Bones
Not all bone injuries are as obvious as a bent and broken arm. Repetitive loads on bone can cause stress fractures which may or may not may feel like a small sore spot on the bone. It is important to diagnose these fractures because if not dealt with properly they can progress into a full fracture. For a conclusive diagnosis, it is necessary to perform a bone scan however your physio can help determine if a scan is needed.
Bones can also be injured or irritated by tendons. If a tendon is repeatedly placing high levels of force through a bone it may need to adapt and place more bone around the area to make itself stronger. This is why when a bone is broken, it will heal with a callus around it, meaning that, if healed correctly, should be stronger than before the injury!
If you suspect you have an injury to your bones we strongly advise that you seek an opinion from a medical professional sooner rather than later.
Bursa
Bursa are fluid filled sacks located around joints or areas that need cushioning or help with sliding. Bursitis is a common problem in several body areas such as the knee, shoulder and hip and means inflammation of the bursa. This is commonly caused by repeated trauma such as pressure on the bursa or impingement. If bursitis is left un attended then it is possible for a bursa to rupture causing more damage. Chronic inflammation of the bursa will lead to thickening of the exterior casing of the bursa that will create further painful symptoms. If your bursa becomes thickened it may require surgical intervention. If you think you have an inflamed bursa it is very important not to try and work through pain, as this will only aggravate the bursa and cause further inflammation. Your physio can help you with techniques to reduce the swelling and pain of the bursa and help you return to normal activity.
Cartilage
Cartilage is the smooth, flexible yet durable material that covers the ends of our bones and allows our joints to move smoothly. It is the main component affected in osteoarthritis when it becomes inflamed and degenerated. Cartilage unfortunately does not receive a blood supply, therefore when it is damaged it cannot repair itself. In some instances, it is possible for young people to undergo surgery that stimulates the growth of cartilage however it is unsuitable for widespread cartilage damage or osteoarthritis. Cartilage can also be injured through trauma, it is not uncommon for knees to be injured in this way. If you suspect you have poorly functioning or injured cartilage giving you joint pain then your physiotherapist can help you to decrease your pain and increase your function in a number of ways.
CT Scan
A CT scan is also a two-dimensional image however it is taken using a magnetic field and therefore is more useful in detecting changes in cartilage, ligaments and tendons as well as more detailed imaging of bone.
Mal-union is a term used to describe the lack of healing at a fracture site. Depending on the time since the initial fracture mal-union does not necessarily mean that the bone won’t heal, it may just be slow to heal.
Degenerative change is a broad term which describes the appearance of cartilage and or bone on a CT scan. Some normal degenerative changes would be expected to be present on an image from anyone over the age of 25, these are not always a bad thing, they are normal. In many cases even people with advanced degenerative changes are able to make a full recovery and regain pain free movement through rehabilitation with your physiotherapist.
Fascia
Fascia is a fibrous connective tissue that is found throughout your entire body. There are three main types of fascia. The Superficial Fascia is mostly associated with your skin, the Deep Fascia, is associated with your muscles, bones, nerves and blood vessels and the Visceral Fascia, which surrounds your internal organs.
The Deep Fascia or muscle fascia is the connective tissue that surrounds and encloses your individual muscles and muscle groups. Its function is to hold the muscle together and keeps it in the correct place. Your fascia separates your muscles so they can work independently of each other and your fascia provides a lubricated surface so that the muscles can move smoothly against each other.
Fascia can become bound up when you are inactive for lengthy periods of time, due to inactivity or injury. If your fascia is bound up it prevents your muscles from moving freely against each other, and leads to a stiffness or tightness that decreases your normal range of movement – preventing freedom of movement. Stretching regularly will help to keep your muscles and fascia in good working order, and will prevent them from seizing up.
Headache
Many people do not realise that headaches can be caused by the neck. Headaches are often associated with stiff necks, this is because stiff muscles can constrict blood flow and cause tissues in your skull to feel pain. It is also possible for a problem in the neck to refer pain to a part of your head, making you think that the problem is in the head. When your physio assesses a patient with a headache they can determine if/which part of the neck is causing the pain and treat the area by mobilising, massaging, dry needling or warming the area to relieve pain and then advising the patient on which exercises and stretching routines will help to prevent the headache returning.
There are two main categories of headache; primary and secondary. Primary headaches are due to idiopathic causes and include migraines and tension headaches while secondary headaches are as a result of an existing condition and can be from more sinister causes. It is important to consult a primary health professional such as a physio or GP about your headache to ensure that your pain is not being caused by serious disease.
Jaw (TMJ)
The jaw is a joint between the mandible and temporal bones and is an integral joint in many daily functions. Due to a poor joint surface area congruency (how well the two bones fit together) the Temperomandibular joint or TMJ (jaw) has a small cartilaginous disc that sits in between the two bones and help to make the jaw stable and movements easy and absorb shock from chewing movements.
Ligaments
Ligaments are strong pieces of connective tissue that connect bones to bones and help keep our body in place. Ligaments are most commonly injured in a single incident when put under trauma and can either tear or rupture. It is important to know that if a ligament is fully ruptured it may only hurt for a few seconds; this is because the pain fibres are torn. Ligament injuries require rest and support and should be assessed by your physio to determine the severity of the injury and decide if the injury needs a further opinion by a sports doctor or surgeon.
Treatment options for your injured ligament include bracing, taping, unloading, reducing inflammation and guiding you on your road to recovery through graded exercises.
MRI
MRI’s are the most comprehensive imaging technique but unfortunately are the most expensive so are used more sparingly than others. It is able to provide a three-dimensional image of the body and can detect all types of body tissue.
MRI’s are commonly used to scan the spinal column to detect the cause of a person’s pain and are often the source of much anxiety. They will often show degeneration of the inter-vertebral discs, disc protrusions or bulges, narrowing of the vertebral column and other large words that are intimidating. These words aren’t always as bad as they sound! People are able to live normal pain free lives with disc bulges, and disc degeneration happens to everyone.
One study investigated the prevalence of disc bulges, protrusions and extrusions amongst people who had no low back pain and found that over 50% of people had a disc bulge on at least one level, meaning that it is possible to have a disc bulge and live a normal pain free life! Here at City Physiotherapy we are experts at modifying your life and helping you to regain pain free movement.
Muscles
Muscles are made up of small fibres which are laid out in an organised manner. The fibres can contract and shorten, allowing us to move. Muscular injuries are not uncommon and can happen almost any time when you are moving. Injuring a muscle either involves a tear or a bruise to the muscle belly. Pain in a muscle is not necessarily due to an injured muscle, pain can be referred from nearby joints or nerves, or can be a result of increased tension or decreased blood flow to a muscle. It is therefore important to seek professional help even for what might seem like a simple muscular pain.
A muscular tear is usually the result of a heavy load, very quick movements, or high repetitions. A tear will usually occur at a specific moment that you would be able to remember and will often feel similar to a grabbing or sharp pain.
Immediately post tear or bruise the muscle will begin the inflammatory process, which begins with bleeding. This is why you should begin the RICE (rest, ice, compression, elevation) process straight away. By limiting the amount of bleeding using the RICE process you can help to minimise the recovery time of your injury.
The next stage of your muscular injury requires your physiotherapists assessment to determine what your injury is, how serious the injury is and how to manage it. Standard management of a muscular injury involves a rest period followed by rehabilitation of the muscle including specific exercises and treatments designed to get your body moving better than before!
Some common muscles to injure include your calf, hamstring, quads, hip flexor, pectorals and biceps.
Nerves
Nerves are the electrical wires of the body, and can be injured or dysfunctional just the same as other body tissues. Nerve pain will often feel different to muscular pain, often feeling like a sharp, hot, shooting or burning pain.
Nerves can be painful in a variety of situations, which include continual pressure on them (usually through a restrictive tunnel), a blow to the nerve, being continually stretched or being suddenly forcibly stretched or the nerve itself can become swollen or tight. Nerve pain can be complicated due to referring symptoms. This means that where you feel the pain is not necessarily the area in which the problem is. This can happen with most injuries, however is more common with nerves.
Nerves can also be the source of problems with muscles. Nerves control all movements made by a muscle, which means if a nerve senses danger it will often contract a muscle slightly to protect it from over stretching. This is a common cause of ‘tightness’ or muscle spasm and is something your physio can help with.
Tendons
Tendons are vital parts of our body that connect muscle to bone. Tendons can be injured suddenly or over time. A sudden tendon injury will often be very painful and noticeable. A sudden tendon tear or rupture requires immediate assessment by a health care professional.
Tendon injuries that occur over time can be classified into two main groups, tendinitis and tendinosis.
Tendinitis is the inflammation of a tendon as a result of repeated heavy loads and many small micro tears. This irritates the tendon which then becomes painful.
Tendinosis is the degeneration of the individual fibres of the tendon as a result of overuse of the tendon. This degeneration causes fibres to be laid out incorrectly, making the tendon weak. The tendon then becomes irritated when it is placed under load meaning that it is constantly in a state of repair.
Tendinitis and Tendinosis are initially both managed in the same way, with rest and unloading of the tendon. Tendinitis has the ability to heal quicker and management from your physio will focus on reducing inflammation through massage, taping, and treating surrounding structures until the strengthening phase is reached. Tendinosis often takes longer to heal with the primary focus of your physiotherapist being to stimulate the correct healing of the tendon.
Early intervention is critical with both of these conditions meaning that the sooner you begin treatment with your physiotherapist, the quicker the recovery is likely to be. Don’t leave it until it is unbearable!
Ultrasound
There are two main types of diagnostic ultrasound; Musculoskeletal (muscles and bones) or Vascular/General (blood vessels, heart, pregnancy etc).
Physiotherapists are able to refer a patient directly to a radiology clinic for musculoskeletal diagnostic ultrasounds however a referral from a General Practitioner is required for a vascular/general ultrasound.
An Ultrasound doesn’t give off any harmful radiation and can be a very useful tool in diagnosing bursitis, muscle tears, tendonitis or inflammation/swelling within joints. Your City Physio physiotherapist can also refer you for corticosteroid injections under ultrasound guidance. Steroid injections may be a useful adjunct to treating common conditions such as bursitis in the rotator cuff in your shoulder, around your hip joint or around your patella/knee cap region.
Vertigo
Vertigo is a disorder of the inner ear and may also be called dizziness. It is caused by a dysfunction in one of the 2 parts of the inner ear which help us to keep our balance. Specially trained physiotherapists are able to help with these problems by using vestibular rehabilitation to retrain, reposition or reset a persons vestibular system. If you are experiencing symptoms similar to these it is advisable to visit your GP or physiotherapist to seek help, often times a solution can be found.
X-Ray
An X-Ray is a two-dimensional image most commonly used to diagnose bone injuries or analyse the anatomy of a joint. They are very useful for diagnosing fractures however not all fractures are always recognisable on an X-Ray, for example, new stress fractures can be undetected. When using X-Ray to detect the level of bone growth post fracture it is important to understand that X-Ray imaging can lag behind the actual level of bone growth.
Your physiotherapist can refer you for X-rays at a radiology clinic, should they feel they are warranted as part of accurately diagnosing your injury or pain.
X-Rays are also useful in detecting joint anatomy. Joint space narrowing is a common term used in radiology that simply means some of the cartilage on the ends of the bone has been worn away which makes the bones appear closer together, this is a common descriptor of osteoarthritis.
A bone spur is a piece of bone that has grown away on top of an existing bone which can cause pain by impinging on other moving parts of your body. Bone spurs commonly grow in areas that endure high stress such as your heel, shoulder, ankle and wrist. It is possible for bone spurs to exist in our body and not cause any pain, however, usually spurs are detected as a result of discomfort they cause you. In the situation that the bone spur is causing you too much pain an operation may be needed.
