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Peroneal tendinopathy

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Peroneal tendinopathy

Peroneal tendinopathy

Peroneal tendinopathy or peroneal tendonitis is characterized by an aching pain and swelling in the perineal tendons. These are located in the lower, outside portion of the ankle. A tendon is soft-tissue that attaches a muscle to a bone. The muscles involved in this condition are the 2 peroneal muscles in the lower leg, called the peroneus longus and the peroneus brevis.

Anatomy

?There are two peroneal tendons that run along the back of the fibula. The first is called the peroneus brevis. The term “brevis” implies short.  It is called this because it has a shorter muscle and starts lower in the leg. It then runs down around the back of the bone called the fibula on the outside of the leg and connects to the side of the foot.  The peroneus longus takes its name because it has a longer course. It starts higher on the leg and runs all the way underneath the foot to connect on the other side of the foot. Both tendons, however, share the major job of turning the ankle to the outside. The tendons are held in a groove behind the back of the fibula bone.

Causes of Peroneal Tendonitis

  • A sudden increase in weight bearing activities, particularly walking, running or jumping
  • Inadequate or unsupportive footwear
  • Muscle imbalances of the lower limb
    Poor lower limb biomechanics
  • Incomplete rehabilitation following an acute ankle injury, such as an ankle sprain

Symptoms of Peroneal Tendinopathy

  • Gradual worsening pain over the outside of the ankle
  • Pain during and/or after weight bearing activities
    Pain with turning the foot in and/or out
  • Instability around the ankle when weight bearing

Diagnosis

A full examination from a physiotherapist can be all thats needed to diagnose peroneal tendonitis
Patients with this condition usually experience pain behind the outside ankle during activities putting stress on the perineal tendons. Pain can also be noticed following these activities or following a rest period. This may be noticed especially upon waking in the morning. There may be swelling when the injury first happens. There will also be pain when testing resisted foot movements.  Stretches into various positions of the foot inversion, and resisted movements can cause pain behind the outside ankle.
Diagnosis may be confirmed with an MRI scan or ultrasound investigation
a diagnostic Ultrasound may be used for detecting all types of peroneal injuries.

What else could it be?:

Symptoms of peroneal tendinopathy mimic various other conditions of the ankle joint. So, before diagnosing peroneal tendinopathy we should rule out other possible injuries by doing the following tests:
Ankle Sprain: ligament testing by the Physiotherapist
Ankle fractures: special tests by the Physiotherapist
Os trigonum syndrome: MRI, physiotherapy testing
Chronical lateral ankle pain with other cause: MRI
Longitudinal peroneal tendon tear: MRI
Peroneal subluxation: ultrasonography, CT, MRI or peroneal tenography
Flexor Hallucis longus tendon injury

Physiotherapy rehabilitation

Treatment for peroneal tendonitis includes a program of stretching, strengthening, mobilisation and manipulation. It also includes proprioceptive exercises, icing, ankle bracing or k-taping during contact sports. If symptoms are severe, a cast or ROM boot immobilization may be worn for 10-20 days. After symptoms resolve, you will begin a progressive rehabilitation programme along with a gradual increase to full activity.

The use of a biomechanical ankle platform (BAPS), deep tissue friction massage, ultrasound electric stimulation can also be included in the physiotherapy
Also, shock wave therapy (ESWT), acupuncture is used to treat tendinopathy. But there is only limited evidence from studies for these treatments.
There is evidence for using manual therapy, specifically the lateral calcaneal glide.

If you have any further queries please call PhysioNow. Our experienced physiotherapists would be happy to help you. Call Today to get started 289-724-0448.!

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De Quervain’s Disease

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De Quervain’s Disease/ Texting thumb.

De Quervain's Disease

De Quervain’s Disease

De Quervain’s Disease or nowadays known as texting thumb is a painful inflammation of tendons in the thumb that extend to the wrist. The rubbing of the inflamed tendon against the canal it passes through causes pain at the base of the thumb and into the lower arm. It is commonly seen in females over 40 years of age.

Causes of De Quervain’s Disease

1. Simple strain injury to the tendon.
2. Repetitive motion injury. Workers who perform rapid repetitive activities involving pinching, grasping, pulling or pushing are at increased risk. Specific activities including intensive mousing, trackball use, and typing. Other activities including bowling, golf, fly-fishing, piano-playing, sewing, and knitting can also cause De Quervain’s Disease.
3. Frequent causes of De Quervain’s Disease include stresses such as lifting young children into car seats, lifting heavy grocery bags by the loops, and lifting gardening pots .
4. De Quervain’s Disease often occurs during and after pregnancy. Factors may include hormonal changes, fluid retention and more lifting.
5. Rheumatoid arthritis.

De Quervain's Disease

De Quervain’s Disease/ Texting Thumb

Onset and Symptoms of De Quervain’s Disease

Onset can be gradual or sudden. Pain is felt along the back of the thumb. There can be Pain directly over the thumb tendons, and pain may travel into the thumb or up the forearm. The bottom of the thumb or the side of the wrist might also be sore or swollen.
It may be hard and painful. Symptoms may get worse when the thumb is moved, particularly when pinching or grasping things. Some people also have swelling and pain on the side of the wrist at the base of the thumb. The back of the thumb and index finger may also feel numb. People might experience a funny sound like a squeak, crackle, snap, or creak when they move the wrist or thumb.
If the condition is not well addressed, the pain can spread up your forearm or down into your thumb.

How is De Quervain’s Disease diagnosed?

De Quervain’s Disease is diagnosed based on history and physical examination. X-rays, or ultrasound may be used to rule out other causes of pain.The Physiotherapist may use special tests to help diagnose De Quervain’s. More information can be found here.

Physiotherapy Treatment

Your Physiotherapist will likely recommend that you wear a specific wrist splint with a thumb spica for 4 to 6 weeks . PhysioNow carries these wrist splints in stock. You’ll also need to stop doing activities that worsen the condition.

Wrist brace with thumb spica

De Quervain’s Disease

The physiotherapist after a thorough assessment could choose different therapy approaches to help with the swelling, pain, and function.
These treatments may include Ultrasound, K-taping, acupuncture, and manual therapy. Other Physiotherapy treatments may include specific exercises focusing on range of motion, strength, and flexibility. These would be given for a safe and effective return back to function.

Recovery times vary depending on your age, general health, and how long you’ve had the symptoms.
If your disease has developed gradually, it’s often tougher to treat. So, it may take you longer to get relief. Your doctor may give you anti-inflammatory medication, or may inject the area with steroids to curb pain and swelling.

In our experience at PhysioNow, more than 99% of people with De Quervain’s Disease get better with Physiotherapy treatment provided. If however, you are one of the outliers, your doctor may recommend surgery. The operation would release the tendon’s tight covering so that the tendon could move smoothly. It’s an outpatient procedure, which means you go home afterward. Your doctor will recommend physiotherapy after surgery which includes an exercise program to strengthen your thumb and wrist.

If you or someone you know suffers from De Quervain’s Disease, please call us today. Our skilled Physiotherapists can Help!

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Vertigo

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Benign paroxysmal positional vertigo(BPPV)

Vertigo

Vestibular Systems
• Comprises five sensory organs that provide your brain with information about head position and movements including head rotation, linear movements and static positions of the head relative to gravity
• Five sensory organs including 3 semicircular canals and 2 otoliths

 

BPPV is a mechanical problem in the inner ear. It occurs when some of the  crystals that are normally embaded in gel in the ear become dislodged.  They then can move into one or more of the 3-fluid filled semicircular canals.

Benign paroxysmal positional vertigo(BPPV) is  one  of the most common causes of vertigo. It creates a false sensation of spinning.
• Benign: it is not life threatening
• Paroxysmal: it comes in sudden, brief spells
• Positional: it gets triggered by certain head positions or movements
• Vertigo: a false sensation of rotational movement

 

Symptoms
a)      Dizziness
b)      Vertigo (sensation of spinning)
c)       Nausea
d)      Sense of imbalance or unsteadiness
e)      Poor gaze stability
f)       Vision disturbance

Visual Coordination screening

 

Diagnosis

• The relationship between the inner ears and the eye muscles are what normally allows us to stay focused on our environment while the head is moving.  The dislodged crystals make the brain think you are moving when  you are not. This mistakenly causes the eyes to move, which makes it look like the room is spinning. This is called Nystagmus.

• The Nystagmus will have different characteristics that allow the practitioner to identify which ear the displaced crystals are in and which canal is involved.
• The most common tests are DIX hall pike and Roll test.
• There are two types of  BBPV.  One type, where the loose crystals can move freely in the fluid of the canal(canalithiasis). The more rare type is one where the crystals are thought to be hung up on the bundle of nerves that sense the fluid movement(cupulolithiasis).

Physiotherapy Treatment
• One maneuver that is used for the most common location and type of BPPV is called the Epley maneuver. However , that will not work for all people . Often people have tried the Epley maneuver themselves or had it performed on them without success.
• In the vast majority cases, BPPV can be corrected mechanically by a Registered Physiotherapist. Once your  provider knows which canal is involved and what type it is , we can take you through the appropriate treatment maneuver.

Check out this video for an example of the  Epley Maneuver.  Please do not attempt this yourself until you have been properly assessed and screened by one of our Registered Physiotherapists to see if this maneuver will be appropriate for your condition!

If you have any further questions, please call PhysioNow today! Our experienced Vestibular Physiotherapists would be happy to help you.

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Baseline Testing Concussions

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Baseline Testing

Why is baseline testing Concussions important?

There are no  special tests to diagnose and gauge the severity of concussions.  Athletes are recommended to undergo baseline testing before the beginning of the sports season. Baseline test results are helpful  for most healthcare professionals  involved in an athlete’s concussion care. This includes Physiotherapists, Physicians, Concussion Specialists, and Vision Therapists.  Baseline tests let the Physiotherapist compare the before injury  function to the results of post concussion baseline testing. It’s a great tool  to measure the severity of concussions.  It helps therapists to make  treatment goals.  Safe return to sports following concussions can be determined with this tool.

 

Components of Baseline testing  Concussions

 

  • Impact Test, This is the gold standard test.  It  looks at different functions of your brain before and after concussion. It is a computer based test. It usually takes about 30 minutes. The test assesses your ability to process information, and remember things.  It also tests how quickly you can follow  instructions/tasks. It’s the most scientifically validated test and recently got approved by the FDA.

 

  • Visual Coordination screening 
    Visual Coordination screening
     Following concussion, functioning of the visual system  is greatly affected. This involves the eyes and part of the brain that processes visual information.   Correct vision and clarity of  vision is not affected. However, the ability of your eyes to move together is affected. This usually leads to symptoms like dizziness, difficulty focussing,  and headaches. Testing the visual system before the sports season provides valuable information about the function of the visual system.  It allows for treatment of any problems.

 

  • Balance and Postural stability– With Post-concussive injury, both static and dynamic balance is affected. You can feel dizzy with standing, change in position or with certain movements. Most sports require an intact balance system to improve performance.

 

Registered Physiotherapists at PhysioNow are trained to conduct baseline testing before the beginning of  the sports season and following concussive injury. Registered Physiotherapists at Mississauga are skilled to assess any deficits in your baseline testing and treat them. Visual coordination exercises  will be done to help you  return to sports faster .

Please call today to get your baseline testing done or to treat your concussion.

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Golfers elbow

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Golfers elbow

Golfers elbow

Golfers elbow is the overuse injury to the wrist flexor muscles. The muscles travel from the inside of the elbow leading to pain with resisted wrist flexion and resisted pronation of the forearm. The cause of the Golfers elbow is repeated wrist bending, improper lifting, throwing and swinging movements. People involved in racquet sports, using tools as screwdrivers and working on computers are usually affected.

Symptoms

Symptoms include pain and tenderness around the inside of the elbow. They often also include pain with making a fist, stiffness of the elbow, and a weakened grip with downward movement of the forearm. Pain typically gets worse with a tight fist and picking things up with the wrist in a bent position.

Check out this article for more information about Golfers elbow.
Diagnosis

The condition is usually diagnosed through special tests such as wrist flexion against resistance. Differential diagnosis from other conditions such as cervical radiculopathy, ulnar neuritis, strain of flexor-pronator muscles is usually done by the physiotherapist.

Management

Early management helps to prevent loss of grip strength and mobility of the elbow. Management includes physiotherapy treatment and in rare cases surgery depending upon the severity of the condition. Your Physiotherapist at PhysioNow will work to stretch the common flexors of the wrist, do deep friction massage to break the scar tissue, and mobilize your elbow joint or cervical spine if pain is referred from the neck. They will also plan grip strengthening exercises, do tapping and educate you regarding the precautions to help in quicker healing. This will help to prevent any recurrence of Golfer’s Elbow. In many instances, a golfer’s elbow brace is beneficial. We carry these braces at all PhysioNow locations. Lastly, Golfer's Elbow may also be beneficial as a treatment for Golfers elbow.

In addition, the use of Laser therapy,application of a ‘Hawk tool’ and cupping can be used to reduce pain and promote healing. Your physiotherapist will educate you regarding these physiotherapy treatment options. So, don’t wait, book your appointment at PhysioNow today to get started on your treatment!