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7 Steps to Reducing Tension Headaches
7 Steps to Reducing Tension Headaches
By Principal Physiotherapist Jodie Krantz
To get relief from tension headaches, follow this process to ensure effective diagnosis and treatment.
Step 1: Get a check up from your GP
Although most headaches are harmless, it’s a good idea to see your GP to ensure it is not being caused by something more serious. You should see your doctor immediately if you have severe pain, which is not relieved by normal over-the-counter medications, if it was related to a head injury, or involves loss of consciousness, fever, vomiting, blurred vision, difficulty speaking or numbness of the arms or legs. Your doctor can assist with diagnosing the cause of your headaches. Tension headaches and migraines are the most common cause of headaches and many people have a combination of the two.
While visiting your GP, consider discussing your stress levels and mood. Anxiety and depression can be contributing factors when you have recurrent headaches.
Step 2: Start keeping a headache diary
This will help you to keep track of your headaches, to know whether you are improving and to get a better understanding of the likely triggers for your headaches. Taking your headaches diary with you when you visit a health care professional assists with the process of diagnosis and treatment of your headaches. Download a headache diary here.
Step 3: Get a headache assessment from your Physiotherapist
See your Physiotherapist for a check up. Ask for an assessment of your posture, flexibility, muscle strength and endurance, as these factors are likely to be contributing to your headaches. Some headaches are caused by referred pain from the small facet joints in your neck. These headaches often respond well to gentle mobilization techniques.
A common cause of headaches is poor posture. People who get recurrent tension headaches are often holding their head too far forward, causing the muscles at the back of the neck to work overtime. They may also have a tendency to hunch the shoulders forwards and upwards, tightening the upper trapezius and other adjacent muscles. These muscles are often the primary source of the headaches which are felt in the back of the head and neck, in the temples and behind the eyes. The pain is often described as being like a tight band around the head.
Once you’ve had an assessment your Physiotherapist can help you work out a treatment and / or home exercise programme to relieve your headaches. At Free2Move our approach is to provide the minumum necessary one-to-one treatments and get you self-managing through a customised exercise programme in the shortest possible time.
Request a Headache Assessment at Free2Move
Step 4. See your Dentist
Jaw tension is another common cause of tension headaches. It’s a good idea to have your dentist check whether you have been clenching or grinding your teeth. A lot of people – some dentists say most – clench their teeth in their sleep. This will be evident from the wear patterns on your tooth enamel. A night guard (occlusal splint) can often reduce or even eliminate headaches associated with jaw tension. The Feldenkrais Method is also very helpful for reducing jaw and neck tension, which can lead to headaches.
Try a free Feldenkrais Lesson on Releasing your Neck and Jaw. You can also see your Physiotherapist for one-to-one assessment and treatment of jaw pain or tension.
Step 5: Get an ergonomic assessment of your workstation
Do you sit at a computer for long periods of time? How is your posture while you work? Although most people try to maintain good posture at their desk, this is hard to attain and even harder to sustain if your ergonomic set-up is incorrect. Consider asking your employer to arrange an ergonomic assessment of your workstation. To request an ergonomic workstation assessment in Perth Western Australia, Contact Us at Free2Move.
The two most important factors are your chair and your monitor. Most good ergonomic chairs have 3 levers underneath, one to adjust chair height, one for the angle of the seat and a third for the angle height and position. The back rest should also be adjustable so that the lumbar support is in the right place. Get your chair properly adjusted and each day when you sit down to begin your work check that it’s in the right position. Use a footstool if required and ensure that the top of your monitor is level with, or just below the height of your eyes.
Speaking of eyes, when was the last time you had them tested? Eye strain can also be a cause of tension headaches.
Last but not least, get up out of your chair and walk around once an hour at the very minimum. There are some great programmes and apps now to help remind you about this. Make sure you have a system in place.
Step 6: Improve your exercise regime
It’s not a theory, it’s a fact: regular cardio-vascular exercise can reduce the frequency, severity and duration of tension headaches. Exercise helps because it improves circulation to all your muscles, reduces stress and tension, and has a beneficial effect on the brain and nervous system, through which all pain is sensed.
Aim to spend a minimum of 2.5 hours every week participating in an enjoyable form of moderately vigorous activity. The ideal is 30 to 60 minutes of exercise at least 5 days per week. You can walk, swim, cycle or play sport – anything that increases your heart rate and gets you breathing a little more deeply. This needs to become part of your regular routine, so it’s a good idea to put a structure in place that supports that.
Walking often works because it’s free and you don’t need any special equipment or environment. It’s also a form of locomotion and an fundamental ability to maintain as you get older. So walk to work, walk your dog or walk with a friend and help each other maintain your exercise goals. If it’s too wet or hot you can even walk inside your local gym or shopping centre.
Step 7. Reduce your stress levels
Stress often contributes to recurrent or chronic tension headaches. People who are stressed may resort to unhealthy ways to reduce stress, such as excess use of alcohol, smoking, taking pills or drugs, overeating, excess consumption of sugar or caffeine. Some people avoid facing their worries and concerns by being so busy they never have time to slow down or by watching TV to avoid thinking or feeling.
Important aspects of reducing stress are eating a balanced nutritious diet, participating in regular exercise and getting adequate sleep.
Healthy ways to relax include things like going for walk in nature, taking a hot bath by candlelight or getting a massage. Consider doing some gardening, listening to music, or playing with a pet. You could consider taking classes in Feldenkrais, meditation or Tai Chi. Whatever you do, build it into your weekly routine and set aside time that you will devote to relaxing your mind and body.
Reducing stress includes taking responsibility for the way that you manage problems, thoughts and emotions. If you can’t change the circumstances that result in stress, change the way you respond to it. For help and support with managing stress in Australia, talk to your GP about a referral to a Clinical Psychologist. You may be eligible for a rebate through Medicare.
My Experience of Varicose Veins Surgery
My Experience of Varicose Veins Surgery – by Jodie Krantz
Deciding on a procedure
It was with some hesitation that I finally decided to undergo surgical stripping of the short saphenous vein in my right calf. Although my varicose veins were not severe or painful the faulty and unsightly valves had been growing in size and number over the previous two years. I was also experiencing some swelling in my leg during hot weather and plane flights.
When I first met with my surgeon I was hoping he would suggest injection therapy or laser treatment. These procedures seemed a lot less invasive, however my surgeon explained that injection therapy was far less successful and that patients often had to return for many treatments before a good result was obtained.
Laser therapy was not recommended for this particular vein, because laser treatment involves heat which potentially could damage the common peroneal nerve which lies close to the short saphenous vein.
What my surgeon told me
Surgical stripping, my surgeon explained, was usually a day stay procedure with return to work possible within 1 to 2 weeks.
The surgery would be performed with me lying on my stomach but I would wake up on my back. It would result in a small incision behind the back of my knee where the vein would be tied. I would also have several small incisions in the back of my calf for the removal of each of the faulty valves. The incisions would be closed with dissolving stitches and / or steri strips. Afterwards I could expect some bruising and swelling which would be controlled with bandaging, followed by wearing a surgical stocking continuously for the first 3 days. After this time it was recommended that I wear the stockings during the day for the first 10 to 14 days removing them if required for comfort at night. I was encouraged to massage the leg generally with Hirudoid cream to assist with the resolution of the bruises.
Regular walking would be important the 6 weeks following the surgery in order to re-establish the circulation in my leg. Exercise would help to reduce the swelling and to divert the circulation to alternative veins. My surgeon told me there was a 90 percent chance that the varicose vein would not recur.
CLICK HERE if you are looking for an Exercise Programme following Varicose Vein Surgery
My experience of varicose vein surgery
Due to having neck issues I requested the use of a face hole during the procedure, rather than have my head turned to one side. I awoke after the surgery without any pain. Soon I realised that my leg was very numb and that I couldn’t move my toes or foot upwards or outwards. Some numbness was to be expected, however I had complete sensory and motor loss in the distribution of the common peroneal nerve.
The nursing staff were excellent. They released my bandages thinking that they might be too tight. My surgeon visited me and explained that they had injected a local anaesthetic and that this was the probable cause of my foot drop. It would take about 6 hours to wear off.
In actual fact it took almost 24 hours before I began to regain the ability to move my foot normally, so I had to stay in hospital overnight. I walked with a lopsided limp, somewhat like a stroke patient. I was very anxious and already planning my rehabilitation! However it turned out my surgeon was right and complete movement and sensation came back when the anaesthetic wore off.
The rest of my post operative recovery was without further complication, however the bruising was a lot more severe and painful than I expected. I felt this aspect was down played by my surgeon. In retrospect I would not go through this surgery again unless the veins were really painful.
Beginning my rehabilitation exercises
The only instructions I was given were to walk for at least 30 minutes everyday for the first 6 weeks. Once the local anaesthetic wore off, putting any weight on my leg was very painful despite regular analgesia. I was unsure whether to attempt 30 minutes of walking on the day after the surgery. As a physio I was disappointed that more information was not given about post operative exercises.
It made more sense that the exercise should be progressed gradually over the first week. The problems I encountered included severe bruising with large lumps in the calf where the valves had been, marked tightness of my muscles and fascia and a tendency to walk with a limp. As a result I developed an exercise program to help others in the same situation to recover from varicose vein surgery.
Five years later – very happy with the outcome
It is now five years since I had the varicose vein surgery. There has been no recurrence of the varicose veins and the scars are almost invisible. Overall I’m very happy with the outcome.
Read more about Exercise following Varicose Vein Surgery
Exercise Programme following Varicose Veins Surgery
Exercise Programme Following Varicose Veins Surgery
Exercise safely after your varicose vein surgery with advice from an experienced physiotherapist. Jodie Krantz from Perth in Western Australia went through this surgery herself and writes with 30 years experience in her profession.
This article is a step by step guide that takes you through the days and weeks immediately following your surgery. It will give you the confidence to help yourself recover as quickly as possible.
Please note: the following is a general guid only guide only and may not apply to everybody. Always take the advice of your surgeon and other medical personnel. Read our disclaimer
Day 1
As soon as you wake up after the surgery begin the following bed exercises at least once an hour:
Ankle exercises
Move your feet and toes and down rhythmically. Circle them 10 times in each direction. The purpose of this help maintain your circulation and prevent the rare but serious complication of a deep vein thrombosis.
Knee and hip exercises
Bend and straighten your knee slowly and gently 5 times by sliding your foot along the bed. This helps to prevent stiffness and also keeps your circulation going.
Walking
You should be allowed to get out of bed and walk soon after you have eaten your first meal. Walk to and from the bathroom on the first day and if possible a little further.
Analgesia
Take your pain medication as advised by your doctor. Pain relief will help you perform your exercises better and therefore improve your recovery.
Comfort
Elevating your affected leg on a soft pillow may assist your circulation and reduce swelling. Check with your medical staff first.
Applying Surgical Stockings
Before putting on your surgical stockings turn the stocking inside out down to the heel. Slide your foot into the stocking up to the heel then ease it up over your leg – it will hurt! Surgical stockings with a cutout toe hole are easier to put on. Place a plastic bag on the end of your foot then slide the stocking on over the plastic bag. Remove the bag through the toe hole.
Day 2
The pain may be a bit worse on the second day as the local anaesthetic wears off. Take your prescribed or over the counter analgesic medications so you can get yourself moving.
Bed exercises
Continue your bed exercises as above on an hourly basis.
Walking
Extend the duration of your walking to periods of up to 10 minutes if possible. Try to get up and walk at least once every 2 hours.
Analgesia
Continue to take pain medication as required. It will help you do your exercises so you can recover more quickly.
Day 2 to 5
In place of the bed exercises get out of bed and walk every hour during the day for a short period. Walk continuously for at least 15 minutes twice a day on flat ground. You may find the walking is quite painful to begin with however the longer you walk, the less pain you should experience.
When walking, try to put your full weight on the affected leg and minimise limping as much as possible. Do not rush the weight bearing phase on your affected leg and try to use the muscles of this leg normally. Always wear your surgical stockings when walking. Avoid prolonged sitting or standing and elevate your leg when lying down.
Day 6 onwards
By now the pain should be starting to decrease, though you will likely still feel very tight and stiff. Even if it’s still really uncomfortable it’s important to keep moving and to try to gradually increase the duration of your walking.
Walking
Continue your walking programme for at least 30 minutes everyday. Include some hills. Start each walk slowly and try to put even weight on both legs. Gradually lengthen your stride and increase your speed as you start to feel more comfortable. Ensure that your stride length is the same on both legs.
Using a pedometer may help to encourage you with your walking. I recommend the fitbit which i found incredibly motivating. It logs the number of steps you have taken each day, the distance covered and the calories you’ve burned. Little flashing lights on your wrist band show your progress and give you positive feedback. The fitbit also monitors your sleep quality at night.
Stretches
The muscles and fascia of the calf and / or inner thigh are likely to become very tight following your surgery. These stretches should be performed gently. Listen to your body and do not push into pain. Remember, everyone responds differently to exercises. If you are experiencing any difficulties please ask your doctor or physio for advice.
You will need:
- A carpeted floor space or exercise mat
- A strap with a loop (for example resistance tubing, yoga strap or dressing gown cord)
This stretch sequence has 3 parts all done in the same position. Remember, the leg that’s not moving remains bent with the foot on the floor. This helps you stabalize the pelvis and protects your lower back from injury.
- Hamstrings:
- Lie on your back with knees bent, feet flat on the floor
- Put the loop of your strap around your foot of the operated leg
- Hold the strap with both hands
- Lift your foot up high and try to straighten the knee
- Keep the other foot standing on the floor
- Slowly lower your leg towards the floor, keeping pelvis stable
- Raise and lower your leg like this 10 times, breathing fully
2. Calf muscles:
- Keep your leg up as high as possible, knee straight
- Having your foot up helps reduce swelling in the calf
- Gentle flex and extend your ankle 10 times, keeping the knee straight
- Circle your ankle 5 times in each direction
3. Inner thigh muscles (hip adductors)
- Do these exercises extra slowly for the maximum benefit
- Keeping a stretch on the back of your thigh and the knee straight slowly lower your leg out to the side
- Consciously allow the muscles of the inner thigh to let go
- You can allow the bent knee (non-operated leg) to move outwards slightly to counterbalance
- Keep the pelvis as stable as possible – this will help with core strength
- Bring the leg back to the vertical and repeat 5 times
It’s also fine to do all the above exercises on the non-operated leg.
Massage
Soft tissue massage can be helpful for relieving congestion and breaking down scar tissue, while improving comfort and mobility. Refer to the advice of your surgeon as there are situations in which massage could be inadvisable or dangerous (especially infection or deep vein thrombosis).
You will need to start extremely gently for your safety and comfort. Begin by lightly rubbing in the Hirudoid cream, working it in an upward direction (towards the groin). Don’t use excessive pressure or you will only worsen the brusing.
From approximately 4 weeks after the surgery you can begin to use a bit more pressure and include small circular movements over the lumps in your calf or thigh.
Beyond 6 weeks
See your surgeon for a post operative check. Continue all your exercises until you have no further symptoms. If you’re not normally someone who exercises regularly, consider making a 30 minute walk part of your daily routine for the rest if you’re life.
As little as 2.5 hours of moderate activity every week (ideally as 30 minutes minimum every day) can reduce the chance of your veins recurring as well as improve your general and physical health. You are likely to live both a longer and happier life if you make this simple lifestyle change. If you need motivation go with a friend, join a walking group or buy a fitbit, smart watch or pedometer.
If there are still lumps in your thigh or calf after 6 weeks, use a foam roller to massage the soft tissue daily. A professional massage can really help. It always seems to take twice as long as you think to recover from surgery. I still had some lumps remaining after 4 months. One year after the surgery I still had scars. However in time they all disappeared. I hope you also have a great outcome.
Good luck!
Tight Hamstrings or Short Hamstrings: Why are they a problem?
Tight Hamstrings or Short Hamstrings: Why are they a problem?
Many people have short hamstrings, the main muscle group in the back of the thigh which bend the knee and extend the hip. Shortened hamstrings are more common in men. Spending a lot of time sitting may be a contributing factor. Another factor is sitting with your pelvis tilted back and knees bent. This posture results in a loss of the lumbar lordosis, the natural arch of the lower back. It not only places strain on the joints, discs and muscles of your lower back but it also puts the hamstrings in a shortened position.
LENGTHEN YOUR HAMSTRINGS EASILY by trying this Free Feldenkrais Lesson.
Shortened hamstrings make it more difficult to bend and lift things safely, because they limit the forward tilt of the pelvis. Some people believe they have short hamstrings because these muscles feel tight, however tightness is a sensation, not an actual limitation in mobility. It is possible to over-stretch the hamstrings, which can result in reduced pelvic stability, so if in doubt get advice from your health professional.
The Straight Leg Raise test is a quick test that can be performed by your Physiotherapist to determine whether your hamstrings are a functional length. Most people need 80 to 100 degrees of hip flexion, which allows you to sit on the floor with legs long and still keep your back fairly straight. If your hamstrings are tight but not short, you may be better to massage on a long foam roller rather than stretching them.
The Feldenkrais Method offers many creative ways to lengthen the hamstrings without straining the lower back. This gentle method helps you reduce excess tension in the muscles without the need for passive stretching.
Lengthen Your Hamstrings
Lengthen Your Hamstrings
Are your hamstrings long or short, tight or relaxed? Lengthening your hamstrings can help with running, kicking, sitting, bending and lifting more easily. Try this simple ‘Awareness Through Movement Lesson’ in the Feldenkrais Method to help lengthen your hamstrings.
READ MORE about the difference between tight and short hamstrings.
Lengthen your Hamstrings
A Feldenkrais Awareness Through Movement Lesson by Free2Move Principal Physiotherapist Jodie Krantz
KEYS TO SUCCESS
Do all movements slowly and mindfully. The movements should be made as smoothly as possible and in such a way that they do not cause you pain. Focus on the sensations you feel in your body. Try to reduce the amount of effort you use. Don’t do anything that hurts. If you feel pain, make the movement smaller and slower. If you can’t do the movement safely, just do the movement in your imagination – it will still awaken the same parts of your brain! Remember this lesson is not a stretch class, you will get better results if you go gently.
DISCLAMER
Please remember, you need to be fully responsible for your participation in this lesson. Seek medical advice before commencing any new exercise especially if you have pain or movement issues. Free2Move / Jodie Krantz cannot be responsible for any injury incurred during this movement process and you participate 100% at your own risk.
TEST MOVEMENTS
Stand comfortably. Slide your hands down the front of your legs, bending forwards, staying in a range that feels safe for you. Notice how this feels in your back and your hamstrings (back thigh muscles). How far do you go easily? What does it feel like in your back and the back of your legs? Sit in a chair and feel the effort required to hold yourself up against gravity.
SERIES OF MOVEMENTS- Lie on your back. Stretch legs long and arms by side. Feel your contact with the floor.
- Bend your knees, put feet flat on the floor. Then cross your right ankle over the left knee. Explore your right foot with the right hand. Which surfaces can you reach easily?
- Take hold of your right foot with your right hand across the top of the foot and around the outside border. Keep your thumb together with the fingers. If you can’t reach the foot easily, make a loop out of some fabric, a strong resistance band or a dressing gown cord, loop it round your foot and hold onto the end of the loop.
- Raise and lower the foot slowly several times, each time pointing the big toe in a different direction.
- Does your leg lift your arm? Or does your arm lift your leg? Experiment with both ways of doing this. Which is easier? REST
- Lift your leg about half way up and take your leg slowly from side to side. Let the whole body follow. Use this as a way to roll over onto each side. REST
- Optional step: Lie on your back again. Link your right index finger around the right big toe. Raise and lower the foot this way several times. REST
- Place your left hand behind the back of your head. Lift your right foot with your right hand but this time lift your head with your left hand at the same time. Do you go higher?
- Go back to the original movement (See 4 above) and repeat. Is it easier? Do you go higher with less effort? REST.
- Now hold your right foot again with your right hand, as before. Is your right knee to the left or right of your right arm? Assuming your knee is outside (to the right) of your right arm, begin to straighten your knee and then move your arm to the outside of your elbow.
- Continue to bend and straighten your right knee, while holding the right foot with your right hand and keep swapping your knee from the inside of your arm to outside of the arm and back.
- Stretch your legs down long and rest again. Does one leg feel longer? Flatter to the floor? More relaxed?
- Repeat the whole sequence on the left side.
- Rest and feel your contact with the floor again.
- Hold one foot with each hand. Lift both feet together. REST
- Lie on your back and feel your contact with the floor again.
- Stand and walk and see how you feel. See what it feels like to sit in a chair. Has your posture improved effortlessly? Repeat the test movements above and notice any changes in your ability and the quality of your movements. Test out your ability to bend down and pick up something from the floor without compromising your back.
- Over the next few days repeat a few of these movements from time to time. In between times, notice any changes to your movement, flexibility and body awareness.
If you enjoyed this lesson try our video entitled ‘Free Your Hips Part 1’ – CLICK HERE
Common Types of Arthritis
Comparison of Rheumatoid and Osteo Arthritis Common Types of Arthritis
Arthritis is a common condition causing joint pain, stiffness and swelling. The most common types are Osteoarthritis and Rheumatoid Arthritis. These are distinctly different. In this article we will describe Osteoarthritis, Rheumatoid Arthritis and Fibromyalgia.
Osteoarthritis
Osteoarthritis (OA) is the most common form of arthritis. It occurs when the cartilage that lines the joints wears down. This may be due to past injury, cumulative wear and tear or simply the ageing process.
OA commonly occurs in the large weight-bearing joints of the body – the hips, knees, feet and spine but it can also affect any of the synovial joints in the body, including the fingers, thumbs, shoulders, elbows and jaw. There is usually stiffness in the morning and pain may be worse after prolonged or heavy activity.
Over time the cartilage becomes thinner and loose pieces debris can float in the synovial fluid, which lubricates the joint. The bony surfaces of the joint can also develop projections called osteophytes. These may contribute to pain and inflammation.
Research shows that keeping active and maintaining your weight in the healthy range is the best approach to managing osteoarthritis. Advanced osteoarthritis can result in loss of normal strength and mobility. Eventually surgical options such as arthroscopy or joint replacement may be indicated. Physiotherapy can help delay the need for surgery.
Rheumatoid Arthritis
Rheumatoid Arthritis (RA) is an inflammatory auto-immune condition in which the body’s immune system attacks the joints. Morning stiffness can typically last for half an hour or longer after rising. Pain and inflammation can be severe if the condition is left untreated.
This form of arthritis commonly attacks many joints in the body on both sides. This includes the small peripheral joints in the hands and feet, spinal joints, shoulders, elbows, knees and hips. In Australian diagnosis is usually made by a rheumatologist based on history, clinical examination, blood tests and X-rays or scans.
In RA, the synovial lining of affected joints becomes inflamed and the joints are red, hot and swollen. Without treatment there is thickening of the joint capsule. The adjacent cartilage and bone can become damaged causing joint deformity. RA can also affect blood vessels, lungs, heart and skin. New medications are available that help prevent the joint destruction and tissue damage, which people with rheumatoid arthritis previously developed.
The cause of RA is unknown, but it’s more common in women, affects smokers more than non-smokers and there are appear to be hereditary factors.
Gentle exercise helps rheumatoid arthritis sufferers to relieve stiffness and promotes good circulation, maintaining joint mobility without aggravating pain and swelling. Examples are walking, swimming, hydrotherapy. Feldenkrais can also help to maintain mobility without causing excessive joint strain.
Fibromyalgia
Fibromyalgia is not really a form of arthritis, but it has many similar features. These usually include chronic pain, aching and tenderness in multiple soft tissues and joints without changes on Xrays or blood tests. Fatigue, sleep problems, anxiety, memory problems and / or mood changes are also common. The cause is unknown, but being overweight and inactive is a risk factor.
READ MORE about how Feldenkrais can help Fibromyalgia.
VIEW VIDEO presentation on Fibromyalgia by Jodie Krantz – includes gentle Feldenkrais exercises in sitting.
Treatment: How We Can Help
Physiotherapy, Clinical Pilates and the Feldenkrais Method can all be helpful in managing the pain of arthritis and fibromyalgia. This is where our experienced Perth physios can really help. At Free2Move we initially provide a full assessment, hands-on treatment and home exercises. Therapeutic exercises help to maintain strength and range of movement without aggravating pain or swelling. Exercise also helps with circulation which supports the healing process.
CLICK HERE to read about Turmeric, a natural supplement to help ease arthritis pain and inflammation.The best place to begin is by booking an individual assessment, so that we can work out which treatment or exercise programme is best suited to your needs.Thoracic Outlet Syndrome
Thoracic Outlet Syndrome
In Thoracic Outlet Syndrome, the brachial plexus (a bundle of nerves) and far less often, the subclavian nerve or artery can become compressed by surrounding structures. These structures are:
- The first rib
- The clavicle (collar bone)
- The scalenus anterior muscle
- The scalenus medius muscle
Symptoms of TOS may include arm numbness, pain, pins and needles, coldness or heaviness of the arm. The ulnar nerve is the most commonly compressed and this supplies the inside of the elbow, the little finger and the ring finger so symptoms are often felt but not confined to these area. Sometimes TOS may affect the whole hand, arm, neck and even the side of the face. Symptoms are often aggravated by overhead activities (such as hanging out washing or sleeping with the arm overhead) put traction on the brachial plexus.
Causes and Types
Structural Thoracic Outlet Syndrome is a rare condition, which involves bony restriction of the space through which the nerves and blood vessels pass. This may be due to an abnormality present from birth, such as an extra rib attaching to the lower cervical spine or may be the consequence of injury. Investigations such as a CT scan or MRI can help with diagnosis. Physiotherapy may still be indicated, however consultation with a specialist medical practitioner may be advisable. In some cases it requires surgery.
Functional Thoracic Outlet Syndrome (also known as Physiological Thoracic Outlet Syndrome) is very common condition in which prolonged postures (such as sitting at a computer with shoulders hunched forwards and down) may result in compression of the nerves of the brachial plexus. Excessive tension or hypertrophy of the adjacent muscles may cause direct compression. Muscle imbalances can also alter the position of both the first rib and the clavicle contributing to nerve compression, pain and numbness in the arm. Physiotherapy plays a vital role in this form of the condition.
Muscle imbalances, posture, breathing and TOS
Muscle imbalances occur when particular muscles may become short and tight due to overuse of poor posture. These include the scalenus anterior and medius and the pectoralis major and minor and the subclavius. The opposing muscles are usually weak (rhomboid major and minor and trapezius). The result of this imbalance (or perhaps the cause of it) is poor posture. When the shoulders and clavicle pulled forward and down for prolonged periods, this may result in a reduced space in the thoracic outlet. In addition an upper chest breathing pattern will tend to pull the first rib upwards, further reducing the size of the thoracic outlet, with the potential to cause TOS.
Scalene Muscle Tightness
There are three scalene muscles and the two at the front, scalenus anterior and medius, connect the side of the neck to the first rib. The brachial plexus passes in between them and may become compressed. Painful trigger pains in the scalenes may also refer pain to an area just behind the scapula (shoulder blade) the upper arm, forearm and thumb side of the hand. Tight scalenes can also cause neck pain. If you breathe with an ‘upper chest’ breathing pattern the scalenes can pull the first rib up towards the neck and Clavicle, further reducing the size of the thoracic outlet and putting pressure on the brachial plexus.
Pectoralis Minor Tightness
The pectoralis minor connects the front of the shoulder to the front of the chest wall. It pulls the shoulder forwards and downwards and when the shoulder is in this position for prolonged periods, it becomes tight, short and sometimes painful. Trigger points in this muscle may refer pain to the front of the shoulder and chest and the inside of the arm, little finger and ring finger. ‘Pectoralis Minor Syndrome’ occurs when this muscle compresses the brachial plexus as it passes between the muscle and the chest wall. Pectoralis minor can also affect the thoracic outlet by pulling the clavicle down, reducing the functional size of the thoracic outlet.
Pectoralis Major and Subclavius tightness
The pectoralis major and subclavius muscle pull the shoulder forward and so tightness will accentuate the aggravating posture. In addition subclavius can pull the first rib upwards in a person who has an upper chest breathing pattern.
Rhomboids and Trapezius Weakness
Weakness in the middle trapezius and rhomboids muscles can result in the ‘shoulders down and forward’ position that predisposes to Thoracic Outlet Syndrome. Strengthening these muscles and correcting posture can help to reduce pressure on the structures which pass through the thoracic outlet.
Above: brachial plexus passing under the pectoralis minor and in between the scalenes
Physiotherapy Programme for overcoming Thoracic Outlet
- Stretch the relevant tight muscles (usually scalenes, pectorals and subclavius)
- Massage the affected muscles and treat trigger points with acupressure or acupuncture
- Mobilise the first rib in a downwards direction
- Improve breathing pattern by teaching relaxed diaphragmatic breathing where relevant
- Strengthen the opposing muscle groups (usually trapezius and rhomboids)
- Improve posture and muscle use – taping may be helpful
- Teach brachial plexus nerve glides for radial, median and ulnar nerves as relevant.
Recovering from a Lumbar Disc Injury
Recovering from a Lumbar Disc Injury
A disc bulge or prolapse can occur in the neck, lower or middle back. The lowest lumbar discs (L4/5 and L5/S1) take the most weight and often form a ‘hinge point’ for movement of the trunk. By far the majority of lumbar disc injuries occur at these two levels.
Basic Anatomy and Pathology
To understand a disc bulge or herniation first requires a basic understanding of the anatomy. The spine consists of a series of 24 vertebrae, plus the sacrum and tail bone at the base of the spine. Each inter-vertebral discs sits between a pair of vertebrae, acting as a shock absorber and allowing the spine to bend. Each disc is a mini-hydraulic system, with tough, concentric fibrous layers on the outside (the annulus fibrosus) and soft mobile material in the centre (the nucleus pulposis).
A disc bulge occurs when a weakness in the outer wall (the annulus fibrosis) allows the disc to change shape. The material on the inside (the nucleus pulposis) bulges outwards deforming the outer wall, which may put pressure on sensitive surrounding structures including the nerve roots. This is a common and less severe form of disc injury.
A disc herniation (also called a disc prolapse) occurs when pressure on the disc causes the softer nucleus material to crack the outer wall of the disc and leak out.
Most commonly the material bulges towards the back of the body, either centrally or to one side, where it may put pressure on sensitive structures such as ligaments and spinal nerves. Local swelling and inflammation may increase this pressure. Irritation of the nerve roots in the lower back may cause sciatica – pain anywhere along the course of the sciatic nerve, which passes through the buttock, down the back of the thigh, where it divides in two branches which go down the lower leg to the foot. (Not all leg pain associated with lower back problems are caused by sciatica however.)
Symptoms
With a minor lumbar disc bulge or herniation, pain will be localised to the lower back, possibly radiating to the buttock or thigh at times. The pain is usually worsened by prolonged sitting, bending, or simply staying in any one position for too long. In more severe cases, pain may extend down the leg on one or both sides, or alternate sides, sometimes as far as the foot. The pain may be constant or may come and go.If the disc impinges on a nerve root, there maybe be neurological signs such as numbness, pins and needles or loss of power in parts of one or both legs. People with significant neurological symptoms may have to consider surgery, however surgery poses significant risks and in most cases it is worth trying less invasive approaches first.
Things to consider
Please bear in mind two things. Some people have a disc bulge on MRI or CT scan but no pain at all. Also pain often comes from more than one structure. You could have an un-diagnosed problem in addition to the disc bulge, such as a jammed facet joint or sacro-iliac joint or soft tissue pain from muscles and ligaments, which cannot be imaged well with CT scanning. Inflammation, instability or minor mal-alignment may not show up on any scan. Just because a disc problem shows up on your scan does not prove that this is what is causing your pain.
Can a disc heal?
Now the important question about the disc. Can it heal? YES. A major prolapse or herniation may not heal by itself and surgery may be advisable in some cases, but potentially a bulge and small to moderate sized prolapses can be healed by the body’s own repair processes in time. How long? That depends on how severe and how unstable it is, your age and most importantly how much stress you put on it, which is the part you can control. It also depends on the state of your spinal and abdominal muscles, as weakness or imbalances in these may be part of what caused the problem in the first place.
With a disc bulge, the walls of the disc are still intact, and healing time is shorter, though in some cases it can still take months. With a disc herniation (prolapse) it can take many months or even years to resolve.Once you injure your disc, it will be unstable for a period of time (months or years for a severe prolapse). This means that the disc will bulge a lot more than usual when you are weight-bearing (eg standing, sitting, bending, lifting) and typically gets worse as the day goes on. An unstable disc is more likely in a young or middle aged person because as you get older the disc dehydrates and the nucleus becomes more rigid – stiffer but more stable. Young people may heal quicker after a disc injury due to tissue repair processes.
How to recover in the shortest possible time
Acute stage: severe, disabling, constant pain
- Rest. Rest. Rest some more. Get horizontal as frequently as you can during the day. Take time off work. Avoid sitting as much as possible and if you do sit never slouch on the couch. Lie down or stand leaning back against the wall if you are tired.
- Avoid lifting anything over 2 – 5 kg and avoid any thing else that aggravates the pain.
- Don’t stiffen against the pain. Try to keep moving and relax your muscles. If possible get up and walk around regularly but lie down again if pain starts to worsen.
- Learn some gentle exercises that you can do at home to maintain your range of movement and activate the spinal support muscles. Get professional help from an experienced Physiotherapist for this.
- See your doctor for a neurological examination and medication to assist with managing the pain. Too little pain medication may result in severe muscle spasm and create a vicious cycle of pain and tension. Too much analgesia and you may unknowingly move in a way that aggravates the problem.
- Try other pain relieving measures such as a heat packs, cold packs or a TENS machine.
- If you absolutely have to sit, try various back supports to improve your posture and spinal stability for example an individually moulded back brace can be fitted for you and worn a few hours a day to improve spinal stability and comfort while you are on your feet. A lumbar support cushion can often help when you have to sit.
The single biggest factor in disc healing, in my opinion, is NOT STRESSING IT. You want to maintain your physical fitness, range of movement and strength to the best of your ability without aggravating the pain. Aggravation of the pain may mean that you have pushed the wall of the disc out further again, worsening the bulge.
Importantly, no practitioner can ‘put a disc back in’ though some claim to. The temporary relief of pain associated with adjustment / manipulation may be due to the release of neuro-chemicals – your body’s own pain relieving substances. Massage and physio can relieve other aspects of the pain such as joint stiffness and muscle spasm, but this is also temporary. There is also a high risk of aggravating a disc injury with spinal adjustment, manipulation or even massage.
Be very cautious with any exercises. You have to start with very minimal subtle exercises and progress vary carefully under professional guidance and listening to your own body.
Sub-acute stage: moderate pain which comes and goes
- Gradually get moving. Walking can be a helpful exercise for some people, others find it aggravating. Pace yourself. Listen to your body’s messages. Try walking in warm, waist-deep water, but remember anything can aggravate your symptoms if you over-do it.
- Restrict sitting to short periods of time if it aggravates your pain and always use adequate lumbar support, such as a BodyBolster or contoured lumbar cushion, especially when driving or sitting at a computer. (Free2Move sell both.)
- Have a Physiotherapy assessment and get an individual exercise programme specific to your individual situation. Remember that the wrong exercises or exercising too soon can make you worse instead of better.
- Get your Physiotherapist to show you how to test the safety of any exercise. Learn which type of exercises relieve your pain – for example spine neutral or extension based exercises are usually best for lumbar disc pain.
- Be careful but not overly cautious (or stiff) when bending and lifting. Don’t lift anything over 5 to 10 kg. Get your Physiotherapist to check your lifting and bending techniques.
- Learn to let go of the muscle spasm (Feldenkrais classes are amazing for this – more effective than a massage and you can do it for yourself).
- Improve postural awareness (Feldenkrais and Clinical Pilates)
- If you aggravate things go back to the acute stage.
- Have patience. A moderate disc bulge will take around 6 weeks to get better but only IF you do the right thing, but may never heal if you keep aggravating it.
- See your doctor if symptoms don’t improve.
What if it becomes chronic?
A ‘chronic’ condition is one that persists over time without improving, usually more than 3 months. Once a condition becomes chronic it is harder to reverse, because the body adapts to it. Changes occur in the way your brain interprets pain messages. Muscle imbalances and compensation patterns often develop. These may have been part of the initial cause of the injury, or may have developed as part of your body’s response to the injury. Either way once this occurs the disc injury and / or the pain associated with it become the body’s ‘normal’ state and you have to find a way to break the cycle.
Recent research shows that people who develop low back pain have difficulty activating the deep abdominal and pelvic muscles which are a part of the normal stabilising mechanisms of the lower back. The muscles may have become weak, difficult to activate, or there may be a delay in their activation, so that they are too slow to switch on. You may go to lift something for example and at the critical moment, if the muscles have not engaged to stabilise your lower back, the result is strain and further injury.
Muscle spasm or tightness is also extremely common in people who have chronic lower back. Immediately after your injury, the muscle spasm actually helps to protect you, It restricts your movement and helps avoid further damage. Long term though, the muscle spasm becomes a source of considerable pain and inhibits normal movement. Here’s an analogy: If you break a leg and don’t get it set in plaster (or surgically fixed) the bone might not ever heal. But if you left the plaster on for the rest for the rest of your life, the plaster would become the problem, rather than the solution to your problem.
Surgery may be less likely to be effective once pain becomes chronic, because surgery can help correct the structural problems but the defective way that the muscles are working can only be corrected by skillful muscle re-education. If you do end up having surgery it is absolutely essential to participate in a specific muscle and posture re-training programme that is customised to your particular strengths and weaknesses. It is very hard to work this out yourself, even if you are a therapist or movement teacher, because you will almost certainly have ‘blind spots’, things you are not aware of about your own habitual muscle use.
The major tasks in recovering your normal muscle function and posture are:
- Correcting imbalances which occur when one muscle group becomes habitually tight and it’s opposing group switches off or becomes significantly weakened.
- Sensing ‘neutral’ postural alignment in order to correct your posture.
- Learning safe ways to move and do everyday things so that you won’t re-injure yourself, for example learn to improve the way you roll over, get up from lying or sitting, bend, reach and lift so that there is the least possible strain on your back.
- Read More about Chronic Pain
Good luck and remember it will take time to recover. Make sure you get professional help so that you are sure you are on track, but also it’s critical that you learn to listen to your own body signals. For this I have not discovered anything better than the Feldenkrais Method.
Free2Move Physiotherapists are now able to offer secure video linked online consultations using Telehealth technology.
BOOK HERE
Copyright Jodie Krantz February 2020
Joint Hypermobility Frequently Asked Questions
Joint Hypermobility Frequently Asked Questions
What is Joint Hypermobility?
Joint Hypermobility is a condition in which joints can be moved beyond the normal or expected range of movement – sometimes referred to as being double jointed. When Joint Hypermobility affects multiple joints in the body, it may be due to a systemic condition causing excessive mobility of the connective tissues which bind the body together, including ligaments, tendons, muscles, skin, blood vessels and the gastrointestinal tract.
Does Joint Hypermobility cause pain?
The condition does not necessarily cause pain in and of itself, in fact it may be an advantage to have extra flexibility, for example, many dancers and gymnasts are hypermobile. However the disadvantage is that extra flexibility may result in poorer stability, a difficulty in sensing the position of joints (reduced proprioception) and a susceptibility to injuries such as joint sprains or dislocations along with slower recovery.
What is Joint Hypermobility Syndrome (JHS)?
Joint Hypermobility Syndrome, sometimes called Benign Joint Hypermobility Syndrome (BJHS), refers to a group of conditions in which Hypermobility occurs along with chronic pain (pain lasting more than 3 months) and affects multiple joints. It has been recognised condition since 1967.
Why does it take so long to arrive at a diagnosis of JHS?
Joint Hypermobility Syndrome has been under recognised and under treated by health professionals and the medical establishment, though awareness of the condition is growing. Because people with JHS may exhibit a good range of movement even when they are in severe pain, their pain may have been ignored or trivialized at times. It may even have been implied that they are exaggerating or imagining the pain or that they are just suffering from anxiety.
What are the Causes?
Joint Hypermobility is often hereditary, so if you have very flexible joints, it’s likely that one or both of your parents do also. It’s more common in women and in children and adolescents.
Problems with proprioception and sometimes coordination can lead to frequent injury. Recovery from injury is often prolonged, due to recurrent re-injury of the healing tissues. Re-injury may occur without the person realising that it’s happening at the time, such as during periods of prolonged poor posture. A person with hypermobility usually has greater than average spinal movement for example, so can slouch even more fully than someone who is relatively stiff, putting the spinal discs under great pressure.
More serious causes of Joint Hypermobility include several genetic conditions such as Ehrlers Danlos Syndrome (which may cause fragile skin, easy bruising, heart, vascular and lung disorders) and Marfan Syndrome (which may cause skeletal abnormalities, eye, vascular, heart and lung problems). For this reason, people with Joint Hypermobility who have other symptoms are advised to consult a knowledgeable physician for a thorough medical assessment.
Why do people with JHS feel stiff?
Lack of joint stability may result in having to work harder in the muscles to hold yourself up against gravity, so people with Joint Hypermobility may find prolonged sitting and standing extremely difficult. This can lead to slouching along with painful overuse of the superficial muscles, along with limited activation of the deeper ‘core’ muscles that would normally assist with balance and stability. The result can be feeling tight and stiff all over, however stretching (for example yoga classes) may exacerbate the problem by increasing joint mobility.
What other problems may be associated with Joint Hypermobility?
Varicose veins, hernias, pelvic organ prolapse, irritable bowel syndrome, stretch marks and scarring, snapping or clicking joints, scoliosis, fibromyalgia, osteoarthritis, pronated feet, fatigue, anxiety and depression are conditions which may be related to and co-exist with Joint Hypermobility. Conditions which affect the autonomic nervous system, including palpitations, dizziness, fainting and excessive sweating are also more common in people with JHS.
Is it better to rest or exercise with JHS?
Regular physical activity, especially during the teenage years when the body is growing quickly, assists the development of a strong and healthy musculo-skeletal system that is resistant to injury. However with JHS pain can cause avoidance of exercise and physical de-conditioning. In the long term this can result in more pain. Although rest may be required at times to assist with tissue healing following injury, staying active and improving cardio-vascular fitness, strength, core stability, balance and posture and keystones in the management of JHS.
Recommended exercises include Clinical Pilates, the Feldenkrais Method, swimming, hydrotherapy and Tai Chi. Contact sports and any forms of exercise with a high risk of injury are not advisable for most people with hypermobile joints. The important thing is to find a balance and exercise that is right for the individual. Advice from a Physiotherapist with an understanding of JHS can be very valuable.
Connect with others
There is a is a great new blog site where you can get information and support. Visit Hypermobility Connect.
How We Can Help
The Feldenkrais Method is very useful when someone has moderate or severe pain. People with JHS frequently report that they don’t feel pain during physical activity, they only feel it afterwards, when it is too late to change the way in which they move.
Feldenkrais helps you become more aware of small discomforts, before they develop into pain, so that you can stop and change the way you are doing something. Because it is so gentle even people with severe pain can participate in one-to-one Feldenkrais sessions, with view to progressing to classes, where they can gain greater independence and freedom from pain. Through gentle movement lessons, participants clarify their ‘self image’ – the detailed map of the body, which everyone has in their brain. Improved body awareness and proprioception reduces the frequency and severity of re-injury, allowing the body to repair the damaged tissues.
Clinical Pilates can assist teenagers and adults with JHS and mild to moderate pain to safely improve their body awareness, posture and strength, promoting a return to more vigorous forms of physical exercise. Individual assessment is essential prior to commencing our programmes.
Learning easy graceful movement through Feldenkrais
Awareness Through Movement Feldenkrais Lesson Learning easy graceful movement through Feldenkrais
No strain, more gain with Feldenkrais
By Jodie Krantz (Physiotherapist and Feldenkrais Teacher)
The Feldenkrais Method…
The Feldenkrais Method is named after its inventor,Moshe Feldenkrais, Israeli judo master and internationally renowned physicist. By exploring exactly how we move, and then expanding our movement repertoire we not only enhance the quality of our movement, but open up all sorts of new possibilities, some of them delightful and unexpected. Feldenkrais is not primarily about exercise or therapy. It is about learning.
In “Awareness Through Movement” lessons, students are verbally guided through a series of gentle and often relaxing, (but not necessarily easy!) movements, mostly done lying on the floor or sitting in a chair.
Unusual and thought provoking, the lessons stimulate and challenge both the mind and body to find more efficient patterns of coordination that help us in our everyday lives. Students work very gently and slowly and are encouraged to do only what feels safe and comfortable for them. In “Functional Integration” students receive an individual one-toone lesson, while lying or sitting, comfortably clothed, on a low padded table. The practitioner provides the student with very gentle and respectful hands-on movement guidance.You have to walk before
you can run…Moshe Feldenkrais studied the way in which we learn to move as a children. Children appear to move so freely and easily, even though their
coordination may not be fully developed. They also seem to learn very quickly compared with adults. The
Feldenkrais Method takes us on a journey through the ‘basics’ of movement, often mirroring the developmental sequence. We use a ‘trial and error’ method of learning similar to that used by babies. These fundamental movements then become building blocks for more
difficult and complex actions.Kick the habit…
Most of us, particularly as we get older, simplify our movements so that they become less varied. Have you ever noticed that you always tend to dry yourself or brush your teeth in the same sequence? Do you
cross your legs with the same leg on top each time? Do you tend to chew more often on one side of the mouth? Such habits are not usually conscious and they have the benefit that we don’t have to think about how to move every time we want, say, to get dressed or drive the car.
The trouble with habits is that they are not always the most efficient way
of moving. They often result in some parts of the body getting ‘worn out’ and other parts losing strength and flexibility because of disuse. In Feldenkrais we update and improve upon our own particular movement habits learning to move in a wider variety of different ways, so that the
wear and tear is shared more evenly.The impossible becomes possible…
Feldenkrais is about the impossible becoming possible, the possible easy and the easy graceful.
Difficulties such as aches and pains or limitations in our strength, flexibility or coordination can motivate us to find new ways of moving that reduce the strain and restore a sense of wellbeing. For example if you can’t get up off the floor without assistance you may learn a simpler way of doing it. Or maybe you can sit
unsupported by the back of a chair, but what if it were to become so easy it felt almost effortless? Imagine rolling over in bed (easy for most
people) becoming so fluid and graceful that you find yourself sleeping as deeply and peaceful as a baby? In Feldenkrais wedon’t have to try hard to improve. Consciously focusing our awareness on how we do
things and exploring a variety of movements alternatives, begins to reprogramme the subconscious part of our brain, changing our automatic movements and posture.
You’re the boss…
With Feldenkrais lessons, you are considered to be the ultimate authority on your own body. Only you know it from the inside and especially
as your body awareness increases, you can feel whatis right for you and what is harmful. This is an opportunity to take charge of your own wellbeing. Your Feldenkrais teacher is there simply to guide you in a process of learning about yourself, from yourself.
