, and you get better and better until you are fully recovered. Unfortunately, this is not always the case. Sometimes rehab can be like a game of snakes of ladders, where you will make improvements and things will progress nicely, and then can drop back down again with setback or flare up. This can be when it gets particularly frustrating for a client, as you have spent time and energy doing the rehab, only for it come back. This sort of situation can occur with achilles tendinopathy, particularly for runners. They are progressing nicely, with a reduction in pain, an increase in strength, and they have gradually increased their running and are incredibly happy, then they try a bit too much or go a bit too fast or for too much distance, and the tendon flares up again.

In situations of flare ups like the example above, it is important for clients to try to take stock of things, and this is where our role as Physiotherapists is crucial. Throughout our sessions we are taking data and recording what your able to do and how you react to it. So, when you feel down or frustrated about having a set-back or not being able to achieve something without issues, we can show you how far you have come and the progress you have made from your first session. It is our way of making sure you do not “throw the baby out with the bath water.” So rather than packing in the exercises or saying, “I’m just going to stop running”, we would re-evaluate where the client is, we’d aim to reduce the irritation, restore the strength and range, and suggest a lighter speed and volume of running for the time being whilst we build up again.

As a take home message, it is important to remember that being in pain and being injured is no picnic, and the rehab can take twists and turns as you go along. But as you go through the rehab journey the most important thing is to be kind to yourself, do the things that bring you joy, and not take away the activities that you give you quality of life.

Author: Kieran Sasiadek

Senior Physiotherapist

If you would like any further information, reach out to us on 0749111010 or via email at kieran@jtphysio.com

Knee Replacement

Mon, 19 Jun 2023 14:13:48 GMT

Knee Replacement

Were you aware that preoperative physiotherapy can enhance results in total knee replacement surgery?

Introduction

The most common reason for total knee replacement is osteoarthritis. Preoperative physiotherapy and exercise, also known as prehabilitation is thought to improve recovery and functional performance following surgery. A recent paper reviewed the literature and investigated the effectiveness of prehabilitation on subjective and objective outcomes following total knee replacement and compared outcomes to those who did not receive physiotherapy and exercise preoperatively.

What did the authors find?

They found that patients who underwent preoperative rehabilitation prior to their total knee replacement surgery had a significant reduction in pain, length of hospital stay and functional performance, compared to those who did not receive physiotherapy and exercise preoperatively.

What does this mean?

This research has shown that patient’s who complete an exercise program before surgery recover quicker. Working with a Chartered Physiotherapist before your surgery can also provide an opportunity to learn about your surgery, what to expect and increase your confidence.

If you or anyone you know are scheduled for a total knee replacement, it would be beneficial to contact a Chartered Physiotherapist for advice and exercise beforehand to help your recovery.

If you would like any further information, reach out to us on 0749111010 or via email at aiveen@jtphysio.com .

Thanks for reading.

Aiveen.

References

Vasileiadis, D, Drosos, G., Charitoudis, G., Dontas, I. and Vlamis, J (2022) Does preoperative physio therapy improves outcomes in patients undergoing total knee arthroplasty? A systematic review. Musculoskeletal Care.

Author: Aiveen Lavery

Achilles Tendinopothy

info@jtphysio.com (Kieran Sasiadek) — Tue, 22 Dec 2020 09:22:34 GMT

Achilles Tendinopothy

The Achilles tendon (AT) originates from the calf muscle and inserts onto the calcaneus or heel bone. It is the largest and strongest tendon in the human body as it has to withstand 12x your body weight load during running. The AT transmits forces from the calf muscle complex to the foot and ankle, also known as the ‘powerhouse muscle’ in long distance runners. It is not surprising that the AT is commonly afflicted among runners and often manifests as a ‘tendinopathy’ which is an umbrella term used to describe pain and dysfunction. Although runners are mostly likely to experience Achilles tendinopathy it can also affect recreational athletes as well as sedentary individuals. Achilles tendinopathy can emerge from a multitude of factors (i.e age, genetics, medication), but it is commonly caused by a repeated microtrauma to the tendon that does not heal and over time builds up.

Symptoms include:

•pain when squeezing the tendon or heel bone

•pain on loading i.e hopping, running and walking

•decrease in strength and range of movement in the ankle joint

•morning stiffness

•Minimal pain at rest

Athletes can be expected to return to sport anywhere from six weeks up to one year though symptoms can sometimes persist to varying degrees for years. It is important you seek a chartered Physiotherapist to guide you through your rehab and injury management. Exercise is found to be the most effective in terms of management and should be the cornerstone of treatment. There is recent evidence for the use of shockwave therapy for Achilles tendinopathy, as it can stimulate soft-tissue healing, increase the blood flow to the treated site and induce an inflammatory-mediated healing process. Here at JT Physiotherapy, we can provide you with a mixture of both exercise and shockwave therapy for the best possible outcome.

Vegetarian Diets & Nutrients

Mon, 19 Oct 2020 18:31:00 GMT

Vegetarian Diets & Nutrients

Vegetarians typically don’t eat meat, poultry, fish or shellfish. However different types of vegetarian diets exist, for example Lacto-ovo vegetarians eat dairy foods and eggs but not meat poultry or seafood, Ovo-vegetarians eat eggs but exclude all other animal foods including dairy, whereas Vegans don’t eat any animal products at all, including honey.

Well-planned vegetarian diets can be nutritious and healthy. They are associated with lower risks of heart disease, high blood pressure, type 2 diabetes, obesity, certain cancers and lower cholesterol levels. This could be because such diets are lower in processed food, contain fewer calories and more fibre and phytonutrients (these can have protective properties) than non-vegetarian diets.

If you are eating a vegetarian diet there are some specific nutrients you need to consider:

Protein

Protein is made up of building blocks called amino acids. Some amino acids are essential, as the body can’t make them itself. Animal proteins contain the complete mix of essential amino acids. Soya, quinoa and hemp are plant foods containing all the essential amino acids.

Most other plant proteins provide some, with each plant providing a different combination. So, as long as you’re eating a mixture of different plant proteins you’ll be getting all the essential amino acids your body needs.

Vegetarian sources of protein include:

If you eat them:

Iron

Red meat is the most easily absorbed source of iron, but various plant foods also contribute:

To help your body absorb iron from plant foods, include a source of vitamin C with your meal (e.g. vegetables, fruit or a glass of fruit juice).

Calcium

Dairy foods are rich in calcium. If you’re not eating these, include plenty of the following:

Vitamin D

Our bodies make vitamin D from sunlight during the spring and summer (with sufficient exposure). Foods that contain vitamin D are limited, such as:

Additional supplements are recommended for groups at risk of deficiency including all pregnant and breastfeeding women, children under five-years-old, people aged over 65 years and people who are not exposed to much sun. As i mentioned in the last few weeks, the UK has recently updated recommendations, “Everyone over the age of four should take 10 micrograms of vitamin D every day, particularly from October to March”. This is of note as Ireland lies at a similar latitude and as such we are exposed to similar levels of sunlight during these winter months.

Vitamin B12

Eggs and dairy foods contain Vitamin B12. Vegans should include fortified foods containing Vitamin B12 (check the label):

Omega-3 fats

There are two types of omega-3’s:

The long versions are particularly good for us and current advice recommends eating two portions of fish a week, one of which should be oily. The short versions may not have the same benefits. Although our bodies can convert some ALA into EPA and DHA, the conversion isn’t very efficient.

To maximise this conversion:

Well-planned vegetarian diets are appropriate for all stages of life and have many benefits. These guidelines will help you enjoy all the health benefits and ensure you are eating a nutritious and complete diet.

Liam Leech

BSc (Hons) Sport and Exercise Science, MSc. ANutr.

Vitamin D Update

Mon, 19 Oct 2020 16:56:00 GMT

Vitamin D Update

Earlier this year I talked about the importance of Vitamin D. Recently, the UK recommendations have been updated. This may be of interest as the original guidance was similar to current Irish recommendations.

Although the current recommendations for vitamin D are based on bone health, it has been suggested that vitamin D may have a role in other health outcomes, which include reducing the risk of cancers, cardiovascular disease, infectious diseases and autoimmune diseases.

The primary source of vitamin D is via direct exposure of the skin to sunlight. Dietary sources are limited. It is found naturally in a small range of foods including oily fish, egg yolks, and also in fortified foods such as milk, breakfast cereals and infant formula. Offal meat such as liver and

kidney are a good source of Vitamin D but are not recommended for infants and pregnant women due to their high Vitamin A content.

There are various factors that can determine exposure to sunlight such as geographical location, season, time of day, and cloud cover. This is especially important in countries such as Ireland at latitude 40–60 °N and above. At such latitudes there is insufficient sunlight exposure from October to March to facilitate synthesis of vitamin D.

Deficiency in children can lead to the development of rickets which can cause permanent deformities to the bone, weaken muscles and reduced growth.

Deficiency in Adults can result in osteomalacia, a softening of the bones leading to bone pain and muscle weakness. It may also put men at increased risk of colorectal cancer and women at increased risk of developing breast cancer.

Current Irish recommendations

Due to the variability of sun exposure it is difficult to take a ‘one size fits all’ approach, however an intake of 5 micrograms per day is recommended for most of the population.

All babies living in Ireland should be given a vitamin D only supplement providing 5µg Vitamin D from birth. (FSAI Guidelines)

People aged 65 years or older and people who are not exposed to much sun should take a supplement of 10 micrograms a day

Pregnant and breastfeeding women should also take 10 micrograms of vitamin D a day.

The new UK recommendations

Everyone over the age of four should take 10 micrograms of vitamin D every day, particularly from October to March

Pregnant and breastfeeding women and at-risk groups (such as people from ethnic minority groups with dark skin, elderly people and those who wear clothing that cover most the skin) should take 10 micrograms per day all year round

Children between the age of one and four should take 10 micrograms of vitamin D supplements all year round

All babies from birth up to one year of age should take 8.5 to 10 micrograms per day (particularly those being breastfed)

Health officials in Scotland and Northern Ireland have updated their guidance in line with the new recommendations, but only for people aged over six months.

Liam Leech

BSc (Hons) Sport and Exercise Science, MSc. ANutr.

The Office and Exercise

Mon, 19 Oct 2020 16:44:00 GMT

The Office and Exercise

A major study published in the UK medical journal, “The Lancet”, has found that office workers must exercise for one hour a day to combat the heath risk of modern working lifestyles. Research on more than one million adults found that sitting for at least eight hours a day could increase the risk of premature death by up to 60 per cent. Researchers found that globally, more than 5 million deaths a year are linked to physical inactivity – a similar number to lives lost to smoking, and a higher figure than that caused by obesity.

Lead scientist Professor Ulf Ekelund, from Cambridge University and the Norwegian School of Sports Sciences, said: “We found that at least one hour of physical activity per day, for example brisk walking or bike cycling, eliminates the association between sitting time and death.”

“You don’t need to do sport, you don’t need to go to the gym, it’s OK doing some brisk walking maybe in the morning, during your lunchtime, after dinner in the evening. You can split it up over the day but you need to do at least one hour,” he said.

A decent walk – at a speed of just over three miles an hour – was enough to achieve the benefit, he stressed.

Movement is the best medicine

These findings show that the current recommendations for adults (at least 30 minutes a day of moderate activity) may be insufficient to to combat the dangers of eight hours sitting in the office.

Another study in the BMJ has highlighted the many benefits that any sort of physical activity can have on your health.

A team of American and Australian researchers analysed a series of studies published between 1980 and 2016 examining the associations between total physical activity and at least one of five chronic diseases – breast cancer, bowel (colon) cancer, diabetes, heart disease, and stroke.

They found that a higher level of total weekly physical activity was associated with a lower risk of all five conditions.

Again, the researchers highlighted an important take away fact – this doesn’t have to mean hitting the gym; it can include being more physically active at work, engaging more in domestic activities such as housework and gardening, and/or engaging in active transportation such as walking and cycling.

How you can be more active at work:

– Get outside at lunchtime for a nice walk

– Use a standing desk

– Take a 5 minute break every hour to walk to the printer, to the next office or just to get a cup of water

– Take the stairs and leave the lift!

– Don’t use instant message all the time, walk over to your colleagues and have a face to face conversation.

Liam Leech

BSc (Hons) Sport and Exercise Science, MSc. ANutr.

TMJ

Mon, 19 Oct 2020 16:19:00 GMT

TMJ

The temporomandibular joints (TMJ) are two of the most frequently used joints in the body. Without these joints, simple things like talking, eating and yawning would be severely hindered. Dysfunctions of the TMJ can involve the muscles, the disc and the joint. This can result in pain, restricted jaw motion and joint noise.

Complex system

The TMJ is a member of a complex system and must not be looked at in isolation. It is made up of bones, joints, ligaments and muscles. These structures work together to allow the jaw to carry out different functions like smiling, speaking, swallowing and breathing! The normal function of the TMJ is therefore vital for human survival.

Symptoms of TMJ dysfunction

What can a physiotherapist do for TMJ dysfunction?

A physiotherapist would take a detailed subjective history and then perform an objective assessment of your cervical spine and TMJ. There are various interventions for TMJ pain, including manual therapy and motor control exercises. Due to the TMJ’s close relationship to the cervical spine, good results can be achieved by strengthening up the muscles around the upper quadrant. Reformer Pilates is a great way of doing this, which is offered here at JT Physiotherapy.

Tips for Acute Jaw Pain

1. Keep your jaw in a neutral posture (tongue on roof of mouth, teeth apart, lips together)

2. Maintain good neck posture as the jaw and neck are dependent on one another

3. Cut food into small pieces to avoid opening your jaw too much

4. Avoid stressful situations. Use relaxation techniques or practice mindfulness.

More Information

If you have symptoms of TMJ dysfunction or would like more information, contact us for an assessment with one of our Charted Physiotherapist’s.

Aiveen Lavery, MISCP MCSP

When can I go back after an injury? – Injury and the “Envelope of Function”

Mon, 19 Oct 2020 16:10:00 GMT

When Can I Go Back After an Injury?
– Injury and the “Envelope of Function”

We’ve all been injured before, even physiotherapists! I’m sure you’ve noticed that when you’re sore or injured you aren’t able to do everyday things as well or as much as you could before and you may also be in pain. Your injury may even affect your ability to do your job fully or to train as much as you like.

Normally when we do a tough workout or we’re on our feet all day our bodies have the capacity to cope with this loading. Our bodies react to this loading through numerous physiological responses, our bodies adapt, we recover and we can get up and go do it all again the next day. Our bodies are amazing in this way!

However if the loading is too excessive, our bodies fail to adapt quick enough and to recover quick enough thus our body’s capacity to tolerate load is reduced. This may lead to a “reactive response”, i.e. injury and/or pain to tissues and structures in the body. Our tissues now have a reduced capacity to loading for activities we would usually deem as our day-to-day activities and can be painful: going for a run, washing the dishes, driving, walking the dog, going to the gym, sleeping…. Stress, sleep, work-life balance and our habits and behaviours can also influence the body’s ability to tolerate load.

This is discussed by Scott Dye (2005 – see reference below) with his “envelope of function” theory and eloquently put to graph form by Tom Goom:

When we have an injury or a painful episode, our “manageable” loading can be reduced significantly and our “excessive” loading ramps up. Basically, it doesn’t take much for our pain to come on or to get worse. During this stage, rehabilitation is important to get us back to our baseline levels by a graded return to our own “normal” activities. We can do this by reducing the load in terms of frequency, volume and intensity – this applies to our daily activities as well as sport and training – and by increasing our tissues’ ability to tolerate loading by improving their strength and endurance to same. Pain relieving modalities may also help in the early stages as well as addressing any lifestyle and work issues that may have played a role in your injury.

Aine Tunney, MISCP

Reference:

https://www.researchgate.net/profile/Scott_Dye/publication/7749608_The_pathophysiology_of_patellofemoral_pain_-_A_tissue_homeostasis_perspective/links/0deec53684c4eaa81e000000/The-pathophysiology-of-patellofemoral-pain-A-tissue-homeostasis-perspective.pdf

Let’s disc-cus discs!

Mon, 19 Oct 2020 15:47:00 GMT

Let’s Disc-cus Discs !

Our intervertebral discs consist of two layers: the inner layer called the nucleus pulposus and the outer layer called the anulus fibrosus. The anulus fibrosus consists of concentrically arranged Type I and II collagen fibres and fibrocartilage which keeps the nucleus pulposus under tension. On the other hand, the nucleus pulposus contains loose fibres within a muco-protein gel. The intervertebral discs lie between the central bodies of our spinal vertebrae except for the C1-2 and C0-1 levels, the two uppermost spinal segments in the neck.

Above and below each disc there are hyaline cartilage endplates derived from the respective spinal segments above and below each disc, thus forming a strong and robust fibrocartilaginous joint called a symphysis . These endplates are both bony and cartilaginous in nature and create an exceptionally strong and robust attachment to the anulus pulposus of the disc. The endplates:

The discs and their respective endplates also act as ligaments to hold the vertebrae together.

The position of our discs are also maintained by the longitudinal ligaments. The posterior longitudinal ligament is fused with the discs over a broad surface from the C2 segment in our neck right the way down to the sacrum. The anterior longitudinal ligament crosses all the spinal segments and discs at the front of the spinal column from neck to sacrum. It is thicker and slightly narrower over the vertebral bodies but thinner and slightly wider over the intervertebral discs.

Discs are the shock absorbers of the spine; the equivalent would be the cartilage in the knee joint. The nucleus pulposus helps to distribute pressure evenly across the disc from loading and prevents excessive forces on the vertebral endplate. Loading compresses the discs, and when it is de-loaded, they regain their original shape over time. When we move our backs, the discs, as elastic elements, are compressed or stretched unilaterally depending on the direction we are moving in.

Putting all this anatomical information together we can clearly say that our discs are strong , biomechanically secure , robust and fit for purpose !

Injuries to the Discs

Like other structures in the body discs can become injured…but they can heal! In a similar way, the severity of disc injuries and also how the body interprets and responds to such an injury is different from person to person. Sometimes the disc may be injured (anulus fibrosus and/or nucleus pulposus) but it is not the structure that is causing the pain. Facet joints of the vertebrae, spinal ligaments, synovial membranes of the spinal joints, nerves and muscles may be involved in producing pain in relation to a disc injury as a protective mechanism or from inflammation.
Nakashima and colleagues (2015) stated that:

So we can infer that people who are pain-free with no symptoms can have similar age-related degenerative changes of the different structures in their spine to those people who have pain. This is summed up nicely in a table taken from Brinjikji and colleagues’ systematic review (2015):

Also in 2015, Chiu and colleagues concluded that:“Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc sequestration had a significantly higher rate of complete regression than did disc extrusion….The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs.”

However, disc injuries can be severe enough to cause debilitating pain, impinge on nerve roots or protrude into the spinal canal with the possibility of neurological signs and symptoms. If in doubt, get checked out by your G.P. and Chartered Physiotherapist.

Aine Tunney, MISCP

References

Brinjikji, W., Luetmer, P.H., Comstock, B., Bresnahan, B.W., Chen, L.E., .A. Deyo, R.A., Halabi, S., Turner, J.A., Avins, A.L., James, K., Wald, J.T., Kallmes, D.F. and Jarvik, J.G. (2015) Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology, 36: 811-816.

Brukner, P. and Khan, K. (2012) Clinical Sports Medicine , 4th Edition. Sydney: McGraw Hill.

Chiu, C.C., Chuang, T.Y., Chang, K.H., Wu, C.H., Lin, P.W., Hsu, W.Y. (2015) The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation, 29(2):184-95.

www.DrJarodHallDPT.blogspot.com

Nakashima, H., Yukawa, Y., Suda, K., Yamagata, M., Ueta, T., Kato, F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects . Spine. 2015;40(6):392-8

Platzer, W. (2004) Color Atlas of Human Anatomy, Vol. 1 Locomotor System, 5th Edition. Stuttgart: Thieme.

Sweet Potato

Mon, 19 Oct 2020 15:35:00 GMT

Sweet Potato

At JT Physiotherapy we looooove the SWEET POTATO, they can do no wrong! Sweet or savory, the choice is endless! Ideal for gluten intolerance/allergies, those of us who are carb conscious, those looking for a dessert taste in a main – score!

Question: Have you tried to cook it in your toaster yet….???

Method:
Turn up your toaster to its highest setting,
slice your fresh sweet potato around 1/2 cm thick & pop it in.
Once it starts to brown, take it out!
Done!

Sweet or Savory? What’s your preference?
Try Ricotta & Berries! For a Protein Boost try Avocado & Egg.
Word on the street is Peanut Butter & Banana is a delicious combo too!

We recommend checking for drool after reading this!

Patellar Tendinopathy

Mon, 19 Oct 2020 15:23:00 GMT

Patella Tendinopathy

Patellar tendinopathy is a common cause of pain at the front of the knee. It is often referred to as jumper’s knee. The pain is specific to the patellar tendon, just below the knee cap. The prevalence is particularly high amongst athletes, especially those involved in jumping sports such as basketball and volleyball. It tends to affect young boys and men and those who have better jumping ability. Patellar tendinopathy can result due to the repetitive nature of the sport causing excessive load on the tendon.

Tendinopathy research has developed a lot over recent years and this pathology is thought to be caused by changes within the properties of the tendon, rather than acute inflammation. Overload is a key factor in the onset of the pain. This can be from an increase in volume of jumping or a return to sport after a period of downtime. There are some intrinsic factors related to patellar tendinopathy such as reduced quadriceps/hamstring flexibility and reduced ankle/foot mobility which should be addressed.

As with any other tendinopathy, it is important to address the pain first. There is recent evidence for the use of shockwave therapy for patellar tendinopathy. This can help the unhealthy tissue regenerate and accelerate tissue healing. The results are promising and have a positive effect on pain and function. This is something that we can offer here within the clinic at JT Physiotherapy. However, exercise should always be the main form of treatment and tendons respond best to a graduated and specific loading programme. It is important to work closely with your physiotherapist in order to get the best selection of exercises to help gear you towards your goals.

Aiveen Lavery, MISCP MCSP

Chartered Physiotherapist Post

Mon, 19 Oct 2020 15:19:00 GMT

Chartered Physiotherapist

Physiotherapy Job Summary:

JT Physiotherapy Clinic is offering a suitable Chartered Physiotherapist the opportunity to join our Team.

JT Physiotherapy has been open since January 2013 and has locations in Letterkenny (ROI) and Derry (NI). We have been steadily growing to a point where we can no longer cope with our current caseload and have developed a considerable waiting list for new appointments. Service at our clinic is our first priority and we need a fresh, enthusiastic and motivated clinician to join our Physiotherapy Team. This Physiotherapist would initially be working primarily in our Letterkenny Clinic but may potentially work in between both clinics at a later date.

Our Clinics are multi disciplinary and services include: Physiotherapy, Running Analysis, Massage, Reformer Pilates, Strength and Conditioning, Nutrition and Orthosis Prescription.

Consistency between our clinicians is important and every patient walking through the front door needs to leave with the same experience and high level of service.

This position would best suit a Physiotherapist not set in their ways and wishing to continuously develop professionally, focusing not on only on injuries but identifying and correcting movement dysfunctions and encouraging optimal lifestyle habits. A positive attitude is essential.

The position will be full time and will involve some evening and weekend work. The right candidate must have 2 years post graduate Musculoskeletal experience and have excellent manual therapy and clinical skills. Previous experience in the private sector is desirable but not essential and salary will be based on experience. Applications are welcome from applicants who already have full registration in Ireland or UK.

We view our staff as our most valuable asset in the clinic. The successful candidate will receive excellent professional development opportunities in a fantastic working environment. We look forward to hearing from you.

Tibialis Posterior

Mon, 19 Oct 2020 15:08:00 GMT

Tibialis Posterior

Tibialis Posterior (Tib Post) is a muscle of the lower leg that starts deep to the calf. It then runs behind the medial malleous of the ankle and attaches to the bones of the feet, in particular the navicular. Tib Post plantarflexes (points) the foot and ankle, and inverts (turns in) the ankle and foot. It is not that common to injure this muscle in isolation but it can be overloaded and become painful, along with the calf muscles and Achilles tendon, due to overloading with regards to training and activity, neglect of strength and mobility work to calf region, maladaptive biomechanics and sometimes footwear. Higher up the chain, the stability at the knees, hips and lumbo-pelvic region can impact on how the foot and ankle moves this either elongated or shortening Tib Post leading to overloading and pain. We need Tib Post, as well as the other muscles at our ankles to be working at their optimum to help us walk, run, keep active and fully participate in sport.

Posterior Tibial Tendon Dysfunction (PTTD)

This a condition of the Tib Post tendon that usually has a gradual onset, is degenerative in nature and mainly occurs in the middle-aged population. These are the four phases of PTTD

Foot orthoses can help with these symptoms in the appropriate phase, along with exercise therapy and advice on symptom management. Please consult your Chartered Physiotherapist to determine a treatment plan for you.

NB: Foot pronation is a good thing! We need it to enable our feet to successfully clear the ground and propel us forward, whether we’re walking or running. If you have always had “flat feet” and they’ve never been painful then your feet do not need to be corrected as your body has adapted to them and has coped with them for all this time.

Aine Tunney, MISCP

References:

Alvarez et al (2006) Stage I and II Posterior Tibial Tendon Dysfunction Treated by a Structured Nonoperative Management Protocol: An Orthosis & Exercise Program. Foot and Ankle International , 27(1): 2-8

Kulig et al (2009) Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Physical Therapy, 89(1):26-37

Should you run or exercise through your pain?

Mon, 19 Oct 2020 14:48:00 GMT

Should You Run Or

Exercise Through Your Pain?

Should you run or exercise through your pain?

To start with, it’s always your decision to rest or to exercise. Generally the advice is that, if you are sore when running or exercising, that you can continue if your pain remains mild, i.e. it is 5/10 or below (see scale below), it resolves the next day and the overall issue is improving. However, if your pain is or becomes severe (6/10 or above), if there is a suggestion that there is serious injury or if your pain does not settle the following day, the consensus is that you do not run, exercise or participate in sport.

Sometimes you can run through your pain if you can modify it as you go to test your pain threshold, to “poke the bear” so to speak (this is different to injury threshold which is your ability to move when injured). Or you can go down the graded exposure route of shorter or slower runs/exercises then gradually returning back to your usual levels of exercise. If these options aren’t viable and your pain is still severe, please do make an appointment to see your Chartered Physiotherapist to get you back to your best. “If in doubt, get it checked out.”

Aine Tunney, MISCP

Lateral Collateral Ligament Injuries

Mon, 19 Oct 2020 14:01:00 GMT

Lateral Collateral Ligament Injuries

The lateral collateral ligament (LCL) is located on the outside of the knee. It is the primary restraint to various stresses and can be injured through sport. LCL injuries are not as common as medial collateral ligament (MCL) injuries. However, LCL injuries rarely occur in isolation, which is why it is important to have it assessed by a Charted Physiotherapist to determine if other structures are involved and provide you with the best course of management.

Mechanism of Injury

The LCL can be injured when the tibia has been forcefully turned out or when the knee goes into hyperextension. For example, in soccer, landing from a header and tackling can put the knee into this position. It is also very common for athletes to continue to play on despite sustaining an injury to this ligament. This is down to the strength of other supporting structures around the area including the posterior capsule and posterolateral corner, made up of the LCL, popliteus, biceps femoris and the popliteofibular ligament.

Symptoms

Management

Initial management may include bracing or non-weight bearing through crutches dependent on the extent of the injury. It is important to start strengthening exercises early in the rehabilitation process to prevent muscle atrophy and allow ligament modification. As always, exercise based rehabilitation plays an important role in the recovery of LCL injuries. Without active participation of the athlete, the outcomes are likely to be poor. Timeframe in terms of return to play can be anywhere from between 6 and 12 weeks.

Aiveen Lavery, MISCP MCSP

How many calories does that bad night’s sleep cost you?

Mon, 19 Oct 2020 13:51:00 GMT

How Many Calories Does
That Bad Night’s Sleep Cost You?

In recent years, adequate sleep has emerged as a third pillar, along with exercise and healthy eating, as a way to help control weight. While more research is needed to explore the links between chronic sleep loss and health, the importance of sleep is already well established.

It is a restorative process. It helps the brain commit new information to memory. Sleep loss has an effect on mood. It may result in irritability, impatience, inability to concentrate, and moodiness. Serious sleep disorders have been linked to high blood pressure, increased stress hormone levels, and irregular heartbeat. Sleep deprivation alters immune function, including the activity of the body’s killer cells. Keeping up with sleep may also help fight cancer. Sleep deprivation contributes to a greater tendency to fall asleep during the daytime. These lapses may cause falls and mistakes such as medical errors and road accidents.

But have you ever noticed that the less you sleep, the more hungry you feel the next day? New research published in the European Journal of Clinical Nutrition has allowed researchers to put a number on the average surplus calories consumed by sleep deprived individuals. This is one of the first times that researchers have been able to calculate the actual caloric impact on insufficient sleep.

The authors examined the results of a number of studies, in which subjects included 172 people ages 18 to 50, both male and female, who were either normal weight, overweight, or obese. All of the studies included control groups of people who did get enough sleep – 7 to 12 hours in bed at night. People in the sleep deprived groups logged between 3½ to 5½ hours in bed.

The researchers found that the sleep deprived consumed an average of 385 calories extra per day. To put this into context, it is nearly a fifth of the energy requirements of the average moderately active 30 year old woman.

In previous studies, researchers speculated that a lack of sleep had an impact on hormones related to hunger, such as leptin and ghrelin, which resulted in a tendency to overeat when in a sleep deprived state. However the researchers of this study believe that the reason people overeat may be more “hedonic,” in nature. In other words: tired people overeat because they’re seeking pleasure.

A weakness in the review is that none of the studies lasted more than two weeks, making it impossible to definitively say whether the extra calories caused weight gain. This is an area of further study the authors are involved in.

Liam Leech

BSc (Hons) Sport and Exercise Science, MSc. ANutr.

Sacroiliac Joint – Part 1

Mon, 19 Oct 2020 13:39:00 GMT

Sacroiliac Joint – Part 1

The Sacroiliac Joint (SIJ), of which we have two, is the joint articulation between the sacrum and the two pelvic bones. The SIJs are essential for effectively transferring loads between the lower limbs and the spine. They are highly specialized joints that permit stable (yet flexible) support to the upper body. The sacrum, pelvis and spine, and the connections to the arms, legs and head are functionally interrelated through muscular, fascial and ligamentous interconnections (Vleeming et al, 2012). This means that when you experience pain in the pelvic region we need to consider the pelvis, spine and limbs as an integrated, interdependent and dynamic biological structure, not just focus on the painful spot. However the most likely cause of a specific SIJ injury is “jarring” of the leg if coming off a step or a sudden force going through the limb when standing on one leg.

Many ligamentous, fascial and musculous tissue cross the SIJs but none specifically work on the joints. The main muscles that do have an indirect impact on the SIJ are: gluteus maximus and minimus, psoas, multifidis, pelvic floor muscles and the diaphragm, transversus abdominus, latissimus dorsi, piriformis, biceps femoris of the hamstring group, thoracolumbar fascia, external and internal obliques.

The SIJ is encased in a capsule that has a smooth anterior wall and irregular bands comprising the posterior wall. The capsule has a nerve supply and is surrounded by several strong ligaments which influence its range of motion. In turn, these ligaments are related to the thoracolumbar fascia which is itself derived from fibres of several larger back muscles that surround the joint at a distance.

Current research now supports the existence of very limited ranges of motion of the SIJs in all three of their planes. The average range is 2 ° of movement (Goode et al, 2008; Kinsgard et al, 2017).

Research has shown that increased SIJ laxity is not associated with pregnancy-related pelvic pain and that pregnant women with moderate or severe pelvic pain have the same laxity in the SIJs as pregnant women with no or mild pain. (Damen et al, 2001). Research has also found that there are no provoking or relieving movements or positions that are unique or especially common to SIJ pain therefore other structures, above or below, may be the source of pain. Reliability of palpation testing for SIJ pain has been found to be poor (Robinson et al, 2007) which means palpating the SIJ under the thoracolumbar fascia and the surrounding muscles and ligaments is not useful in telling use that the SIJ is the source of pain.

Diagnosis of SIJ pain

The current gold standard for diagnosing SIJ pain is to use fluoroscopically-guided, contrast enhanced intra-articular anaesthetic nerve blocks (Laslett et al, 2005) – which we obviously cannot do in a physiotherapy clinic! From a physiotherapy assessment point of you, the tests that are both clinically effective and backed by best evidence available is a group of tests called Pain Provocation Tests. These consist of six specific tests that put the SIJ under stress in different ways. If three or more of these tests are painful, we can deduce that the SIJ is the source of pain. If there are less than three tests positive or if none of the six tests induce pain, we can confidently say that the SIJ is not the source of pain. We also need to assess the joints and musculature above and below the SIJ to get a complete picture. Treatment options and exercises for SIJ-related pain will be discussed in Part 2.

Aine Tunney MISCP

References

Stress Fractures

Mon, 19 Oct 2020 11:40:00 GMT

Stress Fractures

Stress fractures fall under a continuum of bone stress injuries which include mild bone strains, stress reactions, stress fractures and ultimately a complete fracture. These types of injuries can be the result of an accumulation of loading over a period of time, without adequate recovery. The focus of this blog today will be on stress fractures.

What is a stress fracture?

A stress fracture is essentially a crack within a bone. Common sites include 2nd and 5th metatarsals, tibia, fibula and the navicular within the foot. A stress fracture represents failure of the bony skeleton to absorb repetitive loads. Failure to successfully manage load can result in pain and performance impairment.

Common Symptoms

Common symptoms include a diffuse ache along the surface of the bone which is worse with impact and settles with rest. However, if your symptoms are worsening, you may experience pain at rest along with some swelling.

Cause of stress fractures

Loading and training variables such as volume, intensity and surface play a big role. However, there are other factors to consider such as inadequate calcium or caloric intake, hormonal factors such as menstrual disturbance in females or reduced testosterone in males, osteoporosis, decrease bone density, muscle weakness and leg-length differences. The main loading factors are as follows:

How can a Physiotherapist diagnosis a stress fracture?

We will take a thorough subjective history, looking for any changes in load that may have contributed to your injury. We can then look at your movement through a range of functional activities, test your muscle strength and mobility, perform impact tests and palpate the site of pain. Referral for radiological examinations such as a CT scan, MRI, bone scan or DEXA scan may be required but this is not always essential.

Management

First and foremost, it is essential to get an accurate diagnosis of your injury. It is therefore vital that you seek an opinion from a Charted Physiotherapist. The key to successful treatment of stress fractures is a period of reduced loading. It is therefore important to avoid the aggravating activity to aid your recovery. Most stress injuries will require a period of rest but dependent on the site of the stress fracture, complete rest is often not desirable. Relative rest will include a period of specific rehabilitation and conditioning. Reformer Pilates can be a great way to maintain strength and mobility in the surrounding structures without compromising the healing process. All in all, this will ensure an expedited return to sport specific training and return to play.

Aiveen Lavery, MISCP MCSP

Meal Timing and Weight Management

Mon, 19 Oct 2020 10:21:00 GMT

Meal Timing and Weight Management

For anyone interested in the implications of meal timing strategies and how they can help or hinder weight management, the American Heart Association has released a “scientific statement” on the subject.

They wanted to establish whether breakfast is actually good or bad for health and weight control, if fasting will reduce body weight and can it improve glucose control?

There are numerous animal studies that have found when food consumption occurs at all hours this can have adverse effects on health. This may have implications for human health in contemporary society.

The AHA found that generally breakfast remains an essential daily meal for optimal well being, however it also states that intermittent fasting holds promise for weight loss. Intentional planning of meals and snacks can maximise the benefits of healthy food consumption while minimising pitfalls such as excessive snacking and late-night consumption.

The AHA found that meal timing makes a difference because many of the body’s internal clocks which regulate metabolism are more affected by food consumption than by daylight and night-time. In animal studies, mice gained more weight and developed more diseases when fed around the clock than when fed only in a “window” of nine to 12 hours. This occurs even though total calorie consumption remains the same in both conditions.

On key aspects of meal timing and frequency, the committee made the following observations:

Breakfast

In one study of 20- to 39-year-olds, those who regularly consumed a breakfast cereal were 31 percent less likely to be overweight or obese. Also, three large-group studies have shown significantly lower diabetes rates among breakfast eaters.

Intermittent fasting

It was found that if a fasting plan reduces overall calorie consumption, subjects should lose weight and improve glucose control. They also found that every-other-day fasting produces better results than 5:2 fasting however they noted that nothing is known about long-term success and health outcomes linked to intermittent fasting.

Night-time eating

Several large-group studies have shown increased obesity, metabolic syndrome and chronic inflammation among those consuming calories late in the day vs. earlier. Men who fall asleep at night and then wake up for a snack face particular risks — a 55 percent increase in heart disease. In one study, subjects who maintained the same total daily calories, but moved 300 calories a day from dinner to breakfast and managed to lose an average of more than 45 pounds in 36 weeks.

The AHA’s advice on the subject:

Liam Leech

BSc (Hons) Sport and Exercise Science, MSc. ANutr.

Cervicogenic Headaches

Fri, 16 Oct 2020 15:09:00 GMT

Cervicogenic Headaches

Headaches are a very common problem experienced by all and it is quite unusual not to have at least an occasional headache. There are many types of headache but it is thought cervicogenic headaches are the most common. This is the medical term used to describe headaches arising from a problem in your neck. The good news is that by working on your neck, symptoms can be alleviated. Headaches are normally harmless, although at times can be a pointer for serious pathology. Which is why it is important to seek advice from a trained medical professional to ensure nothing sinister is missed.

What causes my neck headache?

There can be many drivers responsible for your neck headache. The most common includes musculoskeletal structures such as the upper three cervical joints and surrounding muscles. Neurovascular structures can also be involved. Any irritation of these structures can send a pain signal to the trigeminocervical nucleus (TCN) which is a region of the upper cervical spinal cord. The information is then transmitted to the brain and interpreted as a headache.

Let’s explore these in more detail

Upper neck joints: the most common areas of dysfunction tend to be around C0-1, C1-2 and C2-3. These areas can be either hypomobile (too stiff) or hypermobile (move too much). Once an area becomes stressed too much, this can trigger pain signals to the brain and cause a headache.

Neck muscles : there are several muscles originating in the upper neck and shoulder area which can contribute to your neck headache. The most common reason these are symptomatic is most likely down to muscle weakness. This muscle weakness can cause overload and lead to feelings of tightness and muscle fatigue. It will eventually place further demand on the passive structures such as the joints.

Nerves: the cervical athend occipital nerves are the nerves can become symptomatic through direct irritation or compression, commonly from age related changes and or a cervical disc bulge. This can lead to nerve sensitivity and abnormal neurodynamics.

Symptoms

How can physiotherapy help?

A charted physiotherapist should take a full history and thorough clinical examination to confirm the diagnosis. There a range of treatment techniques which can then be used to help relieve your symptoms.

Exercise based therapy : any weaknesses identified in the examination should be targeted through appropriate strengthening exercises. Mobility exercises can also be given to help reduce the feeling of stiffness.

Manual therapy : stiff joints, namely around the upper three cervical joints can benefit from joint mobilization and soft tissue release on surrounding areas, to help get things moving and feeling a little better.

Good advice : being able to self-manage your condition is an important goal. Therefore, receiving good, honest advice about what to do and what not to do is essential.

More Information

Aiveen Lavery, MISCP MCSP

Golfer’s Elbow

Fri, 16 Oct 2020 13:43:00 GMT

Golfer’s Elbow

Introduction

The elbow is one of the most stable articulations in the body. The bone structures, the joint capsule and the medial and lateral ligaments allow motion and provide this high level of stability. Overuse injuries are common around this joint and are likely to involve the tendon on either the outside (lateral) or inside (medial) of the joint. This is often referred to as either tennis elbow or golfer’s elbow. Although tennis elbow is much more common, golfer’s elbow can provide similar levels of pain and impairment. It is known as an overuse injury and is related to continued or repetitive wrist movements and normally develops gradually over time.

Presentation and symptoms

Golfer’s elbow is characterized by pain on the bony point on the inside of the elbow (medial epicondyle) which may refer into the forearm. Symptoms are usually aggravated through any dexterous tasks or when bending or rotating the wrist against resistance. Examples include turning a door knob, shaking hands, swinging a golf club or tennis racquet and lifting weights.

Treatment

As with all tendinopathies, education, load reduction and a strengthening programme is important. Relative rest, ice and NSAIDs can be used which can help to provide short term pain relief. If you are involved in golf or tennis, it may be worth considering your swing and stroke mechanics. These can be modified to help deload the painful area and facilitate a pain free return to full sport. Other forms of treatment may include soft tissue release, joint mobilization, dry needling and shockwave therapy.

Aiveen Lavery, MISCP MCSP

Exercise Therapy for Pain

Fri, 16 Oct 2020 10:45:00 GMT

Exercise Therapy for Pain

Physiotherapists give out exercise therapy programmes to our patients as part of the overall treatment, including to those with chronic, i.e. long-term, musculoskeletal conditions. These conditions include long-term back and neck pain among others.

The results of this review and meta-analysis show that there is small but significant short-term benefit from exercise programmes that go into pain compared to those programmes that are pain-free. There appears to be no difference at medium-term or long-term follow-up, with moderate to low quality of evidence, demonstrating pain need not be ruled out or avoided in adults with chronic musculoskeletal pain. The findings of this review also showed adults with musculoskeletal pain can achieve significant improvements in patient-reported outcomes with varying degrees of pain experiences and post-recovery time with therapeutic exercise, and pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes.

A theoretical rationale for a positive response to exercises into pain is the positive impact on the central nervous system. Specifically, the exercise addresses psychological factors such as fear avoidance (avoiding certain movements and activities in case they cause pain), kinesiophobia (fear of movement) and catastrophising (worst case scenario thinking), and is set within a framework of ‘hurt not equalling harm’, thus, in time, reducing the overall sensitivity on the central nervous system, with a modified pain output. This then improves the quality of life and pain levels for people with chronic musculoskeletal. However this study concludes that more work needs to be done in assessing the long-term benefits of moderately pain-provoking exercises.

Take home message: “Hurt does not equal harm.”

This is from an “open access” online first systematic review from the British Journal of Sports Medicine (BJSM) and is available at:

Smith, B.E. et al (2017) Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. BJSM , 0:1–10. doi:10.1136/bjsports-2016-097383

Aine Tunney MISCP

JT Physiotherapy require part-time Administrator

Wed, 14 Oct 2020 16:50:00 GMT

JT Physiotherapy Require

Part-Time Administrator

JT Physiotherapy & Reformer Pilates Clinic, located in Letterkenny & Derry are looking for a part-time, Office Administrator.

Do you know anyone who may be interested?.

Job brief

JT Physiotherapy are looking for a reliable Part-Time, Office Administrator. They will undertake administrative tasks, ensuring the rest of the staff has adequate support to work efficiently.

The tasks of the office administrator will include bookkeeping/ managing appointments and updating databases. The ideal candidate will be competent in prioritizing and working in a team environment. They will be self-motivated and trustworthy and ensure smooth running of the business and contributes in driving sustainable growth.

Responsibilities

Requirements

If you are interested, please email your CV with a short cover letter to packie@jtphysio.com. The closing date for applications is the 19th of December.

Polycystic Ovary Syndrome (PCOS)

Wed, 14 Oct 2020 16:01:00 GMT

Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a relatively common condition where women may have a number of small cysts around the edge of their ovaries. Affecting around 1 in 10 females, there are several symptoms associated with PCOS, including:

• irregular / absent periods
• difficulty in getting pregnant
• excessive hair growth
• difficulty in maintaining a healthy body weight
• thinning of scalp hair
• acne
• depression or mood changes

Not all women with PCOS will have all of these symptoms and each can vary in severity. They usually appear in the late teenage years to early twenties. In many cases however, the only symptoms are menstrual problems or failure to conceive.

Causes

The exact cause is unknown, but insulin resistance, weight gain and certain hormonal imbalances are often associated with its development.

Treatment

In overweight women, the symptoms of polycystic ovary syndrome (PCOS) can be greatly improved by losing excess weight. Eating lots of fruit and vegetables, choosing lean meats and low-fat dairy foods as well as limiting the amount of fatty and sugary foods and drinks you consume. If you are trying to conceive, it is particularly important that you have a diet rich in nutrients and are also taking a folic acid supplement. You can talk to your GP about this.

The Glycaemic Index (GI) is a ranking system, showing how quickly your blood sugar rises after eating different carbohydrates. All women diagnosed with PCOS should consider swapping some high GI foods with lower GI options. Eating low GI foods can improve insulin levels. Insulin also increases testosterone levels, and although testosterone is often thought of as a male hormone, all women need a small amount. However excess testosterone can lead to acne, excess hair and irregular periods.

You may find that swapping some high GI foods for low GI foods helpful even if do not need to lose weight, it has been shown that low GI diets improve the body’s ability to respond to insulin in women with PCOS.

There are many benefits to be gained from being physically active but the most relevant to PCOS is that it improves your body’s response to insulin. Healthy eating and being active are very important to prevent long-term health concerns linked to PCOS, such as heart disease and diabetes.

If you have any of the symptoms listed above and are concerned, speak with your GP as there are other treatment options available. But remember, if you are overweight, even a small amount of weight loss can improve PCOS symptoms, including reducing the amount of insulin that your body needs to produce. This then reduces testosterone levels and improves the chances of ovulation. You can lose weight by following a suitable diet and aiming for 45-60 minutes of exercise every day. A loss of between 0.5-2 pounds a week is a safe and realistic target. If you still feel you need some extra support with weight loss, feel free to contact me at the clinic on the details below or email liam@jtphysio.com

Liam Leech

Liam Leech ANutr.
MSc. Human Nutrition, University of Ulster
BSc (Hons) Sport & Exercise Science, Loughborough University

What is Chronic Pain?

Wed, 14 Oct 2020 15:31:00 GMT

What is Chronic Pain?

This is perhaps the $64 million-dollar question but the British Pain Society defines it as ‘any pain lasting more than 12 weeks or beyond the time that full healing would have been expected following trauma or surgery’. But this only scratches the surface as chronic pain persists, often for several months or years. The very nature of chronic pain can influence every aspect of a person’s lifestyle for extensive periods of time.

Research evidence shows that people who live with chronic pain can become isolated from their once normal lifestyles as the pain not only affects their physical ability to function i.e. move around, pop to the shops and even socialise, but it also affects them emotionally and psychologically.

It is perhaps this aspect of chronic pain that is most challenging to manage, as people in persistent pain develop a constant fear of making the pain worse, or they may have periods where they feel more at ease only for the pain to return, haunting their daily lives and often causing them to adopt an approach where ‘if I do nothing, I can’t make it worse’. Changes in physical pain behaviour, such as guarding, holding limbs in fixed positions or limping can also occur and often negatively contribute to the painful condition itself.

But doing nothing is often the reason why their pain symptoms deteriorate as their physical strength, flexibility and fitness also deteriorate, which can further reinforce the pain symptoms and further restrict their lifestyle.

The Cochrane Library, which is responsible for systematic reviews of the latest evidence in medicine & healthcare, reports that physical activity may reduce the severity of long-term pain and improve people’s overall physical and mental health, as well as physical functioning. The types of exercise the review looked at were aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi.

Much of the latest evidence also supports a team approach to managing chronic pain, which may involve treatment from your GP or a physiotherapist, but also Pain Management services, where physiotherapists work alongside Occupational Therapists, Clinical Nurse Specialists, Clinical Psychologists and Pain Management Consultants.

This places physiotherapists in a primary position to assist patients with chronic pain and the Chartered Society of Physiotherapy (CSP) chief executive, Phil Gray says that physiotherapy is proven to be an effective treatment for chronic pain that enables people to live full and active lives.

Chronic pain can also affect any body part, but the latest statistics show that 80% of all adults will experience acute back pain as some point in their lives. And whilst only 5-15% of these people go on to develop permanent disability, this accounts for 90% of the NHS expenditure on back pain as a whole.

This suggests that chronic pain is a significant problem and one where there is no specific recipe to solve it.

There are a number of Health & Work-Related Risk Factors that can cause pain:

Commonly we encounter people who have hurt themselves whilst exercising and common risk factors include:

But, there are also a number of Psychological Risk factors which can lead to or exacerbate pain:

The likelihood of any one of us being exposed to any number of these risk factors is very high and the best advice is to address an injury or pain issue at the earliest opportunity.

At JT Physiotherapy , we have a wealth of experienced physiotherapists, who can offer individualised assessment, advice and guidance on managing chronic pain conditions and develop treatment plans using various types of conventional physiotherapy & exercise techniques.

Furthermore, our Pilates Instructors can offer specific knowledge regarding safe ways to use Reformers for people with persistent pain conditions to help improve flexibility and build strength.

Christian van der Merwe MCSP

Adductor Related Groin Pain

Wed, 14 Oct 2020 15:15:00 GMT

Adductor Related Groin Pain

The main symptom is pain in the adductors region. In the early stages of adductor related groin pain, symptoms may reduce after a warm-up, increase after prolonged activity or flare up after the activity. This may be later that evening or wakening up the next morning. As symptoms progress and worsen, there is a reduction in performance. The location of pain may depend on the onset of injury. Insidious onset will present at the proximal insertion site whereas an acute onset may present at the insertion or myotendinous junction (site of connection between tendon and muscle).

With all field-based sports, the main aggravating factors include sprinting, change of direction and kicking. The acceleration and deceleration elements of sprinting tend to aggravate the adductors, whereas slow jogging should not. Cutting and turning at speed tends to work the adductors hard. Known risk factors for adductor related groin pain include a history of injury or weakness.

If experiencing adductor related groin pain, the hip joint itself should be considered as a differential diagnosis. The hip may be a source of pain. Hip pain often presents with a deep anterior pain that can also be felt in the adductor region. Another important consideration is genitofemoral nerve entrapment with groin pain. The genital branch of the genitofemoral nerve runs in the inguinal canal and can cause pain into the adductor region. However this has a different character of pain – the patient usually reports burning pain or pain into the perineum or scrotum.

I am often asked to explain the main difference in adductor related groin pain and pubic related groin pain. The patient will always report pain in the adductor region, it is recognised on palpation and with pain on resisted testing. Pubic related groin pain is less common, but it is pain on the pubic symphysis reproduced on palpation. It is important to clear if this is the same pain that is specific to the pain felt during/after activity.

If you are a female and reporting groin pain, an important differential diagnosis to clear is a stress fracture. This is incredibly common in middle-aged female distance runners. If there is a potential stress fracture you need to stop running immediately. A neck of femur fracture may present with a deep anterior pain which is reproduced with examination of the hip. A pubic rami stress fracture will present as deep adductor pain that can be reproduced on palpation of the inferior ramus. Pain may be worse on the first steps of running specifically during heel strike as this transfers load up the leg but also may be prominent following no warm up period. Pain will increase with increasing activity and may lead to limping. An MRI is required to confirm this diagnosis due to its high-sensitivity. Yes an x-ray may confirm the diagnosis if chronic, but alone cannot be used to exclude the diagnosis of a stress fracture.

If you experiencing adductor related groin pain or experiencing any symptoms discussed please do not hesitate to contact and book an appointment at JT Physiotherapy today.

Cathal Ellis

The effect of dehydration on sporting performance

Wed, 14 Oct 2020 15:04:00 GMT

The Effect of Dehydration

on Sporting Performance

Anyone training for marathons, (or any performance goal) be mindful of hydration.

The effect of dehydration on sporting performance and physiological function is well documented. Dehydration of 2–3% body mass will significantly impair performance, and even smaller levels of dehydration have a measurable negative effect on the thermoregulatory response to exercise.

Why?

Muscles contract as we exercise, this increases heat production and as a result the body core temperature begins to rise.

The body ramps up sweat production to decrease temperature as the sweat evaporates from the skin. This will continue as long as we remain hydrated.

But if not hydrated, then as sweat is produced, over time blood volume will decrease as a result of a decrease in body fluids.

This is when we have a problem!

Decreased blood volume means a decreased ability to dissipate heat from the core via the circulation and also stroke volume (the amount of blood pumped by the heart in a contraction) is decreased. This will cause our heart rate to increase in order to compensate for the reduction of blood being pumped out of the heart during each contraction.

The result of dehydration in terms of performance is reduced muscular endurance and overall physical performance.

Check the colour of your urine. A pale straw colour would indicate you are fairly well hydrated. Anything darker and you need to have a look at your hydration strategies.

Liam Leech

Liam Leech ANutr.
MSc. Human Nutrition, University of Ulster
BSc (Hons) Sport & Exercise Science, Loughborough University

Concussion in Sport: Facts you need to know

Wed, 14 Oct 2020 14:25:00 GMT

Concussion in Sport:

Facts you Need to Know

Concussion has become an increasingly topical subject in contact sports and various media outlets, leading to greater discussion about whether there is an increased incidence or risk of concussion in contact sports, or simply whether we are now more aware than ever that it poses a significant injury risk.

Concussion accounts for 3-8% of all sports related injuries in young athletes, although in part due to better symptoms recognition and reporting.

Concussion is now classified as a traumatic brain injury (TBI) and whilst that sounds like scaremongering, it needed to be stated that concussion arises because of physical forces being directly or indirectly applied to the brain causing it to move aggressively around inside the skull.

Recognition of concussion can be difficult as the presentation of symptoms may be delayed by up to 72 hours. Both the threshold for getting symptoms and the type of symptoms you can experience with a concussion vary. For example, loss of consciousness only occurs in 10-15% of cases.

The latest evidence suggests you only need ONE of the following symptoms to suspect concussion.

Obvious signs of concussion include:

Less obvious signs of concussion can include:

Young people under 19 years of age and people who have had previous concussions are particularly vulnerable to new concussion injuries.

Furthermore, headwear including scrum caps (rugby) or helmets (hurling) does not reduce the incidence of concussion – they merely minimise cuts/lacerations or blunt force injuries to the facial region.

Usually, you can expect a complete recovery after a concussion, providing some very simple but important steps are adhered to, and physiotherapists are well placed to manage this recovery process:

Concussion is unfortunately part and parcel of contact sports, and with extra attention being focussed of player safety, we all have a responsibility to promote safe play – referees should aim to eliminate dangerous play during matches, coaches should teach and educate their players about using safer techniques in competition and the players have a responsibility to report any adverse symptoms at the time of injury.

Finally, medical professionals, such as physiotherapists have a key role in identifying injuries when they present themselves and ensuring a complete recovery from concussion symptoms, irrespective of the time it takes to do so.

Christian van der Merwe MCSP

The Younger Athlete in Football – Sever’s Disease

Wed, 14 Oct 2020 11:31:00 GMT

The Younger Athlete

in Football – Sever’s Disease

Over 50% of football players worldwide are below 18 years of age. The overall injury rate was shown to be between two and seven injuries per 1,000 hours of football. The incidence of injury increases with age, reflecting the increasing speed of the game and greater intensity of play.

The growing skeleton reacts to loading in a different way to the skeletally mature skeleton. Most injuries reported involve the lower extremity, with the ankle, knee and thigh most commonly affected. The focus of this blog today will be on a very common cause of foot pain in children and adolescents, Sever’s Disease.

What is Sever’s Disease?

It is an overuse syndrome frequently seen in growing active children, affecting those between aged five and thirteen years of age. In simple terms, the heel bone grows faster than the leg muscles and tendons, which causes excessive stress on the growth plate.

What are the symptoms?

Treatment

It is a self-limiting condition but can often take anywhere between six and twelve months to settle. A large part of the management of Sever’s Disease is activity modification. This may include reducing the frequency of sessions per week to help deload the area. As a result of the tightness through the lower leg muscles, your Physiotherapist may prescribe specific stretching and strengthening exercises. Soft tissue massage techniques can also be used to help complement this. Other exercises may include specific torso and hip strengthening to distribute the load better throughout the kinetic chain.

Aiveen Lavery, MISCP MCSP

The Iliotibial Band (ITB)

Wed, 14 Oct 2020 11:11:00 GMT

The Iliotibial Band (ITB)

Did You Know…?

Aine Tunney MISCP

Senior Physiotherapist

References:

Falvey et al, 2010; Willet et al, 2016; Wilhelm et al, 2017.

Sacro-Iliac Joint – Part 2

Wed, 14 Oct 2020 10:34:00 GMT

Sacro-Iliac Joint – Part 2

Recap

Before we get into Part 2, here is a quick refresher on the anatomy and function of the sacro-iliac joint (SIJ). The sacrum with the coccyx (aka the tailbone) and the two ilium bones that make up the pelvis do not form unstable joints, they cannot move, go out of place or go out of line (unless it’s from an extremely high velocity impact where there would be a fracture and/or dislocation). The shape of all these bones that fit together to make the pelvis and the SIJs, as well as the strong ligaments that hold them together, ensure that the SIJs are strong and stable (sounds like a certain political slogan). This is the SIJ’s form closure , i.e. its anatomical shape and structure. All this means that SIJs are really well equipped to deal with the transfer of all the load and weight that must go through this area from our legs up and our trunks down as we move and get on with our daily lives. If you need a bit more detail, have a quick look at Part 1 .

Treatment

Following our objective assessment ( see Part 1 ), your physiotherapist will proceed with a treatment plan and you will both go through the goals of your treatment. You physiotherapist will provide you with options in how to best manage your SIJ. Everyone is different so the self-management advice offered will be different from person to person.

Manual therapy treatment is used for pain relief. We physically cannot make any structural difference to the SIJs and their position using hands-on therapy and manipulation techniques (Wingerden et al, 2004; Richardson et al, 2002; Tullberg et al, 1998) but we can use manual therapy to desensitise the painful structures around the SIJ in order to reduce pain and help you move better. However, as physiotherapists, we need to be mindful that other areas of the body and other structures may refer pain into and around the area of the SIJ and we would treat this accordingly.

Remember the SIJ only moves approx 2-3° when we move, which is approximately 3-5mm of movement, so it makes it very difficult to figure out if the joint is lax, stiff, or moving more than its normal available range ( see Part 1 ). We need our muscles to both contract and relax to allow us to move the SIJs as we put different loads through the joints, even with their very limited range: this is called force closure .

To help you achieve your optimum movement, reduce your pain and force closure of the SIJs, we need exercises! Like all our treatments the exercise therapy we provide will be tailored to you – there is no hard and fast rule for the best exercise for the SIJs. The exercises provided may address strength & mobility issues of the muscles at the trunk, abdominals, back (upper and lower), hips and legs. The biggest focus though would be on improving your daily activities and overall quality of life. We, at JT Physiotherapy, aim to get you back where you want to be.

Aine Tunney MISCP

References

Anterior Ankle Impingement

Wed, 14 Oct 2020 08:42:00 GMT

Anterior Ankle Impingement

The ankle is one the most commonly injured joints in sport. In international football, ankle injuries constitute 11-23% of all injuries recorded during FIFA competitions. In lower level amateur players, the rate of ankle injury is quite high, representing 35% of all injuries. A high percentage of these injuries normally involve the lateral ligament complex on the outside of the ankle. However, there are many other conditions which may present very similar, resulting in a longer delay in return to sport.

Anterior ankle impingement, often referred to as footballer’s ankle is characterized by persistent pain at the front of the ankle exacerbated by dorsiflexion (upward movement of the foot). This condition is also characterized reduced ankle mobility, often noticed whilst stretching the calf in standing. Aggravating activities can include squatting, climbing stairs or hills and sprinting. The athlete may also report feelings of instability around the joint.

Ankle impingement can be a result of bony or soft tissue changes, sometimes both. It often presents as a result of an ankle sprain, recurrent ankle sprains or activities that require repeated dorsiflexion such as landing or deep squatting. Repeated compression at the front of the joint can result in pinching of the joint capsule and synovium which will eventually cause pain. This can also lead to bony changes at the front of the talus or tibia, which can accelerate repeated ankle sprains.

A Charted Physiotherapist will look take a thorough subjective history and in depth clinical examination to aid diagnosis. A plain x-ray can also be a good aid and is a very useful investigation in the case of ankle impingement.

Load management is key in terms of non-surgical management of ankle impingement. Being able to avoid the aggravating activity is important. An exercise programme will be developed to address deficits identified in the clinical examination to facilitate a successful return to sport. If other interventions fail, a steroid injection may help or arthroscopic debridement surgery can give a good results. Working closely with your physiotherapist will determine which course of treatment is best.

Aiveen Lavery, MISCP MCSP

Physical Activity

Tue, 13 Oct 2020 16:08:00 GMT

Physical Activity

This is a great infographic from Ireland Active, summarising the ideal daily dose of physical activity we all should be achieving (from the “National Physical Activity Plan for Ireland 2017”).

Way back in 1985, Carl Caspersen and colleagues described physical activity and exercise:

This all means that you don’t have to play sport or be a “sporty” person to get in that optimal daily dose of physical activity. It is so easy to get into the habit of getting up in the morning, going to school/work, come home, do homework and/or watch TV, some nights go to an exercise class, have dinner, relax and go to bed. And repeat. We need to get more physical activity into our daily routine, not just when our instructor tells us to do another round of burpees! A healthy diet and eating well, good sleeping patterns and overall good well-being are also majorly important. Have you ever found that being more physically active helps you make better food choices and sleep better?

It is up to us to decide on the best way to be more physically active in our daily lives. If you don’t know were to start or are wary of more activity due to injury or pain, please contact you Chartered Physiotherapist.

Aine Tunney MISCP

References:

The Importance of Grip Strength

Tue, 13 Oct 2020 16:07:00 GMT

The Importance of Grip Strength

Doing my usual channel-hopping one evening, I recently caught a repeat episode of BBC One’s “How to Stay Young” series. It was one of those “sit up and take notice episodes” as participants in the show were put through their paces with a wide range of biometric tests to see what their bodies’ age was versus their actual age. It was quite a shock to some. One such test which we physiotherapists often use is the grip strength test, and I don’t mean a handshake! This test involves gripping and squeezing a device called a hand-held dynamometer (HHD) and the force generated by your grip is calculated in kilograms of force generated.

As we age, our grip strength does lessen but higher grip strength in all age groups, from multiple studies, has shown to be associated with better health outcomes, and a lower risk of cardiovascular disease and all other causes of mortality (Leong et al, 2015). Good grip strength is also indicative of good shoulder strength so we tend to assess your grip strength if you’ve had a shoulder injury, especially to your rotator cuff muscles (Sporrong et al, 1996). We would do the same if you had a neck, elbow, wrist, hand or finger/thumb injury too. The HHD gives us a number to work with but using it also allows to assess grip strength quality, pain levels, grip endurance and speed of contraction. Some chronic conditions can effect gripping ability, however it still aids us in our clinical exam. We can also incorporate gripping strategies into rehabilitation and, given that it’s such a functional task, having good grip strength is necessary for our day to day lives.

References:

• Leong, D.P. et al (2015) Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE). The Lancet, 386(9990): 266-273.
• Sporrong, H. et al (1996) Hand grip increases shoulder muscle activity, An EMG analysis with static hand contractions in 9 subjects. Acta Orthop Scand, 67(5):485-90.

Aine Tunney MISCP

Back2Basics Clinical Pilates Program

Tue, 13 Oct 2020 15:15:00 GMT

Back2Basics Clinical

Pilates Program

Protect your back and neck with an evidence based approach.

The Back2Basics program will be overseen by a Chartered Physiotherapist with an Initial consultation incl. a spinal evaluation prior to commencement of the course. Over the 6 weeks, participants will receive individual home exercise programs and take part in 12 Pilates classes with 12 educational sessions after each class. At the end of the program you will have a follow up consultation to track your progression.

Package includes –

An educational session and group discussion will be held at the end of each clinical Pilates class on topics such as –

Morning and Evening classes available. All classes are run by an experienced Chartered Physiotherapist. More than €300 worth of treatment for only €200.

Call 074 911 1010 for more information , program begins on the 19th of July

Move Better, Feel Better, Get Active

*Initial Consultation must take place prior to the beginning of the program to make sure of participant suitability.

Osteoarthritis (OA) and Exercise

Tue, 13 Oct 2020 14:55:00 GMT

Osteoarthritis (OA) and Exercise

Osteoarthritis (OA), or arthritis as it’s more commonly known, is not inevitable as we get older! It is definitely becoming more prevalent. We don’t know the specific causes of OA, however age (not always the older you are as teenagers can get OA too), gender (women more than men), obesity, history of joint injury or surgery and genetics may play a role. There appears to be no known single cause for development of OA but it is more likely to be a cascade of physiological processes or events that lead to its development. It’s worth remembering that we can have these arthritic changes to our joints with minimal or no pain present. Pain can be a symptom of OA but the main symptoms would be stiffness, reduced mobility for functional tasks and intermittent swelling. We cannot reverse the progression of OA but we can improve mobility, function, reduced pain levels and maintain a good quality of life.

OA involves pathological changes to the cartilage of a joint. As we move there is a constant renewal and repairing of our bodies and our cartilage is no different. If the renewal and repair phase of the cartilage is slower than the demand placed on it then pathological changes within the cartilage and the affected joint start to occur. We, biomechanically, can no longer take the normal loads through our joints and the process of OA may then occur. It is a “wear and repair” degenerative disease where the rate of ware is greater than the rate of repair.

In terms of physiotherapy and OA, we at JT Physiotherapy mainly see people with OA of the knee.Knee arthritis can be effectively managed with supervised exercise therapy and this approach is now part of every clinical guideline worldwide. This isn’t to say that other forms of pain management will not be undertaken. Our assessment will determine what you need and how best to improve things for you – it’s a team approach! With regards to exercise therapy, like a medication that would be prescribed to you, the frequency, intensity and dosage is just as important as the exercises that we do.

Initially low impact or minimally loaded exercises are useful for pain management and to increase confidence: cycling (road bike or static exercise bike), swimming/aquatic therapy, walking, yoga, etc. Running is recommended if you can tolerate it – evidence shows that it does not speed up or cause arthritis! The worse thing you can do for OA of your knee is to stop moving. Find an exercise, an activity that works for you and you enjoy, and then keep doing it! Your Chartered Physiotherapist can help you explore your options.

Pharmacological management of OA may be required and this is something to discuss with your GP and/or consultant but it is also worthwhile informing your Chartered Physiotherapist what medications you’re taking.

Unfortunately surgery may be an option for some people with knee OA depending on joint dysfunction severity.

• See also: http://www.arthritisireland.ie/

Aine Tunney MISCP

“What is your why?”

Tue, 13 Oct 2020 14:25:00 GMT

“What Is Your Why?”

Physiotherapists are medically trained allied healthcare professionals whose role is to help improve function, movement and pain as a result of injury, disease processes and disorders, conditions and environmental factors (World Congress World Confederation for Physical Therapy [WCPT]).

Everyone has different reasons for attending physiotherapy. However, we may be clinical experts in the human body but you are the expert of your own body! This in turn means that to get you where you want to be and doing whatever “meaningful movement” means to you, there should be collaboration and teamwork with your physiotherapist, rather than a lecture! We need to establish evidence-based physiotherapy treatment plans and long-term goals together. This process it made more efficient and personal by letting us know “what is your why ” – your motivation or main reason(s) for seeing us.

Your physiotherapist can’t do all the work for you and the process will require effort and patience on your part, maybe even some behavioural changes to help you on your physiotherapy journey, but letting us know your motivation, your why , allows us to better understand your perspective and improve the quality of the treatment we provide.

Aine Tunney MISCP

Suffering from Shin Splints?.

Tue, 13 Oct 2020 14:17:00 GMT

Suffering from Shin Splints?

Training for Upcoming Marathon/ Half- Marathon and suffering from Shin Splints ?.

Ironically, all your hard work and training is the cause of your shin splints. When you’re training for a marathon or a similar event, you intensify your training plan week-by-week and this can overwork the muscles, tendons and bone tissue. The repeated stress to the shinbone and the muscles attached to your bone can often cause shin splints.

For those who might not be aware, shin splints are medically referred to as Medial Tibial Stress Syndrome (MTSS), which causes pain to either the inside or the outside of the large bone in the lower leg. If you have shin splints, you might also suffer from other symptoms such as mild swelling and tenderness along the affected area. Often, the pain can decrease once we are warmed up but tends to worsen again as we cool down. The biggest aggravating factor with shin splints is the repetition of running. Step after step the impact and stress from the muscle pulling on the bony attachments causes an inflammatory cycle to occur.

Shin splints are a common complaint in the clinic, with a lot of runners, walkers and footballers coming through the door for treatment and advice. Some people are more at risk of shin splits than others. They include those who play sport on hard surfaces, runners who have just started a new training plan or ramped up an existing training plan quickly, and those who have flat feet or high arches.

Prevention and Treatment

The treatment of shin splints is multi faceted. You should try and avoid activities that cause pain and discomfort and opt for low-impact activities such as swimming and cycling. If you continue with aggravating activity you will not allow the area to recover. You don’t have to stop training but you need to stop activities that re produce pain. You can also try other simple things such as gently stretching your Achilles and calves.

One of the biggest things to look at in treating and preventing shin splints is getting a running analysis done. Often the first thing people look at when injured is their running shoe but the most important factor in running injuries is optimising the way you run. Finding the cadence, posture, foot contact time and foot placement that is right for you. This is not a one size fits all either and what is right for you and your goals may differ from another runner and his or her goals. If you are training for a marathon, you should also try and cross train with an activity that has less impact on your shins – such as swimming, walking and cycling. Offload the shins while still getting the positive physiological benefits of training. You should also avoid hills and try and train in areas that are flat, as this has less impact on your shins. Strength and conditioning is becoming part of a lot of athletes’ lives and to prevent shin splints you should try and strengthen your trunk, hip, thigh and calf muscles. Strength and single leg stability around the hip is essential and there is a lot of research to back this up out there. Strength training should be incorporated into every runners training plan twice per week. Believe it or not this is just as if not more improtant than the runs you do.

Finally, my advice is to remember to start activities slowly, increase the intensity slowly and remember to rest if you need to.

If you want to know more about our Runner MOT Packages, a tailored strength program to suit you or discuss what you can do to minimise your risk of run related injuries give us a call and we can get you on the right track. on 074 911 1010 / 028 7126 9262.

Move better, feel better!

Johnny Loughrey MISCP

The Pelvic Floor

Tue, 13 Oct 2020 14:02:00 GMT

The Pelvic Floor

Do you find that you leak when you sneeze or cough? Do you find sex painful? Is a pelvic organ prolapse holding you back from doing what you want to do every day?

I’m Lorraine Boyce, a specialist Physiotherapist in Women’s Health and Pelvic Floor Therapy and I’m here to help you with these kinds of issues. Most people associate Physiotherapy with sports injuries, joint pain or the general musculo-skeletal aches and pains that we all get from time to time. However, the area of Physiotherapy that I specialise in is quite specific, focusing on your pelvic floor internally alongside treating your low back and pelvic girdle externally.

Many people are surprised that Physiotherapy can actually address a lot of the pelvic issues I treat, such as bladder and bowel control, chronic pelvic pain and prolapse.

Often, women rely on medication for overactive bladder or surgery for prolapse without realising that Physiotherapy is a very effective option for treating complaints like these. From hands-on manual therapy techniques to tailored exercise therapy, use of e-stimuation and biofeedback to provision of a support pessary, there are so many treatment approaches for any pelvic floor complaint you might have.

The five most common issues that present to me for pelvic floor physiotherapy are:

My blog, the Mummy Manual, is there as a resource for you to get answers to those questions you might have and to be a source of information on the topics that we just tend not to talk about, so do check it out and perhaps I can help you with some of your women’s health needs. I am delighted to have been asked to contribute to JT Physiotherapy’s Newsletter from time to time and I am looking forward to answering any questions you have about Women’s Health issues, so feel free to mail me or call me at 0749161453.

www.lorraineboycephysio.ie

Instagram: the_mummy_manual

Facebook: @femalephysio

Stress Fractures – Local Woman Article

Tue, 13 Oct 2020 13:58:00 GMT

Did you know that physiotherapy before total knee replacement surgery can help improve outcomes?

Introduction

A recent paper reviewed the literature and investigated the effectiveness of prehabilitation on subjective and objective outcomes following total knee replacement and compared outcomes to those who did not receive physiotherapy and exercise preoperatively

What did the authors find?

What does this mean?

Cause of stress fractures

• An increase in load or number of applied stresses
• Inadequate recovery time between sessions
• Normal load to weakened bones (low bone density or osteoporosis)
• Load applied exceeds bone capacity to handle that load

How can a Physiotherapist diagnosis a stress fracture?

How Can I Prevent a Stress Fracture?

To reduce your risk of sustaining a stress fracture, it is important to understand factors which can be modified such as muscle strength, surface, footwear and nutrition. For example, if you do not have sufficient muscle strength, repetitive loading to an area can ultimately lead to overload and a stress fracture. Therefore, strength based exercises will help increase your tissues capacity to be able to handle load, which will in turn reduce your risk of injury. It is also vital to ensure you have adequate recovery between your sessions to allow the bone to adapt and strengthen.

Aiveen Lavery, MISCP MCSP

Vald Performance Testing System

Tue, 13 Oct 2020 13:24:00 GMT

Vald Performance Testing System

Leading Letterkenny and Derry based clinics JT Physiotherapy & Reformer Pilates are delighted to unveil the new Vald Performance Testing Systems .

The NordBoard, Groinbar and HumanTrak from Vald will help increase performance through the monitoring of movement analysis and give real-time accurate results of strength testing. Elite teams in the English Premier league and the Irish Rugby Team have used and continue to use this system. Vald Performance Testing Systems allow J.T. Physiotherapy to give real-time results, which will aid rehabilitation programs for our patients and also work with athletes/teams to increase performance. The system also enables us to help coaches monitor players who may be of injury risk.

Vald Performance Further Information

The NordBoard is a fast, easy, accurate and reliable system to hamstring strength and imbalances and helps identify people of high risk to hamstring injuries. The Groinbar tests hip abduction and adduction strength as well as a host of other muscle groups through isometric and eccentric holds. The HumanTrak is a movement analysis system that captures body movement and biomechanical data. The testing systems will highlight any abnormalities that may be causing injury but also work as a guide to help screen any players/patients that may be high risk of injury in the future so we can relay feedback that will help patients coaches.

All the Physiotherapists at J.T. Physiotherapy are Chartered and with their knowledge and the additional information from the Vald Performace equipment, patients get the best possible treatment whether it be for an injury, injury prevention or to improve overall strength.

If you would like to book your Vald consultation for you or your team call 074 911 1010 or 028 7126 9262 or visit www.jtphysio.com .

By – Neve Scanlan – Work Placement Student

Deele College

Join the JT Physiotherapy Team

Tue, 13 Oct 2020 13:06:00 GMT

Join the JT Physiotherapy Team

Are your a Chartered Physiotherapist and would like to work with a great team, JT Physiotherapy Clinic are looking to recruit a part-time and full-time chartered physiotherapists to join our Team and work across both business locations of Letterkenny and Derry.

Service at our clinic is our first priority and we need fresh, enthusiastic and motivated clinicians to join our Physiotherapy Team. Our Clinics are multi-disciplinary and services include: Physiotherapy, Running Analysis, Massage, Reformer Pilates, Strength and Conditioning.

A positive attitude is essential and this position would best suit a Physiotherapist wishing to continuously develop professionally, focusing not on only on injuries but identifying and correcting movement dysfunctions and encouraging optimal lifestyle habits.

The positions will involve some evening and weekend work. The right candidates must have 2 years post graduate Musculoskeletal experience and have excellent manual therapy and clinical skills. Applications are welcome from applicants who already have full registration in Ireland or UK with previous experience in the private sector is desirable but not essential.

The successful candidate will receive excellent professional development opportunities in a fantastic working environment. Remuneration includes Salary + Commission ( aligned to business targets ) . Please forward your CV and cover letter to packie@jtphysio.com .
Closing date for applications is Friday 4th of January 2019 at 12 noon.

Optimising Performance for Runners

Tue, 13 Oct 2020 11:28:00 GMT

Optimising Performance for Runners

Achieve you running potential with JT Physiotherapy

Running is a great form of exercise and you’ll be glad to know that research just published has concluded that long distance runners did not have more prevalent osteoarthritis nor more severe cases of osteoarthritis compared to controls.There are a few common running injuries that we see through the door here at JT Physiotherapy. These can include, medial tibial stress syndrome (often known as shin splints), Iliotibial Band Syndrome (ITBS), Achilles Tendinopathy and patellofemoral pain syndrome (PFPS, sometimes known as ‘runner’s knee’). Research suggests that up to 80% of running injuries are caused through training error.

JT PHYSIOTHERAPY’S TOP TIPS FOR RUNNERS

Recover

There’s a lot to be said for doing the simple things well. Recovery is often neglected amongst individuals due to time and poor planning and implementation. Sometimes it can be harder to rest than run but this is just as important as your runs. For example, simple things like getting more sleep can have a significant positive impact on performance. Recent research completed this year suggests that 7 to 9 hours sleep per night is recommended for healthy adults, but athletes need 9 to 10 hours to reach their full potential.

Get stronger

We need to be strong enough to run. If a muscle group lacks tissue capacity, the only way we are going to increase capacity is to challenge that muscle group to get stronger and adapt. Targeting the trunk, hip, thigh and calf muscles is essential and should be incorporated into every runner’s training plan twice per week.

Settle symptoms

Runner’s are often tempted to train despite ongoing issues. We should always allow the tissue to settle and optimise the environment it has to heal before making a return to running. When we do make a return to running, this should be gradual. A return to the same level may only exacerbate symptoms and further delay your training.

What JT Physiotherapy can offer runners

Chartered Physiotherapy assessment

We are very experienced in managing running injuries. An assessment will help paint a clearer picture as to why you are in pain. There could be many variables at play so we can help identify those factors and devise a management plan to help manage your symptoms and reduce the risk of recurrence.

Running analysis using the Opto-Gait software

This can be a useful assessment tool to identify any biomechanical factors that may be contributing to your symptoms. Recent research also suggests that gait retraining can be a useful technique to reduce risk of injury as well as improve efficiency and performance.

Reformer Pilates

It is often cited within the literature the importance of midline stability and control for runners. If we have a reduction in stability, then this can place more stress on certain structures such as the Achilles tendon or Iliotibial Band (ITB). Reformer Pilates is a great way to improve stability, control as well as overall conditioning.

Aiveen Lavery, MISCP MCSP

Cross Border Directive

Tue, 13 Oct 2020 10:41:00 GMT

Cross Border Directive

The Cross Border Directive (CBD) allows EU residents to avail of health services in other EU member states.

How does the Cross Border Directive Work?

The Cross Border Directive is operated by the HSE. It allows patients on the HSE waiting list to access Physiotherapy treatment (and other treatments) within Northern Ireland or other EU member states; thus receiving their treatment ASAP.

The HSE can reimburse costs incurred; repayment is usually the amount that the treatment would cost in Ireland or the cost of your treatment in Northern Ireland, if that is less.

This means that if you are a public patient on a waiting list for Physiotherapy Treatment you could attend our Derry clinic, receive treatment from our experienced Chartered Physiotherapists and apply to have costs reimbursed.

How to apply for Cross Border Treatment

The process is very straightforward.

1. In the first instance you should contact CBD on 0567784546 / crossborderdirective@hse.ie to clarify whether you are eligible for the treatment and to discuss the amount you are entitled to claim back. The patient must pay the costs initially so it is important to have a clear understanding of the process and your entitlement at the outset. Request the appropriate (pink) application form at this point.

Click here for details https://www2.hse.ie/services/cross-border-directive/about-the-cross-border-directive.html

2. Patient is referred for Physiotherapy treatment by GP or consultant. Referral must be addressed to the name of our Physiotherapist, not to JT Physiotherapy. Referral must be signed by doctor personally, not by her/his staff on her/his behalf.

3. Patient attends appointment(s) and is discharged back to GP post treatment.

4. Apply for a reimbursement of your costs – following your appointment(s) you will submit the following to the HSE for reimbursement:
• GP referral letter
• Invoice & receipt from JT Physiotherapy
• Receipt as proof of travel to N. Ireland e.g. purchases ANY item from a shop in the vicinity of clinic and keep the receipt.
• Application form (No. 1) completed by patient and treating Physiotherapist.

We cannot accept liability for any disapproved reimbursement applications as repayment is at the discretion of the HSE. Contact details for CBD: 0567784546 / crossborderdirective@hse.ie

Gluteal Tendinopathy

Tue, 13 Oct 2020 09:42:00 GMT

Gluteal Tendinopathy

Gluteal tendinopathy is common in both the athletic and non-athletic population. It tends to affect females over 50 years of age (Segal et al. 2007) and is often associated with changes in load. Symptoms tend to be located on the outside of the hip and are aggravated by walking or running.

A study by Mellor et al. (2016) showed a 78% success rate in those who received exercise and education, compared to 58% success rate with corticosteroid injection, and 52% success rate in the wait and see group.

Exercises included in this study focused on functional retraining, targeted strengthening for the hip and thigh muscles, and dynamic control of adduction during function.

Picture demonstrating the typical pain pattern in gluteal tendinopathy, from Williams and Cohan (2009).

If you have pain on the outside of your hip, be sure to see a Chartered Physiotherapist who will perform a full assessment and provide you with the most appropriate management plan to suit your needs.

Simple tips to help reduce pain

If you have any questions, contact us on 0749111010 or via email at aiveen@jtphysio.com .

References

Segal, N.A., Felson, D.T., Torner, J.C., Zhu, Y., Curtis, J.R., Niu, J., Nevitt, M.C. and Group, M.O.M.S. (2007) Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of physical medicine and rehabilitation , 88(8), 988-992.

Williams, B.S. and Cohen, S.P. (2009) Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesthesia & Analgesia , 108(5), 1662-1670.

Mellor, R., Grimaldi, A., Wajswelner, H., Hodges, P., Abbott, J.H., Bennell, K. and Vicenzino, B. (2016) Exercise and load modification versus corticosteroid injection versus ‘wait and see’for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC musculoskeletal disorders , 17(1), 196.

Author: Aiveen Lavery

2018 Consensus Statement on Treatment of Patellofemoral Pain

Tue, 13 Oct 2020 09:32:00 GMT

2018 Consensus Statement on
Treatment of Patellofemoral Pain

Every two years, scientists and clinicians who are active researchers in the field of patellofemoral pain meet at the International Patellofemoral Research Retreat, the location of which changes every year. In 2017 they were in Australia’s sunny Gold Coast! The aims of this biennial Retreat are to: (a) share the latest PFP research developments; (b) discuss the literature to formulate consensus statements to disseminate knowledge; and (c) develop a future research agenda for PFP. The revised consensus statement on exercise therapy and physical interventions for the treatment of PFP was recently published in the British Journal of Sports Medicine (BJSM). The background of PFP and their findings are described below.

Patellofemoral pain (PFP) is a common, persistent musculoskeletal condition that presents as pain around or behind the kneecap during loading activities such as squatting, going up and down stairs and running. Approximately 23% of adults and 29% of adolescents in the general population are affected annually, and almost 36% of professional cyclists also experience PFP. PFP tends to persist in about 50% of people, in some cases for up to 20 years. It may also precede the onset of osteoarthritis at bony interface between the patella and the femur. Pain and symptoms associated with PFP can limit participation in daily and occupational tasks and reduce levels of physical activity.

Exercise therapy is the intervention of choice for patellofemoral pain, with the largest body of evidence supporting its use to improve pain and function in the short, medium and long terms. There is still uncertainty regarding the use of patellar taping/bracing, acupuncture/dry needling, manual soft tissue techniques, blood flow restriction training and gait retraining in the treatment of people with PFP. However, the group state that it is important to reiterate that these interventions may still have a place in managing PFP, but that further robust research is required.

Even with exercise therapy, the group recommend further research into its specifics: frequency, contraction type, rest, time under tension, dose–response relationship especially in adolescents. They also encourage researchers in this area of study to to investigate the role of education in PFP management as well as interventions aimed at addressing psychosocial impairments that have been identified in people who experience PFP. The group state that there is a clear need for minimum reporting standards in PFP research publications to allow replication of interventions in clinical practice to help clinicians, like us at JT Physiotherapy, provide the best quality of care for people with PFP.

Below are the group’s recommendations:

1. Exercise therapy is recommended to reduce pain in the short, medium and long terms and improve function in the medium and long terms.
2. Combining hip and knee exercises is recommended to reduce pain and improve function in the short, medium and long terms, and this combination should be used in preference to knee exercises alone.
3. Combined interventions are recommended to reduce pain in adults with patellofemoral pain in the short and medium terms. Combined interventions as a management programme incorporates exercise therapy as well as one of the following: foot orthoses, patellar taping or manual therapy.
4. Foot orthoses are recommended to reduce pain in the short term.
5. Patellofemoral, knee and lumbar mobilisations are not recommended in isolation.
6. Electrophysical agents are not recommended.

Reference:
Collins, N.J. et al (2018) 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast,Australia, 2017. BJSM, 0:1–9. doi:10.1136/bjsports-2018-099397

Aine Tunney MISCP

Senior Chartered Physiotherapist Role

Tue, 13 Oct 2020 09:24:00 GMT

Senior Chartered Physiotherapist Role

JT Physiotherapy Clinic due to expansion are looking for expression of interest for 2 Senior Chartered Physiotherapists to join our Team in both clinic locations of Letterkenny and Derry.

Consistency between our clinicians is important and every patient walking through the front door needs to leave with the same experience and high level of service.
This position would best suit a Physiotherapist wishing to continuously develop professionally, focusing not on only on injuries but identifying and correcting movement dysfunctions and encouraging optimal lifestyle habits. A positive attitude is essential.

The positions will be full time and will involve some evening and weekend work. The right candidate must have 2 years post graduate Musculoskeletal experience and have excellent manual therapy and clinical skills. Previous experience in the private sector is desirable but not essential and salary will be based on experience. Applications are welcome from applicants who already have full registration in Ireland or UK.

The successful candidate will receive excellent professional development opportunities in a fantastic working environment. Please forward your expression of Interest with a CV and cover letter to packie@jtphysio.com . Closing date for applications is the 15th of August 2018.

TY Work Experience

Tue, 13 Oct 2020 09:22:00 GMT

TY Work Experience

I’m in my final 3 weeks now at JT as I enter my final month at JT Physiotherapy. I can’t believe how quick my time here has gone by, from January until now has just flown by. I’ll be sad to leave my work experience here that’s for sure. My final week at JT is Wednesday the 23rd and we break up for our Summer holidays from school on Friday the 25th, so it’s the final week of everything, from work experience to our TY year.

I started my work placement here at JT because I wanted to work in an environment where I would hopefully work some day, a physiotherapy clinic. I mentioned at the beginning of my blogs that I wanted to become a physiotherapist when I finished school and my choice hasn’t changed, working at JT each week has only made me want to do it more!!

I had the chance to work alongside so many talented people and I’ve been able to gain loads of knowledge from them. Talking to the physios about college, courses, work, leaving cert subjects etc may seem boring to others but it has given me knowledge, from people who have completed the courses I want to do. I now have an understanding of the different courses and paths that are available. That information is so beneficial to me. College is a daunting thought as it is, so being able to talk to someone and learn from their experiences, to me is fantastic.

The best thing about working at JT each week has to be the incredible staff team and atmosphere here. It’s such a nice place to come to each week. As well as having to do work experience I’ve been able to see how a business operates on a day-to-day basis. I think work experience is great for students, a key part of TY, as it gives us the chance to experience the real world of work outside of a classroom. JT has been a brilliant business to work for and there isn’t one bad thing I could say about them. I’ve had a brilliant time!

I’ve mentioned this in all of my blogs, but the other highlight of my time at JT has to be the Reformers Pilates Classes. I have really enjoyed taking part in each class. I remember the first time I did reformers back in January, I didn’t know what to expect. I love it now and I hope to continue attending the classes after I complete my work experience. It has so many health benefits but it’s also really fun at the same time. The hour flys by. Definitely one of the highlights of working at JT Physiotherapy!

I have to say I’ll miss being here every Wednesday. It’ll be strange not coming into Letterkenny on a Wednesday morning. I’ll have to find something else to do on a Wednesday now. Most people at school think it’s weird when I say “I’ll miss work experience” as most of them can’t wait for it to be over but I always learn something new every week and I will miss that.

Throughout my time at JT I have achieved more than I ever expected. I’ve written an article, I’ve created advertisements, I’ve conducted research, worked on reception, learned how the systems worked, learned how to do reformers Pilates, wrote a blog, took part in a CPD, saw how the shockwave machine worked and the list goes on. I never expected to do this much at work experience and I have the JT team to thank for making my time so enjoyable.

Like I said before, I will be heading into 5th year in September, I will be sitting my Leaving Cert in 2020. Choosing subjects was a difficult task as these subjects have a big affect on your future. Certain colleges/ courses require certain subjects. Talking to the physios definitely made my decision easier as I had an idea of what I needed to do. Biology, P.E., Spanish and Music where the 4 subjects I chose. I chose Biology and P.E. as they are used for going down the Physiotherapy path, Spanish, as most colleges require a second language and lastly Music to hopefully get my points up. It’ll be a tough couple of years ahead, plenty of work and study involved but I have a goal set, I want to achieve it, hopefully one day I’ll become a Physiotherapist.

Over the 18 weeks at JT I learned so much and I’ve matured as a person. At the beginning of my time at JT phone calls terrified me, booking people in for appointments over the phone or trying to help them with an inquiry just terrified me. I was honestly a bag of nerves, until I got used to it. I apologise to anyone who I dealt with at the beginning, I was so nervous. But I have overcome that fear and now I think nothing of working on reception and answering phone calls. It doesn’t seem like a lot but these little things make a big difference and it was a fear I overcame during my time at JT.

Work experience is definitely a highlight of my Transition Year and I’m so happy I was able to complete it here at JT. I want to say a huge thank you to Johnny, Packie and the amazing team that work at JT Physiotherapy. I have said it 1,000 times but I have loved it here and each and every week I was made to feel welcome and I honestly can’t thank them all enough. I have loved every single minute I was here! Thank you JT Physiotherapy for what has been an amazing opportunity and the best work experience I could have ever wished to do.

Niamh Scanlon

Deele College Raphoe

Weight loss and osteoarthritis pain

Tue, 13 Oct 2020 08:55:00 GMT

Weight Loss and Osteoarthritis Pain

Knee osteoarthritis (OA) is the one of the most common joint conditions. It is the most frequent cause of reduced mobility and quality of life. Obesity is thought to be a major risk factor for knee OA (Felson et al. 1988). Recent studies carried out on weight loss and OA have found that small changes can make a significant difference to symptoms.

Christensen et al. (2007) found up to 50% improvement in symptoms with a 10% reduction in body weight. Further studies have also found similar results (Messier et al. 2013, Christensen et al. 2015). This can be a useful strategy to help manage symptoms and delay or avoid joint surgery.

References

Christensen, R., Bartels, E.M., Astrup, A. and Bliddal, H. (2007) Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Annals of the rheumatic diseases , 66(4), 433-439.

Christensen, R., Henriksen, M., Leeds, A.R., Gudbergsen, H., Christensen, P., Sørensen, T.J., Bartels, E.M., Riecke, B.F., Aaboe, J., Frederiksen, R. and Boesen, M. (2015) Effect of weight maintenance on symptoms of knee osteoarthritis in obese patients: a twelve‐month randomized controlled trial. Arthritis care & research , 67(5), 640-650.

Felson, D.T., Anderson, J.J., Naimark, A., Walker, A.M. and Meenan, R.F. (1988) Obesity and knee osteoarthritis: the Framingham Study. Annals of internal medicine , 109(1), 18-24.

Messier, S.P., Mihalko, S.L., Legault, C., Miller, G.D., Nicklas, B.J., DeVita, P., Beavers, D.P., Hunter, D.J., Lyles, M.F., Eckstein, F. and Williamson, J.D. (2013) Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. Jama , 310(12),1263-1273.

Author: Aiveen Lavery

Iliotibial Band Syndrome (ITBS)

Tue, 13 Oct 2020 08:32:00 GMT

Iliotibial Band Syndrome (ITBS)

What is the Iliotibial Band?

The Iliotibial Band (ITB) is a dense fibrous band of connective tissue which runs down the length of the thigh, from the outside of the hip to the shin. Due to its physiological make up, it is a very strong and tough, non-contractile piece of tissue. The tensor fascia lata (TFL) and glute maximus tendons also insert into the ITB. The ITB is a very common cause of pain on the outside of the knee. This condition is most often referred to as Iliotibial Band Syndrome (ITBS).

What are the symptoms of ITBS?

Runners and cyclists are most often affected by ITBS and the symptoms can be variable. Generally, pain is felt on the outside of the knee which can be sharp in nature. The onset of pain tends to be sudden with no real mechanism of injury. It can be aggravated by descending stairs or hills.

What causes ITBS?

The causes of ITBS are multifactorial, however it is thought that 80% of running injuries are caused by training error. For example, increasing the volume or intensity of your sessions too quickly. It is important to change your training load gradually to avoid doing too much too soon and causing injury.

There is lots of debate on whether pain from the ITB is a result of ‘friction’, where the ITB rubs against the bony aspect on the outside of the knee. However, there is evidence to challenge this view, stating it could potentially be fat pad compression which is causing the inflammation.

Muscle imbalance can also have a huge role to play in developing ITBS. Specific muscles such as gluteus medius, gluteus maximus and the quadriceps are often weak. For example, if the glutes are weak this can load the TFL too much as a compensatory effect. Due to the attachments of the TFL to the ITB this can be a large contributing factor to the pain. In addition to muscle weakness, it is important to have tissue flexibility around the hip and knee assessed as this can contribute to your symptoms.

Individual biomechanics can also have a role to play. There are 3 main issues which we look out for in our gait analysis which are discussed below:

Should I foam roll my ITB?

Recent evidence suggests no. Foam rolling the ITB directly can in fact irritate structures and exacerbate patient’s symptoms. Soft tissue release should therefore be directed at the muscles which have a direct tensioning to the fascia, the TFL and glutes. Foam rolling these muscles will therefore have a much greater effect in the management of your symptoms.

Management of ITBS

Evidence based research highlights ITBS responds well to conservative management with a success rate as high as 94%. A physiotherapy assessment can help to identify any contributing factors such as muscle weakness and tissue flexibility, as well as movement control and biomechanics. Management can include advice regarding loading, re-training, manual therapy and most importantly, an individual home exercise plan.

Aiveen Lavery, MISCP MCSP

Hamstring strain injury

Fri, 09 Oct 2020 08:15:00 GMT

Hamstring strain injury

A significant rate of hamstring strain injury (HSI) has been observed in soccer (Hägglund et al. 2009), Gaelic football (Wilson et al. 2007) and Australian football (Saw et al. 2018). Following a return to sport, hamstring re-injury rates are high (Roe et al. 2016, Wangensteen et al. 2016) and result in a significant amount of injury-related time loss (Roe et al. 2018).

The aetiology of hamstring injuries is multi-factorial in nature and are thought to be the result of the interaction between several non-modifiable and modifiable risk factors (Mendiguchia et. al 2012). Emphasis has been placed on modifiable risk factors as these have the scope to be altered to reduce injury, by implementing injury reduction strategies (Meeuwisse, 1991). Of these risk factors, eccentric strength has received most attention (Croiser et al. 2008, Sugiura et al. 2008, Yeung et al. 2009).

The NordBord (Vald performance, Australia) has been shown to reliably measure eccentric knee flexor forces during the Nordic hamstring exercise (Opar et al. 2013). Opar et al. (2014) used measures derived from this device to predict athlete’s risk of future HSI. They found that 28 players with low eccentric hamstring strength in pre-season were significantly more likely to sustain a HSI in the subsequent competitive season.

Targeting modifiable risk factors such as eccentric strength in training programmes could have significant implications in injury reduction strategies. A recent systematic review and meta-analysis of 8459 athletes revealed a 50% reduction in HSI when the NHE was introduced as preventative training (van Dyk et al. 2019).

Figure 1. NordBord Hamstring Testing System

For more information on the VALD testing system, contact us on 0749111010.

Author: Aiveen Lavery

References

Croisier, J.L., Ganteaume, S., Binet, J., Genty, M. and Ferret, J.M. (2008) Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. The American Journal of Sports Medicine , 36(8), 1469-1475.

Hägglund, M., Waldén, M. and Ekstrand, J. (2009) Injuries among male and female elite football players. Scandinavian Journal of Medicine & Science in Sports , 19(6), 819-827.

Meeuwisse, W.H. (1991) Predictability of sports injuries. Sports Medicine , 12(1), 8-15.

Mendiguchia, J., Alentorn-Geli, E. and Brughelli, M. (2012) Hamstring strain injuries: are we heading in the right direction? British Journal of Sports Medicine , 46, 81-85.

Opar, D.A., Piatkowski, T., Williams, M.D. and Shield, A.J. (2013) A novel device using the Nordic hamstring exercise to assess eccentric knee flexor strength: a reliability and retrospective injury study. Journal of Orthopaedic & Sports Physical Therapy , 43(9), 636-640.

Opar, D.A., Williams, M., Timmins, R., Hickey, J., Duhig, S. and Shield, A. (2014) Eccentric hamstring strength and hamstring injury risk in Australian footballers. Medicine & Science in Sports & Exercise , 46.

Roe, M., Blake, C., Gissane, C. and Collins, K. (2016) Injury scheme claims in Gaelic games: a review of 2007–2014. Journal of Athletic Training , 51(4), 303-308.

Roe, M., Murphy, J.C., Gissane, C. and Blake, C. (2018) Hamstring injuries in elite Gaelic football: an 8-year investigation to identify injury rates, time-loss patterns and players at increased risk. British Journal of Sports Med icine, 52(15), 982-988.

Saw, R., Finch, C.F., Samra, D., Baquie, P., Cardoso, T., Hope, D. and Orchard, J.W. (2018) Injuries in Australian Rules Football: an overview of injury rates, patterns, and mechanisms across all levels of play. Sports Health , 10(3), 208-216.

Sugiura, Y., Saito, T., Sakuraba, K., Sakuma, K. and Suzuki, E. (2008) Strength deficits identified with concentric action of the hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters. Journal of Orthopaedic & Sports Physical Therapy , 38(8), 457-464.

van Dyk, N., Behan, F.P. and Whiteley, R. (2019) Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. British Journal of Sports Medicine , 53(21), 1362-1370.

Wilson, F., Caffrey, S., King, E., Casey, K. and Gissane, C. (2007) A 6-month prospective study of injury in Gaelic football. British Journal of Sports Medicine , 41(5), 317-321.

Yeung, S.S., Suen, A.M. and Yeung, E.W. (2009) A prospective cohort study of hamstring injuries in competitive sprinters: preseason muscle imbalance as a possible risk factor. British Journal of Sports Medicine , 43(8), 589-594.

JT Physio

Large Rotator Cuff Tears

Large Rotator Cuff Tears

Pre/post-operative physiotherapy at JT Physio

Pre/post-operative physiotherapy at JT Physiotherapy

References

Dry Needling

Dry Needling

Trigger Finger

Trigger Finger

De Quervians Tenosynovitis

De Quervians Tenosynovitis

Rehab Journey and Setbacks

Rehab Journey and Setbacks

Knee Replacement

Knee Replacement

References

Achilles Tendinopothy

Achilles Tendinopothy

Vegetarian Diets & Nutrients

Vegetarian Diets & Nutrients

Protein

Vegetarian sources of protein include:

If you eat them:

Iron

Calcium

Vitamin D

Vitamin B12

Omega-3 fats

To maximise this conversion:

Vitamin D Update

Vitamin D Update

Current Irish recommendations

The new UK recommendations

The Office and Exercise

The Office and Exercise

Movement is the best medicine

How you can be more active at work:

TMJ

TMJ

Complex system

Symptoms of TMJ dysfunction

What can a physiotherapist do for TMJ dysfunction?

Tips for Acute Jaw Pain

More Information

When can I go back after an injury? – Injury and the “Envelope of Function”

When Can I Go Back After an Injury? – Injury and the “Envelope of Function”

Let’s disc-cus discs!

Let’s Disc-cus Discs !

Injuries to the Discs

References

Sweet Potato

Sweet Potato

Patellar Tendinopathy

Patella Tendinopathy

Chartered Physiotherapist Post

Chartered Physiotherapist

Physiotherapy Job Summary:

Tibialis Posterior

Tibialis Posterior

Posterior Tibial Tendon Dysfunction (PTTD)

References:

Should you run or exercise through your pain?

Should You Run Or

Exercise Through Your Pain?

Should you run or exercise through your pain?

Lateral Collateral Ligament Injuries

Lateral Collateral Ligament Injuries

Mechanism of Injury

Symptoms

Management

How many calories does that bad night’s sleep cost you?

How Many Calories Does That Bad Night’s Sleep Cost You?

Sacroiliac Joint – Part 1

Sacroiliac Joint – Part 1

Diagnosis of SIJ pain

Aine Tunney MISCP

References

Stress Fractures

Stress Fractures

When Can I Go Back After an Injury?
– Injury and the “Envelope of Function”

How Many Calories Does
That Bad Night’s Sleep Cost You?

Part-Time Administrator

in Football – Sever’s Disease