Acute Wry Neck
Neck pain is one of the world’s most common musculoskeletal conditions, and any pain in the neck lasting 6 weeks or fewer can be categorized as ‘acute’ neck pain. Around two-thirds of the population will experience neck pain at a given point in their life.
Neck pain is one of the world’s most common musculoskeletal conditions, with any pain in the neck lasting 6 weeks or fewer categorised as ‘acute’ neck pain. Around two-thirds of the population will experience neck pain at a given point in their life (Vos, C, 2007).
Acute wry neck (or acute torticollis) is a painful neck linked to muscle spasm, joint stiffness, and pain with movement of the head and neck. The cause may not always be known but there is a strong connection to sleeping in an abnormal position without proper head and neck support, inappropriate seating, poor posture while at a desk, or carrying heavy unbalanced loads.
Symptoms may resolve themselves within 7 days to 2 months, but low grade pain may linger for up to a year. Recurrence of acute pain symptoms is very common.
What Are The Risk Factors?
People aged 35-49 years old
Occupations such as office workers
Sleeping disorders
Depression or anxiety
A previous history of neck pain
Women are more prone to neck pain than men
Sedentary lifestyles
Smoking
Being overweight or obese
How Can You Manage Your Neck Symptoms
There are a number of things you can do at home, such as:
Take analgesics such as ibuprofen and paracetamol
Thermal therapies
Heat pack (hot water bottle wrapped in a tea towel or a wheat bag placed on neck for up to 20 minutes)
Ice pack (a packet of frozen food wrapped in a tea towel or a cold pack placed on the neck for up to 10 minutes)
Check your pillow to make sure that your head and neck are well supported while sleeping
Avoid sleeping on your belly
Avoid using a rigid neck brace, you want to keep your head and neck mobile
Take caution while driving a car or riding a bike as performing head checks may aggravate your symptoms
If your pain persists despite medication and advised actions, it is important your consult with your GP or healthcare professional.
Are There Any Exercises I Can Try On Day One?
There are no ‘magic bullet’ exercises to fix all neck problems, typically gentle movements to help restore your normal range can help. Here are some simple exercises that might help you move a little better, sooner.
Gentle exercises for day one
Chin tucks
Supine (laying on your back with the head supported) neck rotation
Shoulder rolls
Gently massaging the muscles around your neck
Follow up exercises
PNF (Proprioceptive Neuromuscular Facilitation) neck side flexion stretches
Flexion-rotation neck stretches
How Richmond Rehab Can Help
While there is a good chance your neck pain may resolve on its own, there are still viable treatment options that can be provided by the staff at Richmond Rehab, such as:.
Screening your condition to make sure your symptoms are typical of Wry Neck, and referring you for further investigation where/ if appropriate
Soft Tissue Therapy to help ease muscular tension and pain
Spinal Mobilisation to restore restricted joints and improve your neck function
Exercise Therapy designed to restore movement in your neck, restore strength and help reduce the likelihood of recurrence
Education regarding what you can do to help manage your pain as symptoms ease with time
Posture... What Is It & What Can You Do?
Posture is the position in which the body is held while stationary or while in motion, static and dynamic respectively, and while many people know and understand what an ideal posture is very few make the effort to make it a practice in their daily life.
Overview
Posture is the position in which the body is held while stationary or while in motion, static and dynamic respectively, and while many people know and understand what an ideal posture is very few make the effort to make it a practice in their daily life. What is relatively unknown is how posture and body and facial expression can affect our mood; standing tall, head up, shoulders back, with an expression on your face that looks happy will actually make you happier and more susceptible to positive thinking. (Kleinke, C, et al, 1998)
Posture and the Effects on Mood
It is well documented that your posture, both standing and sitting, and even gait - manner of walking (Michalak, J, et al, 2009) can indicate your current mood and emotional state. When in a negative mood your body tends to slump, lean forward, and basically wants to be in a position where you are looking down. When in a positive mood your body tends to want to be upright and head tall, walking with a strut of sorts. But that is only looking at it one way, cause and effect; but can changing the posture consequently affect your mood?
A study done by Veenstra, L., Schneider, I.K. & Koole, S.L. (2016) showed that a more negative mood can be generated by manipulating the posture of the participant to a forward slumped one, but if the posture of the participant was upright or neutral, then they proved to be resistant to being induced to a negative mood. The same was done in the opposite case where the participant was more likely to be influenced into a positive mood when placed into an upright posture, such as having a higher self esteem. And research does show that motor actions and stable postures do have a correlating effect on emotional processes (Michalak, J, et al, 2014).
Not only can a positive or negative mood be generated via change in posture, but other research has been done to show that practicing an upright posture can decrease fatigue and and have a positive effect in cases of diagnosed depression (Wilkes, C, et al, 2017). Even adopting a particular breathing pattern and alter your emotional state (Philippot, P, et al, 2010).
Ideal Standing Posture
When looking at a more ideal posture, a simple assessment you can employ is called the Plumbline Posture Assessment (Norris, C.M., & Berry, S, 1998). Take the person you are assessing and get them to stand with one of their sides facing you and you look at these structures:
The ear
Shoulder joint
Middle of the torso
Hip joint
Knee joint
Lateral malleoli (prominent bone bulging out in ankle region)
Now if you draw a line along those structures you can get a sense of how ideal your posture is, the straighter the line the more ideal posture you have.
What can Richmond Rehab do for you?
There are a number of factors that can change your posture such as: body conditions, pregnancy, work, and physical activity (sports and gym), and there are also a number of ways to work on correcting your posture. Education and exercises and techniques from our expert team will get you understanding why your posture is the way it is and how to effectively counter it.
References
Tension Type Headaches
A tension headache is generally a diffuse, mild to moderate pain in your head that's often described as feeling like a tight band around your head. A tension headache(tension-type headache) is the most common type of headache, and yet its causes aren't well-understood.
Tension-type headaches (TTH) can be identified as either episodic or chronic. It is usually described as having a tight, vice-like band around the head. The headache is not particularly painful, ranging from mild to moderate pain; and while not debilitating, some light and/or noise sensitivity may occur (Chowdhury, D, 2012).
Who Is Affected?
TTH is the most common headache disorder, internationally affecting 32% of men and 42% of women. This suggests that approximately seven million Australians are likely to have TTH.
The onset of TTH is usually in the age range of 20-30, but data from a Sydney Clinic shows that around 15% of people who came in with a TTH were under the age of 10 and over the age of 50 (Headache Australia, 2018).
Types of Tension-Type Headaches
In terms of the classification of TTH, it can be put into three subtypes (Bendtsen, L, 2009):
Infrequent Episodic TTH - Headache with a frequency of 1 day or less per month
Frequent Episodic TTH - Headache with a frequency of 1-14 days per month
Chronic TTH - Headache with a frequency of 15 days or more per month
Symptoms
Some of the symptoms of TTH include (Headache Australia, 2018):
Dull and persistent pain on both sides of the head (bilateral)
Vice-like, pressing pain that goes on or around the head
Decreased range of neck movements
Photophobia (Sensitivity to Light)
Triggers
Phonophobia (Sensitivity to Sound)
Trouble concentrating or difficulty sleeping
Nausea and Indigestion
Despite being dubbed Tension-Type Headache, there are a few triggers outside of muscular tension, such as:
Psychological Stress
Mental Exhaustion and Fatigue
Medication Overuse
Bright lights or Loud Noises
Poor Posture
Depression
Insomnia and Disturbed Sleep
Treatment
In the pharmacological approach, simple analgesics such as ibuprofen has seen an effective response from TTH sufferers when taken at early onset of an attack and at an adequate dose.
If the attacks increase in intensity and frequency, stronger analgesics has its limitations, as it has a chance to turn an episodic TTH into a chronic TTH. This is due to medicine overuse, which can have the opposite intended effect and actually make the TTH worse (BMJ Best Practice, 2018).
From a physical therapy approach, Falsiroli Maistrello et al., (2018) has found that manual trigger point therapy, specifically applied around the head and neck can reduce the intensity, frequency, and duration of a TTH attack. Correction of posture (work, home, or driving) and a home exercise program also has merit (Chowdhury, D, 2012).
Lastly, psychological stress and mental wellbeing are big factors to TTH, and so, decreasing stress and some relaxation training can help.
What Richmond Rehab Can Do For You
Trigger point therapy, correction of posture, and a home exercise plan have shown to have positive results in the treatment of tension-type headaches. Our practitioner Julius Principe has a keen interest in treating headaches and migraines. Utilising a multidisciplinary approach, Julius can work collaboratively with your current health care professional to help you manage your symptoms.
Patellofemoral Syndrome
Patellofemoral Pain Syndrome is a common knee condition for those with muscle imbalances or malalignment of the knees. Julius has contributed a Myotherapy perspective on something we see every week.
Patellofemoral pain syndrome (PFPS) is a term used to describe pain in or around the kneecap (patella) and distal end of the femur bone. It is commonly seen in the adolescent, young adults, and person’s who undergo a high amount of physical activity . Quite a high number of cases of presented knee pain can be classified as PFPS.
The Anatomy
The kneecap is a rounded triangular bone that sits in the femoral groove over where the bones in the leg (the femur and tibia) meet. The patella plays a large role in helping the knee bend, therefore is active in most movements involving the lower leg. Injury to this site can cause difficulty with walking, standing, and general activities.
Causes
The exact cause of PFPS is largely unknown, but many therapists believe that major factors that contribute to PFPS is an imbalance or weakness of the muscles, and traumatic injury to the site. The imbalance or injury may cause the patella to come out of alignment of the femoral groove and start to grind amongst the surrounding cartilage which causes irritation and pain.
Associated symptoms of Patellofemoral Pain Syndrome
The main symptom of PFPS is presented as knee pain with walking, sitting with knees bent, and sports that involve running or jumping. Other symptoms include popping or grinding sensations in or around the knee. There may also be times where your knee may give way and lapse it’s support involuntary while walking or running.
Managing Patellofemoral Pain Syndrome
Remedial massage has proven to be an effective management tool for PFPS by restoring muscle balance and range of motion of the knee, but in addition, a great way to manage PFPS is by a few home care exercises, more specifically lower body proximal exercises.
The exercises below are just a few examples you can do to strengthen weak muscles and restore some balance to the area to relieve pain.
Lying Kicks:
Lying on your back, place a rolled up towel or blanket under the affected knee, then proceed to straighten your knee all the while resting the back of your thigh on the rolled up towel. Hold for 5 seconds, repeat 5 times.
Bridging:
Lying on your back with your knees bent, activate your core and glutes to lift your hips off the floor and create a straight line from your knees to shoulders. Hold for 30 seconds, repeat 3 times.
Hip Abduction:
Lying on your side, keep your bottom leg bend and your top leg straight. Slowly raise your top leg. Hold for 10 seconds then relax, repeat 3 times each side.
Straight Leg Raise:
Lying on your back, keep one leg bent while the other remains straight. Slowly raise the straight leg 30 centimeters off the floor. Hold for 10 seconds then relax, repeat 3 times each side.
Backward Kicks:
In a standing position, without leaning forward keeping your toes pointing forward and legs straight, slowly kick one leg back. Repeat 10 times with each leg.
Seated Kicks:
While seated in a stable chair, have your knees bent to 90 degrees and assure you have a nice grip with the floor. One leg at a time, try to keep your foot in the same position while activating the muscles in your leg as if you were kicking forward. Repeat 10 times with each leg.
Julius Principe
MYOTHERAPIST
This article has been prepared by Julius Principe. Please leave your comments below if you have any further questions about PFJ.
How Muscle Tissue Healing Works
Strained a muscle before and wondered how exactly the body heals itself and the internal process involved? This blog looks at the four healing process involved from the moment of injury till the moment your back into action!
We've all been in the situation where we've strained a muscle where it's put us out of action for periods of time. This blog looks at what goes on internally with how exactly the body heals damaged muscle tissue.
A muscle strain occurs through damage to the muscle fibres, which make up the length of the muscle, overstretch and tear causing pain at rest or on movement, swelling, bruising and inflammation resulting in the inability to use that muscle. This can occur anywhere on the muscle whether it’s at the muscle tendons (the thicker part at the ends of the muscle where it attaches to bone) or to the muscle belly (the central 'meaty' part of the muscle). For more on muscle strains click here.
So what exactly goes on during the recovery processes? Lets get sciencey and discuss the 4 phases of tissue healing, which are:
- Bleeding
- Inflammation
- Proliferation
- Remodelling
Bleeding Phase
This occurs immediately after sustaining the injury and is really brief, however the bleeding does depend on which structures have been damaged. Vascular tissue, such as muscle, will bleed for longer than other tissues such as ligaments in relation to volume and duration. The vascular tissue bleeding will usually last between 4-6 hours unless complications arise from affected structures surrounding the tear.
Inflammation
Following the bleeding comes the inflammation to the site that is the redness, swelling and heat we see when someone goes down from this type of injury, which is vital to the tissue repair process. Inflammation to the area can also be exacerbated by other contributing factors such as overuse injuries, joint dysfunction or nerve entrapment. The inflammatory phase has a fast onset of a few hours (just as the tissue bleeding phase finishes) and continues up to 3 days as it gradually reduces after a couple of weeks.
Profliferation Phase
This phase is where tissue regeneration begins, involving the body’s natural repair material, which is collagen for muscle strains also known as scar tissue. This phase occurs between 24 and 48 hours of the injury and concludes roughly after 3 weeks. Between the start and the end of the proliferation phase is where the high majority of scar tissue is produced and the final product of scarring continues until a matter of months from the injury.
Remodelling Phase
Lastly the remodelling phase begins at the peak of the proliferation phase (when majority of collagen fibres/scar tissue is formed) around weeks 2-3 but can also start earlier. It’s really important to get treatment at this stage, as the scar tissue is eventually able to perform as perfectly working, quality muscle tissue. Once the recovery stages is complete, the damaged tissue in severe strains is left with a neat and perfectly functional scar capable of being put under load or stretched as normal muscle tissue would.
If you have sustained a muscle strain, it’s best to get it assessed my one of the physiotherapists. This will determine the severity of the strain through muscle testing, treatment to assist in speeding up the recovery time to promote the proliferation phase and especially the remodelling phase; and to be educated through what you can and cannot do through the stages of muscle recovery.
Source:
Electrotherapy on the web
http://www.electrotherapy.org/modality/soft-tissue-repair-and-healing-reviewBrukner, P., & Khan, K. (2006). Clinical Sports Medicine. McGraw Hill.
Rotator Cuff Tears
Tears in the Rotator Cuff are a very common shoulder injury. Many of us have partial tears without evening knowing! Mark has created a great infographic to help illustrate what a cuff tear is and what to expect if you develop one.
What Is The Rotator Cuff?
The rotator cuff is a group of tendons in the shoulder that combine to help provide stability to the shoulder joint. As the shoulder has a large range of motion, it is easy to see that these muscles play an important role. With this large range of movement however, the stabilising cuff muscles/tendons are prone to injury.
What Are The Symptoms Of A Rotator Cuff Tear?
Common symptoms of a cuff injury include;
- shoulder pain
- weakness, particularly when the arm is up in the air
- pain running down the outside of the shoulder muscles
- clicking +/or popping in the shoulder with movement
- difficulty lying on the affected shoulder in bed
How Is It Diagnosed & Treated?
A rotator cuff injury is commonly diagnosed in the clinic by a Physiotherapist or Myotherapist using their clinical reasoning. Depending on the level of disability, the shoulder often responds well to conservative treatment such as; rest, ice, mobilising the shoulder, and rehabilitative exercises. If the symptoms don't improve with 3 weeks or if the impairment is significant, a referral for imaging may be required. Depending on the severity of the tear, surgical intervention to repair the tear followed by rehabilitation may be required.
Mark Gelo
Myotherapist
This article has been written and prepared by Mark Gelo. If you have any questions for Mark or would like to know more about rotator cuff tears, please leave your comments below.