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cervicogenic headache

Cervicogenic Headaches – What are they and what can cause them?

These types of headaches are classed as secondary headaches. Pain is felt in the head, resembling a headache, however, the source of the pain has developed in the neck.

This can be caused by a number of issues, including tightness and strain in the neck muscles. This tension can lead to restricted movement of the neck and discomfort in the neck and shoulders. Overuse of these muscles can be due to a person’s type of work, for example, driving and long periods working at a computer, sporting activities, lack of sleep, stress and anxiety. These tense muscles in the neck, often result in a headache.

Remedial massage to the neck and shoulder muscles, can have a positive effect on reducing the tightness in the muscles, resulting in an increased range of movement and reduction in pain and discomfort. By working through the muscle adhesions, using various massage techniques, including trigger point therapy, the stiffness in the neck can be reduced and full length of the shortened muscles can be restored.

There are a number of changes that can be implemented, which can help to reduce the build up of muscle tension. For instance:

  • changing your sleeping position
  • ensuring your workstation has the correct ergonomic set up
  • taking regular breaks
  • stretching the muscles
  • correcting poor posture

These changes, together with remedial massage, can be of huge benefit to those overused, tired muscles and in turn can result in reduced cervicogenic headaches.

Tendonitis, tendinosis and tendinopathy? What’s the difference and when will I get better?

There is a lot of misunderstanding when it comes to tendon injuries, with many confusing terms and sometimes contradicting advice on how best to treat them.

What do tendons do and how do they work?

We often think of tendons as merely a connection a muscle has to the bone, to allow it to transfer a pulling force, much like pulling on a string or rope. We have since discovered tendons to be a lot more complex! Their primary role is actually to store and release energy, much like a spring, to allow us to propel ourselves. This is particularly obvious with the Achilles tendon at the ankle when we are sprinting. It is responsible for much of the forward propulsion, and allows us move efficiently with less metabolic energy expenditure.

What happens when a tendon is injured?

A tendon is injured when there is a force exerted on it that exceeds what it is capable of withstanding. What we have found is that when there is damage to tendon tissue, that area of the tendon does not heal. Even when re-scanned long after the injury and once pain has settled and tendon function has restored, the tendon will still look the same on ultrasound.

Tendinopathy  This is a broad term to describe any pathology of a tendon.

Tendonitis Refers to inflammation of the tendon, which is actually a less common cause of tendon pain than you might think! However the term is loosely used out of habit to described any tendon pain or pathology.
Tendinosis This is non-inflammatory degeneration of collagen fibers in the tendon due to repetitive overloading and is a much more common cause of tendinopathy or tendon pain. As a result, they typically don’t respond that well to anti-inflammatories, and are best treated with rehabilitation exercises to strengthen the intact tendon tissue.

How are tendon injuries treated?

Studies have shown scans on individuals with even quite extensive tendon tissue damage, go on to be relative pain-free and high functioning with appropriate non-surgical treatment and rehabilitation. The key is, that even when there has been significant damage to part of the tendon, there is generally still a lot of good quality, functioning tendon tissue around it, and it is this part of the tendon that we are looking at strengthening and conditioning with our exercises, to allow it to operate at capacity.
It is not just a case of ‘stretching it out’ – in fact, in some cases this could actually cause further tissue damage and prolong your road to recovery. We need to use gradual strength and loading exercises to recondition the function of the tendon. Everyone’s injury will be slightly different, and require a tailored approach, so it’s best to see a health professional for proper advice and management.
In the case of a complete tendon rupture, then surgical intervention is required.
Our goal with rehabilitation exercises is to improve the capacity of the tendon to store and release energy, well above the daily demands that will be exerted upon it, thus reducing the risk of re-injury.
We see a lot of tendon injuries through the clinic, most commonly of the shoulder and hip region. A thorough physical examination is often enough for us diagnose the nature and severity of tendon injury, and develop a treatment plan to get you back to full function. In some cases we may decide to get an ultrasound or MRI to further assess the degree of tendon injury and rule out any other pathology. Treatment generally comprises gradual progression through a program of exercises designed to increase the load tolerance of the tendon, in combination with hands-on manual therapy to maintain pain-free range of motion through the region.
Feel free to contact us if you would like more information on tendon injuries, or if you would like to book a consultation, you can use our online bookings or phone on 9581 3331.

Check out the short video below on how tendons work!

frozen shoulder

What is Frozen Shoulder? What is the Best Treatment?

frozen shoulderFrozen shoulder is the commonly used name for ‘Adhesive Capsulitis’, which is a condition that causes the shoulder to become very pain and stiff. This can sometimes occur following minor trauma to the shoulder, but often happens due to no apparent reason, which can be both confusing and frustrating for patients.
It affects 2-5% of the population, typically between 40 to 65 years of age, with certain risk factors such as:

  •  previous shoulder injury
  • diabetes
  • thyroid disease

How Does it Happen?

The shoulder joint, by design, is an incredibly mobile joint with a very large range of motion. The shoulder joint, like other joints in the body, is surrounded by a capsule, that allows this free range of motion. The capsule is also important in  providing stability, sensory feedback, and aiding in lubrication of the joint. Tightening of this capsule due to adhesions, is what causes Adhesive Capsulitis.

The condition follows three distinct phases:
1. The Freezing Stage – This is where the joint gradually starts to stiffen over time. This initial stage is usually characterised by an achy shoulder at rest, very painful with movements, and difficulty sleeping due to the pain.
2. The Frozen Stage – This is the longest stage, and where the joint stiffness plateaus at it’s peak. This period is where people find greatest difficulty with performing daily tasks due to stiffness, but often the pain is less than the initial phase.
3. The Thawing Stage – Where the shoulder starts to gradually recover, and shoulder movement and function is restored.
The good news about frozen shoulder, is that for most people it will generally recover on it’s own over time. This can typically take anywhere from 9 months up to 3 years, with the average being about 18 months. Appropriate therapy is important in managing recovery.

What is the Best Treatment?

Current clinical guidelines for frozen shoulder suggest a combination of the following treatment:

Education – Understanding the nature of your pain, and what to expect in terms of time for recovery, can make managing it a lot easier.
Maintain Normal Activities – It is helpful to continue using the affected shoulder as much as possible. Not using the affected shoulder can further restrict free movement and increase sensitivity of painful structures within the joint.
Manual Therapy and Exercise – Treatment provided by your health practitioner  can assist in speeding up the recovery time, and reducing pain as it naturally recovers. Treatments shown to be effective include specific exercises to improve range of motion and strength at the shoulder joint, and joint mobilisation and manipulation performed by your health practitioner.
Joint Injections – For some people, corticosteroid injections into the joint, can be very helpful, especially when combined with joint mobilisation and manipulation.

shoulder therapy

If you need more information regarding frozen shoulder, do not hesitate to contact us at the clinic on 9581 3331, and book an appointment to discuss what type of treatment is appropriate for you.

“Shoulder Pain and Mobility Deficits: Adhesive Capsulitis,” J Orthop Sports Phys Ther 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302.