Autumn is coming – Time for reflection…Oh, and clearing the garden.

June 2, 2015

A few days ago I decided (on the spur of the moment), to take down a Magnolia tree that was shading the house. To be frank, the real reason is that it was giving the local squirrel population a convenient bridge to my roof space and therefore extending my ongoing battle with there smart little beggars!

However, the point of this reflective post is that I did EXACTLY the opposite of the advice I give to my patients! With frowning solemnity, I tell them how silly it would be to treat ANY physical activity differently to the way that we should approach exercise and movement. This of course includes gardening, especially the , “I was only moving a large pot/I was only felling a tree/I was only double-digging the potato plot ready for next season”, comments that I smugly listen to and gently shake my head sadly at.

I made the decision (good, as I had been putting it off for a while), leapt to my feet and gathered the tools I’d need (pretty good, as this shows planning and commitment), fired up the chainsaw and plunged in (really not so good, as I’d done no physical preparation and hadn’t got proper eye protection), and then spent several hours turning a perfectly good tree into fuel for the open fire and a huge pile of debris that I couldn’t be bothered to take to the dump because my back hurt, my shoulders were knackered and my quads were shaking from spending too much time terrified up a ladder!

What lesson should I draw from this? The most practical answer to that is probably go to work and earn the money to employ a professional (but then would he arm up either?). What should I and you and, indeed a professional tree surgeon, have done?

The image to the right might be one answer, but I think we can take a more pragmatic approach and

SUDDEN-ONSET WRIST PAIN

September 29, 2011

Wrist pain is common. Wrist pain starts for many reasons including trauma, overuse and disease, but I think we often overlook its importance when there isn’t an obvious injury like a fall. The emphasis for many sports and fitness enthusiasts, both consumers and providers, is on the bigger, perhaps more impressive structures.
Sure, there are many articles on the web about grip strength, and forearm strength, but what I see as missing from many of these articles and blogs is any attention to the ‘non-muscular’ structures, like tendons and fascial integrity of the retinacula. These connecting structures that provide stability and ‘packaging’ for the mobile structures like joints and muscles have an unglamorous image.
Wrist pain is amazingly frustrating to anyone who suffers from it, but especially to the active and fit because it inhibits or prevents almost every they do, from dressing to lifting their favourite weight to leaning on the wrist to perform a press-up or sprint start.
One common problem is strain of the ulnar collateral ligament (often called the styloid ligament),  on the outer (ulnar), side of the wrist. It usually starts after overuse or strain of the wrist, perhaps as when over-stretching the grip and especially when cocking the wrist sideways.
You will note that Matt’s wrist, although subject to the stress of an off-centre 44kg load, remains aligned with his forearm and is not deviating to either side.
So, why does this ligament give so much trouble. It is small, short and rather insignificant looking.
The styloid ligament is a rounded cord, attached above to the end of the styloid process of the ulna, and dividing below into two fasciculi, one of which is attached to the medial side of the triquetral bone, the other to the pisiform and flexor retinaculum.
In other words, from the end of the outer forearm bone to two of the wrist bones and some fascia.
So why does it matter if it small, short and insignificant? Well, small doesn’t just have to beautiful. It can be functional and vital as well (and I did say insignificant looking!). The answer is in its role in stabilising for the wrist, prevention of excessive radial deviation  and helps in the limiting over flexing of the wrist. (Remember it is blended with the flexor retinaculum).
In anatomical terms it is very complex and forms part of the triangular fibrocartilage complex. In functional terms, the TFCC forms a cushion for the end of the ulnar bone and is a major stabiliser of the wrist.
So what happens when you stuff it up?
First, there is pain, particularly on wrist flexion and ulnar and radial deviation (sideways motion). Extension tends to feel sore and compressive rather than sharp, like the other movements.
Second, swelling and sometimes heat is seen over the outer side of the wrist. The whole wrist, hand and even forearm may feel stiff and ‘full’, as if pumped up, but not in a healthful way!
Third, you may find it confusing; overall grip might feel reasonable, but pinching index and thumb together can be really sharp. There may well be lots of clicking across the joint, especially if you twist the wrist. It is not necessarily painful, but a bit disturbing. The elbow may well click also.
Fourth, painkillers may not be all that effective and finding a comfy position is hard to achieve.
All these features and no doubt many others, are ‘normal’ for sprains and strains. They are however a message not to plough on regardless. Symptoms should be settling over a matter of days as long as you use common sense practice – any longer than a week, the suspicion must be that it is more than a sprain.
Self treatment includes the old faithful’s of R.I.C.E or Rest, Ice, Compression and Elevation. The example on the right is a bit extreme (I’m sure you will be a lot neater), but you get the idea.
Keep the joints moving with plenty of articulation WITHOUT LOAD, strip out any trigger points you may have in your forearms with a TPT ball (I recommend the one from this link), or just deep thumb pressure assuming you haven’t rogered the other wrist as well.
Slowly reintroduce exercise with some gentle weight bearing, perhaps with the wrist strapped initially and do take your time. It is worth remembering that ligaments do not have a good elastic limit, like muscle and tendon fibres.
The relevance of that is that if you overstretch a ligament badly, continue to over-stretch it or ignoring these injuries, they will become less and less competent. And we don’t want that do we?
Keep well and strong. Contact me here if there are any questions arising from this brief offering.
Andrew

Maintenance Care Using Spinal Manipulation for Chronic Low Back Pain

February 17, 2011

Filed under: Uncategorized — Andy Bellamy @ 10:55 am

In a randomised trial looking at the outcomes of spinal manipulation as a maintenance treatment, the authors cam to this conclusion;

“This study showed that chronic LBP patients who received maintenance care over a 10-month period of time following their initial treatment had better results regarding post-treatment pain and disability levels than patients who stopped treatment after 1 month of care. The maintenance care patients also had improved lumbar mobility and better perceptions of their general health than their no maintenance counterparts”.

Senna M & Machaly S
Rheumatology and Rehabilitation department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Spine – Published Ahead of Print. Acceptance, 17 January 2011 DOI: 10.1097/BRS.0b013e3181f5dfe0.