Category Archives: upper limb


Cartilege occurs in many parts of the body, the cartilege in the septum of your nose (middle part) and your ears is called elastic cartilage because of it’s flexability. There is cartilage between your ribs and sternum, in your airways and your spine between the discs. The cartilage that lines the ends of your bones, articular cartilage is what today’s post is about.

Articular cartilage exists in 4 layers and it’s function is to cushion shock, distribute weight evenly and allow the smooth gliding motion of healthy joint action. Articular cartilage is found in the joints of your hands, wrists,  feet, ankles, knees, elbows and hips. It is white, rubbery and slippery when wet, the “grissle” in chicken and lamb legs is articular cartilage.

When cartilage is worn it can feel and even sound like sandy grits are moving in the joint, when wear becomes extreme as in the case of advanced osteo arthritis a painful grinding bone on bone sensation that sounds like the timber on an wooden ship can be quite audible. I once nursed an elderly female patient whose OA was so extreme I could feel her knees vibrate all the way to her wrists when I helped her stand up. OA is very painful when it gets to that point.

Excess body weight, poor nutrition and hydration, bad posture, lack of exercise, genetic factors and trauma all take a toll on articular cartilage. For as long as the surface of joint cartilage is intact the it will bend and straighten smoothly (provided the other tissues of the joint are working).

Kneeling down on hard surfaces pressurizes and can progressively damage the cartilage behind your knee cap. Bending any joint too far or in the wrong direction can damage cartilage too. Auto immune diseases such as  rheumatoid arthritis and polymyalgia rheumatica can make cartilage swell and make the joint weak and painful. Costochondria can result from a rib cartilage injury and make breathing painful. Shoulder dislocations can damage cartilage too.

Cartilage contains no blood, it’s nutrition occurs through cellular food and waste leeching back and forth through it’s outer membrane. This makes cartilage slow to heal, knee meniscus, shoulder rotator cuff and hip labrum are all terms describing cartilage of different locations.

Joint replacement (and partial replacement) is most often performed because of irreparable cartilage damage. Stem cell injection at the time of writing has produced some very promising results but does not work as well on everybody and steroids can reduce cartilage inflammation.

Sports clinics are kept very busy with cartilage injuries, particularly of the knee. Cartilage trauma is often accompanied by by ligament and tendon trauma too particular when the joint twists too far.

There was an American rheumatologist who got interested in the apparent benefits of consuming shark fin cartilage as a cure for arthritic pain. He ran a trial of 15 OA patients who had not responded that well to the drugs he gave them so he ground down ordinary chicken cartilage and put it in capsules that his trial patients took 3 times a day. He reported that after 6 weeks 13 of them had noted improved symptoms.

Not all things work as well for all people, but keeping your weight down and having good balance and posture will all help sustain healthy cartilage. Damaged leg cartilage may cause you to limp and this can create lower back pain, Self Massage to the back and hips can help keep you going.

Massage Tools

Hands that are not accustomed to kneading tight muscles can tire long before the muscles they are working on soften, whether they are your own or someone else’s. This is why we use massage tools.

There are plenty of hand held massage tools that are commercially available, from cheap plastic moulded dolphins  to expensive vibrating electrical  massage tables.

Then their are improvised massage tools such as tennis balls that you can roll your body against on the floor or walls.

Massage tools are good way to protect finger and thumb joints from repetitive strain. If you have never received professional massage training it is easy to make the mistake of over using your thumbs in particular.

Thumbsavers are a moulded plastic massage aid that costs less than $20 and are available online. I mainly use my thumbsaver on my own neck but they are useful for Self Massaging your hands and feet too.

If you have some experience and training in therapuetic massage, you will  recognize a hand-held massage tool as an extension of your own body. If you have never learned to massage nor  have ever even received one start out using Self massage gently and as instructed.

Massage over only your muscles never over your windpipe, breast tissue, on top of a bone or firmly over internal organs in your abdomen. The correct pressure to apply has a relaxing effect on the muscle. If you cannot relax into the pressure  you are going too hard.

Nothing beats a pair of skilled strong hands but massaging yourself costs you nothing and is way better than going without. It is good to know how to make yourself feel better in a healthy way, knowledge is power.

Massage tools do not have the be hard objects pressed firmly into tight muscles. A soothing, soft caressing massage can be given and received with a dermal brush or even a fur glove to relax you.

Massage tools are more effective for massaging yourself than massaging others because you cant really be sure how much pressure you are applying when using it on someone else. Using a massage tool on your own body lets you know straight away if you need to go firmer or softer.

If you have any numbness in your body from disease or injury make sure you are not chafing your skin by rubbing too hard or too long.


Treatment Reactions

When we go and have remedial treatment for a painful musculo-skeletal injury or condition there is sometimes discomfort in the following few days afterwards, this can happen whether it is from a massage, from spinal manipulation or assisted stretching. Generally this is more likely to happen if it is your first treatment or the first you have had for a long while and usually it is nothing to worry about.

One of the reasons that post treatment discomfort occurs is that you might have left getting treatment way longer than you should have which has caused greater resistance to the normal movement in your body, comparing this to a nut that has partially rusted on to a bolt is not entirely wide of the mark.

Another cause of post treatment pain is seeing a therapist who is completely new to you, it can take a little while for the new practitioner to work out what your tolerances are, it is not just a simple case of  big strong guys getting big and strong treatments and smaller lighter clients getting soft treatment. Over the years I have been surprised on many occasions by small petite women asking for and responding well to very firm massage. Likewise I have also treated some big men who have surprisingly low pain thresholds.

The nature of the physical problem ofcourse matters alot. A fresh injury for instance that has localised redness and swelling is often best treated indirectly and around the actual trauma site, atleast to start with anyway. A more familiar recurring sore lower back or neck problem that you experience a “good pain” from when pressed on the other hand, is usually treated directly from the outset.

It is important that you tell the practitioner if he or she is taking you too firmly, usually a practitioner can tell by the way your body reacts to being touched if they are going too hard or not but if they don’t it is no use waiting till the end of the treatment and then complain to the practitioner about it. Worse still saying nothing to the therapist and then telling everybody how rough they were afterwards is not fair on either you or the therapist. Don’t be shy, how you feel matters so tell us.

If you are concerned about how you feel afterwards you can always phone your therapist or send an email and ask them if what you are experiencing is normal or not. It is  not usually a good idea to go prodding and poking it yourself if you don’t think it feels right.

Finally it is a good idea to reflect on the event/s that occurred in between your visit to your practitioner and the pain you felt afterwards because if you decided to run around the block because you felt a bit better after having your lower back massaged it might be your fault, treatment cannot replace common sense. If you really want to know if and when it is safe to try a particular activity again just ask.

Thoracic Outlet Syndrome

Your thoracic outlet is located at the junction of your shoulder and torso, it is the internal opening where the nerves and blood vessels enter your arm from your body. Thoracic Outlet Syndrome (TOS) is a condition where the thoracic outlet becomes constricted which creates pressure on the nerves and blood vessels that pass through it. This pressure creates localised pain in your neck, shoulder and upper back accompanied by pain, numbness, weakness and tingling in your arm and hand.

When TOS occurs 95% of the time it is the result of pressure on the nerves in the thoracic outlet rather than on the veins and arteries. The most common causes of TOS are trauma to the shoulder and neck, from poor postural habits and from sport and other activities that  strain the neck.

In the case of trauma a broken collar bone might bend downwards at the fracture line creating pressure on the thoracic outlet. A whip-lashed neck, particularly from a side on impact can create inflammation and swelling that likewise pressurises the nerves, veins and arteries in your shoulder.

When TOS is caused by poor posture and repetitive strain the scalenes (muscles at the side of your neck)  stiffen to the point where they start to occlude the thoracic outlet  thus creating symptoms in your arm and hand.

Less commonly a minor deformity of the vertebrae (bone) in your neck might create TOS taking the form of a false short rib.

The symptoms and causes of TOS are similar in many ways to that of carpel tunnel syndrome (CTS), with the important distinction that CTS can be exclusively a problem of repetitive strain to the muscles of the forearm.  CTS also affects the whole hand whereas TOS affects only the little finger side of your hand.

Sport and other physical activity that requires repetitive raising of your arms above your head can cause TOS, these activities include weight lifting, swimming, volleyball and working above your head as often experienced by plumbers and electricians. Avoidance of these activities lessen the likelihood of getting TOS.

Sitting for long periods infront of your computer screen can give you TOS, always remember that your body is made to move, that is why we have muscles and joints. Doing regular neck stretching exercises can go a long way to protect you from getting TOS.

TOS is described as being positional or static. If your symptoms only occur when you arm is held in a particular position your TOS is positional. If your TOS is constant it is static.

The most effective therapies for treating TOS include osteopathy, chiropractic, physiotherapy, acupuncture, massage and stretching. Avoiding activities that have caused the symptoms are obviously helpful too but if you cannot do this because it is part of your job you are best advised to get regular preventive treatment and exercise.

If your TOS is the result of a deformed vertebrae or depressed fracture of the collar bone you may require surgery.


Fibromyalgia is an autoimmune disease that effects up to 5% of the population. Being an autoimmune disease it has no definate cause, no permanent cure, no definative diagnostic test and it does not manifest the same in all the people who have it.

A person of any age can get fibromyalgia, even children. Women suffer from it more often than men do and one in four sufferers can no longer work because of it.

The symptoms can be severe and varied, everyone who suffers from it will have muscle and joint pain which is where it’s name comes from (fibro-fibrous tissue such as tendon and ligament, myalgia-muscle pain), but other symptoms can include insomnia, fatigue, rashes, weakness, depression, headaches, nausea, menstrual problems, poor memory, foggy thinking and weight gain.

Some sufferers can notice a big improvement after a year while others others  have a hard time with it for much longer. One single “magic bullet” will rarely bring the symptoms under control, the best results usually come from using several different strategies and treatments together.

Medications both pharmacuetical and non-pharmacuetical, massage, chiropractic, osteopathy, acupuncture, stretching exercise and alkaline based diets all work to some extent for fibromyalgia sufferers.

Fibromyalgia like polymyalgia rheumatica is most intense first thing in the morning, it can make you feel much older than you really are. Sufferers tend to loosen up a bit as the day progresses but even on a good day with active fibromyalgia resourcefulness is required to go about your daily business.

If your knees are effected getting on and off the toilet can require extra thought and planning, showering will be easier than getting in and out of baths and using a long handled shoe-horn might come in handy too.

If your shoulders are effected getting in and out of coats might become an embarrassing task on a crowded bus and reaching objects off the top shelf at the supermarket might make you feel like a croc too.

Maintaining an upbeat outlook on life can be seriously tested with fibromyalgia and it can create pressures in even the best relationships. Despite how bad you might feel with it you can still look quite normal and because blood tests cannot detect it you might feel like a hypochondriac, it is hard to avoid suffering over your suffering with fibromyalgia.

Unfortunately it is not just hale and hardy physical people who get down about this condition because of the way fibromyalgia can effect your powers of concentration, even something passive like reading a book is more difficult than usual.

If meditation isn’t your thing learning some other form of mental relaxation using breathing techniques or even hypnosis might help you take your mind off it. If you are not a person who would normally entertain using alternate medicine you might need to change your mind because being stubborn won’t do you any good atall with this condition. Likewise if you don’t normally like “taking drugs” you might need to if want to keep working.