Category Archives: upper limb

Ankylosing Spondylitis

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Ankylosing spondylitis (AS) is a progressively debilitating disease that primarily effects the spine. The small tendons and ligaments in your spine become inflamed which is bad enough in itself but as they heal they calcify, effectively turning into bone. The flexible tissue turning into rigid bone stiffens and eventually fuses the spine, your other joints, your eyes, heart, lungs and bowel can all be effected by AS too .

AS effects three times as many men as women and the average age for the onset of symptoms is 24. The pelvis and spine are effected in all adult AS sufferers, in women the pain is less severe but their wrists and ankles are more likely to be effected than with men. Children are less likely to experience back pain with AS but their hips and knees are worse and sometimes need replacement surgery at a relatively young age.

Weight loss and fatigue are common, the symptoms are worst in the early morning and improve with exercise, night sweats and fever are common too. The body in general will be better with regular stretching but more than anywhere else the muscles in the front of your thighs and hips (lateral to your groin) need to be kept flexible. If an AS sufferer allows their hip flexors to stiffen they will not be able to stand up straight, they can develop a permanent stoop forward at the hips.

There are effective drugs that can help control the symptoms of AS but you will be even be better still if you get regular body work or manipulative therapies, not just for your hip muscles but all over. Sometimes physicians may not specifically recommend other therapies such as remedial massage or chiropractic to their AS patients but this does not necessarily mean that these therapies will not help them. If you have AS and your doctor has no specific objections to other types of musculo-skeletal therapies it might be in your interests to try them.

Climate has it’s effects too, AS sufferers usually find that cold whether much more adversely effects them than warm weather. It may not be practical for you to move to a warmer place away from family, friends and work but something as simple as the way dress can make a difference. About a year ago I suggested to an AS  client that he wear a scarf to make his neck feel more comfortable and  it worked very well for him. He had never thought of trying this before, his doctor did not suggest it and it took me while to think about suggesting it too, sometimes simple things work very well.

The lungs of AS sufferers are effected through inflammation in rib joints making breathing uncomfortable, this can be helped by being posture conscious at all times, not wearing tight restrictive clothing, not eating large meals, bodywork and most importantly learn to breath from your diaphragm not costally (deep not shallow).

Get advice from your therapist about using Self Massage and stretching to alleviate your AS.

PMR (Polymyalgia Rheumatica)

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As the name suggests PMR effects our muscles (myalgia) and joints (rheumatica). PMR is one of the 80+ auto immune diseases that can strike without warning, with no easily discernable cause and can be very debilitating. The symptoms of PMR vary from person to person although it does seem to be universally agreed that the larger joints in your body are the worst effected particularly your shoulders. Other symptoms may include a sudden inexplicable weight loss, jaw tension headaches and pain in other joints including your fingers, wrists, elbows, spine and toes. A blood test would reveal a high ESR, more women than men suffer from PMR,  50+ is the typical age demographic and the symptoms of PMR can be similar to the symptoms of other auto immune disease such as fibro myalgia or rheumatoid arthritis.

PMR tends to be episodic, for most the symptoms  start in the shoulders and are most severe first thing in the morning. Raising your arms above your head when your shoulders are acute can be very painful and restrictive, though fortunately they usually respond well to anti-inflammatory drugs…..so long as you have no high blood pressure or stomach ulcers. Corticosteroids such as prednisone can lessen the symptoms significantly though apart from being contra-indicated for hypertension and stomach ulcers you may experience weight gain using this drug aswell as severe mood swings and an inability to relax. The original onset of symptoms can last from 12 months to 4 years but if it recurs it is usually of less intensity than the first time.

Unlike muscular problems where you get a little warning before you get into a painful position, PMR can suddenly feel very intense and stop you in your tracks the moment you bend a joint even a little too far. Potentially the most serious symptom of PMR is Giant Cell Arteritis (GCA), it is this that causes the jaw tension headaches which, if left untreated can blind you.

Some PMR sufferers try an alkaline or nightshade free diet and find they do not help, others who try claim such diets definately do work. In either case you can still take your medications if you want to use both, so long as any food you eliminate from your diet has it’s nutritional values replaced by some other food. Many who get diagnosed with PMR find alot of relief from acupuncture, ice packs, massage, osteopathy and chiropractic, these therapies can be used in conjunction with pharmacuetical treatments too.

For a previously active and able bodied person the onset of PMR can be scary and demoralising, any exercise at all in the early acute stages may prove impossible, even having sex may require some adjustment. Practising meditation and relaxation techniques can help you cope with PMR as will planning what you do when you go out, if your knees are affected you might find that stairs are best avoided and getting into and out of coats can be embarrassingly difficult too. Like many other health problems that effect your abilities your facility to distract yourself and remain positive is an important part of  managing PMR.

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.

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.