Neck Pain

Should I receive manual therapy and/or exercise for my neck pain?

Background:

·         Neck pain affects approximately 1/3 adults each year¹

·         Many people with neck pain say it is disabling²

What is effective treatment for neck pain?

·         The best available evidence suggests a multimodal approach including manual therapy and exercise may be the optimal treatment for neck pain^3-6. 

What do most people do for their neck pain?

·         A survey in 2001 suggested that only 1/4 people with neck pain receive care from a health care practitioner⁷.

·         Many people with neck pain receive care with limited or no supporting evidence, including: heat, cold, electrotherapy, massage, bracing, ultrasound, and certain narcotics⁸.

·         The treatment with the most supporting evidence, exercise, is underused⁸.

Why are patient decision aids helpful?

·         It is important that people with neck pain are involved in their own care to make sure that their treatment matches their preferences⁹

·         In order to make a treatment decisions, patients need support and knowledge

·         Patient decision aids increase patients knowledge and get people more involved in their own treatment decisions¹⁰

Why is a patient decision aid for neck pain needed?

·         We recently conducted a study where we asked people with neck pain about their experience in seeking care for their condition¹¹

·         People said they needed more useful information and needed to be listened to

·         People with neck pain also voiced concerns over the potential benefits and side effects of treatments, in particular, chiropractic manipulation

·         The patient decision aid attached provides the useful information needed to make a decision on whether or not to receive manual therapy and exercise for neck pain.

·         The patient decision aid provides a tool to help people discuss the risks and benefits of treatment with their health care provider

Should I receive manual therapy and exercise for my neck pain?

·         The decision aid attached to this blog post is meant to help you decide whether or not to receive manual therapy and exercise for your neck pain¹².

·         You can use it on your own or take it with you to your doctor or physiotherapist to talk about the options

References:

1)      Croft PR, Lewis M, Papageorgiou AC et al. Risk factors for neck pain: a longitudinal study in the general population. Pain 2001 September;93(3):317-325.

2)      Webb R, Brammah T, Lunt M, Urwin M, Allison T, Symmons D. Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population. Spine (Phila Pa 1976 ) 2003 June 1;28(11):1195-1202.

3)       Graham N, Ho E, Khan M, Gross A, ICON. Physical Modalities for Neck Pain: A Systematic Overview. Unpublished

4)       Gross A, ICON. Manual therapy and exercise for neck pain: A systematic overview. Unpublished.

5)      Gross A, ICON. Psychological Care, Patient Education, Orthoses and Prevention for Neck Pain: A Systematic Overview. Unpublished.

6)       Khan M, Gross A, Sataguida L, Lowcock J, Peloso P, Shi Q, Langevin P, ICON. Medicinal and Medical Injections for Neck Pain: A Systematic Overview. Unpublished.

7)      Cote P, Cassidy JD, Carroll L. The treatment of neck and low back pain: who seeks care? who goes where? Med Care 2001; 39(9):956-967.

8)      Goode AP, Freburger J, Carey T. Prevalence, practice patterns, and evidence for chronic neck pain. Arthritis Care Res (Hoboken ) 2010; 62(11):1594-1601.

9)      Institute of Medicine (2001).Crossing the quality chasm: A new health system for the 21st century.National Academy Press. Washington, DC.

10)  Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD001431. DOI: 10.1002/14651858.CD001431.pub3.

11)  MacDermid J, Walton D, Miller J, ICON. What is the experience of receiving care for neck pain. Open Orthopaedics 2012 (unpublished).

12)  Miller J, Gross AR. Should I receive manual therapy and exercise for my neck pain? A patient decision aid. Physio-pedia 2012. Available at: www.physio-pedia.com. 

Ankle Sprains

Eramosa Physiotherapy: Client Education for ...
“Ankle Sprains”

What is an ‘ankle sprain’?

-          a sprain refers to damage that occurs to ligaments after they have been put under a certain amount of stress

-          ligaments are meant to withstand forces placed on a particular joint in the body and provide mechanical stability during activity

-           ankle sprains most commonly occur to the ligament(s) on the outside or lateral aspect of the ankle, but can also occur to the ligaments on the inside or medial aspect of the ankle

-          sprains can be graded from 1 to 3 depending on the amount of damage to a ligament

What are other injuries that can occur at the ankle?

-          Avulsion Fractures

-          Stress fractures

-          muscle strains

-          Achilles tendonitis

-          Neuropathies

How do ankle sprains happen?

-          A lateral ankle sprain, the most common of all ankle sprains, occurs when

o       the foot is forcibly turned inwards

o       landing from a jump

o       stepping off a step onto the side of the foot

o       landing on uneven surfaces with a twist

-          a medial ankle sprain does not occur as often as a lateral sprain because the foot is stronger and more stable along the inside of the ankle joint but can be sprained by:

o       a high force exerted that forces the foot outwards

-          a high ankle sprain may occur in people who

o       participate in sports involving boots (hockey and skiing), as well as football, rugby, wrestling, and lacrosse

o       a high ankle sprain occurs to ligaments that hold the two leg bones together (tibia and fibula) at the bottom of the lower leg

What will aggravate a sprained ankle?

-          Depending on the grade of tear, walking may cause pain

o       Grade one: no/little limp

o       Grade two: limp and unable to put weight through the foot

o       Grade three: unable to put weight through the foot and the leg of the injured ankle

-          The injured ligament is tender and painful when touched

What will relieve a sprained ankle?

-          Depending on severity, not walking on it

-          No touching or pressing on the ligament

-          Wrapping the ankle as soon as the injury has happened with a tensor band to help prevent much swelling from pooling in the ankle complex/ foot

-          Recognition of injury and initial treatment (see below)

-          Physiotherapy

How will I know if I’ve sustained an ankle sprain?

-          *note: depending on the grade, severity of signs and symptoms will vary:

o       swelling within the first two hours

o       tenderness over ligament

o       a feeling of instability with standing and/or walking

o       bruising

o       loss of range of motion (movement)

What long-term issues may arise if this injury is not dealt with?

-          After you’ve sprained an ankle, the recurrence rate of sustaining another sprain is as high as 70% (1), so treatment is vital for maintaining function

-          Chronic ankle instability: a sequence of ankle sprain injuries that lead to residual symptoms and decreased physical activity abilities (i.e. running)

-          Altered gait (walking) mechanics

Treatment:

The natural history of this injury or prognosis for ankle sprains is proportional to the severity and grade of injury.  Thus, a grade 2 injury takes longer to heal than a grade 1. 

-          Typical treatment protocol:

o      

In the early stage of healing, the goal is protection of the damaged  ligament  to ensure no further damage can be done.  Ice is commonly used to help to decrease pain and help slow down any build up of inflammation and swelling soon after injury.  Elevation of the foot above the heart will help promote movement of any swelling in the ankle back toward the heart to flush out.  The most recent evidence suggests that early mobilization and functional treatment is more effective than immobilization with casts or special boots; in terms of returning to work/sport, less swelling, less instability and greater patient satisfaction (2).  During this early stage, stretching of muscles to prevent contractures and simple pain-free movements at the ankle are recommended to help move fluid out of the swollen foot as well as help maintain the amount of possible movement before progressing to more aggressive treatment

o       In the subacute healing stage, the goal of treatment is to eliminate residual swelling, obtain complete pain-free range of motion in the movements of the foot, and begin strengthening muscles surrounding the ankle to help with function

o       In the final stage of healing, walking with a normal gait pattern is promoted, further strengthening is encouraged, balance exercises are incorporated into a home exercise program to ensure safe and effective walking, stair-climbing, running etc...

o       It is recommended that after one sustains an ankle injury, braces should be worn to prevent further injury/ies when performing leisure activities; whether the activity is a recreational or competitive nature (2)

-          Advanced treatment:

o       development of balance over time and return-to-sport activities are incorporated toward the end of treatment to help you get as close to pre-injury level as possible

o       Return-to-sport activities may not be necessary for all patients

What can Physiotherapy do for this injury?

A registered physiotherapist will help arrange and follow through with a treatment plan that works best for you.  With their extensive knowledge regarding the use of manual therapy to help increase range of motion and decrease pain used in conjunction with modalities, such as a TENS machine, to further aid in decreasing pain, you will notice results after one visit.  Particular stretches and exercises will be prescribed as a part of a home exercise program to help you help yourself get the results you are looking for in no time. 

References:

1.      Hubbard TJ, Hertel.  Mechanical Contributions to Chronic Lateral Ankle Instability.  Sports Med. 2006;36(3):263-267.

2.      McKay G, Cook J.  Evidence-based Clinical Statement: Physiotherapy management of ankle injuries in sport [Internet].  Australia: Australian Physiotherapy Association, 2006 [cited 2012 March 25]. Available from: www.physiotherapy.asn.au