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What is Cervical Radiculopathy? – Blog by Stephen Lee

Cervical Radiculopathy is a clinical term describing neurological symptoms originating from the cervical spine (neck) which is irritated. This is commonly called “pinched nerve”. The nerve roots from the cervical spine may be compromised by many structures in the neck.

What are the Causes?

There could be many reasons to cause cervical radiculopathy. It could be due to a disc prolaspe in the cervical spine, or bony changes like stenosis and osteophytes (bone spurs)impacting the canals where the nerve runs through. In middle aged to elderly, it is more common to have degenerative changes causing these symptoms. Whilst in the younger popluation, it is more likely a disc prolapse or trauma.

What are the symptoms?

Symptoms usually include pain, weakness and or numbness to shoulder down to the fingers. This can be in a determatomal pattern depending on which level the affected cervical segment is. Most people feel pins and needles and may experience weakness like inability to grip or lift.

How is it diagnosed?

Immediate scans are not always required with cervical radiculopathy. Careful clinical findings and assessment by a Physiotherapist can identify the symptoms. Your neck movements, strength, sensation, reflexes and some special tests may be assessed. Other diagnostic tests may involve a plain X-Ray, MRI, nerve conduction tests may also be used in conjunction.

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What are the treatment options?

There are many options when it comes to treating cervical radiculopathy. This depends on the level of pain, level of irritability, length of symptoms and if there are any abnormal signs.

  • Medication – Your doctor may prescribe oral steroids or NSAIDS (Anti-inflammatories) to help reduce inflammation and irritability.
  • Injections – when oral medications are not effective to help reduce the inflammation, steroid epidural injections via X-Ray to the affected level can be effective in reducing pain in the short and long term.
  • Physiotherapy – There are many techniques we use to help with cervical radiculopathy. Treatment is usually broken down into 3 phases
    • Reduction – Your Physiotherapist is trained to assess the severity of your problem. It is very important to reduce the acute pain which may be inflammatory in nature and to identify movements and exercises which help relieve the arm pain. Treatment may include traction, manual therapy and exercises to help offload structures compressing on the nerve. Specific exercises to restore neck range of movement, strengthening exercises, Mechanical Diagnosis & Therapy (Mckenzie) exercises, dry needling, massage are some techniques Physiotherapists use. You may be recommended supports , postural rolls to help with your problem.
    • Maintenance – As the pain starts to settle and the correct exercises are utilized, we recommend to continue the exercises which have been effective for a period of time until the pain has subsided. This could be up to 4- 6 weeks. It is important to maintain good posture during this period to prevent recurrences.
    • Recovery & Prevention – Once the pain has settled and depending on what activity or goals you’d like to return to, your Physiotherapist will be able to identify other factors that may cause recurrence like poor muscle activation, poor work setup etc. The aim is to be able to return to previous activity pain free.
  • Surgery – This is the last resort for those who have failed conservative treatment or if there are significant neurological symptoms. The most common procedures are Anterior Cervical Disc Fusion (where the cut is made through the front and the vertebraes are fused). Other procedures include Posterior Cervical Laminectomy (where the cut is made from the back). Anterior Disc Replacements are also increasingly common as well. Surgery can offload the nerve when there is bony spurs and large disc herniation.

Image result for mckenzie neck exercisesCervical Epidural Steroid Injection

Book an appointment today for your assessment!

Blog By Stephen Lee (Physiotherapist, Cred Mckenzie Therapist)

Temporomandibular Joint (TMJ) Disorder

What is the TMJ?

The temporomandibular joint is a hinge joint that connects your mandible (jaw) with the temporal bones of your skull which sit in front of your ear. It allows you to move your jaw side to side and up and down so as you can eat, talk and yawn. Pain caused by the TMJ is referred to as TMJ disorder.

What are the symptoms of TMJ Disorder?

  • Pain or tenderness of your jaw
  • Aching pain in and around your ear including ringing sounds in the ears (tinnitus)
  • Neck or shoulder pain
  • Headaches
  • Blurred vision
  • Difficulty opening/closing mouth, e.g. difficulty chewing
  • Clicking/popping sensation
  • Swelling on side of your face
  • Jaws that get stuck/locked in an open or closed mouth position

What are the causes?

  • Acute injury to your jaw
  • Arthritis in the joint
  • Displaced disc
  • Poor posture
  • Long term chronic grinding (bruxism) or clenching of teeth
  • Malocclusion – teeth that don’t fit together properly
  • Stress
  • Higher risk in females aged 20-40years

How is it Disorder diagnosed?

Your physiotherapist will first take a thorough history and conduct a physical exam to rule out other conditions and correctly diagnose TMJ Disorder. This examination may include:

  • Palpation of the joint and surrounding muscles
  • Observation of posture, jaw deviation
  • TMJ movements, taking note of any clicking, pain, popping that may occur
  • Assessment of neck/shoulder to rule out other potential conditions
  • Referral for an x-ray if an acute injury or occasionally for an MRI to rule out any other medical problems
  • Referral to dentist/orthodontist to exclude any dental causes

How is TMJ Disorder treated?

Address contributing factors

  • Avoid excessive chewing – where possible try to eat a soft diet to avoid foods that are difficult to chew, avoid chewing gum and biting fingernails
  • Correct posture
  • Relaxation techniques to manage stress and ease muscle tension
  • Avoid pressure on your TMJ, e.g. avoid lying on your painful TMJ during sleep or resting your chin in your hand
  • Avoid extreme jaw movements
  • Keep your jaw in a relaxed position with your teeth slightly apart to avoid clenching/grinding your teeth

 

Manual Therapy

  • Massage of muscles around the joint including masseter and temporalis
  • TMJ mobilisations to relieve stiffness
  • Addressing any issues within the neck/shoulder region

Exercises

  • Postural correction exercises
  • Gentle stretching exercises
  • Strengthening exercises of the muscles that act on the joint
  • Exercises to address issues within the neck/shoulder region

Other pain management techniques

  • Ice packs can be placed on the jaw for up to 15minutes at a time
  • Over the counter anti-inflammatory medications
  • Self massage

Referral

  • Referral to an orthodontist/dentist for an oral splint or night mouth guard to hold your jaw in a more relaxed position, correct your bite by putting your teeth position and reduce the effects of clenching/grinding. Your dentist may also wish to perform other treatments.
  • Very severe cases may require surgical opinion

What is the prognosis for TMJ Disorder?

Most cases of TMJ Disorder respond really well to conservative management. Less than 1% of cases require surgery.

Book an appointment today for your assessment!

Blog By Kara Giannone (Physiotherapist)

Cervicogenic Headaches

Cervicogenic headaches are headaches that originate from the cervical spine (neck). Patients with this condition usually experience a gradual onset of head and neck pain associated with a sustained posture or causative movement. Pain is typically experienced on one side of the head, usually at the back of the head, but it may radiate over the temple or behind the eye and spread to both sides of the head.

Most patients will experience tenderness upon palpation of their upper neck joints and tenderness through the surrounding muscles.
Cervicogenic headaches are often accompanied by stiffness and pain in their neck, particularly in the upper three vertebrae. Some patients may also experience associated pain, pins and needles or numbness radiating into their upper back, shoulders or arms.

Contributing Factors:

There are many factors that may cause patients to experience cervicogenic headaches. Your physiotherapist will thoroughly assess and help you to address these factors. Such factors may include:
• Poor sitting posture, excess slouching and rounded shoulders.
• Inappropriate desk set up
• Poor lifting technique or poor workplace ergonomics
• Previous history of whiplash injury
• Poor sleeping posture or inappropriate mattress/pillow
• Muscle imbalances
• Muscle weakness
• Muscle tightness
• Neck and upper back stiffness
• Increase in stress

Diagnosis:

In most cases a thorough clinical history and physical examination by your physiotherapist will be sufficient to diagnose cervicogenic headaches. In some cases your physiotherapist or GP may request an MRI, X-Ray or CT scan to confirm the diagnosis. Specialists and surgeons may also request a diagnostic nerve or joint block in some cases, where pain is chronic and does not respond to conservative.

Treatment:

Treatment for cervicogenic headache is multi-faceted and will depend on each individual’s contributing factors. Treatments often will include:
• Postural re-education including exercises, taping and/or bracing
• Clinical pilates
• Exercises to strengthen postural muscles, improve flexibility and strengthen the deep cervical neck flexors
• Soft tissue work and trigger point therapy
• Joint mobilisation or manipulation
• Dry needling
• Ergonomic advice
• Recommendation of appropriate pillow and sleeping posture
• Advice regarding analgesia and referral to pharmacist or GP where appropriate

Prognosis:

Most patients who experience cervicogenic headache will make a full recovery with appropriate physiotherapy intervention. Rate of recovery may vary depending on severity of pain, how long it has been happening, and compliance to treatment. In the case of acute cervicogenic headache you should experience relief in symptoms within a few days, although pain may take several weeks to resolve completely. More chronic pain will generally take longer to resolve and may take weeks to months.

In the event that despite appropriate physiotherapy management symptoms remain persistent,  your physiotherapist may suggest referral to a specialist who can offer other treatments including injections and in some cases, surgery.

Feel free to contact our clinics to help relieve some of your neck pain.

Blog by Claire De Vos.

Dry Needling?

What is dry needling? Does it hurt? How does it work? Is it the same as acupuncture? These are all common questions patients frequently ask and that this blog will aim to answer…

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What is dry needling?

Dry needling involves the use of a sterile acupuncture needle inserted into tight muscle bands known as trigger points or along a particular nerve pathway. The aim is to bring about a local twitch response within the muscle and the bigger the twitch response, the more effective the dry needling is likely to be in decreasing pain and relaxing overactive muscles.

How much does it hurt?

Patients often report feeling no pain at all or a slight sting somewhat similar to a mosquito bite that should subside within a few seconds.

How does it work?

It has been shown to help the following

* Increase blood flow,

* Change the shape of cells within trigger points,

* Alter the chemical content of trigger points,

* Block pain nerve pathways,

* Stimulate regions in the brain,

* Release endorphins,

* Create an immune response,

* Activate brain waves that elicit a relaxation effect, and

* Deactivate trigger points within muscles

How does it differ from acupuncture?

Image result for acupuncture

Acupuncture is believed to work by redirecting the flow of energy, known as chi, within the body, with the aim of relieving tension, stress and pain. Acupuncture is derived from eastern medicine and hence uses spiritual paradigms. Needles are inserted into acupoints along the body’s meridian pathways, often very distant to the site of pain, and no local twitch response is seen. This is very different to dry needling which is based on western medicine philosophies and therefore uses anatomical and biological concepts as discussed.

Ultimately, dry needling is a very effective tool in relaxing overactive muscles and in the treatment of pain. So, have a chat with your physio and see if dry needling is appropriate for you!

Is extra training required to perform dry needling?

Yes. Our Physiotherapists who are trained are required to do a course prior to needling. If you want to know if dry needling is appropriate for you book with our trained Physiotherapists now!

Blog by our Physiotherapist Kara Giannone

What is Fibromyalgia?

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What is Fibromyalgia?

Fibromyalgia is a condition characterised by unexplained, chronic and widespread pain throughout the body. The severity of symptoms can vary greatly between those affected, with the most common complaints including:

  • Flu-like body aches
  • Muscle tenderness
  • Increased sensitivity to pain
  • Headaches
  • Fatigue
  • Sleep disturbances
  • Anxiety/Depression
  • Problems with cognition (including memory and concentration)
  • Bladder/bowel problems

Fibromyalgia is not a progressive condition, as it does not cause any damage or inflammation to the body tissue where the pain is felt. Those affected will find that the severity of their symptoms will vary greatly over time. Symptoms may even disappear for extended periods of time with the appropriate management. Fibromyalgia sufferers often report flare-ups of pain tend to coincide with stressful periods, weather changes and with overexertion.

Who is most affected?

Fibromyalgia affects between 2-4% of the population, unfortunately though, many people go undiagnosed. This is due to there being no ‘gold-standard’ testing available. As a result, it takes between 5-7 years on average to diagnosis Fibromyalgia. This usually includes tests to rule out other conditions which could be causing the symptoms and a physical assessment of tender points through the body.

Women are 9 times more likely to develop the condition and it can affect people of any age, but is most prevalent in the 40-60 year old age group.

There is a huge correlation between fibromyalgia and anxiety/depression disorders. Additional triggers of fibromyalgia include having a history of physical trauma (in particular motor vehicle accidents), post-traumatic stress disorder, obesity and autoimmune disorders.

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What can you do to manage your symptoms?
Fibromyalgia is a chronic condition, so there is no cure, but there are ways to manage your symptoms. In addition to medical management, exercise based therapy is an integral component of managing the condition long-term. In particular, low impact exercises such as walking, hydrotherapy and Pilates are effective activities for reducing your symptoms as well as your general health.

Other important tools include stress management and relaxation techniques, pacing your activity, eating a balanced diet and having a good support network around you.

If you are living with chronic pain or fibromyalgia, have a chat to your physiotherapist about commencing an appropriate exercise routine to manage your symptoms and optimise your quality of life.

At Total Physiocare, we run both 1 on 1 and group Pilates classes taken by a Physiotherapist at our Camberwell, Heidelberg and Reservoir Clinics. We also conduct Hydrotherapy classes at Reservoir Leisure Centre twice weekly. Additionally we have gym facilities at all clinics, and can provide you with an individualised exercise program (eldercise) or our Total Fit program to set you up with the tools for long-term effective management of Fibromyalgia.

fibro3 By Emily Shortal