Tuesday, September 30, 2014

Monday, July 21, 2014

Ankle Sprain


Ankle Sprain

We have all had one - What Happened?


ankle sprain mechanism and injury, anatomy of ankle sprain
Ankle Sprain Anatomy
Everyone has suffered an ankle injury or sprain at some point in their life.  The most common form of an ankle sprain is an inversion mechanism of injury.  Inversion, meaning the inward twisting of the ankle, is most common because of the anatomy of the ankle joint comprised of the distal fibula and tibia.  The medial distal tibia, or medial malleolus, is much larger than the lateral malleolus and has stronger ligaments.  The medial ligament is call the deltoid ligament, which is a broad fanlike ligament.  On the lateral aspect of the ankle, there are mainly 3 ligaments:  anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament.


A sprain is defined as partial tearing of a ligament.  Ligaments attached bone to bone and provide our skeletal system stability.  When the ankle is maximally inverted, when someone "rolls their ankle," the ligaments are stretched maximally.  One of 2 things will happen, either partial tearing of the ligaments, or indicates the ligaments are strong, the distal fibula will break.  If the force is great enough, the distal fibula will break and the medial deltoid ligament will pull strongly enough to fracture the medial malleolus.  Often this injury, called bimalleolar ankle fracture, require surgical repair.

Ankle sprains are graded on a scale of 1-3.  This refers to the severity of partial tearing of the ligament.  Generally, grade 1 is able to be "walked off," and involves less than 25% of the ligament.  Grade 2 requires some protected weightbearing with crutches and involves up to 50% of the ligament.  Grade 3, involves all of the ligaments being torn and the ankle will be unstable.

Sometimes a pop or snap was heard at time of injury.  It is very difficult to determine if there is an ankle fracture or sprain based on symptoms and a x-ray is required.  Once a fracture is ruled out, early rehabilitation is essential for return to function

Ankle pain, swelling, bruising are the most common symptoms after an ankle sprain.  Walking may be difficult but is encouraged as early as possible.  The traditional RICE treatment should be started initially.  Rice stands for rest-ice-compression-elevation.  I like to add a “N” to the end standing for NSAIDs – RICEN.

The initial treatment can be completed at home, physical therapy is definitely helpful because of their knowledge, ability is, equipment that the average person does not have available to them.  And important, often overlooked aspect of rehabilitation is massage.  Initially, in combination with elevation, light massage can help with edema and pain control.  Edema can slow down the healing process and removing it will improve healing.  After 7 days or so, deeper techniques can be implemented to increase blood flow.  After all, the foot and ankle is farthest from the heart, less blood supply means slower healing.

Cross friction massage is beneficial to break up scar tissue, increased blood flow to the ligament.  This should be done while the ligament is in a stretched position.  Pressure should be within limits of pain.  The movement should be across the tendon, back and forth like plucking a guitar string.  It will be uncomfortable but should not cause guarding.  Treatment length is advised to be 5 or 10 min. long.  Every other day versus every day is better for recovery.  If there is increased swelling, skip the next treatment to allow for the edema to resolve.

Bracing may be required to protect the ligament once returning to sport or activity.  Biking is a great initial activity because there is no lateral movements to the ankle.  Cutting sports should be the last activity to return.  Once you are able to walk in a straight line without pain, try jogging.  If able to jog, tried jumping and/or cutting activities.  Once you're able to pass these "functional" activities, he may return to her activity level.

It is very common for ankle swelling to persist for a couple of months.  Continue to treat conservatively with ice, anti-inflammatories, elevation.  Massage may be continued as needed.

There is essential to seek orthopaedic care immediately after the injury to rule out a fracture because this is very difficult to know without an x-ray.  However, it you're able to walk immediately after and his symptoms resolved after a couple of days, conservative treatment should be adequate.  It is any concern, please see your orthopaedic doctor.

Monday, July 7, 2014

Patellofemoral Syndrome

quadriceps angle, q angle
Q-angle (Quadriceps angle)

Patellofemoral Pain Syndrome

Anterior knee pain - What's Going on?


Patellofemoral syndrome (PFS) is the most common affliction encountered in the field of orthopedics. Commonly effecting women, between the ages 12-18 and 24-32, accounts for the most office visits for complaints of anterior knee pain.  PFS can also effect men, but because of anatomical differences between men and women, the later often encounter more problems.  This is because of the "Q-angle" which is a measurable angle for the hip down to the knee, is difference between the sexes.  This angle changes the angle at the knee, and alters the pull of the quadriceps muscle.  The pull on the knee cap or patella is now slightly lateral.  This can cause some compression under the lateral edge of the patella resulting in pain, increased wear, patellar instability and early arthritis.

Symptoms include anterior knee pain, pain in the front or side of the knee cap or patella.  Pain is usually worse going up or down stairs, kneeling or squatting, getting up from a chair, getting out of the car, and commonly hurts if the knee is bent for extended periods at a desk or riding in the car.

The primary treatment is multifactorial.  The old adage "RICE" is definitely part of the regimen.  Rest, ice, compression, and elevation is the treatment for the pain and inflammation.  Avoid aggrivating activities which can be running, but commonly include stairmaster, squats, lunges, and knee extension machine.  Physical therapy is usually required to increase medial quad strength, and improve the flexibility of the ITB (illiotibial band) and lateral retinaculem.
knee pain, chondromalacia, lateral tracking patella, patellofemoral pain syndrome
Lateral Patellar Tracking and
Chondromalacia


Bracing and kenesiotaping can be helpful adjuncts to therapy but doesn't address the underlying issue.

Massage therapy can be very helpful to stretch and release the lateral retinaculem and ITB to help improve patellar alignment and tracking. Massage can also help increase blood flow and decrease pain.

Getting the correct treatment is very important to proper recovery and return to activity.  Chronic problems may have a deeper structural cause.  This needs to be evaluated by an orthopedist with a radiograph or x-ray.  If the knee cap is coming out of place or popping in and out, this may need further treatment is physical therapy, massage, and bracing do not help.



Wednesday, June 18, 2014

Proven Physiolgical Relaxtion from 5-minute Foot Massage


 

Physiological relaxation after foot massage


 

A brief foot massage has been proven to provide physiological relaxation to patients who are ill, especially those in an intensive care unit.1  In a previous research study, a brief five-minute foot massage was offered to patients and a critical-care unit.  Physiological data was collected including heart rate, blood pressure, respirations, peripheral oxygen saturation of the tissues.  These vitals were re-measured after the brief foot massage.  There was no change in the peripheral oxygen saturation.  However, there was an obvious and significant decrease in heart rate, blood pressure, and respirations.  This proves that in extremely stressful situations, something as simple as a five-minute foot massage can increase relaxation which is proven by the physiological changes recorded.

Whether you are nurse taking care of patients, a massage therapist providing relaxation, even a psychotherapist, or loved one caring for a family member, a gentle foot massage can provide proven relaxation.  This could be an excellent way to begin a treatment or therapy session, break the ice, or just to make someone feel at ease and relaxed.


1  Immediate effects of a five-minute foot massage on patients in critical care
Intensive and Critical Care Nursing, Volume 15, Issue 2, April 1999, Pages 77-82
Julie Hayes, Carol Cox


 

Monday, June 9, 2014

Stronglite Versalite Pro Portable Massage Table

Stronglite Versalite Pro Portable Massage Table

Portable Aluminum Frame Massage Table


The StrongLite Versalite Pro portable massage table exemplifies it features within its name.  It is versatile AND light.  Redesigned and upgraded with lighter aluminum framing, this portable massage table weighs in a 27 pound!  This allows the user greater portability and less strain.  This massage table can be used indoors and outdoors due to its non-corroding, aluminum frame.  Great for athletic events, beachside work, or poolside treatments, or wherever else you can imagine.   Comfort is provided by the 2 ¼ inches, two-layer foam system covered by a luxurious satin touch vinyl in your choice of four great colors.  It cleans easily.  Adjustable height from 23-33 inches.  The Versalite Pro aluminum framed portable massage table will support up to 750 pounds working weight (450 pounds drop test).  All these superior features are backed up by the Stronglite limited lifetime warranty!  Just like the carrying weight, the price is light too!  Check it out further at Elite Spa Care 

Stronglite Versalite Pro Portable Massage Table, portable massage table


Stronglite has been producing quality massage equipment for the massage therapy and spa communities for years.  As massage and personal health and fitness have become more and more popular, it has gain popularity in the medical, sports, fitness, and beauty salon markets.  Massage continues to prove it benefits and how licensed massage therapists can make a difference.  Our goal at Elite Spa Care, is to provide these innovative products at great price and value so the LMT's can continue to help promote health and fitness in communities around the world. 

Monday, May 5, 2014

Scar Massage

Scar massage is crucial to a full recovery after any surgical procedure or injury.  Scar tissue is how we heal.  Honestly, we heal quickly and messy.  Our body just wants to survive, and piecing itself back together quickly is essential.  When we heal, collagen knits us back together quickly and irregularly.  Whether it be our skin, fascia, muscle, or even bone a "scab" of cell building matrix begins the remodeling phase.  Our body heals that injury or insult over and over again for months and months.  This is why sometimes the area stays swollen or red for a long time; that is the healing process.
 

scar massage, myofascial release, MFR, massage, deep soft tissue
Scar after scar massage and remodeling

Sometimes, our body needs some help.  The collagen and healing matrix forms a messy pile or clump of fibers like a pile of pick-up-sticks.  One may remember that games of jumbled sticks on the ground.  In the same way, that how all those fibers are clumped.  Massage is a crucial therapy to help stress those fibers to get them to all line up in a line.  The act of massage disrupts that clump and will improve the remodeling of that scar.

The benefits are real.  Scar massage can improve the appearance of the scar and in some cases help it be invisible to a first glance.  It will also make the scar more supple and soft.  The tissue will move more naturally and freely.  Pain is usually reduced.  There are some topical products available at the drug store that can aid in scar remodeling.  But nothing beats trained hands.

There are a couple of different techniques and devices that can aid in scar massage.  Usually some time of lubricant is used.  Vitamin E containing products or lotions are known to aid in scar tissue reduction.  Stretching get muscles and tendons loose and supple.  Cross friction massage can be performed by rubbing one or two finger with mild to moderate pressure across or perpendicular to the scar to help those collagen fibers align.  Myofascial release (MFR) is used by massage and physical therapist to get the skin and deeper tissues, including the fascia to move freely as intended.  Finally, there are many devices and instruments that can aid in the massage and breaking up of scar tissue.  They can be used by professionals and at home alike.

All these methods and techniques can help scar tissue remodel after surgery or an injury.  This is essential for proper healing, scar appearance and pain reduction.  See your medical massage professional or physical therapist for scar management.  Check out these personal massagers that may aid in the massage of scar tissue.  Always check with a physician first to make sure scar massage is performed appropriately at the right time.