Peroneal Tendinopathy

Peroneal tendinopathy is caused by repeated tension or stress on the tendon of the muscles that run down the outer side of the lower leg (the peroneal muscles). Peroneal tendon injuries are usually due to increased loads and overuse of these peroneal muscles. Over time, the tendon thickens in an attempt to manage the increase in load more effectively. This makes the tendon vulnerable to painful straining, inflammation and tearing. 

The peroneal muscles act to:

  • turn the foot outwards
  • prevent the foot from rolling in
  • help point the foot downwards
  • centring and stabilising the body’s weight over the foot when standing on one foot

What Causes Peroneal Tendinopathy?

Causes can vary. Tendinopathy often develops over years without symptoms.

  • Symptoms may develop gradually for no apparent reason
  • Inadequate or unsupportive footwear
  • Change in footwear in long distance runners
  • Poor biomechanics and/or muscle imbalances of the lower limb
  • A sudden increase in weight bearing activities, particularly walking (uneven surface), running, jumping and landing
  • Lateral ankle sprains with resultant instability issues (inadequate rehab)

What are the Symptoms of Peroneal Tendinopathy?

People with peroneal tendinopathy may experience:

  • Initially the pain can seem to be sporadic but if you pay close attention you may start to notice a pattern
  • Gradual worsening pain over the outside of the ankle
  • Stiffness or pain in the morning or on initiation of exercise and after loading
  • Pain during and/or after weight bearing activities
  • Pain with turning the foot in and/or out – not always
  • Firmly touching the affected peroneal tendon can cause pain or tenderness

This condition can often lead to weakness or instability in the ankle without proper management.

How is Peroneal Tendonitis Diagnosed?

Diagnosis is made from taking your clinical history and further supporting with physical testing. Tendinopathies have a distinguishable clinical history so can be made by an experienced health professional. 

Osteopaths are 5 years university trained in the musculoskeletal system and are well placed to make an accurate diagnosis. Tendinopathies rarely require imaging for a diagnosis.  These are usually only necessary when a tendon is not responding to the course of treatment, or to rule out other pathology that may be delaying healing times. Often an ultrasound or MRI can be used in this instance. 

Is Treatment Available?

The prognosis/ healing time-frame for peroneal tendinopathy is variable, depending on the stage of the injury.

Treatment in the initial stages is aimed at reducing load and allowing the irritated tendon to settle. Once the pain lessens, tendons recover through progressive loading.  Addressing weakness in lower limb musculature and restricted biomechanics is important also to prevent recurrence.

Chronic tendinopathies will take much longer to recover. The treatment at this stage is largely based on active rehabilitation to improve the tendon’s ability to respond to load. However, loading for tendinopathies is tricky. Tendons respond to load differently, if you load incorrectly, it may make the condition worse, therefore going to see an experienced health professional is key to a fast and complete recovery.

What Can I Do to Prevent it?

Prevention is key! There are several things you can do to reduce your risk of developing peroneal tendinopathy:

  • Wear correct, supportive footwear for you – this may be different for each person, podiatrists are very helpful for finding the best shoe for prevention strategies.
  • Gradually increase your training load or exercise level
  • Maintain a level of activity in the “off-season”
  • Improve your balance and ankle proprioception

For further information about this condition or any others please feel free to reach out via my email address breanna@pakenhamosteopathy.com.au or call the clinic. Thanks for reading!

Thoracic Outlet Syndrome

Thoracic outlet syndrome is an impingement condition that can result in numbness and tingling into the hands and forearms. It can be caused by a variety of factors, the main one being poor postural habits, which is especially common in office workers and students.

Other factors which contribute are:

  • Stress
  • Excess weight
  • Poor sensory awareness of one’s body positioning
  • Stomach sleepers
  • Large chested women
  • People who have to hold their arms up for long periods of time
  • Traumatic injuries from a car accident (shoulder strap can tear/strain muscles with scar tissues build up during healing)
  • Previous collarbone fractures are just a few.

Anatomy

The thoracic outlet refers to the area from your neck to the top of your shoulder. Though this opening there are several nerves and vessels, which pass through to supply the muscles of your arm and hand. They can become trapped at various sites these locations, between muscles in the neck called the scalene muscles, over the top of the rib cage, under the collarbone and through the armpit under the pec muscles.

Signs & Symptoms

  • Numbness & tingling of hands and/or arms especially at night
  • Pain, tingling of the neck chest or arms
  • Pins and needles when doing overhead activities for prolonged periods
  • Heaviness and weakness of the arms and sometimes swelling in severe cases
  • Poor circulation of hands and finger

Treatment time frame

A conservative approach is recommended. Strengthening your shoulder and back muscles is essential to help achieve long term resolution while stretching your shoulder and neck muscles to open the thoracic outlet space will help provide symptomatic relief and pain reduction. Treatment to improve range of motion and posture are key. Exercises, done over time, take the pressure off your blood vessels and nerves in the thoracic outlet. Symptoms may vary however, a reduction in symptoms and resolution is usually achievable within 2 months.

Osteopathy Treatment

Osteopathy treatment will aim to:

  • Loosen off the muscles in the neck and upper shoulder, which will reduce the compression on the nerves/vessels
  • Improve the way your upper back and neck joints work so good posture is easier to maintain and movements of your neck and arm become less painful.

For conditions like these, where everyday activities can aggravate the pain, it’s essential that you are active in the recovery. Management aimed at education such as:

  • How to manage symptoms at work
  • What movements/activities you should avoid
  • How to sit and stand with a posture that will not aggravate your symptoms that you can maintain at work and at home as good posture is critical to managing TOS symptoms

Once you no longer have pain we’ll be focusing on the best way to avoid recurrence, via retraining and strengthening of your shoulder blade muscles, and going through postural changes at work and home.

What Can I do to Help Recovery?

  • Better bra support for large chested females (e.g. less long line bra)
  • Rapid breathing and stress and worsen the symptoms, practice diaphragmatic breathing
  • Avoid looking up, bending the neck back, or holding your arms up for long periods of time
  • Don’t carry a purse or bag on the affected shoulder
  • Avoid tummy sleeping if possible with arms up under your pillow
  • Postural bracing – recommended for desk workers
  • Take frequent breaks at work to move and stretch
  • Avoid activities that worsen symptoms, or find ways to adapt activities so that they don’t cause symptoms
  • Create a work area that allows you to keep good posture and doesn’t make symptoms worse

It’s essential to seek treatment sooner rather than later as nerves have a good memory and don’t appreciate being compressed, the sooner of symptoms the better the prognosis will be and a faster recovery time.


If you are experiencing any of these signs and symptoms or have in the past and want to prevent recurrence come and see us for a consultation to get on the track to recovery. Or if you have questions about this post, please feel free to email me breanna@pakenhamosteopathy.com.au 

Below Your Low Back Pain

The Sacroiliac Joint is the joint where the sacrum (area below the lower back) meets the pelvis. We each have a left and a right sacroiliac joint and these joints help to support the weight of the upper body, transferring forces through to the lower limbs. They are strong weight bearing joints with irregular edges that help lock the joints together like a wedge, preventing much movement within the joint.

Sacroiliac joint pain is often caused by the compression or repetitive loading of the strong ligaments that help hold the joints together. Pain can be caused by inflammation or bruising of the ligaments or joint capsule, interference to the nerves around the joint or muscle dysfunction.

Force closure is the term used to describe the other forces acting across the joint to create stability such as the muscles & ligaments. Force closure is particularly important during activities such as walking when uneven loading of the legs creates shear forces in the sacrum.

Things that affect the SI joint

  • Altered posture and load bearing 
  • Changes in ligamentous & joint capsule tension  
  • Altered muscle length and reduced muscle strength
  • Poor muscular coordination

What does an SIJ injury can feel like?

Due to all the various structures that influence the SIJ, the way the injury feels can vary quite significantly.

Common symptoms may include:

  • Pain can be very intense directing over the joint line and is often sharp and burning, however can also present as a dull ache.
  • The sacroiliac joint itself is usually very tender to touch.
  • Pain is usually worse when standing on the leg of the painful side, walking up and down stairs, when rolling over in bed and getting into and out of a car.
  • Sacroiliac joint pain can refer into the buttock region, across the lower back and sometimes into the hip and groin
  • Sharp, shooting pain in the gluteals/buttock muscles

How Can Osteopaths Treat the SI Joint?

As such a complex joint, treatment revolves around a few key points:

  • Firstly, determining the primary driver. This means figuring out the cause of the pain.
  • Unloading the unhappy and overworked issues.
  • Retraining the load transfer through the pelvis.
  • Increasing the load capabilities of the issue.

We use many different treatment modalities, but commonly a treatment will involve any (or several) of the following;

  • Manual therapies including joint mobilisation and soft tissue mobilisation.
  • Dry Needling (if indicated).
  • Home or gym based exercise programs.
  • Stretching programs.
  • Modification of activity (if indicated).
  • Strapping or compression belts (if indicated).

How to sit

Sit on a chair with your knees apart and slightly turned out

Sit in positions that relax your lower back while it remains supported, using a cushion or a rolled towel behind your back (maintain a natural curve in your back) sit upright when the back is not supported

You can also stretch your hips by sitting high enough so that your knees are slightly lower than your hips

**You can use a ball cushion while you are sitting, or sit on a therapy ball; sitting on a ball cushion allows your tailbone to be free. When you use a ball cushion or ball, you develop active stomach and back muscles over time as a result of trying to maintain your balance.

How to stand

Most people stand with their pelvis out in front and their shoulder’s and ribcage back.

This posture causes the sacrum to jam up. This position can create low back and SI joint aching during prolonged standing.

Correct your alignment by shifting your hips back (slightly tuck your tailbone under), allowing your trunk to move forward so the line of gravity travels through your joints: shoulder, hip, knee and ankle.  Now the pelvis is in neutral: the pubic bone and ASIS line up vertically, and the SI joints are in optimal position.

Thanks for reading!

If you suffer from this condition, please seek help with us! We’ve love to help you get back on you feet and doing the things you enjoy! If you have any questions about this article, please feel free to email me breanna@pakenhamosteopathy.com.au

 

Sedentary Activities Can Result in Upper Back Pain

Often when we experience upper back pain it is not actually an issue with our spine, but rather a problem with the joint where our rib connects to our spine.  Read on to find out more about rib sprains…

What is it?

A rib sprain is one of the most common complaints that osteopaths treat, however it is not an injury that is well known (unless you’ve been unlucky enough to have experienced it first hand!).  Each rib attaches to the spine as a joint and then curves around to attach to your breast bone, called the sternum, via another joint. The ligaments attaching the rib to your spine can be sprained similar to how you can sprain your ankle and this is what is referred to as a rib sprain. 

They can be quite uncomfortable and you will often feel pain “behind your shoulder blade,” or in mid back slightly to one side.  The pain can be constant or intermittent and can be exacerbated by activities such as:

  • driving
  • twisting your upper body
  • reaching overhead or out in front with your arms
  • carrying bags over one shoulder
  • coughing
  • sneezing
  • deep breathing

In severe cases, pain can often radiate into the front of the chest where the ribs attach at the front of the rib cage. 

 

What Causes It?

Rib sprains affect people from all walks of life – from office workers to labourers and athletes to breast-feeding mums. There are many causes of this condition including poor posture, constant reaching and mechanical trauma to name just a few.  The common theme is that rib sprains usually occur with prolonged or repetitive movements.

Having poor posture and being in any one position for an extended period of time such as sitting at a desk, driving or sleeping can result in the shoulders rolling inwards and the spine flexing forwards.  This increases the pressure on the joint where the ribs attach causing the ligaments to sprain once they reach a failure point.

Rib sprains can also occur from overloading the ribs quickly such as lifting or from sport, but in both cases often the joint has been predisposed to injury due to other biomechanical factors.  These may include pelvic imbalances, tight lower back musculature creating a pivot point higher up, or previous shoulder injuries to name a few.  In rare circumstances coughing, sneezing or bearing down to go to the toilet may be enough to cause a rib sprain.

 

What Treatment May Help?

Rib sprains, although painful, mostly heal fully and quickly, within a couple of weeks. However due to the wide range of causes and other factors that can reduce healing (eg. sedentary job), recovery time is very individualised.

The osteopaths at Pakenham Osteopathy will recommend a treatment approach that will help with your pain and decrease the chance of reoccurrence by focusing on biomechanical factors to reduce the load going through the rib joint.  Hands on treatment is generally a combination of massage, gentle articulation, manipulation, dry needling, taping and movement modification to help manage your condition.

If you’ve found this article helpful please share it with your friends.  If you have any questions about rib sprains, please email me directly at breanna@pakenhamosteopathy.com.au

What Does An Osteopath Actually Do?

“What does an Osteopath actually do?” Is a question that we often hear people ask. Trying something you have never experienced before can be a daunting prospect. This blog aims to demystify Osteopathy and give you a better understanding of exactly what is involved in an Osteopathy consultation.

Osteopaths are trained to treat all the muscles, joints, tendons and ligaments in all areas of the body.  Anything in the musculoskeletal system is right up our alley! Some of the more common conditions we see in the clinic include:

  • Low back pain
  • Neck and postural pain
  • Headaches and migraines
  • Sciatica
  • Sporting injuries
  • Arthritis
  • Overuse type injuries
  • Shoulder, hip and knee pain

Depending on what you come in with, we will ask various questions about your presenting complaint.  As an example, “when did you first notice the pain come on?”, “Have you had this before?”, “What helps or makes it worse?” These questions allow us to clarify the specific injury you have and will help us to diagnose your condition.  

Secondly, we’ll dig a little deeper into the impact of the injury on your everyday life.  Questions such as, “Is it stopping you from doing anything that you want to get back to?” or “What has this injury forced you to give up or miss out on”.  These allow us to identify what your overall goals are and what things you’d really like to continue doing injury free.

Also in the initial consultation, we conduct a brief medical history to gain an overall understanding of your health.  This is followed by an examination which involves performing some movements to find out the tissues that are restricted or contributing to the problem. Special orthopedic tests as also carried out giving us more insight into which tissues are involved.

Osteopaths take a holistic approach to treatment, so your osteopath may look at other areas of your body, including the ones that is troubling you. For example, if you have a sore knee, we may also look at your ankle, hips and lower back in order to gain an understanding of what else may be contributing to your injury.

Then comes the fun bit… Treatment!!! Osteopaths use a variety of techniques including soft tissue massage, fascial release techniques and stretching may all help to ease muscle guarding and offload the painful area.  Joint mobilisation or articulation are often used to get restricted joints moving. This technique involves moving a joint through a range of motion repetitively. Dry needling can help to loosen off tight muscles, and we can use manipulation or “cracking” too, to name just a few. 

Lastly, we provide every new patient with an individual management plan which details your diagnosis, how much treatment you will need and how long you can expect recovery to take.  We may provide you with stretches or exercises to do at home to aid your recovery, or advice on lifestyle factors such as posture. We believe knowledge is power so the more you know about your injury, the better your long term outcome.

Hopefully you now have a better understanding of what is involved in an Osteopathy consultation and how we treat the body.  Should you want any further information, we have loads of useful information on the rest of our website here or please make an appointment today by clicking here!

The Shoulder – This Joint Can Move!!!

“Osteopathy… that’s bones right?”

 

Contrary to popular belief, Osteopath’s treat more than just bones. As allied health care professionals, we treat a vast range of conditions in the field of the musculoskeletal system, the shoulder joint being one of them.

 

Now the shoulder joint is a complex joint, with one main point to bear in mind. This joint can move! The shoulder joint is the equivalent to the breakdancing joint of your body – it can move in ways your other joints cannot. In comparison, the hip joint is a weight bearing joint and is engineered to have more stability to be able to withstand heavy loads. The shoulder joint on the other hand (bad pun intended) has a greater range of motion, which it incurs at the cost of stability.

 

As always with break dancers, they are prone to injury. Having that level of mobility comes at certain costs.

 

Stability vs mobility. A joint with a great amount of mobility relies and is dependant on the surrounding muscles to provide dynamic stability. This is where things becomes unstuck. The muscles surrounding the shoulder joint provide stability and support, this in turn makes them susceptible to injury. When a muscle is injured, the ligaments within the shoulder are exposed to injury as well due to now having a greater load placed on them without the support of the surrounding muscles.

 

Other factors that come into play are congruency of the joint which is affected by posture, overworked muscles, weakened surrounding muscles, neck movements and older injuries. As osteopath’s we look at a number of different ways to help aide in your recovery process once injured and get your shoulder dynamics back on track through a complex screening system which takes into account these factors and more.

 

If you’re having trouble with your movement, please make an appointment online today by clicking here. Or call the clinic directly on 5941-4157.

Thanks for reading!

 

Breanna Kerr