Posts tagged back pain relief
Proper Treatment for Ankle Sprains
About ten percent of emergency department visits are the result of ankle injury. Most of these injuries are simple ankle sprains. These injuries are most commonly treated with RICE therapy. Patients are instructed to rest and ice the joint for 20 minutes sessions. Then, the injury is wrapped in compression bandages and elevated. The Jones compression uses alternate layers of elastic bandages and compression bandages. Finally, patients are instructed to elevate the ankle. To reduce pain, ibuprofen is usually provided. Patients who are ibuprofen-intolerant are given acetaminophen instead. This is the common procedure for ankle injuries.
RICE therapy is an effective for of treatment, to an extent. Unfortunately, it does little to prevent future ankle damage. The RICE technique provides initial damage control but more must be done to ensure future injury is avoided. Statistics show that 25% to 40% of all ankle sprains are recurring injuries. If original injuries go untreated, the patient has a good chance of damaging the ankle later in life. Minor forms of disability may also occur. One possible solution is OMT, or Osteopathic manipulative treatment.
The purpose of this treatment is to focus on the patient's unique needs. The specific treatment given to each patient varies from person to person. It is the osteopathic physician's job to examine the patient's injury and decide which soft tissue techniques would be best suited for the job. There are several soft tissue techniques osteopaths can use to manage ankle injuries. The average session lasts for 10-20 minutes. Studies show that OMT sessions do reduce ankle injury pain and many patients experience improved range of motion as well.
There are many soft tissue treatments. The physician studies the bones, from toe to ankle, and decides where most attention should be focused. Osteopaths have many options for ankle treatment. Sometimes muscle energy and strain-counter strain techniques prove useful. In other situations, lymphatic drainage is the main focus of the treatment. Drainage is an important part of the pain reduction process. The majority of ankle injury pain is the result of the fluid that builds up in the joint areas around the bones. This fluid can severely decrease mobility and slow down the recovery process.
Ankle sprains require immediate treatment. Physicians aim to return the ankle to proper working order. The goal is to get the patient up and walking normally as soon as possible. They also try to increase the overall range of motion and reduce pain levels as much as possible. Studies prove that even one Osteopathic manipulative treatment session can greatly improve the recovery process for acute ankle injuries.
Ankle injuries are not to be thought of lightly. Even a slight sprain should receive medical attention. If injuries go untreated, proper healing may never occur, leading to permanent disability. Fortunately, treatment is readily available. RICE (rest, ice, compression, and elevation) therapy and a quick session with an osteopath physician can reduce pain and shorten recovery time. Osteopath therapy also reduces the risk of future ankle injury.
Ankylosing Spondylitis Treatment by Physiotherapy
Ankylosing spondylitis belongs to a group of disorders called the spondyloarthropathies, a group which also includes psoriatic arthritis, reactive arthritis and arthritis related to inflammatory bowel disease. All these conditions are linked by the genetics of a gene on white blood cells called HLA B27 and by the presence of enthesitis, inflammation at the points where ligaments and tendons insert into bone. This can lead to fibrosis at these sites and then bone formation, causing joint fusion (ankylosis) in some cases.
The commonest spondyloarthropathy is Ankylosing spondylitis, which occurs as a reflection of the occurrence of the HLA B27 gene in the population. The gene occurs much less commonly near the equator and much more commonly in northern latitudes, and this is also the pattern with the development of AS. White race people are more commonly affected with around 0.1 to 1.0 percent overall, varying with latitude. Only 1 or 2 people of a hundred with the HLA B27 gene actually develop AS, but if they have a close relative who has the condition the likelihood rises to 15 to 20%.
Three males to every one female is the ratio of patients with Ankylosing spondylitis, as female patients may have much less obvious symptoms and so be missed from the diagnosis. Young men are the commonest presenting group with most consulting a doctor before they are 40 and up to 20% before they are sixteen years old. 25 years is the average age that someone goes down with the symptoms and is uncommon to find a diagnosis of AS in a person over fifty. It is easily overlooked as it can look like mechanical back pain if care is not taken. On questioning how they are in the morning, a typical answer is very stiff.
Low back pain is the major diagnostic alternative but AS patients are generally younger and the inflammatory process leads to different symptoms:
Morning back stiffness lasting half an hour and often longer Back pain improved with exercise Back pain worsened with rest Night pain later on in the night Other joints may be affected Fatigue is common Active inflammatory disease can cause systemic affects such as unwellness, weight loss or fever
On examination the physiotherapist can find a stiff lumbar spine with reduced movements from normal, postural abnormality such as a flat lumbar spine and an increased thoracic kyphosis. In later stages neck movements may also be involved and chest expansion will be reduced from normal. In the third of patients who get peripheral involvement, enthesitis develops in areas subject to mechanical stresses, the most common being the insertion of the plantar ligament in the foot and the insertion of the tendo Achilles to the heel. These areas will be palpated by the physio to help confirm the spread of the disease, helping to focus the treatment plan later on.
The physiotherapist initially notes the postural changes which have occurred in an AS patient such as any spinal deformities, round shoulders, bent knees or an increased cervico-thoracic curve and poking chin posture. The physio will record ranges of movement of the spine and include the neck, thorax and lumbar ranges, also assessing any peripheral joints which may be affected. Any entheses which are reported as painful are palpated to confirm the presence of an inflammatory process, and if the AS is very active then the physiotherapist might also find effusions in the joints, perhaps with a feeling of unwellness, night sweats and poor rest.
Physiotherapists will concentrate on treating the inflamed areas first such as the areas where the ligaments insert into the bone, using insoles, cold, ultrasound and stretching techniques. Routine spinal range of motion exercises are taught to patients with an emphasis on getting to end ranges, concentrating initially on the anti-gravity muscles such as thoracic and lumbar extensors. Neck rotation and retractions and thoracic rotations are also important functional movements not to lose. Patients should rest themselves in good postures such as prone or supine with only one pillow, to avoid accentuating the typical spinal deformities. Treatment for AS in a hydrotherapy pool is beneficial and soothing and patient education important so they keep up their programme.
