Common Conditions and Your Self-Care
Bursitis
Bursitis is inflammation of a bursa. A bursa is a small, flat sac lined with synovium. A bursa reduces friction, usually between tendons and bones.
Your Self-Care
Rest, ice and comfortably elevate the affected limb as much as possible.
Pain-free light contractions and exercises are begun as soon as you can tolerate them.
Rest from aggravating activities. Return to activity is gradual. If a flare-up of acute symptoms is experienced, ice is reapplied after activity.
Self-massage can be performed to the muscles surrounding the bursa. Stretching is encouraged.
The long-term goal is to restore painless, full range of motion and strength.
Gradually progress to more complex exercises.
Altered biomechanics should be corrected.
Get a referral for orthotics if needed.
Ask your physician or a therapist for specific exercises.
Carpel Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a condition that results from the compression of the median nerve as it passes through the carpal tunnel at the wrist. This results in numbness and tingling in the median distribution – that is, the lateral three and one-half digits.
Your Self-Care
Learn about appropriate posture when performing activities that aggravate the condition.
While at the computer, ideally, the wrists are held in a neutral position with the forearm parallel to the floor. The elbow is supported by arm rests that are at a level that allows the shoulders to be supported in a non-elevated position.
If you are using a computer mouse, it should be placed so the wrist, forearm and shoulder are positioned as above. The work space is organized so the keyboard and mouse are directly in front of the chair and not to one side.
Ice is applied to the wrist and forearm frequently during activity. Contrast arm baths (cold-heat-cold) are excellent for flushing out the build up of metabolic waste in the arm and hand.
Frequent stretching of the forearm flexors maintains range of motion of the writs.
Self-massage is recommended for the forearms and for the palms. If tissue health is compromised, vitamin E oil can be used.
Strengthening exercises are introduced gradually but are performed daily once range of motion of the wrist improves.
Stress reduction strategies, such as diaphragmatic breathing and meditation, or activities such as Yoga or Tai Chi, are recommended.
Acupuncture, chiropratic and osteopathic treatments may help you.
You may want to see a physician for a splint. These are only meant to be used temporarily, for about four to six weeks unless otherwise indicated by the physician. The physician may prescribe you physiotherapy.
You may want to see a naturopath or nutritionist for information about supplements, especially vitamin B6.
* The outcome is dependent on the cause of the carpal tunnel syndrome. Systemic conditions will require additional medical care. If this is successful, the CTS will often resolve.
* If CTS is caused by overuse or repetitive action, the prognosis can be good if you are committed to regular treatments and to following the self-care program. In some cases, this may require a prolonged leave from a particular job or, perhaps, shorter hours at a certain task.
* Surgical treatment has varying results, with a 50 to 65 per cent rate of complete success.
Contusion
A contusion is a crush injury to a muscle. It damages the tissue cells and capillaries. It is the result of a blunt force such as a kick, fall or blow. Blood from the broken vessels accumulates in surrounding tissues causing discoloration of the skin and resulting in pain, swelling and tenderness.
Your Self-Care
In the acute stage (just after the incident), apply ice for no longer than 20 minutes. After a few days (subacute stage), start doing contrast applications (alternating cold-heat-cold applications).
After a few days, start self-massage of the affected muscle or muscles.
Do pain-free gentle stretches of the affected limb.
Pain-free range of motion of the surrounding joints can be done. As soon as possible, begin to increase the range to the onset of pain only. Do not push pass the pain.
Start with light isometric contractions (no movement of the joint) of the muscle. When no more pain is present, gradually progress to more complex exercises requiring movement of the joint. Gradually increase in duration and repetition. Ask your physician or a therapist for specific exercises.
With a severe contusion, only when the symptoms of inflammation and pain have ceased can you resume stretching and activity gradually.
Return to the activity that caused the injury once completely recovered and performed without a significant increase in pain.
Cruciate Ligament and Meniscal Injuries
The knee is a frequently injured joint. In addition to the more superficial medial and lateral collateral ligaments, the deeper anterior and posterior cruciate ligaments present clinical concerns, as do the two menisci.
Your Self-Care
For the first few days following injury while the joint is still swollen, you should rest, elevate and ice the knee.
As the swelling diminishes, the remedial exercise program can begin.
Start by obtaining full pain-free range of motion.
Once sufficient healing has occurred and your physician has approved the plan, strengthening of the quadriceps muscles can begin. Ask a therapist or your physician for examples of exercises.
If surgery was required, follow your physicians’ recommendations and the rehabilitation plan accurately.
* Recovery from a Grade 3 cruciate injury takes up to 4 months without surgery, 6 months with surgery (a specific rehabilitation plan needs to be followed for proper recovery).
* Recovery from a minor meniscal tear takes 3 to 4 weeks, while a major tear requires 8 to 12 weeks. If you return to the activity that caused the injury too quickly, there may be recurrent pain and effusion. If the injury was severe enough and surgical repair was not elected, your knee may be prone to weakness, hypermobility, buckling or locking.
Degenerative Disc Disease
Degenerative disc disease is degeneration of the annular fibres of the intervertebral disc.
Stages :
Protrusion
Prolapse
Extrusion
Sequestration (hernia)
Your Self-Care for Degenerative Disc Disease
Heat and self-massage is used on shortened tissues.
Diaphragmatic breathing is encouraged for pain management.
Pain-free range of motion is maintained.
Stretching of specific shortened muscles is followed by strengthening of weaker muscles.
Spine extension exercices are important. Lie prone on a kitchen or dining room table so the pelvis and legs hang over the end of the table.
Avoid a slumped sitting posture since it exacerbates and perpetuates low back pain.
Postural re-education may be helpful for retraining your posture.
Your Self-Care for Acute Herniation
Massage is recommended in acute disc injuries to relieve pain and to promote relaxation.
Hydrotherapy treatment is ice to reduce spasm and pain.
Passive positioning and the location of the pillows is crucial to the acute treatment. Assume a position that reduces the symptoms and is most comfortable.
Gentle long-axis traction should reduce symptoms.
Massage is performed to reduce edema, spasm and pain in muscles that cross the affected area. As the condition resolves into subacute and chronic stages, the treatment can become more vigorous.
Find a pain-reduced position, whether standing, sitting or lying.
Hydrotherapy application is cold to reduce pain and spasm.
Gentle pain-free strengthening exercises are introduced. As the condition progresses to the subacute and chronic stages, strengthening exercises that maintain the lordosis are used and strengthening of all muscles that cross the affected level.
Range of motion is gradually increased.
Correct lifting procedures and correct posture during activities of daily living are taught.
* The prognosis for cervical degenerative disc disease is between if the symptoms are of recent and sudden onset a gradual onset with muscle weakness and atrophy has a poorer prognosis. There may be a few weeks of symptoms, then an asymptomatic period, followed by occasional bouts brought on by overuse or poor posture. In the lumbar spine a similar pattern occurs.
* The prognosis for acute disc herniation symptoms in the cervical spine is good. The most severe symptoms may diminish in a dew days, with full healing taking up to six months. In the lumbar spine, acute disc herniation can take up to eight weeks to heal in most cases. Asymptomatic periods may be interspersed with acute episodes of disc bulging that occur for no apparent reason in either the cervical or lumbar spine.
Frozen Shoulder
Frozen shoulder is painful, significant restriction of active and passive range of motion at the shoulder, most frequently in abduction and external rotation. With frozen shoulder, the joint capsule becomes tightened and inflexible.
A frozen shoulder progresses through three stages. In the acute stage, the joint capsule becomes painfully contracted, with a loss of the axillary recess. In the subacute stage, capsular fibrosis occurs. In the chronic stage, the range gradually returns.
Your Self-Care
Acute Stage
You should sleep in a sidelying position with the involved arm uppermost.
Avoid hyperkyphotic (round back) and head-forward postures.
Self-massage to the affected muscles is indicated.
Applications of cold to the affected shoulder and heat to compensating structures are recommended.
Exercises are limited to passive pendulum exercise in pain-free ranges.
Grasp a towel with both hands shoulder width apart, elbows extended and pull your affected arm in full range of motion, using your unaffected arm, to maintain range of motion.
Perform light exercises for the muscles of the shoulder.
See a physiotherapist for transcutaneous electrical nerve stimulation treatment or for acupuncture to relieve the pain.
Subacute Stage
Sleeping, driving and posture considerations mentioned in the acute stage are a concern here.
Apply heat to the affected shoulder.
When not experiencing acute pain, do pendulum movements. Use a small weight to further distract the joint.
Stretching of the shoulder muscles.
Wall-walking exercises have you standing beside a wall and “walking” the fingers upward to increase range. Start by facing the wall (flexion), then progress to sideways to the wall (abduction).
Exercises for the muscles of the shoulder.
Chronic Stage
You can continue the self-care suggestions as above, gradually progressing the ranges and strength. Pool exercises may also be helpful.
Ask your physician or a therapist for specific exercises.
Illiotibial (ITB) Band Contracture
Iliotibial band contracture is a contracture or thickening of the iliotibial band.
Iliotibial band friction syndrome is inflammation and pain where the iliotibial band crosses the lateral femoral condyle of the knee.
Your Self-Care
Deep moist heat and contrast (cold-hot-cold) applications to the thigh are used. Local ice or cold will reduce the inflammation and pain of an iliotibial band friction syndrome.
Self-massage can be done on the iliotibial band and tensor fascia lata muscle.
Stretches to the tensor fascia lata and gluteus maximus are recommended.
If an anterior pelvic tilt is present, refer to your physician or a therapist for specific remedial exercises.
Try to avoid or minimize activities that shorten the iliotibial band and tensor fascia lata.
Sleep on the unaffected side with a pillow under the affected knee to help reduce the compression of the tight iliotibial band.
* Outcome of treatment depends on the length of time the contracture has existed and the perpetuating factors. However, if long-term postural imbalances are contributing to the condition, the progress will depend on correcting these imbalances and your ongoing compliance.
Inflammatory Arthritides
Inflammatory arthritides are a group of inflammatory diseases affecting connective tissue including the joints.
Your Self-Care
Ankylosing Spondylitis
Exercises to maintain mobility and strength of the hips, entire spine and shoulders.
Posterior pelvic tilt exercises and strengthening for the back extensors and scapular retractors are also useful. Swimming is an excellent exercise that does not stress the affected joints.
Diaphragmatic breathing exercises are important.
Several 15-minute rest periods during the day are recommended, where you can lie on your stomach with the arms above the head to prevent hyperkyphosis. A pillow can be placed under the thorax and a towel roll under the forehead.
Sleeping on a firm mattress with no pillow and sleeping on your back instead of curled up in sidelying to prevent flexion deformities are also suggested.
Rheumatoid Arthritis and Other Inflammatory Arthritides
Exercise to your pain tolerance. Between flare-ups, self-stretching is used to prevent contractures. Pain during activity is a warning to reduce activity levels.
Stress reduction exercises and diaphragmatic breathing are important.
Self-massage between flare-ups is also useful as a pain management tool for all arthritides.
Splints to protect joints, orthotics and devices to help with activities fo daily living may be helpful.
During flare-ups, cool hydrotherapy applications may relieve pain. Between flare-ups, heat is used on affected joints.
Keeping the extremities warm is important.
Migraine
Migraine headache is a paroxysmal neurological disorder with many signs and symptoms.
Primary headaches: those in which the headache is the condition.
Secondary headaches: a result of an underlying pathology, such as hypertension or head trauma.
Your Self-Care
Self-massage of the neck, face and scalp can abort migraine in progress; it is also useful between attacks.
Hot applications or full-immersion baths before a migraine.
Ice packs are applied to the arteries of the scalp and neck during a migraine to reduce the pain.
Aerobic exercise between attacks may help to decrease the frequency of migraines.
Stretching the neck and shoulder muscles is indicated.
Behavioural modifications such as regulating sleep, taking regular meals and exercise, avoiding food-related triggers and managing stress may help decrease the symptoms.
See your physician if the headache worsens.
Osteoarthritis
Osteoarthritis (OA) is a group of chronic, degenerative conditions that affect joints, specifically the articular cartilage and subchondral bone.
The term “spondylitis” is used for arthritis affecting the vertebral column. OA is the most common form of arthritis, or inflammation of a joint.
Primary OA is idiopathic and either local (involving one or two joint groups) or generalized (involving three or more joint groups).
Secondary OA is the result of a known cause, such as joint trauma or an underlying pathology.
Your Self-Care
Deep moist heat for chronic presentations or cold for acute episodes is indicated.
Self-massage to the muscles surrounding the affected joint can help to control pain.
Find relaxation techniques that work for you, such as diaphragmatic breathing.
Rest from activities which aggravate the joint.
Gentle pain-free stretching and pain-free range of motion are important, as are gravity-reduced activities such as swimming.
Rest when the joint feels irritated. Maintain cardiovascular activities (permission from your physician may be required for these exercises). Avoid working in ranges of motion that aggravate the joint when exercising. There should be no pain during or after exercise.
Loads are carried on the affected side. If a cane is used, it is used on the opposite side to the affected limb.
Complementary therapies and supplements is gaining acceptance for managing symptoms.
Overuse Injuries
Any repeated activity, occupational or recreational, can lead to an overuse injury. This type of injury occurs when repetitive microtrauma overloads a tissue’s ability to repair itself.
Your Self-Care
This may be the most challenging aspect of your recovery process.
An initial period of rest from the aggravating activity is necessary to avoid stress on the affected tissue and to allow healing to take place.
Apply ice after any activity that causes inflammation and/or pain.
Once constant pain is no longer experienced, a controlled stress is introduced to the tissue, such as pain-free stretching.
Strengthening activities of affected muscles are gradually progressed from simple to more complex. Eventually, the tissue becomes more tolerant of the loads placed upon it.
Education is essential to correct poor biomechanics and improper techniques such as poor warm-up or cool-down.
Ask your physician or a therapist for specific exercises.
Periostitis and Compartment Syndromes
Periostitis is inflammation of the periosteum. This inflammation develops at the insertion of the leg muscles on the tibia. It usually occurs in muscles that attach posteromedially to the tibia, periostitis may also affect muscles that attach anteriorly. If left untreated, periostitis can progress to a stress fracture.
A compartment syndrome is the result of an increase in pressure within the compartments of the lower leg. There are four compartments surrounding the tibia and fibula, which are divided by dense, inelastic fascia.
Periostitis and compartment syndromes produce pain in the lower leg. These two conditions, as well as tibialis posterior tendinitis and tibial stress fractures are sometimes grouped under the lay term “shin splints”, a non-specific phrase that describes pain along the medial border of the tibia with exercise.
Your Self-Care
Rest from activities and ice applications 3 to 4 times per day are used to control the inflammation.
Self-massage and stretching are used for the entire limb (the leg).
Strengthening of the affected muscles occurs only after pain is under control.
Return to activities is gradual and pain-free. Pre-activity heat to the posterior compartment muscles is indicated.
Get referred for orthotics if needed.
Ask your physician or a therapist for specific exercises.
Piriformis Syndrome
Piriformis syndrome is the compression of the sciatic nerve by the piriformis muscle.
Your Self-Care
Remedial exercise is an essential component to treating piriformis syndrome.
Perform a self-stretch for the piriformis muscle. There are different ways of stretching the piriformis. Use one that is most comfortable for you.
Use a tennis ball on gluteal and piriformis trigger points. While lying on the floor or standing against a wall, the ball is placed over the trigger point and you lean into it. You will experience tolerable discomfort. A referral pattern appropriate to the specific trigger point will likely occur. This position is held until the discomfort resolves.
Strengthening of the weak muscles.
Sitting positions are modified. Avoid sitting on the foot and rolling the knees out to the side but instead keep the knees and feet in midline.
Sleeping positions are modified. A pillow is placed between the knees when you sleep sidelying to avoid excessive adduction of the hip.
Frequent breaks, during any aggravating activity, are taken with stretching or a brief walk performed every hour. Same is applied when driving long distances.
Chiropratic adjustments may be necessary if there is sacroiliac joint dysfunction. Orthotics may also be required if « flat footed » is present.
Diaphragmatic breathing and meditation, or activities such as Yoga or Tai Chi, are recommended.
* If pregnancy is the cause, the condition will often resolve postpartum. Only temporary relief is possible if a systemic pathology is present.
* if the cause involves soft tissue, the prognosis is good, providing you are compliant with the self-care program.
Plantar Fasciitis
Plantar Fasciitis is an overuse condition resulting in inflammation of the plantar fascia. It is the most common cause of foot pain in athletes.
Your Self-Care
Rest (no weight bearing if the plantar fasciitis is severe).
Ice and elevate the affected foot as much as possible.
Ice is applied 3 to 4 times per day to control the inflammation and after activities that cause pain.
Heat is applied to the posterior leg compartment before activity.
Self-massage is performed to the posterior compartment and plantar fascia.
Stretching is encouraged.
The muscles of the feet are strengthened by scrunching up a towel or picking up pencils with the toes.
Get referred for shoes with adequate support and flexibility and for orthotics or heel cups if needed.
Return to activity is gradual, beginning with non-weight-bearing activities such as swimming or bicycling.
Ask your physician or a therapist for specific exercises.
Scoliosis
Scoliosis is a lateral rotatory deviation of the spine.
Functional or postural curves may be voluntarily altered or reversed by positional changes or muscular action. They can be corrected with passive soft tissue stretching, joint mobilization and strengthening exercises.
Structural curves are fixed, due to bony changes, and cannot be corrected by positional changes or voluntary effort. They usually have a childhood onset and correction requires bracing or surgery.
The severity of a scoliosis is measured in degrees. It may also be described as mild (up to 20 degrees), moderate (20 to 50 degrees) or severe (greater than 50 degrees). Mild scoliosis of less than 10 degrees is considered within normal limits.
Your Self-Care
Avoid postures that encourage the scoliosis.
Self-stretching of the shortened muscles is important.
Strengthening for the weaker convex muscles, such as in the lumbar spine.
* The outcome for a functional scoliosis is favourable when you are compliant with a remedial exercise program. Correcting a leg length inequality with shoe support is also important.
Spasm
A spasm is an involuntary, sustained contraction of a muscle. A cramp is a common or lay term for a painful, prolonged muscle spasm.
Your Self-Care
Apply deep moist heat or contrast applications (alternating cold-heat-cold applications).
After the spasm decreased, pain-free range of motion of the affected joint can be done slowly.
A slow complete stretch of the muscle. The stretch should be healed for up to 30 seconds without bouncing.
To reduce nocturnal calf cramps, contraction of the opposing muscle is important when the cramp is experienced and are most effective when followed by a slow stretch.
Sprain
A sprain is an overstretch injury to a ligament, causing a complete or partial tear of the ligament. Ligaments add stability to the connective tissue joint capsule. The cause of a sprain is a trauma-related sudden twist or wrench of the joint beyond its normal range of motion.
Grade 1, Mild or First Degree Sprain: This is a minor stretch and tear to the ligament. There is no instability on passive relaxed testing. The person can continue with the activity with some discomfort. Wait 4 to 5 days before returning to activities.
Grade 2, Moderate or Second Degree Sprain: Tearing of the ligament fibres occurs. The degree of tear is quite variable, from several fibres to the majority of the fibres. There is a snapping sound at the time of injury and the joint gives way. The person has difficulty continuing the activity due to pain. Wait 7 to 14 days before returning to activities.
Grade 3, Severe or Third Degree Sprain: This is either a complete rupture of the ligament itself, or an avulsion fracture as the bony attachment of the ligament is torn off while the ligament remains intact. There is a snapping sound and the joint gives way. The person cannot continue the activity due to pain and instability. Immobilization is generally removed at 6 to 8 weeks. Return to activity follows this and may be delayed for up to several weeks due to disuse atrophy.
* Total healing of a sprained ligament may take up to 6 months for full maturation of the collagen fibres.
Your Self-Care
Grade 1 and 2
For the first 48 hours, apply ice for no longer then 20 minutes, as often as you can. After 48 hours, start contrast applications (ice – heat – ice). Repeat as many times as you wish, but finish with application of ice.
Self-massage of the surrounding muscles and the affected joint. Only light massage is necessary at the early stage on the affected joint. Gradually increase pressure with time.
Once symptoms and pain have decreased, start doing some slow and controlled range of motion of the affected joint and the surrounding joints.
Gradually start some strengthening exercises of the surrounding muscles. Initially, just an isolated contraction against an unmovable object is sufficient. Increase the duration of contraction and the number of repetitions, as it becomes easier. Exercises must be pain-free. Ask a therapist or your physician for examples of exercises.
Weight or body-weight baring exercises, and stretches can then be introduced. The exercises have to be pain-free. It is important to strengthen the surrounding joints and muscles, and the affected joint before returning to activities in order to avoid reinjury. You need to re-educate proprioception at the joint as soon as possible. Ask a therapist or your physician for examples of exercises.
Once the symptoms and pain have ceased, you are encouraged to return to the activities that caused the injury on a gradual basis to avoid reinjury.
Grade 3
Surgery might be required since it is a complete tear of the ligament.
Follow your physicians’ recommendations for proper rehabilitation.
You might need to use tape, a brace or other supports to protect a Grade 2 or 3 strain on activity, especially in a weight bearing limb.
Strain
A strain is an overstretch injury, causing a complete or partial tear, to a musculotendinous unit. A musculotendinous unit is the muscle, its tendons, their osseous attachments and the musculotendinous junction.
Grade 1, Mild or First Degree Strain: This is a minor stretch and tear to the musculotendinous unit. There is minimal loss of strength. You can return to the activity with support such as an elastic bandage, preferably after 2 days.
Grade 2, Moderate or Second Degree Strain: Tearing of the musculotendinous fibres occurs. The degree of tear is quite variable, from several fibres to the majority of the fibres. There may be a snapping sensation or sound at the time of injury. A palpable gap may appear at the injury site. The person has difficulty continuing the activity due to pain and muscle weakness. You can resume activity several days to several weeks after injury.
Grade 3, Severe or Third Degree Strain: This is a complete rupture of the musculotendinous unit or an avulsion fracture as the bony attachment of the tendon is torn off while the unit remains intact. There is a snapping sensation or sound at the time of rupture. A palpable and often visible gap appears at the injury site. Often, the muscle shortens and bunches up. The person cannot continue the activity due to significant pain and muscle weakness. Immobilization is generally removed at 4 to 8 weeks. Return to activity follows this and may be delayed for up to several weeks due to disuse atrophy.
Your Self-Care
Grade 1 and 2
For the first 48 hours, apply ice for no longer then 20 minutes, as often as you can. After 48 hours, start contrast applications (ice – heat – ice). Repeat as many times as you wish, but finish with application of ice.
Self-massage of the surrounding muscles and the affected muscle. Only light massage is necessary at the early stage on the affected muscle. Gradually increase pressure with time.
Once symptoms and pain have decreased, start doing some slow and controlled range of motion of the affected joint and the surrounding joints.
Gradually start some strengthening exercises. Initially, just an isolated contraction against an unmovable object is sufficient. Increase the duration of contraction and the number of repetitions, as it becomes easier. Exercises must be pain-free. Ask a therapist or your physician for examples of exercises.
Weight or body-weight baring exercises, and stretches can then be introduced. The exercises have to be pain-free. It is important to strengthen the joint, the surrounding muscles and the affected muscle before returning to activities in order to avoid reinjury. Ask a therapist or your physician for examples of exercises.
Once the symptoms and pain have ceased, you are encouraged to return to the activities that caused the injury on a gradual basis to avoid reinjury.
Grade 3
Surgery might be required since it is a complete tear of the muscle.
Follow your physicians’ recommendations for proper rehabilitation.
You might need to use tape, a brace or other supports to protect a Grade 2 or 3 strain on activity, especially in a weight bearing limb.
Temporomandibular Joint Dysfunction (TMJ)
Temporomandibular joint (TMJ) dysfunction is a disorder of the muscles of mastication, the temporomandibular joints and associated structures.
Your Self-Care
Self-massage, both extra- and intra-oral, to the affected muscles, is very effective. Muscle stripping and gentle ischemic compressions are indicated.
Hydrotherapy is applied as appropriate. Heat is used to reduce hypertonicity and cold is applied with inflammation.
Self-stretching of the affected muscles.
Self-distraction of the mandibule (lower jaw) is indicated.
Any postural imbalances, such as hyperkyphosis or head-forward posture, should be corrected.
Relaxation exercises are important, such as diaphragmatic breathing.
Avoid activities that stress the TMJ.
During dental procedures, the client should take breaks to pen and close the mouth.
If the jaw deviates to one side when opening, you can look in a mirror while opening and closing the jaw, and practice moving the jaw t the opposite side.
Understand and practice the resting position of the mandible to reduce muscular strain. The client’s lips are closed and the teeth are slightly apart. The tongue rests on the hard palate just behind the front incisors and you breathe through your nose, not the mouth.
Strengthening exercises are used for specific muscles.
* The prognosis is good if you have had the condition for a short period of time. Client education is essential, because often you aggravate the condition by clenching the jaw in response to stress.
Tendinitis
Tendinitis is inflammation of a tendon.
Grade 1 tendinitis has pain after activity only.
Grade 2 tendinitis has pain at the beginning of activity which disappears during activity the returns after activity.
Grade 3 tendinitis has pain at the beginning of activity, ruing activity and after activity. Pain may restrict activity.
Grade 4 tendinitis has pain with activities of daily living. Pain continues to get worse.
Your Self-Care
Relative rest from the activity that causes the tendinitis is important to allow the tissues to heal. Relative rest is continued until the pain and inflammation decrease. This may be difficult to achieve with occupational or sports-related injuries.
Ice is applied immediately after activity. Ice is applied for 5 to 20 minutes at a time.
Slow, pain-free stretch of the affected muscle and its antagonists (opposing) is indicated to regain flexibility.
A progressive strengthening program is started when local tenderness on palpation is absent, when there is no pain on activity and when a full, pain-free stretch is obtained.
Self-massage may be used on the antagonists and on the affected muscle.
The stretching is continued from the acute stage to maintain flexibility.
Contrast applications (cold-hot-cold) are used to increase tissue health. If a flare-up of acute symptoms is experienced, ice is reapplied after activity.
Strengthening exercises increase in complexity, intensity and speed with time. The exercises should be pain free for several days in a row. Ice is applied after exercise.
The long-term goal is to reach a symptom-free stage, where you are able to perform functional exercise without pain. If you do not rest for long enough, if you return to activity too quickly, without gradually strengthening the muscles, you will lead yourself to reinjury and, for athletes, a chronic, difficult and often career-limiting disorder.
You should modify sport of occupational activities, either by changing the activity if possible or by reducing the repetitions or speed.
It may be necessary to change or modify equipment.
A routine exercise program, including stretching, should be maintained.
Ask your physician or a therapist for specific exercises.
* The outcome depends on how long the tendinitis has been present before treatment begins. Longer standing tendinitis may require treatment for up to 6 months.
Tension Headache
Tension headache is a muscle-contraction-type headache. Tension headaches are headaches with muscular origins and are associated with trigger points and other myofascial pain syndromes.
Primary headaches: those in which the headache is the condition.
Secondary headaches: a result of an underlying pathology, such as hypertension or head trauma.
Your Self-Care
Rest from activity following the treatment of trigger points.
A hot bath or other hot hydrotherapy application is indicated for the affected muscles after trigger point therapy.
Diaphragmatic breathing is recommended to reduce stress levels and pain.
Self-massage and stretch is recommended.
Strengthening exercises for any weak muscles. Ask your physician or a therapist for specific exercises.
Perpetuating factors should be reduced or eliminated.
Any postural imbalances should be corrected.
Sleeping in prone position is avoided.
Thoracic Outlet Syndrome
Thoracic outlet syndrome (TOS) is a condition that involves the compression of the brachial plexus and its accompanying artery between the anterior and middle scalene muscles (anterior scalene syndrome) or between the coracoid process and the pectoralis minor muscle (pectoralis minor syndrome) or between the clavicle and the first rib (costoclavicular syndrome).
Your Self-Care
Remedial exercise is an essential component of treating TOS. Some improvement should be noted after three months. The programs should continue for up to 18 months even when you are symptom-free.
A hot shower spray on the neck muscles is recommended to allow easier stretching.
Stretch or the sternocleidomastoid, anterior and middle scalenes, and pectoralis muscles are performed everyday.
Aggravating activities are limited and frequent breaks during activities are encouraged.
Padding is added to straps of a backpack.
The sleep position is modified. For anterior scalene syndrome, it is suggested to elevate the upper end of the bed by 3 to 3.5 inches to keep the chest from riding up and causing compression and to provide gentle traction on the scalenes.
The pillow should keep the head in a neutral position, avoiding excessive flexion and head-donward positioning, as this further encourages shortening of the scalenes.
Applications of deep moist heat over the scalenes and pectoralis minor for 10 to 15 minutes before bed can be helpful.
Drooping shoulders require strengthening of the upper trapezius and levator scapulae.
Rhomboids are strengthened performing bent-over rowing using handweights or using a rowing machine.
* Your compliance with therapy for up to six months, including massage, exercises and activity modification, will relieve symptoms of TOS in the majority of people.
Whiplash
A whiplash is an acceleration-deceleration injury to the head and neck.
Types
Grade 1 or Minimal: There is no limitation of motion; no ligamentous injury; no neurological findings.
Grade 2 or Slight: There is limitation of motion; no ligamentous injury; no neurological findings.
Grade 3 or Moderate: There is limitation of motion; some ligamentous injury; neurological findings may be present.
Grade 4 or Moderate to Severe: There is limitation of motion; ligamentous instability; neurological findings are present; fracture or disc derangement is present.
Grade 5 or Severe: The injury requires surgical management or stabilization.
Healing Stages
Stage 1: Acute injury, inflammation phase, up to 72 hours post-accident.
Stage 2: Subacute, repair phase, 72 hours to 14 weeks.
Stage 3: Remodeling phase, 14 weeks to 12 months or more.
Stage 4: Chronic, permanent.
Your Self-Care
Relaxation techniques such as diaphragmatic breathing are encouraged.
Ice is applied to areas of inflammation during Stage 1. Ice is also used if acute flare-ups occur during the healing process.
Start contrast applications (cold-hot-cold) in Stage 2 to help increase local circulation.
Start self-massage for the affected muscle in the late Stage 2.
In late Stage 1 and early Stage 2, you are encouraged to perform light range of motion of the neck to the onset of pain only. The range that was most injured is regained last.
In late Stage 2, the range of motion is gradually increased.
In late Stage 2, resisted contraction exercises for the posterior cervical muscles are introduced. Aerobic activity will also strengthen the neck muscles, since many of the neck muscles are accessory muscles of respiration.
In early Stage 3, resisted exercises for the posterior and lateral neck muscles can be done (pain-free).
Specific anterior neck muscle strengthening is avoided until posterior and lateral cervical muscles are stronger or late Stage 3.
Avoid prolonged stretching of the larger posterior muscles by pulling the head into flexion.
Many cases resolve in 4 to 6 weeks. It is important to be as active as possible. Pain-free activities of daily living are encouraged.
See a physiotherapist, osteopath or chiropractor if the condition is not improving.
Ask your physician or a therapist for specific exercises.
Reference
RATTRAY, F., LUDWIG, L., Clinical Massage Therapy – Understanding, assessing and treating over 70 conditions (2000), Talus Incorporated, Canada, 1178 pages.
