What is a stress fracture?

A stress fracture is a microscopic fracture of the bone that is so small that it often cannot be picked up on X-ray. If left untreated, a stress fracture can cause significant disability and develop into a full fracture, possibly even requiring surgery. The majority of stress fractures occur in the lower limb, being particularly common in the hip, shins and foot at points where the most force passes through when weight bearing. Most stress fractures are overuse injuries and are common in long distance runners.

What are the symptoms?

As with many overuse injuries, the pain of a stress fracture starts gradually, beginning with pain during or after activity or sometimes the morning after. If activity continues without modification, the pain will gradually increase. Eventually most people are unable to maintain their usual activity level. Stress fractures are common in runners and military personnel who are required to march for long periods. A stress fracture will be more likely to occur in a person who has weaker bone strength, such as someone with osteoporosis, which is itself affected by many factors such as adequate calcium intake, vitamin D deficiency and a history of inactivity.

How are stress fractures treated and how long will it take to get better?

Stress fractures can easily be mistaken for other conditions such as shin splints. As the fracture is often too small to show up on X-ray, definitive diagnosis can be made using MRI or bone scan.

After diagnosis, the most important part of treatment will be resting the area to allow the bone to heal before resuming activity. Stress fractures usually need at least 6 weeks to recover fully. Some areas of the body have poor blood supply, which makes healing more complicated. For example, stress fractures of the navicular bone of the foot may need to be kept still and placed in a boot or cast for a period of time to heal properly. Other aspects of treatment will involve correcting any factors that contributed to the original injury. There is some evidence that unsupportive footwear is a risk factor, along with poor biomechanics and weak muscles that provide inadequate support to the skeletal system during activity. Speak to your physiotherapist if you suspect you may have a stress fracture or simply want to know more.

How to Stretch Properly?

While there are many benefits to be gained from effective stretching, employing an improper technique can actually result in injury. Here are some tips and guidelines for you to follow when stretching:

• Warm up first with an activity such as walking (at least 5 -10 minutes).
• Stretches should be pain-free. You should only feel tension or a tight feeling when stretching. If you feel a sharp pain, this means you're stretching too far and should relax a little.
• Don't hold your breath while stretching; keep breathing to ensure the muscle tissues remain oxygenated during the stretch.
• Stretch both sides. But, if one muscle is tighter than the other, focus on it more until they're both in the same range.
• Avoid bouncing at the end of the stretch because it may lead to injury.
• Hold stretches for 20-30 seconds, if not longer. A 10 second stretch is not always enough to achieve a lasting effect.
• Repeat the stretch 3-5 times with intermittent rest periods in between.
• Make sure your body is aligned properly and observe good posture.

When to Stretch?

Traditionally, stretching has been encouraged before and after any kind of physical activity. However, recent studies show that there is no discerning difference between whether you stretch before exercise/sports or not, both-in terms of performance and injury prevention. In some cases, researchers say that it's okay to omit the pre-event stretch since the post-event stretch is much more beneficial.

Some of our everyday postures and activities can lead to certain muscles becoming tight while the others sit in a lengthened position. These habitual postures that lead to muscle imbalances then become more and more difficult to correct over time. Many therapists will suggest that stretching all muscles generically isn’t as beneficial as identifying which of your muscles are abnormally tight and developing a targeted stretching regime.

Talk to your physiotherapist for advice regarding the best stretching program for your body type, posture and activity levels.

What is Thoracic Outlet Syndrome?

The thoracic outlet is a small opening between the neck and shoulder that allows a variety of nerves and blood vessels to pass safely from the neck and supply the arm, chest and shoulder blade. As this can be quite a small space, any narrowing can cause these structures to become compressed and irritated. This phenomenon is commonly referred to as “Thoracic Outlet Syndrome”. This space can become compromised through trauma to the neck, overuse or repetitive stresses to the arm or the presence of an extra rib in the neck.

What are the signs and symptoms of Thoracic Outlet Syndrome?

Signs and symptoms of Thoracic Outlet Syndrome may depend on whether nervous tissue or blood vessels are involved. In most cases, symptoms will be caused by compression of nerve tissue rather than veins or arteries.

When neural tissue compression is the cause of the Thoracic Outlet Syndrome, reported symptoms may include pins and needles, tingling or numbness of the affected arm. Other symptoms include pain and weakness or tiredness of the arm that increases with work done overhead. Some people may experience neck pain or headaches in the base of their head.

If the vein is affected, there will be swelling and discoloration of the affected arm, as well as pain. When the artery is affected, cramping of the arm or hand during use may occur. Due to decreased blood flow, the arm or hand may feel cold and even change colour.

Who is usually affected?

It is common for people who work with their arms in an above-shoulder position to develop Thoracic Outlet Syndrome. For example, a teacher who writes frequently on a chalkboard, a construction worker hammering nails overhead, or a hairdresser.

How can physio help?

Your physiotherapist will assess a range of things including your posture, the flexibility of your spine, and length of your neck muscles. It is also important to assess the way you move your neck, back and arms.

Depending on the findings of the physical assessment, your physio will help you stretch appropriate muscles, assist with movement modification, and correct your posture. This may involve manual therapy techniques such as joint mobilizations, strapping techniques and soft tissue massage.

Treatment times may vary depending on symptom presentation and response, Thoracic Outlet Syndrome typically can take just a few treatments or several weeks to resolve as well as continuation of a home exercise program in order to resolve the issue.

Orthopaedic surgery is any surgery performed primarily on the musculoskeletal system of the body. Common orthopaedic surgeries you may have heard of are joint replacements and reconstructions.

Physiotherapists have a large role to play in the recovery of these kinds of surgeries especially in the more extensive operations, such as a total hip or knee replacement. It is not unusual to wake up in the hospital a few hours post-op knee replacement, hip replacement or shoulder reconstruction to your hospital-based physio asking you to get out of bed for the first time. This may seem daunting and entirely too early, however there is very well researched evidence for why getting out of bed early is so important: your speedy return to normal health and wellbeing!

Hospital-based physiotherapy typically includes re-learning how to walk and making initial improvements on your range of movement and function of the affected joint. The physio will also help you maintain healthy respiratory function by checking your lungs regularly. Drugs administered during surgery change your breathing pattern, which can lead to complications in the days after surgery.

Following your in-patient stay, it is highly likely your surgeon will request for you to continue with outpatient physiotherapy either in an outpatient hospital-based setting or in a private-practice setting.

With your outpatient physio, your recovery will be measured and monitored, goals will be discussed and set, and you will be given an exercise program created to achieve those goals.

Physiotherapists use a variety of treatment methods to assist a post-operative orthopaedic surgery patients achieve their goals. These include soft tissue work, stretching, hydrotherapy, manual therapy and gym-based exercise.

Recovery from orthopaedic surgery can take up to 12-to-18 months to occur. During this time, it is not unusual to experience bouts of pain and swelling; however these episodes should reduce the further into rehabilitation you progress.

Many post-operative orthopaedic surgery patients can expect to return to a normal life following a period of rehabilitation guided by a physiotherapist. This includes return to some sport and regular exercise!

Note: Please seek professional advice prior to beginning a post-operative exercise program.