Chevron Island Physio

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Lateral hip pain – when should you introduce cortisone injections?

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We see so many people in our clinic each day complaining of pain on the outside of their hips and down the outside of their leg.  They’ve been to the doctor, had a scan and have been diagnosed with Trochanteric Bursitis. Trochanteric bursitis is inflammation or swelling of the bursa (fluid-filled sac near a joint) at the outside (lateral) point of the hip known as the greater trochanter. When this bursa becomes irritated or inflamed, it causes pain in the hip. This is a common cause of hip pain.

It’s a problem that wakes you from your sleep, hurts when you walk too far and stops you doing the things you love to do with family and friends.  Often your doctor or friends will suggest that you need a cortisone injection into the Bursa to get rid of this problem but some of the recent evidence suggests this may not be the best approach.

New research from an internationally recognized hip expert has provided us with specific guidelines for how to achieve the best long term outcome for your hip pain and I’ve listed these below:

Firstly…

Avoid positions that place increased compression on the outside hip structures.  These include the following:

•        Sitting cross legged

•        Laying on the affected side

•        Standing while “hitching” on the affected side

•        Sitting in deep arm chairs or deep chairs where the knees end up higher than the hips.

Secondly…

Avoid getting a cortisone injection.  The most recent research indicates while the injection can help with pain relief in the short term, those patients who opted for a cortisone injection actually did worse over a 12 month period than patients who did nothing at all.

And Finally…

Follow through with a guided exercise program to strengthen the buttock muscles and the muscles around the hip and leg.  This will take a minimum of 6 weeks to take full effect and you will need to carry on with it for at least 12 weeks.   As the muscles around the hip get stronger, it takes pressure off the bursa and hip tendons and allows the area to settle.  If you keep them strong by following through with your program you will be able to get rid of this problem permanently.

Your physio is an expert at prescribing and progressing these exercises and we have specific equipment that is fantastic at targeting these muscle groups.  It is important to get the load and dosage of the exercise correct otherwise you can exacerbate the problem and end up in more pain than you started with.

 

If you would like more information about this revolutionary treatment approach, give the clinic a call and chat to one of our fabulous physio’s.

My hip just won’t go there!

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There’s no better way to ruin the mood then ‘’ow, no ouch my hip hurts in that position’’ . Hip pain (in particular labral injuries) can not only make it difficult & uncomfortable to get through the day, it can also put a dampener on your sex life.

 

Labral injuries are a common hip condition. The labrum is a cartilage structure that runs around the rim of your hip socket (acetabulum). It’s purpose is to make the hip socket deeper and more stable. The labrum can be torn with an acute injury or (more commonly) develop tears secondary to ongoing microtrauma. Often people will complain of a ‘catching’ or ‘clicking’ sensation in the hip joint as you move and it can be accompanied by groin, buttock or lateral hip pain.

 

When repetitive microtrauma is the cause of a labral tear, it will occur in the upper front part of the ring of cartilage. As your hip moves into a more flexed & outwardly rotated position, the ball of the hip can move up and forward, causing a ‘catch’ on the cartilage.

 

Click on the link below to watch a video showing normal hip movement.

 

https://www.youtube.com/watch?v=gQnMPHoDGEc

 

So hopefully it begins to make sense as to why certain position during sexual intercourse can become problematic. If we simplify things, any position that causes the hip to be moved into its outer ranges of joint mobility (think bent up & rotated outward) may be more uncomfortable.

 

This brought me to a quick google of sex positions…. Hopefully nobody checks my browsing history!

 

NOT SO GOOD

Kamasutra #163 Eagle

#209 Captain

#67 Missionary

 

GOOD

#39 Bizet

#131 Plain

# four point kneeling

 

On a serious note, if you are experiencing hip pain with any activity, it’s advisable that you first see a physiotherapist. They will be able to assess what is causing your hip pain and commence management strategies to rectify the problem.

 

In the meantime, to keep your sex life alive, get Googling and find some positions that allow you to maintain your hip in an inner range.

 

And I had to have a giggle, but one website article suggested… “Be creative, have patience with yourself, and remain open to new positions.’’

 

Gillian Burgess

Master of Physiotherapy (MPhty) APAM

Bachelor of Exercise Science (BExSc)

Staying Injury Free in the New Year

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HOW CAN I STAY
INJURY FREE?
BY HEEDING A FEW TRAINING DO’S AND DON’TS YOU CAN SIGNIFICANTLY REDUCE YOUR RISK OF SUSTAINING A WORKOUT-RELATED INJURY.

Many new participants to exercise are worried about the risk of injury. However, in real terms the benefits of exercise greatly outweigh any possible risk associated with maintaining an active and
healthy lifestyle. That being said, there are some common injuries that we do see among the exercising population and you will be happy to know that these injuries can often be prevented, simply by following these tips and training strategies.

Common Injury 1: Anterior knee pain
Some physiotherapy and sports medicine clinics spend nearly 50 per cent of their time treating people who suffer from pain in and around the front of their knee. The cause of this pain can be due to conditions such as patellofemoral pain syndrome, patella tendinopathy or iliotibial band friction
syndrome. Avoid anterior knee pain by:Increasing your level of activity gradually. Do not increase volume or intensity of exercise by more than 10 per cent each week.Avoiding excessive incline running. This increases rotational forces around the knee and puts greater strain on the joint. Keeping your knee in line with your second toe (the one next to the big toe) during most lunging and squatting activities. This helps
reduce pressure on the patellofemoral joint. Making sure you have good shoes. The 10-year-old pair of sneakers that you found in the cupboard will probably not provide adequate support during exercise.

Common Injury 2: Shoulder Pain
Many exercising individuals are at risk of shoulder pain when they start a new exercise program; and the risk of pain in this area more then doubles if you have had a shoulder injury in the past. Common problems that affect the shoulders of active people include rotator cuff tendinopathy, impingement syndromes, acromioclavicular joint strain and referred pain from the cervical spine.

Avoid shoulder pain by:
Including some specific strengthening exercises for the small rotator cuff muscles (your physiotherapist or personal trainer can show you some of these). Making sure you can always ‘see your hands’ when doing weight training exercises such as shoulder presses and pulldowns. Making sure you allow rest days for your shoulders (i.e., do NOT do a heavy chest workout on day one, return for a massive back and shoulders session on day two and then swim 5km on day three.) For those smaller shoulder stabilisers you need to allow suitable rest days to recover from intensive training sessions. Ensuring you have adequate body roll, if you are keen on swimming. Always get a swim coach to check your technique before increasing your distances too rapidly.

Common Injury 3:Low Back Pain
While it is true that some exercising people experience low back pain as a result of exercise, most medical research confirms that exercise is actually one of the best preventative measures you can take, to reduce the risk of lower back pain. However, the people who do end up with back pain may be suffering from conditions such as lumbar disc degeneration, facet joint strain, sacroiliac joint dysfunction or simple lumbar muscle strain and spasm.

Avoid lumbar spine pain by:
Ensuring the joints in your spine are stretched and moved through a full range of motion every day. This may involve simple ‘knee to chest’ stretches and ‘ back extensions’ on your tummy.Moving around as much as you can during work hours, and when you arrive at the gym take five to ten minutes every time, to rotate, flex and extend your spine prior to commencing your exercise routine. Getting your trainer or physiotherapist to show you a range of core stability exercises that will strengthen the muscles that control your lower back. This will also minimise your risk of injury.

Low back pain, shoulder pain and anterior knee pain are all common injuries that can
be avoided this summer.

IN SUMMARY
While many people are concerned about the risks involved in exercise, the truth is that typical fitness centre activities such as weight training, group fitness classes and cardiovascular equipment training have a much lower injury risk than the majority
of team and individual sports. In fact, it is thought that the removal of the‘competitive’ aspect is one of the major reasons for this.Take heed of the suggestions made above, make sure that you consult your local physiotherapist or sports physician about any pain or problem before it affects your training program, ask your personal
trainer to check your exercise technique regularly and, above all, get out there and enjoy being physical!

Interestingly, many low back injuries happen between exercises, rather than during the actual lift, so be extra careful when lifting dumbbells from the floor, or while twisting to place weighted plates on machines.

Do you have hypermobile joints?

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Being hypermobile does not mean that your muscles are flexible. It really means that your joints are hyperlax.

Why do some people have hypermobile joints? It is unclear. There are conditions like Ehlers-Danlos Syndrome (ED) that might include some joint hypermobility. Many people create their own particular hypermobilities by constantly using a range of motion without muscular support or holding their body in a particular postural position.  There is also a class of symptoms that together are labeled Joint Hypermobility Syndrome (JHS).

Physiotherapists can test for JHS it is a relatively simple test. Testing your resultant score will establish if you have hypermobility in one or more joints or Joint Hypermobility Syndrome.

Why bother? Well pain for one but also because of the influence a hyperlax joint/s can have when we move and exercise. Let me explain.

Ligaments support joints they are not like muscle. They do not have elasticity, they cannot respond in resistance to a load. They are like the seat belts in a car and our muscles are like the brakes. With appropriate use of the brakes your seat belt is not required. Think about that for a moment. To rephrase, if your muscles are working properly (correctly aligned) your ligaments are not put under undue stress.

Many of us do put our ligaments under undue stress by relying on them in our postures and daily movements, even when exercising. This inappropriate load applied to the ligaments causes them to stretch out – permanently.

As I mentioned at the outset, people with hypermobile joints often have very very tight muscles. To explain; you can bend forwards and put your hand flat on the floor, however your lumbar spine is overly curved (ie. Lumbar spine joints compensating for your tight hamstrings); or you can maintain a plank pose for 60 seconds but your arms are fully extended, elbows pointing to the left and right (i.e. elbow joints compensating for lazy bicep/tricep control).

Correct alignment is the key. Retraining or maintaining our muscles to protect our joints with correct alignment during movement and/or exercise is vital to the prevention of future injuries or pain.

Hypermobility and exercise noteworthy points:

  1. Exercise cannot increase the stiffness of a lax ligament.
  2. Move well first, then move more. Learn how to isolate and control joint movements.
  3. Concentrate during exercise. Eyes on your body parts (watch your feet, ankles, knees, hips, spine, shoulders, elbows, wrists and hands, even fingers)

Just because your are hypermobile or some of your joints are does it mean that you shouldn’t exercise? Of course not. You are just going to have to work a little harder with a little more mindfulness than your average Joe.

It’s your body, respect it and look after it. Give each joint the stability it needs for pain free movement.
Su Bauman, Physiotherapist

 

HEAT vs ICE

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Knowing whether to use heat or ice on an injury is a common query at Chevron Island Physio.

There are 2 types of injury:

  1. Acute injuries are sudden, sharp, traumatic injuries that occur immediately (or within hours) and cause pain (possibly severe pain). Most often acute injuries result from some sort of impact or trauma such as a fall, sprain, or collision and it’s pretty clear what caused the injury. Common signs and symptoms of acute injury include pain, tenderness, redness, skin that is warm to the touch, swelling and inflammation. If you have swelling, you have an acute injury.
  2. Chronic injuries, on the other hand, can be subtle and slow to develop. They sometimes come and go, and may cause dull pain or soreness. They are often the result of overuse, but sometimes develop when an acute injury is not properly treated and doesn’t heal.

Cold Therapy with Ice
Cold therapy with ice is the best immediate treatment (within 48 hours) for acute injuries because it reduces swelling and pain. Ice is a vaso-constrictor (it causes the blood vessels to narrow) and it limits internal bleeding at the injury site.
Cold therapy is also helpful in treating some overuse injuries or chronic pain in athletes. An athlete who has chronic knee pain that increases after running may want to ice the injured area after each run to reduce or prevent inflammation (not before!).

Heat Therapy
Heat is generally used for chronic injuries or injuries that have no inflammation or swelling. Heat helps to relax and loosen tissues, and to stimulate blood flow to the area. Sore, stiff, nagging muscle or joint pain is ideal for the use of heat therapy. Heat can also help relax tight muscles or muscle spasms. Do not apply heat after exercise. Because heat increases circulation and raises skin temperature, you should not apply heat to acute injuries or injuries that show signs of inflammation (use ice in these cases).

For How Long?
Apply ice treatments for no longer than 20 minutes at a time. Too much ice can do harm, even cause frostbite; more ice application does not mean more relief.
It is not necessary to apply a heat treatment for more than about 20 minutes at a time. Never apply heat while sleeping.

As each case is different, please consult your practitioner for advice.

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