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So far Veronica Seow has created 8 blog entries.

Chronic Ankle Instability

Diagnosing and Managing Chronic Ankle Instability

The ankle joint consists of many bones, ligaments and tendons that plays an important role in maintaining its stability. Consequently, ankle instability happens if any of the related bones, tendons, or ligaments are compromised. The tibia and fibula are intimately joined by the interosseous membranes. These two bones also share connections with the ligamentous complexes of the foot so that any sprain on the ligaments can also potentially cause a distal fracture in the bones of the lower leg. Additionally, the tendons from the muscles of the lower leg—mainly the Achilles tendon and the peroneus longus and brevis, are closely associated with the bones of the foot. Injury to these tendons will likely result in ankle instability.

Mechanism of Ankle Instability

Due to the complexity of the ankle joint ad surrounding structures, any injury to the bones, tendons and ligaments can result in instability. For example, any impact on the heel of the foot from jumping from a higher to lower level will produce a vector of the force directed into the distal tibia. And this can cause fracture and dislocations of the tibia or fibula and cause ankle unsteadiness. Such an injury to the tibia causes an increase in contact stress between the tibia and talus and is an important pathomechanical factor in unstable joints.4 Additionally, the fibula may also have a profound effect on ankle stability.

Damage to the tendons and ligaments supporting the ankle joint can also cause ankle instability. Lateral ankle instability can cause laxity of the superior retinaculum which the ligaments wraps around the proximal ankle joint. This laxity can cause a peroneus brevis split and, in turn, this split results in chronic ankle instability.

Diagnosis of Ankle Instability

When a person present with ankle instability, the first step is to determine whether the injury demands emergency care. During first line of care, the physician should asses the history and etiology of the injury. Most of the ankle injury is ankle sprain and is usually ligamentous or may include bone fractures. With fractures, the person will experience bony tenderness on palpation of the posterior edge of the distal tibia and fibula, or on the medial and lateral malleolus. Inability to bear weight on the affected foot immediately after the injury are also the signs of fracture that requires immediate emergency care.

With ligament injury, the lateral ligamentous complex is more prone to damage due to the anatomical position of the ankle in plantarflexion and inversion. Because of this, most of the ankle sprain occurs while the ankle is in plantarflexion and inversion.

Physiotherapy Management for Ankle Instability

Once the diagnosis of ankle sprain is made, conservative management is always preferred. During the early stage of mild sprain, RICE protocol are usually implemented. For Grade 1 and Grade 2 ankle sprain, a form of immobilization using ankle brace will provide stability to the ankle and provides the ability to walk and climb stairs without further injuring the ankle. When ankle instability is due to compromised integrity of the tendons, management is aimed at correcting the cause of the pathology. Exercise therapy has been the mainstay of treatment to improve the outcome in cases of tendon laxity.

Early functional rehabilitation of the ankle should include range-of-motion exercises and isometric and isotonic strength-training exercises. In the intermediate stage of rehabilitation, a progression of proprioception-training exercises should be incorporated. Advanced rehabilitation should focus on sport-specific activities to prepare the athlete for return to competition. Although it is important to individualize each rehabilitation program, this well-structured template for ankle rehabilitation can be adapted as needed.

Many researchers have examined the effects of various training regimens on the characteristics of chronic ankle instability and the symptoms of acute ankle sprain. The available research regarding rehabilitation of ankle injuries and chronic ankle instability focuses on a wide variety of exercises and programs. Many experts have succeeded using a type of balance board to improve strength and balance measures in subjects with acute injury and CAI. Others have found that incorporating a variety of coordination-training exercises produces significant improvements in measures of strength and proprioception.

Here in Healthworks, our physiotherapist will perform a thorough assessment regarding your injuries and design a general guidelines and precautions. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

Chronic Ankle Instability2021-03-02T13:56:23+08:00

Rotator Cuff Impingement

Rotator Cuff Impingement is a type of injury that causes shoulder pain where a tendon inside your shoulder rubs or catches on nearby tissue and bone as you forward flex or abduct your arm. It usually affects the rotator cuff tendon that connects the rotator cuff muscles that stabilizes the shoulder joint to the humerus.

The estimated prevalence of shoulder complaints is 7–34% with about 14.7 new cases per 1000 patients per year seen in clinics. Of all the shoulder disorders, shoulder impingement syndrome (SIS) is the most commonly reported, accounting for 44–65% of all shoulder pain complaints.

Who gets Rotator Cuff impingement?

Rotator Cuff impingement syndrome is commonly seen in people who are involved in activities and sports with frequent overhead motion like swimming, badminton, squash, basketball and volleyball. The constant rubbing of the rotator cuff between the humerus and top outer edge of the shoulder leads to swelling and further narrowing of the space which leads to pain. Besides that, RC impingement can also result from an injury, such as falls and motor vehicle accidents.

Examination

There were two clinical test can be performed to assess Rotator Cuff Impingement

The first is called the “Empty Can test”. The patient stands up with his shoulders in 90°abduction, 30° horizontal adduction and in complete end range rotation. The therapist fixates his hands on the upper arm of the patient and provides a downward pressure while the patient tries to maintain his position.

The second test is called the “Hawkin’s Test”, the patient stands with the shoulders abducted to 90° and internally rotates the forearm. The presence of pain with movement is an indicator of a possible pathology.

Physiotherapy Management

The aim of physiotherapy management is to reduce pain and swelling of the tendons to achieve normal range of motion and improve the strength of the shoulder. Rest and ice should be implemented at the acute phase of injury to decrease pain and inflammation. It is very important that patients need to avoid activities that increases pain and symptoms. Physiotherapist should guide the patient on when to resume those activities again based on the recovery rate on each individuals.

Physiotherapist can use techniques like muscle release to improve range of motion and prepare patient for strengthening exercises when the pain and inflammation reduces. It is important for patient to do exercises in a correct order; starting with stretching and range of motion exercises and then muscle strengthening exercises.

It has been shown that exercises are effective and support the improvement of shoulder impingement compared to no treatment or placebo.

The following suggestions are to include in the rehabilitation of shoulder impingement:

  1. Gentle Muscle Release
  2. Isometric Exercises to reduce pain
  3. Stretching and range of motion exercises
  4. Kinetic Chain Exercises
  5. Correcting Technique and training errors
  6. Correcting scapula-humeral rhythm and glenohumeral instability
  7. Resistance training to increase mobility

Here in Healthworks, our physiotherapist will perform a thorough assessment regarding your injuries and design a general guidelines and precautions. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

Rotator Cuff Impingement2021-01-26T14:07:45+08:00

Posterior Cruciate Ligament Injury

What is PCL injury?

PCL injuries often occur as part of the knee injury and is the least common ligamentous injuries among the four major ligaments of the knee. PCL injuries often occurs in isolation due to the structural positions. Most of the patients able to tolerate the PCL deficient knee and continue their daily activities but there will complications if its left untreated. Studies have indicate good outcomes of non-operative management in terms of returning to high levels of play and functions.

 

Basic Structure and Function of PCL

The Posterior Cruciate Ligament is made of tough fibrous material and function to control excessive motion by limiting joint mobility. The main function of PCL is to limit the posterior translation of the knee, resist hyperextension and provides a rotational axis and stability. It originates from the medial aspect of the medial femoral condyle and branches into two bundles before inserting into the posterior aspect of the tibia.

 

Causes

A PCL tear occur when a direct blow to the front of the knee or leg below the knee and this puts a significant amount of stress on the PCL. When the PCL stretches to the point of mechanical failure which is considered a tear. This commonly happen when someone is tackled in football below the knee from the front and the person lands on the knee forcefully with their knee bend. It can happen in a motor vehicle accidents as well when there is a head-on collision and hard strikes directly against the knee.

 

Non- Operative Rehabilitation

When considering non-operative management for PCL, it’s important to discuss short and long term goals with the patient for optimal decision making.

Basically, to allow ligament to heal in a neutral position, there are a few essential precaution and guidelines to follow:

  1. Avoid hyperextension for 12 weeks
  2. Prevent posterior tibial translation for 12 weeks (no hamstring strengthening)
  3. PCL brace is to be worn x 12 weeks
  4. PCL loading occurs at higher knee angles. It is prudent to use smaller knee angles (0-50 degree) before progressing to larger knee angles (50-100 deg.) because PCL forces generally increase as knee angle increases.
  5. When working on improving the ROM, prescribe exercises from a prone position to limit the effect of gravity.
  6. Limit WB initially to restore joint homeostasis if the injury is accompanied by effusion and joint bleeding.
  7. Limit isolated hamstrings contraction at greater than 15 degrees knee flexion for at least 16 weeks as it was found to increase the load on PCL.

 

When might surgery be required?

Surgery for a ruptured posterior cruciate ligament is often required when other structures in the knee are also damaged. For example, the anterior cruciate ligamentmedial collateral ligament or lateral ligament sprains.

Also, if you have rotational laxity in your knee. This means your lower leg twists more than normal in relation to the upper leg (femur).

 

Post-Surgical PCL Physiotherapy Rehabilitation

Post-operative PCL repair rehabilitation is one of the most important aspects of PCL reconstruction surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist.

Your rehabilitation following PCL surgery focuses on restoring full knee motion, strength, power and endurance. While protecting the healing repaired ligament in the early phase. You’ll require proprioception, balance and agility training that is individualised towards your specific sporting or functional needs.

Here in Healthworks, the physiotherapist will perform a thorough assessment regarding your injuries and design a general guidelines and precautions. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

Posterior Cruciate Ligament Injury2020-04-07T16:10:03+08:00

Physiotherapy For Tennis Elbow (Lateral Epicondylitis)

Your elbow hurts, you’ve been told to have tennis elbow but have never played tennis. You are referred for physiotherapy by your GP, but first you want to have a good understanding of the symptoms and problem to make sure you get the best treatment.

What is Tennis Elbow?

Tennis elbow or lateral epicondylitis is a common condition and is treatable with physiotherapy. However, not all tennis elbows are the same, and they have to be assessed and treated differently in order to reach optimal result.

Tennis Elbow is the most common overuse syndrome on the lateral part of the elbow. It is a tendon injury involving the common extensor muscle of the forearm. These muscles originate from the lateral epicondyle of the distal humerus. Overuse of these muscles and tendons of the forearm and elbow together with repetitive contraction or manual tasks can put too much strain on the elbow tendons. This injury is often work-related, any activity involving wrist extension, pronation or supination during manual labour, housework and hobbies are considered as important causal factors.

Clinical Presentation

Tennis elbow may cause the most pain when you:

  • Lift something
  • Turn a door knob
  • Make a fist
  • Turn a bottle cap

Factors that cause tennis elbow

  1. Repetitive Motions

People who have jobs or hobbies that involve repeated movements of the hand,      wrist or elbow are at higher risk for developing tennis elbow. When you increase this activity faster than your arm can adapt, tennis elbow will begin.

  1. Ergonomics

When it comes to tennis elbow, the following factors should be looked into and needs alteration if necessary:

 

Seating Posture – Is the keyboard and mouse height ideal to your elbow position? Do the forearm has proper support during typing and does the chair provides good support to the back?

Vibration – do any of the tasks that you need to perform expose your arm to vibration? This can be very stressful on the joints and supporting muscles so these tasks must be performed well, with high quality tools and regularly planned breaks from the task.

There are many ways to treat tennis elbow and following a thorough assessment of your elbow, arm and neck, the physiotherapist will discuss the best strategy for you to use based on your symptoms and your lifestyle. Physiotherapy treatment can include gentle mobilisation of your neck and elbow joints, electrotherapy, elbow kinesio taping, muscle stretches, neural mobilisations, massage and strengthening.

Here in Healthworks, our physiotherapist will do a thorough assessment and design a comprehensive treatment plan for your condition. If there are any queries regarding this article, feel free to contact us at 018-9828539 or drop us an email at contact@myhealthworks.com.my

Physiotherapy For Tennis Elbow (Lateral Epicondylitis)2020-02-18T15:35:01+08:00

Early Development of Core Muscle In Infants

Parents of children with movement difficulties are often told by doctors and physiotherapists that their child has “weak core muscles” and are told to let their child exercise to strengthen those muscles. Just as a tree needs a strong trunk to be able to hold its branches up and withstand elements in its environment, a child requires a strong core to participate in life’s daily activities efficiently. Essentially, core strength or postural control, is both the anchor and launching pad for everything that we do. If a child does not have a strong core, it will affect their neck position, upper back, lower back and lower limb position.

What are core muscles?

The term “core” muscles refers to the trunk muscles that work to hold trunk erect and steady the upper and lower limbs move. The core muscles include the deep spinal extensor muscles as well as the transverse and diagonal abdominal muscles. The neck muscles also play an important role in maintaining a steady and stable head posture. The muscles need to work together in a coordinated manner to keep the head and trunk steady when moving the arms and legs.

Importance of core muscle strength in infants

With no postural control, motor movements are impossible. Postural control is the foundation where other skills are developed. Posture must be stable to allow movements of the extremities such as arms and legs, enabling the baby to complete complex activities such as looking left and right, forward reaching and rolling back and forth. It is important for baby to get as much tummy time as possible, as this is where they begin to develop and strengthen their core and postural muscles. They are then expected to begin to reach for items, developing their core muscles helps them to use their arms and hands to reach and grasp. The next step of development is beginning to roll from their back to their stomach, using those core and postural muscles to assist. They then need to use those muscles to sit independently and hold their weight and heads against gravity, stabilising those muscles.

Posture is important for participation in all aspect of life, like development of child’s attention, focus, respiration and movement patterns, it is essential to be developed. New parents can take advantage of incidental tummy time in holding your baby on your forearm when carrying, having your baby rest on your chest rather than in the cot or carrier

What can be done to improve core muscle strength and stability?

  1. Perform activities in tummy time position
  2. Perform activities in two-point kneeling and half kneeling position
  3. Crawling and creeping
  4. Reach and sit up
  5. Collect object from the floor in kneeling or squatting position
  6. Superman position on the gym ball
  7. Crawling through tunnel
  8. Climbing ladder
  9. Wheelbarrow walking
  10. Play animal walk such as crabs, frogs, bear and kangaroo
  11. Elbow plank
  12. Encourage the child to try new equipment at the playground such as swings, climbing bar, monkey bar, slides and poles.

When beginning core strengthening exercise/activities, start with just a few at time; find some that your child loves to engage in. As time progresses, you should see your child starting to develop self-confidence and endurance. At this point, you can begin adding new exercises.

Here in Healthworks, our physiotherapist will perform a thorough assessment for your child and design a comprehensive exercise based on his/her abilities. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

Early Development of Core Muscle In Infants2020-04-07T10:59:06+08:00

Physical Activity in Elderly

Aging is a multifactorial irreversible process associated with significant decline in muscle mass and neuromuscular functions. One of the most efficient methods to counteract age-related changes in muscle mass and function is physical activity. Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.

The world population is getting older and the percentage of elderly people is continually increasing. It is well known that aging causes gradual changes in the organism, which leads to loss of function, weakness, disease and death. All these negative changes lead to difficulty of performing daily activities.

One of the main questions regarding elderly is: Can we stop the negative changes? No, we cannot stop it, but we can slow down the decrease of physical fitness and functional capacity. We know that with physical activity, balanced nutrients are the most effective ways to counteract the decline of functional capacity related to aging.

Benefits of Physical Activity

Research has documented the benefits of maintaining an exercise program into the later years, using resistance exercise and aerobic training, ideally in combination in order to improve cardiorespiratory and muscular fitness, and functional health, and reduce the risk of NCD.

Mortality

Physical activities have lower rates of all cause mortality, coronary heart disease, high blood pressure, stroke, type 2 diabetes, colon cancer and breast cancer, a higher level of cardiorespiratory and muscular fitness, healthier body mass and composition. Epidemiological studies show a strong inverse relationship between physical activity, health and all cause of mortality. Higher level of physical activity are associated with around 40-50% lower all-cause, cardiovascular disease and cancer mortality rates compared with women with lower activity levels.

Functional Independence

Both muscle strength and aerobic fitness have been strongly linked to functional independence. Aerobic training alone or aerobic training combined with resistance training have been shown to result in improved physical function in older adults without disabilities. In some groups of people with chronic health conditions there are indications of positive effects of increased physical activity and exercise. Physical activity exhibit higher level of functional health, a lower risk of falling, and better cognitive function; have reduced the risk of moderate to severe functional limitation.

Recommended Levels of Physical Activity

  1. Older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week. Or at least 75 minutes a week of vigorous-intensity aerobic physical activity.
  2. Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.
  3. Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.
  4. If older adults cannot perform the recommended amounts of physical activity due to health conditions, they should be as physically active as possible based on their conditions.
  5. Older adults with health conditions and disabilities such as stroke, brain injury, Parkinson disease and other neurological conditions, exercises should be carried out under the guidance of physiotherapist to ensure the safety of the individuals.

Here in Healthworks, our physiotherapist will perform a thorough assessment and design a comprehensive exercise program for you. If there are any queries regarding this article, feel free to contact us at 018-982 8539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

Physical Activity in Elderly2019-08-13T05:38:18+08:00

Fall Prevention In Elderly

Fall can happen anytime and anywhere to people of different ages. However, as we get older, number of fall increases with age which resulting injuries and fatalities. According to the Centers for Disease Control and Prevention in US, falls are the leading cause of fatal and nonfatal injuries in people aged 65 and older. A person who falls may subsequently experiences pain, hospitalization, surgical intervention, admission to a nursing home and develops fear of falling. Fear of falling will cause further functional decline in an already frail patient.

Why Patient Falls?

Normal walking requires muscle strength, balance and coordination to allow proper gait. Freely moving joints, muscles contracting at the right time with the appropriate strength is important to support the body for normal gait and balance. As a person ages, he/ she may experience stiffened joints, decreased in muscle strength, reduced proprioceptive input which results in loss of balance and eventually increase the likelihood of falls. The risk of falling increases with a number of factors.

Risk Factors

1. Gait and balance impairment
2. Reduced muscle strength
3. History of falls
4. Obesity
5. Depression
6. Dizziness
7. Arthritis
8. Visual impairment
9. Medication

Falls put you at risk of serious injury. Still, fear of falling doesn’t need to rule your life. Instead, consider these lifestyle choices to prevent falling.

1. Understand Your Health & Medications
– Talk to your doctor about the side effects of your medications and over the counter drugs, as fatigue or confusion increase your risk of falling. Take medications on schedule.

2. Remove Home Hazards
– Take away boxes, electrical cords, phone cords from the walkway.
– Shift coffee tables, magazine racks to the corner
– Immediately clean liquid spills and grease of foods
– Use non-slip mats in bathtub or shower.

3. Use Assistive Devices
– Install handrails for both sides of stairways
– Install grab bars for shower or tub

4. Physical Exercise
– Physical activity can go a long way towards fall prevention.
– Activities such as walking, water aerobics, and taichi will help improve muscle strength which in turn help in reducing risk of falling.
– If you are worried that you might fall during exercises, consider seeing a physiotherapist for a thorough consultation and assessment regarding your current physical fitness. The physiotherapist will create a custom exercise program aimed at improving the muscle strength, balance, coordination and proprioceptive input.

Here in Healthworks, our physiotherapist will perform a thorough assessment and design a comprehensive exercise program for you. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

Fall Prevention In Elderly2019-06-25T02:26:57+08:00

Child Developmental Delay

When you notice that your child is crawling, creep and scoot on his bottom but hasn’t start walking while other children of his age has already walking. The first thing you have in mind was about his motor development. Most children gain the ability to walk independently between the age of 11 months to 15 months. If your child is not walking by 18 months, his progress is considered delayed and delayed walking is caused by number of reasons.

Risk Factors for Developmental Problems:

  1. Genetic

Children are placed at generic risk by being born with genetic or chromosomal abnormality. Down Syndrome is an example of genetic disorder that causes developmental delay because of an abnormal chromosome.

  1. Environmental

Environmental risk results from exposure of harmful agents either before or after birth. It includes a child’s life experiences. For example, children who are born prematurely, face severe poverty, mother’s depression, poor nutrition, or lack of care are at increased risk for developmental delays.

 

Developmental Delay and Paediatric Physiotherapy

The most important thing a parent can do for delayed child is provide a loving and supporting environment.

A child with developmental delay will benefit from physiotherapy. Physiotherapy treatment for developmental delay should therefore starts as early as possible so that the child’s brain can adapt easily and learn faster. Physiotherapy treatment will focus on improving gross motor skills such as mobility, muscle strength, joint flexibility and balance. A precise treatment plan will be developed incorporating family, carers and teachers so that Child Development Milestones are reached.

Besides that  physiotherapy involves in muscle stretching to lengthen muscles, increase range of motion and prevent joint stiffness and contracture. Physiotherapist also helps in facilitating head and trunk control, supporting the child in sitting to develop weight shifting, coordination and balance. Advice about supportive device such as orthotic devices, walking aids and wheelchair will be given to the parents if necessary.

Physiotherapy treatment has the ability to help your child to achieve their maximum potential and be as independent as possible with their activities of daily living. Here in Healthworks, the physiotherapist will perform a thorough assessment and design a comprehensive treatment plan for the child. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

Child Developmental Delay2019-07-03T09:56:10+08:00
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