A-Z of Injuries - Westport Physiotherapy & Acupuncture Clinic

Meniscus Tears

Torn meniscus is a common injury in sports, where the cartilage between the thigh and shin gets nipped or torn. It can cause knee locking or giving way and if does not recover in 6-8 weeks may require surgical intervention.

Signs & symptoms:

• Swollen knee joint
• Knee joint pain laterally or medially depending on the cartilage injury.
• Knee giving way

Physiotherapy treatment pre or post-surgery is to improve the pain free movement of the knee joint and address any alignment issues that may have contributed to the injury.

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ITB/Runners Knee

Iliotibial band syndrome is a painful overuse injury to the outer part of the knee. It is common in runners and cyclist.

Signs & symptoms:

• Knee pain located on the outer side of the knee
• Pain radiates up the thigh or down the outside of the shin
• Pain made worse by running or cycling

The aim of physiotherapy is to reduce the inflammation and to identify and address the underlying postural alignment issues leading to the increased friction.

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Knee osteoarthritis is a common cause of knee pain that usually begins in middle age. It is a progressive degeneration of the joint due to overuse or a previous injury.

Signs & symptoms:

• History of knee trauma or surgery
• Knee pain and swelling related to activity
• Knee stiffness

A knee replacement surgery may be required but physiotherapy involving strengthening of the muscles surrounding the knees, increase joint range of motion and reducing pain until such time as surgery is required.[...]

(LCL)

The lateral collateral ligament is located on the outside of the knee attaching the femur to the fibula. The injury occurs during sporting activity where the force to the knee joint causes over stretch of the lateral structures of the knee.

Signs & symptoms:

• A history of trauma or twisting
• Knee pain and swelling on outside of the knee
• Knee pain when bending or straightening the knee

The immediate treatment includes POLICE, Protect, optimal loading, ice, compression and elevation. Depending on the severity of the tear it can take up to 6 weeks to recover.

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(MCL)

Is the ligament situated on the inside of the knee joint, linking the thigh bone to the shin bone. The injury usually occurs with twisting or turning and direct impact during sporting activities.

Signs & symptoms:

• A history of trauma or twisting
• Knee pain and swelling on inside of the knee
• Knee pain when bending or straightening the knee

The immediate treatment includes POLICE, Protect, optimal loading, ice, compression and elevation. Depending on the severity of the tear it can take up to 6 weeks to recover. If there is a severe sprain or rupture an orthopaedic review may be required.[...]

Osgood schlatters is a common overuse injury to the knee in adolescents between 9-14 years, especially those who have recently experienced a ‘growth spurt’. It is more common in males than females. It is a form of traction apophysitis that occurs on the shin bone.

Signs & symptoms:

• Knee pain during and following activities
• Lump below the knee cap (enlarged tibial tuberosity)
• Pain on palpation of the tibia

Treatment involves relative rest from aggravating activities, advice on exercises to reduce the stress on the tibia.

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Jumper’s Knee

Anterior knee pain usually occurs as a result of increased activity, especially running and ballistic activities like jumping and hopping. It is commonly seen in active adolescents who are going through a growth spurt, but can affect people at any stage.

There is usually a biomechanical imbalance in the knee, with some muscles around the knee tight and others weakened.

Signs and symptoms:

• Pain, usually associated with activity, felt primarily at the front of the knee, below the patella (knee cap).
• Tenderness on the quadriceps tendon,below the patella (knee cap)
• Pain can also be felt with sitting or driving for long periods
• Tightness at the front and/or the side of the knee

A thorough physiotherapy assessment will help identify any biomechanical imbalance present. This will involve looking at the muscles in the hip and knee as well as an assessment of the foot. Manual therapy and exercises as well as orthotics, if required usually gives a good outcome to this problem

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(PCL)

The posterior cruciate ligament is in the centre of the knee joint and is less likely to get injured than the anterior cruciate. The injury usually happens with a blow to the front of the upper shin.

Signs & symptoms:

• Trauma to the front of the shin
• Vague unsteadiness or insecurity in the knee

Depending on the severity of the injury it can take 6-8 weeks to rehabilitate or may require surgical intervention.[...]

A transport disorder of the lymphatic system: Lymphoedema (swelling) occurs when lymph flow is impaired. Either damage, obstruction or absence of vessels can lead to dysfunction of the lymphatic system. This can result in the accumulation and stagnation of lymph in the tissues. Most often limbs are affected, but lymph oedema can also occur in the face, neck, abdomen or genitals. Tissues with lymphoedema are at risk of infection and susceptible to progression. Lymphoedema is a treatable and manageable condition.

Types of Lymphoedema and Causes:

1. Developmental (inherited) disturbance of the lymphatic system (primary lymphoedema)
2. Acquired damage of lymphatic vessels and/or lymph nodes (secondary lymphoedema)

1. Primary Lymphoedema occurs in women more often than men. In most cases it is found on one side and is pronounced more distal. If it occurs on both sides, there is normally and asymmetry. Primary lymphoedema can be further classified according to the type of occurrence (congenital: already manifest at birth – lymphoedema praecox: occurring before the age of 35 – lymphoedema tardum: occurring after the age of 35)
2. Secondary Lymphoedema can occur following surgical removal of lymph nodes or radiation therapy in the treatment of cancer. Secondary lymphoedema can also occur as a result of the following:

• Post-operative (e.g. after plastic or venous surgery).
• Post-traumatic (e.g. trauma which leads to injury of large lymph collectors such as open fractures, burns, wounds).
• Post-inflammatory (e.g. rheumatic diseases, sinusitis, recurrent phlebitis).
• Post-infection (e.g. recurrent cellulitis, inflammation of the lymph vessels, inflammation of lymph nodes).

Treatment involves decongestive therapy:

Manual Lymph Drainage – Patients receive Manual Lymph Drainage (MLD) to remove excess fluid and protein from the tissues. The MLD is performed to open lymphatics in the unaffected regions so these can help to drain the affected area. MLD stimulates lymphangions to increase their activity, which results in a decompression and emptying of obstructed lymphatic channels.

Exercise – Effective lymph flow depends on sufficient muscle and joint activity, especially if the functionality of the lymphatic system is compromised. Decongestive exercises are most effective if performed while the patient wears compression garments or bandages, which are also essential components in lymphedema management.

Skin Care and Hygiene – Good skin care plays an essential part in the treatment of lymphoedema. Daily skin cleansing with antibacterial washes and neutral balanced pH lotions will help to eliminate possible bacterial and fungal growth and so minimise the possibility of repeated attacks of cellulitis or lymphangitis.

Breathing – The lymph transport in the Thoracic Duct (Ductus Thoracicus) is mainly caused by the action of breathing. Taking into consideration that this duct transports 4 litres of lymph per day explains the importance of diaphragmatic breathing to help increase transport of lymphatic fluid.[...]

Slipped disc:

A disc prolapse in the neck is a common cause of neck pain.

Signs & symptoms:

• Severe neck pain, with
• Associated shoulder and arm pain.
• Weakness or loss of sensation in the arms or hands.

The common causes of neck pain are prolonged computer work, over-head activities and poor sitting posture. You can attend for physiotherapy treatment which will aim to relieve the pain and discomfort using advise on posture, manual techniques and home exercises.[...]

There are three types of nerves in the body:

• Autonomic nerves control the involuntary actions of the body, including heart rate, blood pressure, digestion, and temperature regulation.
• Motor nerves, passes information from your brain and spinal cord to the muscles, which control your movements and actions.
• Sensory Nerves relay the messages from the skin and muscles back to the brain and spinal cord. This information is processed by the brain to let you feel pain, hot & cold and other sensations.

Physiotherapy treats the motor and sensory nerves dysfunction. Injury to these motor nerves can cause weakness, muscle wasting, twitching and paralysis, whereas damage to the sensory nerves causes pain, sensitivity, numbness, tingling or burning and poor postural awareness. [...]

There are three types of nerves in the body:

• Autonomic nerves control the involuntary actions of the body, including heart rate, blood pressure, digestion, and temperature regulation.
• Motor nerves, passes information from your brain and spinal cord to the muscles, which control your movements and actions.
• Sensory Nerves relay the messages from the skin and muscles back to the brain and spinal cord. This information is processed by the brain to let you feel pain, hot & cold and other sensations.

Physiotherapy treats the motor and sensory nerves dysfunction. Injury to these motor nerves can cause weakness, muscle wasting, twitching and paralysis, whereas damage to the sensory nerves causes pain, sensitivity, numbness, tingling or burning and poor postural awareness. [...]

Osteoporosis is a systematic bone disease characterised by low bone mass, compromised bone strength and increased susceptibility to fractures, particularly around the wrist, hip and spine.

• Exercise can help to increase bone density in children especially pre-puberty/puberty, when bones are growing.
• Exercise during and after the menopause can improve muscle tone and decrease bone resorption.
• When it comes to exercise an individual does it depends on the individuals age, ability, DXA scan results (bone density scan), risk of fracture and medical history.

Bone is dynamic tissue, like muscle, that strengthens in response to forces it has to resist. Gravity is one such force, and working against gravity is what we refer to when speaking of "weight-bearing exercise." The combination of compression and tension from gravity and from our muscles plays a major role in bone strengthening.

Although swimming and cycling are great forms of cardiovascular exercise and strengthening, they are both non-weight bearing and therefore have no effect on improving bone density or reducing resorption of bone.

Your bones need additional loading to prevent osteoporosis as well as the general bone loss that naturally occurs with age. This loading comes from weighted & resistance exercises and high impact exercises like walking, running, jumping and dancing. For example walking up and down a stairs 10 times is a third of an adult’s daily weight bearing. You need to move in new ways and to "surprise" the bone, as some researchers are now saying. We need to move in differing directions and at different speeds to encourage the bone to continue to strengthen.

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A shoulder dislocation is an injury where the head of the humerus (arm bone) pops out of its socket, this injury occurs most commonly in contact sports like Gaelic football and rugby.

Signs and symptoms:

• Severe shoulder pain
• The shoulder is obviously out of place.
• Holding the arm protectively against the chest

It is important that it be seen quickly by a qualified medical professional to manipulate the arm back into the socket, so as to reduce the risk of damage to the nerves and blood vessels surrounding the joint.

Physiotherapy is usually started after 2-3 weeks of immobilisation in a sling. The aim of treatment is to; restore stability and strength in the rotator cuff muscles around the shoulder and improve movement.

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This break can occur by falling onto an outstretched arm or landing on the shoulder. The treatment of this injury is dependent on the degree of displacement of the fracture. If the two ends of the bone are in good alignment then conservative management of rest in a sling may be sufficient to allow the fracture to heal. If the alignment is not good surgical intervention may be required.

Signs and symptoms:

• Severe pain
• Bruising may be visible
• Deformity in collar bone, may see the bone pushing against the shin.

Adhesive Capsulitis

Frozen shoulder is a common cause of shoulder pain in people between 40-60 years of age, with women being affected more than men.

Common signs and symptoms:

• Shoulder pain comes on slowly and leads to a gradual loss in shoulder movement, called the freezing phase.
• The frozen phase can last up to a year, with restricted shoulder range of motion
• The last phase is the thawing phase, where there is a gradual increase in range of motion.

Physiotherapy for frozen shoulders aim is to gently stretch the shoulder joint capsule, using passive mobilisations and giving the client home exercise to try and maintain a functional range of motion.[...]

The rotator cuff muscles and tendons main function is to hold the shoulder joint in place. The main ways to injury these tendons are through trauma or repetitive strain injuries. Injury to the rotator cuff will usually begin as inflammation; if the cause is not identified and addressed it can lead to a partial or complete tear of the tendon or muscle. The four rotator cuff muscles are the Supraspinatus/infraspinatus/teres minor/subscapularis.

Signs & symptoms:

• Pain and tenderness when reaching
• Pain putting on jackets
• Closing bras
• Sleeping on the affected side or even when lying on the opposite side
• Shoulder weakness and pain especially with hand overhead or behind back.

Treatment aims to improve strength and pain free range of motion. Due to the nature of the tendon, it can take 100 days for it to regenerate; therefore a rehabilitation programme can take up to 3-4 months to resolve the issue.[...]

This can occur due to the subacromial bursa being squashed or impinged between the rotator cuff muscles and the bone, usually during repeated overhead movement.

Signs & Symptoms:

• Pain or catching sensation on raising the arm up
• Limited shoulder movements
• Pain on touching or lying on the shoulder

Physiotherapy aims to reduce the pressure on the impingement by improving postural alignment, relative rest and a gradual home exercise programme to improve function.[...]

AC Joint Sprains

The acromioclavicular joint is where the collar bone attaches to the edge of the shoulder (acromion). The causes of this joint separation is either a fall onto an out stretched hand or direct contact to the tip of the shoulder. It happens frequently in rugby and falls when skiing. The trauma causes injury to the AC ligament.

The signs and symptoms are:

• Pain on the tip of the shoulder
• Restricted shoulder movement
• Shoulder stiffness
• Difficulty lying on the shoulder

The aim of physiotherapy is to promote healing, may use laser or ultrasound to do this, may also use mobilisations and soft tissue techniques to reduce tension in the area.[...]