Which part of the brain is involved in sensation?

Q: Which part of the brain is involved in relaying somatic sensory information from the skin of the trunk and extremities to the somatosensory cortex? 

A: The thalamus has several functions, one of which is the processing and relaying of sensory information. It receives sensory signals and then relays them to the appropriate cortical area in the cerebral cortex. The thalamus sits between the cerebral cortex and the midbrain, and comprises of a paired structure in the midline of the brain. 

Exercise after pregnancy: looking after yourself

Exercise after giving birth is probably the last thing on your mind with a newborn requiring much of your time and attention, not to mention the sleep deprivation and change in lifestyle. However when you are ready, finding the time to exercise is important and will make you feel a lot better both physically and psychologically. 

 

This article will cover the following:

1. Benefits of exercise

2. When to start

3. Exercise and breastfeeding

4. Some tips to get you started

5. Exercise suggestions 

Latest research on Frozen Shoulder: Effectiveness of conservative & surgical interventions

Article Review

Aim
To review current evidence on the effectiveness of conservative and surgical interventions for treating frozen shoulder.

Methods
Databases including the Cochrane Library, PubMed, Embase, Cinahl and Pedro were searched for relevant systematic reviews and randomised controlled trials (RCTs). The quality of the studies were assessed by two independent reviewers and summarised.

Frozen Shoulder (Adhesive Capsulitis)

What is it?

Frozen Shoulder is a common condition in the middle aged to older population, with reported incidence ~2-5% presenting to GP and affecting women more than men (70% women 40-60 yrs).

As the medical term 'Adhesive Capsulitis' implies, it is when the shoulder capsule (tissue surrounding the glenohumeral joint) becomes stiff (adhesive) and inflamed (capsulitis), leading to significant loss of range of motion (ROM) and pain.
This condition can last from 5-6 months to 2-3 years or more. 

Back Pain: Part II (Strengthening Exercises)

Continuing from Back Pain: Part I (Stretching/Mobility Exercises), this article will look at some strengthening exercises for the back. 

Much of the latest research on back pain have focused on the importance of two muscles: transverse abdominus and multifidus, and their roles in back pain. This is because both of these muscles lie deep in the spine, forming the functional core of the body. The multifidus muscle stabilises the joints at each segmental level of the spine. Hence you may have heard physiotherapists emphasising the importance of retraining your 'core' stability. 

Research has shown that in people with back pain, these two muscles are weakened, their recruitment patterns are altered and their ability to stabilise the spine is impaired. If these problems are not addressed, evidence suggests that the chances for recurrence of back pain would be increased. 

Strengthening these deep core muscles and retraining their activation patterns during functional activities are two essential components of all back rehabilitation. 

Back Pain: Part I (Stretching/Mobility Exercises)

Back pain can be a frustrating condition to fight off as it seems to keep coming back without any warning. You may have been careful with posture, didn't do any heavy lifting or strenuous activity, however you wake up with a bit of a niggle that worsens on specific movements or particular activities.

What causes back pain?

There are many causes of back pain. The spine consists of nerves, discs, joints, muscles, tendons and ligaments which can all produce pain. Without going into too much detail on the topic and theories of pain, back pain can be thought to be a result of a chemical or mechanical cause. Chemical pain could be a result of inflammation which irritates nerve endings and causes pain. Mechanical pain could be due to joints that are stiff or hypermobile, muscles that are strained or overactive (spasm), bulging disc with possible nerve impingement (which can also cause radiating pain down extremities), overused tendons/ligaments, etc. 

Latest research findings on the reliability and accuracy of clinical tests to diagnose an ACL tear

Q: With regards to the tests for ACL tear, which is most reliable and/or accurate?

A: The 3 main clinical tests that are usually performed by therapists to diagnose an ACL tear include the Anterior Drawer test, Lachman test and Pivot Shift test. However the reliability and accuracy of these tests have been questioned. Here are the findings from three studies (Ostrowski 2006; Benjaminse et al 2006; Peeler et al 2010) regarding the reliability and accuracy of these tests.

Do musicians have different brains?

Does musical training reorganise the brain? What are the implications? 

An article published in Psychology Today, June 11, 2010

In the last twenty years, brain imaging studies have revealed that musical training has dramatic effects on the brain. Increases in gray matter (size and number of nerve cells) are seen, for example, in the auditory, motor, and visual spatial areas of the cerebral cortex of musicians.

Do you get wrist pain from typing or writing?

Q: "I get pain in my right hand near my wrist after long periods of typing and sometimes the area around my wrist (palm side) gets a bit swollen too.  What can I do to help the problem?"

A: This sounds like a case of "Occupational Overuse Syndrome" (OOS), or more commonly known as "Repetitive Strain Injury" (RSI). There is usually no discrete pathological cause for RSI - it is rather related to the overuse (and/or improper use) of particular areas of the body resulting in pain and/or other symptoms.

Shoulder Complex (Part III) - Anterior/Posterior/Multidirectional Dislocations & Exercise Rehabilitation

Traumatic Anterior Dislocation

Anterior Dislocation

Mechanism:

• Accounts for 75-95% of dislocations
• Forced abduction and external rotation of the shoulder (eg. basketball player attempting to block an overhead pass - watch video here)

Initial Presentation:

• Severe pain
• Lateral outline of shoulder flattened
• Possible bulge under acromion
• Possible nerve +/- vessel injury

Shoulder Complex (Part II) - The Unstable Shoulder

SHOULDER INSTABILITY

Glenohumeral instability is the inability to maintain the humeral head in the glenoid fossa.

Classification Scheme:

1. Degree

2. Frequency

3. Etiology

4. Direction

Introduction to the Shoulder Complex (Part I) - What structures are involved in providing shoulder stability?

Introduction

The shoulder is the most mobile joint in the human body. A normal shoulder precisely constrains the humeral head to the centre of the glenoid cavity throughout most of the arc of movement. 

Anatomy

Glenohumeral joint (GHJ):

• Multiaxial ball and socket synovial joint
• Large ROM (range of motion) up to 180 deg with 3 degrees of freedom (flexion/extension, abduction/adduction, internal rotation/external rotation)
• Glenoid fossa is relatively shallow and provides little bony support for stability of the humeral head (humeral head = 3 x glenoid fossa; at most, only ~25% of humeral head is in contact with glenoid fossa in any given position)

Shoulder Stability

Shoulder stability is the result of a complex interaction between static and dynamic restraints.

• Static stabilisers (capsule, ligaments, labrum) act as concave structures to deepen the glenoid fossa.
• Dynamic stabilisers include rotator cuff and surrounding larger muscles that provide scapular stability (serratus anterior, lat dorsi, rhomboids, trapezius, pectoralis)

Review on LARS - An alternative for ligament reconstruction

I was asked about the efficacy of LARS as an alternative surgical option for ACL reconstruction. 

In recent years, the use of LARS ligaments have been increasing with promising clinical results. In fact, these ligaments have been in clinical use for over 15 years. LARS stands for Ligament Augmentation & Reconstruction System, and these artificial ligaments are intended for the intra or extra-articular reconstruction of ruptured ligaments.

Knee injury: ACL (Part II)

In follow-up to my previous article on "Knee injury: ACL (Part I)", here is the 2nd half of my discussion to provide an overview of ACL surgery and post-op rehabilitation.

Who will benefit from surgery?

• Individuals with active lifestyles
• Individuals involved in high-level sporting activities (eg. soccer, basketball, netball, footy, skiing, etc)
• Those with recurrent knee instability due to ACL deficiency
• Those wishing to protect their knee joint and cartilage from future damage
• Individuals who have attempted and failed conservative management with recurrent knee pain and instability

Knee injury: ACL (Part I)

My sister-in-law recently ruptured her ACL playing touch footy and will be undergoing surgery in a month. Hence it prompted me to write about the ACL - what it is, what happens with an ACL injury, and provide an overview of surgery and rehabilitation from a physiotherapist's perspective.

What is the ACL?

The Anterior Cruciate Ligament (ACL) is one of the four major stabilising ligaments of the knee.

The other three are: Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL).

The term 'cruciate' is used as the ACL crosses the PCL in a crucifix position.

Baby milestones: 7 to 12 months

Understanding the developmental milestones of a baby is a good way for parents to monitor their child's growth. It is of course important to mention that all babies are different and some may achieve certain milestones later than others, and this is nothing to be worried about (unless you notice this delay happening consistently).

Following on from my previous article "Baby milestones: 1 to 6 months", here listed below are the major milestones to look out for in your child between 7 to 12 months.

Baby milestones: 1 to 6 months

Understanding the developmental milestones of a baby is a good way for parents to monitor their child's growth. It is of course important to mention that all babies are different and some may achieve certain milestones later than others, and this is nothing to be worried about (unless you notice this delay happening consistently).

Here listed below are some of the major milestones to look out for in your child.

1 month: 

• Lifts head when lying on tummy
• Responds to sound
• May stare at faces

2 months:

• Starts to vocalise (ooh, aah, coos, gurgles)
• Can start to follow objects
• Plays with hands
• Lifts head at 45-degree angle for short periods

3 months:

• Smiles
• Lifts head > 45 degrees (and shoulders) when lying on tummy (mini-push up)
• Visually tracks objects
• Recognises your voice

 

4 months: 

• Smiles and laughs more frequently
• More vocalising and responds by cooing when you talk to him/her
• Starts to roll over (most commonly from tummy to back)
• Starts to bring hands together and swipe at toys 

 

5 months: 

• Plays with hands and feet
• Grasp toys
• Rolls over in both directions
• Imitates sounds

  

6 months: 

• Sits without support
• Imitates sounds
• Turns to sounds and voices
• Mouths objects
• Start solid foods

Question received re: Exercises suitable for when sick with the cold/flu

QUESTION RECEIVED 31/8/10:

"What kind of stretches/exercise can you do when you are sick with the flu and a lot of your body hurts? How can you get your blood circulating well without exhausting yourself?"

Good on you for thinking about exercising even when you are sick. It is often so hard to motivate yourself to get up off the bed or couch, or sometimes you just physically are not able to stand up long enough before feeling dizzy or weak.

Here below are some gentle exercises that I would recommend for you to do to keep the blood circulating and prevent your body getting stiff (without causing too much exhaustion). Just select a few that you like and try to do them 3 x a day. I have also written down the sets/reps that I would recommend. Of course, the key is not to over-do, so do what your body can handle!

Ankle pumps

In lying (1-2 sets, 10-15 reps):

• Ankle pumps
• Static quads (tightening the thigh muscle with your knee straight)
• Straight leg raises

Squats

In sitting (1-2 sets, 10-15 reps):

• Seated calf raises
• Knee bends/extensions
• Seated leg marches
• Sit-to-stands

In standing (1-2 sets, 10-15 reps):

• Mini squats
• Mini lunges
• Calf raises (with arms down by side first; then progress to holding arms straight out to sides)

Light strenghtening exercises using hand weights (eg. 1-2kg; 1-2 sets, 10-15 reps):

Bicep curls

• Bicep curls 
• Tricep curls (palm facing inwards with arm held back, straightening/bending elbow) 
• Deltoid flies (with elbow straight, elevate your arm out to the side)
• Overhead press (push arm straight up into the air)

Gentle fitness exercise (15-30 mins):

• Walking is important - If possible, try to get some fresh air and go for an easy walk around your area, sticking to the flats rather than doing hills

Gentle stretching exercises (hold each for approx 15secs, repeat 2x):

• Neck: tilting head sideways, rotating both sides, looking up and down
• Shoulders: 
• Pull one arm across the front of your chest and feel the stretch at the back of your shoulders



Posterior Shoulder Stretch

• With hands together, stretch arm upwards and hold above the head

•  Reverse shoulder stretch

 

• Wrap around shoulder stretch

 

• Calf stretch

• Quads stretch

Hope this has been helpful for you. If you have any further questions, please don't hesitate to contact me.

Exercise during Pregnancy

Considering I just had a baby, this topic is quite relevant and fresh in my mind. As a physio, exercise is second nature to me. I found it rather enjoyable to exercise during my entire pregnancy, and as my body changed throughout the different trimesters, I just simply modified the type of activity I did to suit. (In fact, I exercised even up to the day of giving birth - going for a nice 90min walk in the middle of the day during my early labour contractions, and made me feel so much better!).

Simply put, it is important to exercise during pregnancy. It brings many benefits for the mother's physical, emotional and social health. Although physical activity is beneficial for most people, I must state that under some circumstances, physical activity is not recommended for the health of the mother and baby, and the obstetrician's instructions must be carefully adhered to.  

Body changes during pregnancy
Many changes occur to your body during pregnancy.

• Ligaments become more loose, due to hormones that are released during pregnancy (in particular, relaxin). This may affect the stability of your joints, such as low back, pelvic girdle, sacroiliac joints, and increases the chances of muscle strain/ligament sprain injuries.
• Your pelvic floor supports the uterus, bladder and intestines. The added weight of the uterus, increased fluid and tissue laxity may affect your pelvic floor muscles, leading to problems with incontinence. It is important to perform regular pelvic floor exercises to maintain and improve the control and strength of the pelvic floor muscles.
• Your weight will increase as pregnancy progresses, which will alter your body shape and weight distribution. As your tummy grows forward, your centre of gravity will also shift forward, affecting your sense of balance and coordination
• Your resting heart rate will be increased during pregnancy, so it is important to monitor your heart rate during physical activity. As a general rule, do not exercise above 140bpm. Another way of monitoring your exercise intensity is to use the Borg's Rating of Perceived Exertion Scale (RPE). You should be able to still talk and exercise at the same time. 
• The amount of fluid and blood in your body increases as your pregnancy progresses and so does your core body temperature. Make sure you don't exercise in hot/humid environments, and avoid sudden changes of position as that can cause sudden drops in blood pressure leading to fainting and dizziness.

Benefits of regular exercise during pregnancy

• Improve overall health
• Manage some symptoms of pregnancy such as nausea, tiredness, fatigue
• Reduce back and pelvic pain by strengthening back/abdominal/pelvic muscles (especially as the tummy grows)
• Maintain strong pelvic floor muscles to reduce incontinence
• Maintain pre-pregnancy cardiovascular fitness
• Control swelling (especially arms and legs) due to increased fluid in the body
• Improve posture
• Control healthy weight gain
• Relieve stress and anxiety
• Facilitate better sleep
• Prepare for the physical demands of labour 
• Assist recovery following labour and contraction of uterus
• Facilitate return to pre-pregnancy weight and fitness
• Assist in coping with the physical demands of motherhood

Exercise suggestions
Activities that are generally safe during pregnancy include:

• Walking
• Swimming
• Cycling
• Exercise in water (aquarobics/hydrotherapy)

Aquarobics

• Pilates

Swiss ball exercises

• Yoga 

Yoga

• Pelvic floor exercises (very important, as the pelvic floor muscles are weakened during pregnancy and birth - so it is crucial to perform these pre/during/post-pregnancy)

• Abdominal/Core stability exercises (very important, as the abdominal muscles support the lumbar spine and pelvis - the core)
• Back strengthening exercises 

Activities that are not advised during pregnancy include:

• Sit-ups or stomach crunches (as this may worsen the diastasis recti) 
• Contact sports (eg. basketball, soccer, netball)
• Jumping sports (eg. trampolining, gymnastics)
• Competitive sports 
• Activites requiring sudden and frequent changes of direction and speed (skiing, snowboarding, football) 
• Activites that increase your heart rate too much 

It is a good idea to consult a physiotherapist for a customised exercise program. They can also educate you on pelvic floor and core stability exercises, advise you on exercise progressions, and supervise you to ensure the movements are performed correctly.

Final words

• Exercise is important and beneficial during pregnancy
• Make sure you have variety in your exercise program to keep it interesting and include strengthening and fitness components 
• Drink lots of water
• Monitor your heart rate and temperature during exercise
• Watch for warning signs (such as headache, dizziness, chest pain, heart palpitations, abdominal cramps, vaginal bleeding, sudden change in baby's movements) and consult your doctor immediately
• Consult a physiotherapist for an individualised exercise program and advice on any other problems or questions. Contact us if you would like to be referred to a specialised physiotherapist.

Question received re: Neck and Shoulder tightness

QUESTION RECEIVED 23/8/10:

"How do you treat neck and shoulder tightness that has gone to the point of the muscles being almost as hard as rock?"

Interesting question.
I think the problem here is a postural issue leading to muscular symptoms.
If you work requires you to be always at a computer/laptop and hunched over for the majority of the day, then it is very common to develop neck and shoulder tightness and pain.

Posturally, your head and shoulders will be hunched forward, and if this posture is acquired for a prolonged period of time, it will place a lot of strain across your neck muscles (in particular, trapezius). Adding to the postural problems, stress and tension will make you naturally tense up in the neck and shoulder girdle, increasing the strain and tightness of those muscles.

Some helpful tips:

• Take regular breaks from your computer/laptop (hourly) - look away from the screen, stand up and walk around, stretch your neck and shoulders
• Ensure that your workstation ergonomics are set up appropriately and that you are sitting upright with a good chair

Computer Workstation Ergnomics

• Perform regular stretches to your neck muscles by tilting your head sideways, rotating both sides, bringing your head forward and backwards (hold each stretch for 15s, repeat 2-3x)

• Strengthening of the deep neck flexor muscles and the postural muscles around the neck and shoulders are also important
• Some people have also found alternative therapies such as massage, acupuncture, acupressure to be helpful
  

Flat Feet (or Pes Planus)

Lately I have had quite a few people ask me about flat feet.

Flat feet (or pes planus), is a condition where the arch of the foot is collapsed. This results in the sole of the foot being in partial or complete contact with the ground surface. Flat feet may occur unilaterally (one side) or bilaterally (both sides).

Flat foot

It may be common for young children to have flat feet, as their skeleton and musculature are still developing. Infant flat feet usually resolve by itself over time and normal arches start to develop from 4 years of age and onto adolescence. It is however important to monitor your child's walking as time progresses, looking out for excessive clumsiness, odd patterns of walking, or complaints of heel/foot/lower leg pain.

Causes
Adult flat feet can be caused by a number of factors, including:

• Faulty lower limb biomechanics
• Incorrect walking/running/sporting techniques
• Poor footwear (regular use of flat ballet type shoes, high heels, shoes with no arch or improper sole)
• Prolonged stress/pressure to the foot
• Injury
• Pregnancy

It is common for people with flat feet to over-pronate their foot (roll inwards) as they walk, and also complain of plantar fasciitis (an inflammatory condition of the plantar fascia, causing heel pain most notable first thing in the morning). Some adults may have flat feet without any symptoms; however once symptoms present, it is important to seek a physiotherapist or podiatrist's advice to work out the source of the problem and be treated appropriately.

Treatment
Depending on the cause of flat feet, some treatment options include:

• Taping to support the arch and reduce pain
• Orthotics (does not have to be custom-made, chemist ones are equally as good and cheaper)
• Physiotherapy for strengthening and proprioceptive exercises to retrain the muscles of the foot and ankle
• Correction of lower limb biomechanics (require assessment of the knee/hip/pelvis by a physio to assist with rehabilitation)
• Correction of walking/running/sporting techniques (by sports trainer or physio)
• Improve footwear 

Orthotics

More questions?
If you have any further questions or would like to be referred to a specialised physiotherapist, contact us.

Are you worried about your child's headshape or torticollis?

Plagiocephaly is a condition characterised by flattening of the side of the skull, commonly caused by a positional head preference towards that particular side.

Brachiocephaly is a condition characterised by flattening of the back of the skull.

Scaphocephaly is a condition characterised by a disproportionately long and narrow skull.

Torticollis is commonly associated with head shape abnormalities, in particular plagiocephaly. Torticollis, or wry neck, is a condition which results in tightness and shortening of the sternocleidomastoid muscle of the neck. This is often characterised by a limited range of motion in both cervical rotation and lateral flexion. The head is typically tilted in lateral flexion down towards the affected muscle and rotated toward the opposite side.

Tips for managing early headshape abnormalities:

• Monitor your child for any positional head preference(s)
• If plagiocephaly, facilitate lying on the non-affected side (with rolled towel or pillow placed behind to support spine) under supervision or lying on the back (pressure on back of head, not side)
• If brachiocephaly, facilitate alternate lying on both sides (with rolled towel or pillow placed behind to support spine) under supervision
• Perform regular stretches to the neck (plagiocephaly: towards non-affected side; brachiocephaly: both sides)
• Encourage and facilitate active head turning to strengthen neck muscles
• Perform regular tummy time to strengthen neck muscles
• Sit up in 'Fraser Chair' or baby seat to reduce prolonged time lying down
 

TIPS for managing torticollis:

• Perform regular stretches to the neck (every care), moving in opposite directions to the tight muscle (tilt head sideways towards non-affected side, rotate towards affected side). Hold stretches for approx 15secs and repeat 2-3x.
• Encourage and facilitate active head turning to strengthen neck muscles
• Perform regular tummy time to strengthen neck muscles
• Sit up in 'Fraser Chair' or baby seat to reduce prolonged time lying down

Welcome

Physio Questions is designed to provide reliable and evidence-based answers to your questions regarding any injuries or conditions that you may have. We will also be regularly posting up educational material about common injuries and conditions in an easy-to-understand format. If you have any comments, questions or suggestions, please feel free to send us an enquiry on the Contact page.