Facial Paralysis – Changing a habit of a lifetime
At Range of Motion Physical Therapy Lucan, I have been working with a client who has suffered from Facial Paralysis his entire life. My client approached me a month ago following on from writing an blog on Diaphragmatic Breathing, he explained that he does a lot of running and has always felt the right side Facial Paralysis has effected his breathing. When he runs he feels his right lung does not fill completely and thus he tires quickly and feels very labored.
On examination of his breathing pattern it was obvious he was a chest breather with tight neck and low back muscles, also when breathing I could see his left side was expanding more than his right.
In those of us that are chest breathers we use our neck muscles more (specifically Scalene and SCOM muscles), these muscles would be used to lift the ribs in chest breathers. With my client it stands to reason that his Facial Paralysis would inhibit these neck muscle thus restricting his right side chest breathing pattern.
In terms of a treatment I focused on getting him to change his breathing habit and have him learn to breath through his diaphragm more and remove the influence of his weaker neck muscles. I also released his neck muscles, diaphragm and low back muscles used in the breathing cycle. As a home exercise programme I gave a number of breathing exercises that helped queue him to use his diaphragm more and focus on his weaker right side. He progressed through a couple of stages over 2 weeks.
After only 2 weeks he has noticed a difference in how he breaths (more Diaphragmatic) and feels more control and strength in his right side. At his last appointment I included more basic core straightening exercise to do in conjunction with some more breathing progressions.
I got a great email from him after doing a run session with his club last night…
Hi Andy
Was running this evening and tried to use the new breathing technique. Not sure if I got it 100 per cent but definitely made a difference even the bad effort. However once I got tired I found myself slipping into old habits, but tried to refocus and it worked a bit. My legs didn’t seem to get as tired as before and it felt easier in general.
I am surprised in one way how quickly my body has adapted to it. Though obviously still have a lot to do, but seeing such improvements in such a short time is very encouraging.
Thanks
Great improvements but still work to do to change a habit of a life time…
Hamstring injury prevention and rehabilitation
Recently at Range of Motion Physical Therapy I have been seeing a number of people with a hamstring injury, my clients have varied from GAA and Rugby Players to Triathletes and avid hill walkers. As a result, I have been doing some additional reading up on Hamstring injury prevention and rehabilitation,n and came across this article, and felt the need to share it.
This article gives a great overview of the causes of hamstring injuries, and gives great easy to understand explanations. What I also liked was the authors approach to questioning traditional preventative and rehab exercise techniques. For example they look at strengthening exercises as an intermuscular coordination with both hip and knee and to replicate more high speed movement, this is in contrast to traditional techniques which would have taught to isolate hamstring through the knee joint only and the use of eccentric exercises e.g Russian Nordic Drop exercise, which they now feel is contraindicated in hamstring injury rehabilitation
A systematic approach to hamstring prevention and rehabilitation
This article is well worth a read and you can draw your own conclusions and adopt elements into your training.
Any questions please feel free to contact me below.
Range of Motion Physical Therapy Newsletter April 13
Foam Rolling Exercise for the Lower Body
Working with a number of athletes I am always suggesting they use a foam roller to help with flexibility in between Sports Massages.
With this in mind I did a video clip on how I like to foam roll my lower body (thanks to my sister), clients can now access the clip and follow it as they roll.
Foam rolling helps stretch muscles and tendons while also breaking down soft tissue adhesion and scar tissue. By using your own body weight you can perform a self sports massage, break down trigger points, and soothe leg pain, neck pain, shoulder pain, back aches and tightness, while increasing blood flow and circulation to the soft tissues.
It is advisable to use the foam roller a couple of times a week in conjunction with your stretching routine. Click link below is a good link to some good foam rolling exercises!!
Foam Rolling Clip:
Ankle Proprioception & Strengthening:
As part of a postural assessment I always assess a clients ability to squat as it is a great exercise to assess a number of joints while moving, one area I focus on are the ankles and look for pronation.
Ankle pronation can be as a result of fallen arches, weakness due to an old ankle injury or poor ankle strength. In most cases it should be possible to correct fallen arches and strengthen weak ankles without the use of orthotics…. the Tripod foot position is the first step followed by ankle proprioception exercises.
The Tripod foot position teaches people how to be more aware of their arch so as to correct and evenly balance their weight through their arches, while also helping build the strength and endurance to maintain this position. This exercise takes a bit of practice and once you have mastered it you can practice it anywhere.
The Foot Tripod position involves allowing your body weight to be evenly distributed across three points of contact with the floor.
the Ball of the Big Toe
the Ball of the Little Toe
the Heel
With the tripod foot position it is important to try to balance your weight throughout your foot and try not to use your toes for balance i.e. toe gripping.
Tripod Foot Exercise Video:
Ankle Proprioception exercise are an important exercise to help rehab an ankle after sprain or break. Proprioception or balance is defined as unconscious internal perception of movement and knowledge of the body’s orientation in space. We can teach the ankle where it is in relation to other objects (e.g. striking the ground). Increased proprioception can then help decrease the risk of injury by increasing balance and awareness, and you will be able to control your body more effectively.
Proprioceptive training is done through balance exercises.
Balance Training:
Standing on one leg: Hold for 30 seconds, working up to one minute per leg.
Stand on one leg with eyes closed: Hold for 30 seconds, working up to one minute per leg.
These can be progressed by using a cushion to make you work harder and further improve your proprioception:
Balance on a cushion on one leg: Hold for 30 seconds, working up to one minute per leg.
Balance on a cushion on one leg with eyes closed: Hold for 30 seconds, working up to one minute per leg.
These can be further progressed by introducing movement e.g. squat or catching a ball.
Proprioception Exercise Video:
Fallen Arches and Ankle Stability
At Range of Motion Physical Therapy we see a lot of people with fallen arches, or who are over-pronating or who have poor ankle stability. These problems can be as result of poor arch strength, ankle sprains that have not been rehabed properly or poor ankle proprioception, among other things.
Over the course of the next couple of blogs I am going to show how to improve arch and ankle strength, while also improving proprioception of the ankle.
I always tell clients it should be possible to correct fallen arches and strengthen weak ankles without the use of orthotics….and the Tripod foot position is the first step.
The Tripod foot position teaches people how to be more aware of their arch so as to correct and evenly balance their weight through their arches, while also helping build the strength and endurance to maintain this position.
This exercise takes a bit of practice and once you have mastered it you can practice it anywhere.
The Foot Tripod position involves allowing your body weight to be evenly distributed among three points of contact with the floor.
the first metatarsal head
the fifth metatarsal head
the heel
With the tripod foot position, weight should not be shifted forward towards the toes or backward on the heel at any point during performance of an exercise. Likewise, weight should not be shifted medially or laterally.
I have attached a video to assist you to master the exercise, once you can hold the position you can progress onto doing some simple movements such as a small squats, but making sure you are maintaining the tripod position throughout the movement. If you lose the position stop, reset and repeat. It may also help to tighten your glutes when squatting to help the stability from the hips to feet.
If you would like to learn more please contact me for an appointment.
- See more at: http://www.romphysicaltherapy.ie/index.php/fallen-arches/#sthash.lzUXqxw2.dpuf
Foam rolling lower body
Foam Rolling Lower Body at Range of Motion Physical Therapy Clinic in Lucan I would always advise athletes to use a foam roller a couple of times a week. Working with triathletes and runners on a regular basis I would recommend integrating Foam roller exercises into their stretch routine.
Foam rolling helps stretch muscles and tendons while also breaking down soft tissue adhesion. fascia and scar tissue. By using your own body weight and a cylindrical foam roller you can perform a self sports massage, break down trigger points, and soothe leg pain, neck pain, shoulder pain, back aches and tightness, while increasing blood flow and circulation to the soft tissues.
It is advisable to use the foam roller a couple of times a week in conjunction with your stretching routine.
Rounded Shoulders
Rounded Shoulders
At Range of Motion Physical Therapy Lucan I see quite a large number of people with postural related issues and injuries, in particular rounded shoulders. A large proportion of us slouch at our desks, also as we walk or stand.
You can do a quick test to see if you have rounded shoulders, stand with your arms relaxed, if your hands hang in front of your tights and your hands face back, your chest muscles may be tight, causing your shoulders to hunch forward. Ideal posture will mean your hands hang more by your side and are facing toward your sides with thumb pointing forward.
Rounded shoulders can develop over time as we repeatedly sit in front of a computer, drive a vehicle, or watch TV slouched in a seat. The habit can start as early as our school years, as we slump forward to carry heavy school bags, sitting at our desks. Also if you lift weights and work your “pecs” to much you can create pectoral (chest) muscles that are so strong that will pull your shoulders forward.
When we slouch with shoulders forward, the muscles in the upper back and neck strain, get overstretch and overwork. As we keep rounding our shoulders, our pectoralis muscles become short and tight. As a result,the mid-trapezius and the rhomboids are overstretch and weak. Smaller muscles that were not designed to be postural muscles have to work hard doing a job they weren’t meant to do and chronic tension develops in the neck, shoulders and upper back.
Reversing Rounded Shoulder Posture
If you want to prevent or fix rounded shoulder posture, you can start with some of the simple exercises I have below, in addition to these exercises you can stretch your pec muscles and correct your posture while going about your daily routine.
The exercises below help to strengthen the muscles between the shoulder blades and upper thoracic region.
If you would like to learn more about Postural Education please contact me for an appointment.
Understanding Pain
What Is Chronic Pain and Understanding Pain?
Millions of people suffer from chronic pain — pain that lasts longer than six months. Chronic pain can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating.
With chronic pain, signals of pain remain active in the nervous system for weeks, months, or even years. This can take both a physical and emotional toll on a person.
The most common sources of pain stem from headaches, joint pain, pain from injury, and backaches. Chronic pain may originate with an initial trauma/injury or infection, or there may be an ongoing cause of pain. However, some people suffer chronic pain in the absence of any past injury or evidence of body damage.
The emotional toll of chronic pain also can make pain worse. Anxiety, stress, depression, anger, and fatigue interact in complex ways with chronic pain and may decrease the body’s production of natural painkillers; moreover, such negative feelings may increase the level of substances that amplify sensations of pain, causing a vicious cycle of pain for the person. Even the body’s most basic defenses may be compromised: There is considerable evidence that unrelenting pain can suppress the immune system.
Because of the mind-body links associated with chronic pain, effective treatment requires addressing psychological as well as physical aspects of the condition.
What Are the Symptoms of Chronic Pain?
The symptoms of chronic pain include:
Mild to severe pain that does not go away
Pain that may be described as shooting, burning, aching, or electrical
Feeling of discomfort, soreness, tightness, or stiffness
Pain is not a symptom that exists alone. Other problems associated with pain include:
Fatigue
Sleeplessness
Withdrawal from activity and increased need to rest
Weakened immune system
Changes in mood including hopelessness, fear, depression, irritability, anxiety, and stress
Disability
Check out the video to see what you can do to start helping yourself!!
Range of Motion Physical Therapy Newsletter March
Postural Exercises for Rounded Shoulders
Following on from my shoulder impingement piece last month, I decided to talk more about Posture and in particular Rounded Shoulders. As depicted above rounded shoulders is were our shoulders are being pulled forward by tight chest (pec) muscles and our arms hang more to the front of our bodies than the side.
This shoulder position is not the optimum position for when we move and use our arms, particularly for overhead movement. Rounded shoulders can lead to shoulder impingement injuries in people depending on what they do from day to day.
In an attempt to assist clients and help them to correct this postural issue I explain how rounded shoulders develop and the importance of maintaining a correct posture. I also show some simple exercises to strengthen the muscles between the shoulder blades and upper thoracic region.
Below is a link to my website where you can view the clips.
Rounded Shoulders Exercise:
If you would like to learn more about Postural Education please contact me for an appointment.
Thoracic Outlet Syndrome
Recently at Range of Motion Physical Therapy Lucan, I had a client attend the clinic with what is commonly know as Thoracic Outlet Syndrome (TOS).
The clients symptoms caused them to wake in the middle of the night with numb hands and pins & needles, they described it like sleeping on their arm. The numbness was only present at night and had been ongoing for 2 weeks with no relief.
The client had no history of neck pain or recent injury to neck or shoulders. During history taking the client explained they had recently changed jobs that involved more manual lifting and carrying, with long shifts and long commutes to work by car.
On physical examination there was no pain in neck or shoulder movements, I observed slight restriction in neck movements and very tight neck muscles. Also their posture was not great with rounded shoulders and forward head posture. I was able to recreate the numbness sensation in the arms and hands by compressing down on their collar bone and also having them do a Roos Test.
So what is TOS!
Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between your collarbone and your first rib — become compressed. This compression can cause pain in your shoulders and neck and numbness in your fingers/hand.
Common causes of thoracic outlet syndrome include physical trauma, repetitive injuries from work, such as my client – or sports-related activities. There can also be certain anatomical defects, such as having an extra rib, and pregnancy.
Treatment for thoracic outlet syndrome usually firstly involves physical therapy and pain relief measures. With this client I worked on the tight neck muscles and gave home stretches and educated them on their posture. Following the 2nd treatment I reassessed the client and they reported no numbness into their hands.
In addition to the treatment the client also said using a warm hot water bottle around the tight neck muscles helped relief the numbness.
Please contact me should you wish to discuss this issue or any further issues.
Range of Motion Physical Therapy Newsletter Feb 13
Shoulder Impingement
One of the more common injuries I see at Range of Motion Physical Therapy is shoulder pain. Our shoulders are made up of several joints combined with tendons and muscles that allow a great range of motion of the arm. The shoulder is vulnerable to many different problems, I will focus on the more common source of pain and injury, the rotator cuff and impingement.The rotator cuff keeps the head of the humerus in the shoulder socket.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). This bursa allows the rotator cuff tendons to glide freely when you move your arm. (see image above)
Types of complications:
Tendinitis. The rotator cuff tendons can be irritated or damaged.
Bursitis. The bursa can become inflamed and swell with more fluid causing pain.
Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.
Rotator cuff injuries are common in both athletes and middle-aged people, athletes who participate in overhead sports such as swimming, baseball, or tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible from over use issues.
Symptoms:
- Minor pain that is present both with activity and at rest
- Pain radiating from the front of the shoulder to the side of the arm
- Sudden pain with lifting and reaching movements
As the problem progresses, the symptoms can worsen:
- Pain at night lying on shoulder
- Loss of strength and motion in the shoulder
- Shoulder pain reaching arm behind the back
I would always advise people seek help for an injury that persists for more than 10 days.
Treatment:
In most cases, initial treatment is conservative involving rest, ice and gradual return to function. A physical therapy treatment will include postural assessment and orthopedic test to identify any postural/muscle imbalances in the shoulder and the cause of the impingement. Treatment will involve hands on soft tissue work, strengthening and stretching targeted muscles, to improve movement patterns and prevent the impingement and pain. As your pain is improving, a shoulder strengthening program for the rotator cuff muscles will be initiated.
If you are suffering from shoulder pain and please contact me for an assessment and treatment. www.romphysicaltherapy.ie