With fall approaching, contact sports such as hockey are well underway in Kelowna. Increased sports participation also coincides with an increase in injuries, most often musculoskeletal in nature. The most common cause of soft tissue injuries in contact sports are muscle contusions and strains. A contusion is the result of a direct, blunt force, blow to an area of the body (typically a limb) that can cause damage to muscle fibers. In hockey, these types of blows may be due to contact with another player (usually knee-on-knee collisions), or slashes with a hockey stick. Symptoms of a contusion can include localized pain at the site of the blow, swelling, pain with movement, limited range of motion, and sometimes a palpable mass.
A contusion involves a partial rupture of the muscle(s), leading to the rupture of the capillaries (blood vessels), which then leads to increased bleeding. A hematoma (a collection of blood outside of the blood vessels) can then develop, as well as swelling and inflammation. Despite the damage to the tissue, the affected muscle is still able to function to some degree. The healing process involves the formation of scar tissue and the regeneration of muscle tissue.
There have been numerous studies published over the course of several years that have investigated the best treatment approaches for contusions. Immobilization (or rest) of the affected muscle has been of interest to researchers for years. As it turns out, recent research suggests that the length of time a muscle is immobilized is a key factor in the healing process. Several animal and human studies have now indicated that a short period (24-48 hours) of immobilization immediately following a contusion injury allows the scar tissue connecting the muscle fibers to gain enough strength to withstand future muscle contractions in order to prevent re-rupture. Forms of immobilization may include taping, bracing, or the use of crutches for lower limb injuries. Furthermore, researchers emphasized that long-term immobilization should be avoided in order to promote return to motion and activity.
After the short period of immobilization, gradual movement of the injured area should be started within pain tolerance. Several studies suggest that this early mobilization following a short period of rest plays a great role in helping the muscle fibers to regenerate.
In addition, most people are familiar with the "RICE" principle, which stands for Rest, Ice, Compression, and Elevation. As you may have guessed, the immobilization research above can be summarized by the concept of "rest". Ice, compression, and elevation are also methods that help to limit the bleeding at the injury site. Research suggests that the application of ice causes short term vasoconstriction and decreased blood flow, but does not have any long term vascular effects. Therefore, applying ice immediately following a contusion injury has the greatest therapeutic effects. Compression of the area and elevation can help to decrease subsequent swelling to the injured muscle tissue.
If you have sustained a contusion or muscle injury please consult a health care practitioner to determine the best course of treatment for your condition. The above information summarizes some of the current research on muscle contusions, however, healing time and specific treatment protocols will vary by patient and severity of the injury.
Benign Paroxysmal Positional Vertigo (BPPV) accounts for 32% of all causes of vertigo (dizziness). It can occur in adults of all ages, but often affects individuals over the age of 60, and is more common in women than in men.
Symptoms of vertigo including feeling that your surroundings are moving or spinning, as well as nausea, vomiting, or motion sickness. Symptoms typically occur when there is a change to the position or orientation of the head, especially when bending forward, looking up, lying down, or rolling over in bed. BPPV also affects balance and the person may become unsteady on their feet. In addition, abnormal eye movements (nystagmus) usually accompany the symptoms of BPPV. These eye movements typically beat rhythmically in a vertical or horizontal direction.
In approximately 35% of cases BPPV occurs without a known cause, but may also be associated with head trauma (15%), and inner ear infections (15%). BPPV has also been associated with hypertension, hyperlipidemia, migraines, and stroke.
The physiological mechanism of BPPV involves the vestibular labyrinth of the ear, which contain 3 looped structures called the semicircular canals. These canals are responsible for monitoring the rotation of the head. When calcium carbonate crystals (otoconia) become dislodged from one of the inner ear organs (utricle) they can migrate into the semicircular canals. When the head changes position, so do the crystals in the canals, which causes an unwanted flow of fluid that continues even after the head has stopped moving. This causes the body to falsely interpret that the surroundings are spinning. The direction of the nystagmus (vertical vs. horizontal) can help clinicians determine which semicircular canals are affected.
It is estimated that 50% of BPPV cases resolve spontaneously. The average duration of BPPV is 2 weeks and recurrent episodes occur in 40% of patients. Treatment of BPPV may involve specific physiotherapy maneuvers and an exercise program designed to reposition the crystals out of the semicircular canals. It is then thought that the crystals are reabsorbed by the body. The results of these maneuvers can vary, with some patients experiencing immediate relief, while others may require follow up maneuvering.
If you are experiencing vertigo or dizziness please consult with your primary care provider to determine a diagnosis for your condition. There are several other medical conditions that may cause dizziness or vertigo so it is important to seek medical attention as soon as possible. If you are diagnosed with BPPV your physiotherapist can help guide you through a series of maneuvers that may help to ease your symptoms.
Carpal tunnel syndrome is a condition in which the median nerve becomes irritated or compressed in the carpal tunnel of the wrist. The median nerve supplies the thumb, index finger, middle finger, and radial half of the ring finger (side closest to the thumb). The carpal tunnel houses 9 flexor tendons and the median nerve at the base of the palm. Carpal (wrist) bones surround the tunnel forming an arch. The median nerve can be compressed by decreasing the size of the tunnel or increasing the size of the tendons (swelling within the tunnel). Flexing the wrist to 90 degrees will also decrease the size of the tunnel.
Symptoms such as pain and altered sensation (numbness, tingling) occur in the thumb, index, middle, and radial half of the ring finger, and often result in weakness in the thenar muscles (base of the thumb). Numbness often occurs at night as it is thought that wrists may become flexed during sleep. Loss of grip strength and generalized pain of the wrist and hand are also characteristic of this condition.
Carpal tunnel syndrome is often idiopathic (due to an unknown cause). However, there are some medical conditions that can lead to its onset such as: Obesity, hypothyroidism, arthritis, previous fractures of the wrist, diabetes, and pregnancy. In addition, work related risk factors, such as excessive force, lack of ergonomic positioning, vibrational forces, and repetitive movements have been shown to be associated with the onset of this condition.
The diagnosis of carpal tunnel involves a combination of the patient's history and description of symptoms, clinical findings, and electrodiagnostic testing. Patients often report altered sensation in the median nerve distribution, symptoms that occur while sleeping, and weakness in the thumb muscles. Clinically, tests such as the Phalen's maneuver and Tinel's sign can be performed in a physical assessment by a health care provider. Phalen's maneuver involves flexing the wrist for at least 60 seconds. A positive test is indicated when numbness and/or pain is felt in the median nerve distribution within 60 seconds. Tinel's sign is performed by lightly tapping over the carpal tunnel. A positive result is indicated if the tapping causes a tingling sensation in the median nerve distribution. Electrodiagnostic testing may include nerve conduction tests that can determine median nerve abnormalities.
Prevention of carpal tunnel syndrome involves avoiding repetitive movements, adopting more ergonomic positions and/or the use of ergonomic equipment. Treatment may include bracing/splinting of the wrist, physiotherapy, or surgery. Physiotherapy treatments may include ultrasound, exercise and stretching prescription, and/or manual mobilization by your physiotherapist. Please check with your primary health care provider to determine a diagnosis for your wrist pain and the most appropriate treatment plan for your condition.
The rotator cuff is composed of 4 muscles of the shoulder. Each muscle connects from the scapula (shoulder blade) to the greater and lesser tubercle (rounded prominences of bone where muscles attach) of the humerus (upper arm bone), forming a "cuff".
The function of the rotator cuff is to allow for motion of the shoulder joint and to provide stability. The four muscles of the rotator cuff are outlined below, including where each muscle originates and then attaches, the movement each produces, and the nerves that supply (innervate) each muscle:
This muscle originates on the supraspinous fossa (small groove) of the scapula and attaches to the superior (top) and middle facets (small, smooth area of bone) of the greater tubercle of the humerus. Its function is to abduct the arm (raises the arm out to the side). It is innervated by the suprascapular nerve.
This muscle originates on the infraspinous fossa of the scapula and attaches to the posterior (back) facet of the greater tubercle of the humerus. Its function is to externally rotate the arm. It is innervated by the suprascapular nerve.
Teres Minor Muscle
This muscle originates on the middle half of the lateral (outside) border of the scapula and the attaches to the inferior (below) facet of the greater tubercle of the humerus. This muscle also externally rotates the arm. It is innervated by the axillary nerve.
This muscle originates on the subscapular fossa of the scapula and attaches to the lesser tubercle of the humerus. Its function is to internally rotate the arm and it is innervated by the upper and lower subscapular nerve.
These four muscles can be remember by the acronym "SITS".
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