Category Archives: lower limb

Bursitis

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The bursae are small fleshy sacks filled with fluid that help our joints move smoothly and absorb shock. If you think of bursa as a zip lock bag with a small amount of oil inside and no air and then rub it between your hands, your hands will easily slide against each other and this is how bursa work. There are about 160 individual bursa in your body and they are found near your joints where muscle and tendon slide against each other and over your bones, without bursa your joints would creek and grate within.

Like many other musculo-skeletal problems in the body bursitis is often age related and seems to effect women more often than men. The symptoms of bursitis may include swelling and inflammation in your joint but the main one is pain that is made worse when you press against it. Bursitis is not like that “good pain” feeling that you get when a stiff muscle is rubbed, it is aversive to the touch. Bursitis may feel like arthritis but strictly speaking it is not because it does not primarily effect the joint capsule.

Because bursitis can be age related it may manifest with other musculo-skeletal diseases, so if you doctor has told you that you have it but your symptoms are slightly different from those described here that might be why.

Bursitis is caused by repetative strain injuries, cumulative muscle micro trauma, having one leg shorter than the other, arthritis, standing for long periods, accidental trauma and poor posture. Good old fashion neglect won’t help you either, being generally unfit will not help your bursitis nor will poor water consumption.

When your bursitis is very acute doing any exercise may be painful but when you are in your normal day to day living with bursitis routine, regular stretching exercise is a great idea. Ultra-sound, friction massage, ice packs (4-5 times a day), rest and anti-inflammatories can all help relieve the symptoms of bursitis.

In serious cases of bursitis that do not respond well to other measures, fluid may be aspirated via a needle to relieve pressure inside your effected joint. This type of therapy can be effective  thougfh a little on the uncomfortable side, if you try the gentler options first aspiration may be unnecessary.

I have always found massage to be effective on bursitis (Self Massage too), not so much on where the bursitis pain is actually felt but the muscle attached to the particular tendon that the bursae is cushioning. For instance when a person has hip bursitis you will find thigh muscles not far from the pain site that need to be loosened and stretched. Bursitis usually results from the over use of particular muscles.

Blood circulation and your legs

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The circulation of blood (and lymph) around the body is of paramount importance to your health, it is the transportation system that moves nutrients and hormones to the cells and waste products away from them. Many things adversely effect your circulation- dehyration, diabetes, smoking, lack of exercise, poor posture and sedentary occupations are just a few of them.

When people get circulatory problems they most often first notice them in their extremities, particularly in the feet and lower legs because it is all uphill for the blood and lymph in your legs to make it back up to your heart to be re-circulated.

When the circulation in your legs get weak your feet feel colder, the skin starts to lose it’s healthy pink colour, foot wounds take longer to heal, the skin becomes more easily damaged, your ankles get puffy and  you are more likely to experience numbness and tingling. In extreme cases you can get gangrene too.

Perhaps more than any other single reason for getting poor circulation in your feet is getting old, take a look around on a warm day when people are wearing sandals and going bare foot and ask yourself how many older people have feet that appear as described above.

There is no magic bullet that can miraculously restore the circulation in your feet and lower leg to it’s former pristine condition but if you do following regularly you can help yourself alot.

* Walk for atleast 20 minutes every day.

* Don’t smoke.

* Keep your intake of sugar (and foods containing it) low.

* Get your calves and feet massaged (or Self Massage) often.

* Avoid sitting for more than an hour at a time.

* Do foot pumping and toe wiggling exercises while you are sitting (like the cabin crew tell you to on flights).

* Stretch your calves often.

* Wear good shoes.

* Consider the potential benefits of using orthotics in your shoes.

*Elevate your feet when you are sitting if they get puffy.

It is a shame when people wait until it is too late to look after the circulation in their legs and feet, losing mobility is serious business. You might be surprised how much better you feel for it if you start doing something about it today.

Think about how hard your feet work and the conditions they do it under, they deserve to have a regular rub. Too often people give up on exercise and the legs suffer as a consequence. The exercise you did when you were younger probably won’t suit your needs now so find ones that do, for your fitness and those lovely exercise feel-good hormones.

If you combine Self Massage and exercise your leg circulation will be even  better.

Shin splints

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Shin splints is a painful condition that does, as it’s name suggests, effect our shins. In the early stages of shin splints you may only notice a sporadic discomfort when you walk or run but as it worsens the frequency and intensity of the pain increases until it becomes impossible to ignore. The pain is felt along the edges of your shin bone (tibia) and your fibula the smaller bone in your lower leg. Shin splints have three different causes.

* Flat feet (collapsed arches)

* Running on hard surfaces like the road (and worse still if your running shoes are worn or of poor quality)

*Tight calf muscles (which can also cause plantar fasceitis on your soles)

Shin splints are a form of cumulative muscle micro trauma that effects where the muscles attached to  the fibula and tibia and the fibrous tissue joining these two bones (called your interosseus membrane),  become traumatised and inflamed. Shin splints can also effect the bones themselves.

Shin splints are common in long distance runners and in  other high impact exercise that works your lower legs hard, like aerobics and netball. With each stride you take when you run the muscles in your lower legs can absorb 2 to 3 times the force of your normal body weight because the muscles absorb the force of your downward momentum. This is a type of negative contraction, negative contractions can strengthen your muscles quickly but do so at a cost to your body. Running down hills and rapid changes in the distances you run and even in the surfaces you run on can also make you more susceptible to shin splints.

Shin splints are more likely to happen if you allow your leg muscles to tighten through an absence of good quality stretching and never getting soft tissue therapy such as massage.

Rest, ice packs and anti-inflammatories within the first 48 hours of injury will lessen the symptoms, after this time therapies such as ultrasound passive mobilization, stretching and manipulation will help you recover. If the cause of your shin splints is flat feet (foot pronation or collapsed arches) foot orthotics continuously worn in your shoes will help with your structural problem.

Your calf muscles (gastrocnemius, soleus,  tibialis, peronius) do alot of work, whenever you walk, run, climb or dance these muscles are constantly engaged and tend to suffer from neglect. It is rare for people getting a general massage to ask to have their calves worked along with their neck and back, even though their calves do more work than most other skeletal muscle in the body. Some people dont like having their calves worked because they get too sensitive, if you are having a massage and the pressure that the masseur or masseuse is using is too hard for your calves ask them to go softer rather than completely avoid them altogether, because they are sore for a reason and need attention.

If you Self Massage it is completely up to you how much pressure you use.

When the shock absorbers on your car wear out you replace them, you cannot do this to your body’s shock absorbers.

Muscle micro trauma II

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In many regards slow and steady really does win the race, whether you are trying to become more flexible or stronger remaining well balanced and in control when you exercise or work is important. “Form” is a term used in the fitness industry that defines the best posture and way of moving when you exercise. Good form reduces the risk of workout misadventures such as losing your balance and overstraining both of which can cause muscle micro trauma.

Time tested and proven exercise regimes such as Yoga and Tai Qi exercise your body in a very controlled and focused way that takes your muscles through the full range of their natural movement. The opposite way of using your muscles tends to traumatise them- short, jerky and highly repetative movements builds a type of friction up inside the muscle that is not healthy or sustainable.

Repetative strain injuries (RSI) are caused by using your muscles in such a way, you may get away with it for a long time because the natural pain killing effects of your endorphins and encephalins mask the pain, but sooner or later it will get you.

Ignoring the muscular symptoms earlier on will make you more likely to get tendon and joint problems later  which are much harder and more expensive to fix. You may do data entry all day on a computer, sort mail, dig trenches or even play a musical instrument, all these activities and many more that require repetative short muscular movements can give you muscle micro trauma.

It is useful to think of a rope fraying, one fibre at a time breaking until a relatively small force makes it suddenly tear the rest of the way. Micro muscle trauma can do the same thing. If you are required to do short ranged repetitive tasks with your work try sharing the work load between both your hands.

Sacrificing good form to perform personal best reps is not worth it.

On any fresh muscle trauma ice packs can give you good instant relief and anti inflammatories can suppress the symptoms too, as can stretching provided of course that your symptoms will still allow you to do so. By the time you know that you have a repetitive stain injury caused by muscle micro trauma the chances are that it has been going on for quite some time before you can no longer ignore the symptoms.

It is for this reason that you must be patient and consistent for therapy and preventative measures to start showing results. It doesn’t matter whether it is physio therapy, osteopathy, acupuncture or massage or combinations of these or similar therapies you must be consistent and follow the advice of your therapist, it is unfair (and unintelligent) to think they have failed if your symptoms do not improve immediately.

The good news is that muscle micro trauma is treatable and preventable.

Muscle micro trauma

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Your muscles come in 3 forms, smooth, striated and cardiac. Smooth muscle is involluntary and is found in our internal organs (liver, stomach, lungs etc). Striated or volluntary muscle is, as it’s name suggests under our conscious control, your biceps, triceps and femoral quadruceps are all volluntary muscle,voluntary muscle is also known as skeletal muscle.  Cardiac muscles  are a combination of volluntary and involluntary muscle and this is what your heart is made out of.

When people talk about muscle micro trauma they are referring to cumulative damage to your volluntary skeletal muscle. When you get a full thickness muscle tear to a large muscle like your femoral bicep (also known as hamstrings and found at the back of your thigh) you know about it. A torn hamstring is very painful and debilitating and it even changes the shape of your leg (until the muscle recovers anyway).

When a full thickness (or almost full) muscle tear happens it stops you dead in your tracks when the strenuousness of what you are attempting is too much for what the muscle is capable of.

Micro trauma as it’s name suggests involves a small amount of muscle trauma that is only mildly uncomfortable and inconvenient if noticable at all. Micro trauma happens when you slightly push yourself too far. Micro trauma as a single isolated incident is no big deal, it is when it keeps recurring before it has the chance to heal that it causes problems.

Your muscles are actually bundles of individual fine strands called myofibrils, myofibrils to a muscle are like the individual strands of plant fibre that are braided together to make rope (except your myofibrils are not plaited). Rope works well until enough of it’s individual fibre strands break and the rest of the rope suddenly gives way.

It is kind of like this when too many of your myofibrils are traumatised, this is typically noticed when you might be strenuously working or exercising in a way that you have done for a long time without any drama when suddenly without warning you get a sudden shock of pain and your strength fails because of cumulative muscle micro trauma.

Few people had heard of muscle micro trauma before Jane Fonda was sued for damages when she showed people a method of muscle stretching   on a work out video. Ms Fonda instructed her viewers to do muscle stretches in a jerking way at the end play of the stretches that caused micro trauma.

It is not just stretching exercises that can do this, flexion (weights) exercises full of jerky/rocking movements can  cause cumulative muscle trauma. Working strenuously with repetative movements also causes muscle micro trauma.

Even if you are fully convinced that the way you exercise and play are safe and sustainable get some periodic expert advice to make sure you are on the right track and remain mindful of what is age appropriate for you. Even though sport can be a very healthy thing to do some sports create a great deal of emphasis on the repeated uses of some muscles over others. Stretch and get massaged.