Month: September 2024

Shoulder Bursitis

Author: Jerry Song

Shoulder bursitis is characterised by the inflammation of the bursae, small fluid-filled sacs that cushion and reduce friction between tissues in the shoulder joint. The condition commonly affects the subacromial bursa, which lies between the acromion and the rotator cuff tendons. Shoulder bursitis can cause significant discomfort and limit the range of motion, impacting daily activities and quality of life. While conservative treatments are often effective, manual therapy, including dry needling and myofascial cupping, can play a crucial role in symptom management and functional restoration.

Shoulder bursitis can arise from various factors, often classified into two main categories: acute and chronic causes.

1. Acute Causes:
   • Trauma: Direct impact or injury to the shoulder can cause inflammation of the bursae.
   • Overuse: Repetitive overhead movements or heavy lifting can irritate the bursae, leading to acute inflammation.
   • Infection: In rare cases, bacterial infections can cause septic bursitis, resulting in significant inflammation and pain.
2. Chronic Causes:
   • Degenerative Changes: Ageing and wear-and-tear can lead to degenerative changes in the shoulder, contributing to chronic bursitis.
   • Postural Imbalances: Poor posture, such as forward head posture or rounded shoulders, can increase the risk of bursitis by altering shoulder mechanics.
   • Systemic Conditions: Conditions such as rheumatoid arthritis and gout can cause recurrent bursitis due to systemic inflammation.

Shoulder bursitis affects a wide demographic, with certain groups being more susceptible:

1. Age: The risk of developing shoulder bursitis increases with age, particularly due to degenerative changes in the shoulder joint.
2. Occupation and Activities: Individuals engaged in occupations or activities involving repetitive shoulder movements, such as painters, athletes, and manual labourers, are at higher risk.
3. Gender: While both genders are affected, certain studies suggest a slightly higher prevalence in females, possibly due to differences in shoulder anatomy and biomechanics.
4. Posture and Biomechanics: Poor posture, muscle imbalances, and improper biomechanics can predispose individuals to shoulder bursitis by increasing stress on the shoulder joint and bursae.

Manual therapy offers a range of non-invasive techniques to manage shoulder bursitis, alleviating pain, improving mobility, and promoting healing. Key manual therapy interventions include:

1. Dry Needling

Dry needling involves the insertion of fine needles into specific trigger points or areas of muscle tightness to promote pain relief and muscle relaxation. Benefits of dry needling for shoulder bursitis include:

• Reduction of Muscle Tightness: Targeting trigger points in the shoulder and surrounding muscles can alleviate tightness, improving range of motion and reducing stress on the bursae.
• Pain Relief: By disrupting pain signals and promoting local blood flow, dry needling can effectively reduce pain and inflammation associated with bursitis.
• Improved Muscle Function: Enhancing muscle function around the shoulder joint can stabilise the area, reducing abnormal movement patterns that exacerbate bursitis.

2. Myofascial Cupping

Myofascial cupping involves the use of suction cups to create negative pressure on the skin, lifting and separating the underlying tissues. This technique can:

• Enhance Blood Circulation: Increased blood flow aids in nutrient delivery and waste removal, promoting healing and reducing inflammation.
• Release Myofascial Restrictions: Loosening tight fascia and muscle adhesions can restore normal tissue mobility, reducing pressure on the bursae and alleviating pain.
• Reduce Muscle Spasms: The negative pressure from cupping can relax muscle spasms, improving muscle tone and function in the shoulder region.

3. Soft Tissue Mobilisation

Soft tissue mobilisation includes techniques such as massage and myofascial release to manipulate the soft tissues around the shoulder:

• Massage Therapy: Techniques like deep tissue massage can reduce muscle tension, improve circulation, and decrease pain, facilitating recovery of muscle function and flexibility.
• Myofascial Release: Applying sustained pressure to myofascial restrictions can eliminate pain and restore motion, addressing tightness in the shoulder muscles and fascia.

4. Joint Mobilisation

Joint mobilisation involves applying controlled forces to improve the range of motion and alleviate pain in the shoulder joint:

• Glenohumeral Joint Mobilisation: Techniques to mobilise the glenohumeral joint can enhance joint mobility, reduce stiffness, and correct abnormal mechanics contributing to bursitis.
• Scapulothoracic Mobilisation: Addressing scapular movement can improve overall shoulder mechanics, reducing compensatory stresses on the bursae.

5. Manual Stretching

Manual stretching techniques aim to improve flexibility and reduce tension in the muscles around the shoulder:

• Pectoral and Rotator Cuff Stretching: Stretching the pectoral and rotator cuff muscles can relieve tension and improve range of motion in the shoulder.
• Upper Back and Neck Stretching: Addressing tightness in the upper back and neck can reduce stress on the shoulder and improve posture.

Listed below are some details of a client dealing with shoulder bursitis who is seeking treatment here at HBM, which may also serve as a case study:

Age: 50+

Gender: M

Symptoms: Right shoulder pain

Medical history: Non pertinent

Lifestyle: Frequently goes cycling long distances, and seated for work mainly

The client has received fortnightly treatments here at HBM over the period of 3 months to manage his symptoms, and even after the first treatment has had great improvement in mobility and pain. Educating him on the importance of compliance to treatment due to his active schedule has made a big difference on his quality of life, and after educating him on the possible cause (after numerous questioning and orthopaedic testing) and with some take home exercises and stretches, he’s been able to get back to his daily activities with much improvements on symptoms.

If you or someone you know are dealing with shoulder bursitis, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see Jerry now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain.  Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.

Hallux Valgus Deformity (aka Bunions)

Author: Jerry Song

Hallux valgus is a structural deformity of the foot that involves the angling of the great toe (hallux) towards the second toe, accompanied by a bony prominence known as a bunion on the medial aspect of the first metatarsophalangeal joint (MTPJ). This deformity can lead to pain, discomfort, and functional limitations, significantly affecting an individual’s quality of life. While surgical intervention is often considered for severe cases, conservative treatments, including manual therapy, play a vital role in managing symptoms and slowing the progression of the deformity.

Hallux valgus develops due to a combination of intrinsic and extrinsic factors:

1. Genetic Predisposition: Family history of hallux valgus suggests a genetic component that affects foot biomechanics and structural alignment.
2. Footwear: Wearing narrow, high-heeled, or poorly fitting shoes can exacerbate or contribute to the development of hallux valgus by applying abnormal pressure on the toes and altering foot mechanics.
3. Biomechanical Factors: Abnormal foot mechanics, such as overpronation or excessive supination, can contribute to the development of hallux valgus. Muscle imbalances and weak intrinsic foot muscles may also play a role.
4. Arthritis: Conditions like rheumatoid arthritis can affect joint alignment and contribute to the development of hallux valgus.
5. Trauma: Previous injuries to the foot or toe can impact the alignment of the great toe and contribute to the deformity.
6. Muscle Imbalance: Weakness or imbalance in the muscles supporting the foot can affect the alignment of the toe and exacerbate the deformity.

Hallux valgus develops due to a combination of intrinsic and extrinsic factors:

1. Age: The condition is more common in older adults, with the prevalence increasing with age due to cumulative biomechanical stress and degenerative changes.
2. Gender: Women are significantly more likely to develop hallux valgus than men. This disparity is often attributed to footwear choices, such as high heels and narrow-toed shoes, which can exacerbate the deformity.
3. Family History: Individuals with a family history of hallux valgus are at a higher risk, indicating a genetic predisposition.
4. Footwear Choices: Wearing tight, narrow, or high-heeled shoes regularly increases the likelihood of developing hallux valgus, especially in women.

Manual therapy can play a supportive role in managing hallux valgus by alleviating symptoms, improving foot function, and addressing contributing factors. Key manual therapy interventions include:

1. Dry Needling

Dry needling involves the insertion of fine needles into specific trigger points or areas of muscle tightness to promote pain relief and muscle relaxation. Benefits of dry needling for hallux valgus include:

• Reduction of Muscle Tightness: Targeting trigger points in the foot and lower leg muscles, such as the flexors and extensors, can alleviate tightness and improve muscle balance.
• Pain Relief: By disrupting pain signals and promoting local blood flow, dry needling can effectively reduce foot pain and discomfort associated with hallux valgus.
• Improved Muscle Function: Enhancing muscle function around the foot can aid in improving foot mechanics and reducing abnormal stress on the MTPJ.

2. Myofascial Cupping

Myofascial cupping involves using suction cups to create negative pressure on the skin, lifting and separating the underlying tissues. This technique can:

• Enhance Blood Circulation: Improved blood flow helps in nutrient delivery and waste removal, promoting tissue healing and reducing inflammation in the affected area.
• Release Myofascial Restrictions: Loosening tight fascia and muscle adhesions can restore normal tissue mobility and alleviate pain associated with hallux valgus.
• Reduce Muscle Spasms: The negative pressure can help relax muscle spasms, improving muscle tone and function in the foot.

3. Soft Tissue Mobilisation

Soft tissue mobilisation techniques include massage and myofascial release to manipulate the soft tissues around the foot and toe:

• Massage Therapy: Techniques like deep tissue massage can reduce muscle tension, improve circulation, and decrease pain, facilitating recovery and improving foot function.
• Myofascial Release: Applying sustained pressure to myofascial restrictions can eliminate pain and restore motion, addressing tightness in the foot and lower leg muscles.

4. Joint Mobilisation

Joint mobilisation involves applying controlled forces to the MTPJ and surrounding joints to improve range of motion and alleviate pain:

• MTPJ Mobilisation: Techniques to mobilise the MTPJ can enhance joint mobility, reduce stiffness, and correct abnormal mechanics contributing to hallux valgus.
• Manual Traction: Applying gentle traction to the MTPJ can reduce joint compression, alleviate pain, and improve alignment.

5. Manual Stretching

Manual stretching techniques aim to improve flexibility and reduce tension in the muscles and tissues around the foot:

• Toe and Foot Stretching: Stretching the intrinsic and extrinsic muscles of the foot can relieve tension and improve flexibility, aiding in better alignment and function.
• Calf Stretching: Addressing tightness in the calf muscles can improve overall foot mechanics and reduce stress on the MTPJ.

6. Proprioceptive Neuromuscular Facilitation (PNF)

PNF stretching combines stretching and contracting targeted muscle groups to enhance flexibility and strength:

• PNF Techniques: Effective for improving the flexibility and strength of the foot muscles, promoting better mechanics and reducing pain associated with hallux valgus.

If you or someone you know are dealing with bunions, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see Jerry now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain. Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.

Headaches

Author: Jerry Song

Headaches are one of the most common neurological complaints encountered in clinical practice, affecting individuals across various demographic groups. They can be broadly categorised into primary and secondary headaches, with each category encompassing multiple subtypes. Understanding the etiology of these headaches and the demographics most likely to suffer from them is crucial for effective diagnosis and management.

1. Primary Headaches

Primary headaches are not caused by an underlying medical condition but are disorders themselves. The main types include migraines, tension-type headaches (TTH), and cluster headaches.

1. Migraine

Migraine is a recurrent headache disorder characterised by moderate to severe pain, typically unilateral and pulsating in nature. The pain is often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines can be preceded by aura, which includes visual disturbances or other neurological symptoms.

Etiology: The exact cause of migraines is not fully understood, but it is believed to involve a combination of genetic, environmental, and neurological factors. There is evidence suggesting abnormal brain activity and blood flow changes, as well as dysfunction in the trigeminovascular system.

Demographics: Migraines affect approximately 12% of the global population, with a higher prevalence in women than men (about 3:1 ratio). They are most common in individuals aged 18 to 44, particularly among women of childbearing age due to hormonal fluctuations. There is also a genetic predisposition, as migraines tend to run in families.

1. Tension-Type Headache (TTH)

Tension-type headaches are the most common type of primary headache. They are characterised by bilateral, mild to moderate pain, often described as a tight band around the head. These headaches can last from 30 minutes to several days.

Etiology: The etiology of TTH is believed to involve muscle tension and stress. Psychological factors such as anxiety and depression are also associated with TTH. The pain is thought to result from peripheral activation or sensitisation of myofascial nociceptors.

Demographics: Tension-type headaches affect up to 80% of the population at some point in their lives. They are slightly more common in women than men and are most frequently reported by individuals in their 30s and 40s. Stressful life situations and poor posture are common triggers.

1. Cluster Headache

Cluster headaches are characterised by severe, unilateral pain, typically around the eye or temple, often accompanied by autonomic symptoms such as tearing, nasal congestion, or eyelid swelling. These headaches occur in clusters, with multiple attacks over weeks or months, followed by periods of remission.

Etiology: The exact cause of cluster headaches is unknown, but they are thought to involve abnormalities in the hypothalamus, leading to dysregulation of circadian rhythms. Genetic factors may also play a role, though they are less prominent than in migraines.

Demographics: Cluster headaches are rare, affecting about 0.1% of the population. They are more common in men than women (about 4:1 ratio) and typically begin between the ages of 20 and 40. Smoking and alcohol consumption are significant risk factors.

2. Secondary Headaches

Secondary headaches are symptomatic of an underlying medical condition. The pain is often due to infection, trauma, vascular disorders, or other systemic issues. Common types include:

1. Medication Overuse Headache (MOH)

Medication overuse headache, also known as rebound headache, occurs as a result of frequent use of headache medications. The headache is usually present upon waking and can resemble a tension-type headache or migraine.

Etiology: MOH is caused by the regular use of analgesics or triptans for headache relief, leading to a cycle of overuse and increased headache frequency.

Demographics: MOH is more prevalent in women, particularly those aged 30 to 50. It is also common among individuals with a history of chronic headaches, such as migraines or tension-type headaches.

1. Sinus Headache

Sinus headaches are caused by inflammation or infection of the sinuses, leading to pressure and pain in the forehead, cheeks, and eyes. These headaches are often associated with sinusitis and may be accompanied by nasal congestion, fever, and facial swelling.

Etiology: Sinus headaches occur due to inflammation of the sinus cavities, often secondary to infection (viral or bacterial) or allergic reactions. The pain results from increased pressure within the sinuses.

Demographics: Sinus headaches are more common in individuals with a history of allergies or chronic sinusitis. They are equally prevalent among men and women and can affect all age groups, though they are more common in adults.

1. Cervicogenic Headache

Cervicogenic headache is a secondary headache caused by disorders of the cervical spine and its components, such as intervertebral discs, facet joints, or cervical muscles. The pain is typically unilateral and may radiate from the neck to the front of the head.

Etiology: Cervicogenic headaches result from cervical spine disorders, such as osteoarthritis, herniated discs, or whiplash injuries. The pain is believed to originate from the convergence of nociceptive input from the cervical spine and trigeminal nerve.

Demographics: This type of headache is more common in individuals with neck trauma or chronic neck pain, particularly those aged 30 to 50. It is slightly more prevalent in women than men.

If you or someone you know are dealing with headaches, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see Jerry now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain. Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.