PHYSIOHEALER.

TREATMENT AND FACTORS AFFECTING CERVICAL NECK PAIN.

Although,therapeutic techniques are mostly used such as rest, massage,ice and heat which are certainly the first step in treating the acute onset of cervical spine pain,particularly if muscular in origin. Sometimes several weeks are necessary for resolution.If the symptoms seem to be gradually improving,no medical intervention may be necessary.Avoiding poor neck posture and positions is essential.Sitting up straight and keeping the head centered over the chest while sitting improves posture.

TREATMENT:

So,the helpful modifications include:

(1)Avoid working with the arms up overhead or the neck in a persistently flexed position.

(2)Avoid frequent twisting or turning.

(3)Avoid carrying a computer or heavy bag over one shoulder or cradling the phone to one ear.

(4)Try to sleep with fewer pillows and avoid sleeping on one’s stomach.Massage may loosen up the muscles. Ice may calm the inflammation at the onset of difficulties and heat may later relax the muscles.

SEVERITY OF NECK PAIN:

Neck Pain may be chronic or recent in onset.It may be confined to the neck or radiate to the arms.

Such,as mild or severe and dull or sharp and better or worse with certain physical activities.

a)MILD STAGE:

Headache is usually daily,in back of the skull and radiates forwards over the temple,mild and relieved with minor pain medications.

b)CHRONIC STAGE:

It can be quite severe and mistaken for “migraine”.

FACTORS AFFECTING NECK PAIN:

Factors affecting cervical neck pain are mentioned below:

1.Numbness into the arm.

2.Fatigue of certain motions may be specifically recognized and reported as weakness.

3.Bowel,bladder,gait and balance difficulties gives red flags to spinal cord injury.

4.Stress management may not be linked to psychological tension as it affects neck region and work stress with long hours at the computer or desk.

5.Poor sleep often results in stress as the neck muscles don’t get relax well when sleep is poor.

6.Anti-inflammatory agents,analgesics and muscle relaxants work best for most spine discomfort.Such as, ibuprofen,naproxen and aspirin.

In the last,this approach is for temporary period until the anatomy and mechanics of the spine dysfunction are identified and corrected.

NECK PAIN.

Neck pain which is also called as Cervical Neck pain. In this, physiotherapy can have a massive impact on the global burden of neck pain.Through the application of good examination skills, effective clinical reasoning and appropriate selection of interventions the impact of neck pain for any individual can be significantly reduced. In addition the high tendency for chronicity in neck pain can be lowered with effective management.

INTRODUCTION:

The cervical spine is the most superior portion of the vertebral column, lying between the cranium and the thoracic vertebrae.

It consists of seven distinct vertebrae, two of which are given unique names:

1.ATLAS:

The first cervical vertebrae (C1) is known as the atlas.

2.AXIS:

The second cervical vertebrae (C2) is known as the axis.

ATTACHMENT:
Attached to the back of each vertebral body is an arch of bone that forms a continuous hollow longitudinal space, which runs the whole length of the back. This space, called the spinal canal, is the area through which the spinal cord and nerve bundles pass. The spinal cord is bathed in cerebrospinal fluid (CSF) and surrounded by three protective layers called the meninges (dura, arachnoid, and pia mater).

VERTEBRAL LEVEL:

At each vertebral level, a pair of spinal nerves exit through small openings called foraminae (one to the left and one to the right). These nerves serve the muscles, skin and tissues of the body and thus provide sensation and movement to all parts of the body. The delicate spinal cord and nerves are further supported by strong muscles and ligaments that are attached to the vertebrae.

SYMPTOMS OF NECK PAIN:

Neck pain of soft tissue origin tends to produce symptoms localized to the muscular tissues running up and down both sides of the cervical spine. The discomfort can expand out towards the shoulders, but rarely radiates down the arms.

SYMPTOMS:

They are commonly worse with the head and neck in a fixed, or static, position and better with movement, ice or heat and massage. This tends to be a persistent type of pain, often precipitated by injury or overuse. The cause can be injuries to the muscles and ligaments or to the underlying bones and discs. Once injury occurs, there tends to be a tightening of the muscles, perhaps as a reflex designed to hold the head and neck stable, but this also creates enhanced muscle tone and discomfort from the chronic muscle spasm.

Motor Function:

Almost all of the muscles in both the arms and legs are tested.Maximum power that each muscle can generate and the loss of muscle bulk (atrophy) are assessed.

Sensory Function:

It is tested with either a pin-prick or light-touch method, looking for areas of numbness, tingling or burning.

Reflex Activity:

The arms and legs are tested with the rubber hammer to provide insight to nerve, spinal cord and muscle function.

Gait Assessment And Coordination:

It is checked through balance and pattern of muscle power.
Coordination of both arms and legs is reviewed for both dexterity and balance.

Range of Motion:

Mostly all of the spine, both passively and actively, is performed while assessing the musculature and identifying whether any nerve, spinal cord or pain difficulties emerge.

EXERCISES FOR ACHILLES TENDON.

To preserve flexibility and strength of Achilles Tendon,a treatment plan which is prescribed by physiotherapist and patient has to follow the plan at home to maintain their health and fitness to keep them active and healthy.

Here are some of the stretches that will maintain flexibility and restoration of rupture tendon:

1.Floor Stretch:

Method:

1.Stand about 0.5 metres from a wall, and place your hands on the wall at about shoulder height or you can stand behind a chair, placing your hands on the back of it for balance.
2.Step back with the leg you want to stretch. Keep the leg straight, and press your heel into the floor with your toe turned slightly in.
3.Lean forward, and bend your other leg slightly. Feel the stretch in the Achilles tendon of your back leg.

*Hold for at least 15 to 30 seconds.
Repetition:2 to 4 times a session, up to 5 sessions a day.

2.Stair Stretch:

Method:

1.Stand with the balls of both feet on the edge of a step or curb (or a medium-sized phone book).

2.With at least one hand, hold onto something solid for balance, such as a banister or handrail.
3.Keeping your affected leg straight, slowly let that heel hang down off of the step or curb until you feel a stretch in the back of your calf and/or Achilles area. Some of your weight should still be on the other leg.
*Hold this position for at least 15 to 30 seconds.
Repetition:2 to 4 times a session, up to 5 times a day or whenever your Achilles tendon starts to feel tight.

3.Strength Exercise:

Method:

1.This exercise will get you started on building strength after an Achilles tendon injury.Your physiotherapist can help you move on to more challenging exercises as you heal and get stronger.
2.Stand on a step with your heel off the edge of the step. Hold on to a handrail or wall for balance.
3.Push up on your toes, then slowly count to 10 as you lower yourself back down until your heel is below the step.
Repetition: Repeat exercise 8 to 12 times, half with the knee straight and half with the knee bent.

4.Toe Stretch:

Method:

1.Sit in a chair, and extend your affected leg so that your heel is on the floor.
2.With your hand, reach down and pull your big toe up and back. Pull toward your ankle and away from the floor.
*Hold the position for at least 15 to 30 seconds.
Repetition: 2 to 4 times a session, several times a day.

5.Calf Plantar Fascia Stretch:

Method:

1.Sit with your legs extended and knees straight.
2.Place a towel around your foot just under the toes.
3.Hold each end of the towel in each hand, with your hands above your knees.
4.Pull back with the towel so that your foot stretches toward you.
*Hold the position for at least 15 to 30 seconds.
Repetition: 2 to 4 times a session, up to 5 sessions a day.

SYMPTOMS AND PHYSICAL EXAMINATION OF ACHILLES TENDON.

First of all, symptoms of Achilles tendon will be discussed and then screening out examination and tests to rule out signs and symptoms of Achilles tendon is discussed :

Symptoms of Injury:

Common symptoms of tendon injuries include:

1.Pain down the back of your leg or near your heel.
2.Pain that gets worse when you’re active
A stiff, sore Achilles tendon when you first get up.
3.Pain in the tendon the day after exercising
Swelling with pain that gets worse as you’re active during the day
4.Thickening of your tendon
5.Bone spurs on the heel bone
6.Difficulty flexing the affected foot
7.A “pop” sound and sudden sharp pain, which can mean a ruptured tendon.

Physical Examination:

To look for Achilles tendon problems, an examiner checks for pain, swelling, warmth, thickening, or discoloration around the heel and leg. A knot on the back of the leg may be present with Achilles tendon rupture. Most cases of tendinopathy without a rupture can be diagnosed by physical exam and often do not need further testing.

Radiographic Findings:

Following are the methods for screening out findings:

So, Radiographic Findings are following:

1.MRI (Magnetic Resonance Imaging)

2.Achilles Tendon Rupture Ultrasound

3.CT (Computed Tomography)

4.X-ray Film.

1.Magnetic Resonance Imaging (MRI scan):

An MRI scanner uses a high-powered magnet and a computer to create highly detailed images of the ankle and leg. An MRI scan is the best test to diagnose an Achilles tendon rupture or other problems but it may not always detect tendinopathy.

2.Achilles Tendon Ultrasound:

A probe on the skin reflects high-frequency sound waves off the ankle, producing images of the Achilles tendon. Ultrasound can often diagnose an Achilles tendon rupture.

3.Computed Tomography (CT scan):

A CT scanner takes multiple X-rays, and a computer constructs detailed images of the ankle and leg. An MRI scan is superior to a CT scan in diagnosing Achilles tendon problems.

4.X-ray Film:

A plain X-ray film may identify problems with the bones or ankle joint, but it cannot diagnose Achilles tendon problems.

Tests For Achilles Tendon:

Now,tests to screen out negative or positive findings will be discussed:

Two Tests are performed for Achilles tendon rupture :

1 Thompson Test

2.Matles Test

1.Thompson Test:

Position:Lying prone (on one’s stomach) or while kneeling on a chair.

Practical:The examiner squeezes the calf. The end of the foot should move down in response; if it does not, an Achilles tendon rupture may be present.

THOMPSON TEST

2.Knee flexion (Matles) test:

Position:A person lies face down.

Practical: The examiner bends the knee slowly to a right angle. During this movement, the toe end of the foot should point away from the leg slightly; if it doesn’t, an Achilles tendon rupture may be present.

Common Injuries Of Achilles Tendon :

Now after defining Achilles Tendon, its insertion, attachment and about how Achilles tendon work in function. Now it’s time to discuss about common injuries of Achilles Tendon.

Common Injuries:

1.Achilles Tendinosis:

Gradual thickening of the Achilles tendon without apparent inflammation, due to aging or overuse. Despite the thickening, the tendon is weakened and prone to further injury or rupture.

2.Achilles Tendinopathy:

A general term for tendinitis or tendinosis affecting the Achilles tendon.

3.Achilles or Heel (calcaneal) Bursitis:

Low-riding shoes can irritate the bursa, a sac of fluid cushioning the Achilles tendon at the heel. Pain in the back of the heel, worse with shoes on, is the common symptom.

4.Achilles Tendon Tear:

Tears of the Achilles tendon can be tiny (microtears), or large, causing pain, swelling, and impaired movement. They may occur suddenly during activity, or gradually over time.

5.Achilles Tendon Rupture:

A complete rupture of the Achilles tendon may make a “pop” sound, followed by pain and swelling of the lower leg. Treating an Achilles tendon rupture requires surgery or long-term immobilization of the ankle.

6.Achilles Tendinitis (Tendonitis):

Frequent activity (running or walking) can gradually inflame the end of the Achilles tendon, causing pain and stiffness at the back of the heel. Rest, ice, and stretching may speed healing, which can take weeks.

7.Achilles Peritendonitis:

Similar to Achilles tendonitis, but inflammation and pain occur in the tissue surrounding the tendon, often two or more inches above the heel.

In next blog, we will discuss about symptoms of Achilles tendon rupture/injury and how to do physical examination of Achilles Tendon Rupture to identify further signs and symptoms. Further, we will screen out red flags and discuss about tests which will show positive signs or negative signs of Achilles tendon rupture.