Have you ever woken up with a stiff and painful neck that will only turn to one side? You might have been suffering from acute wry neck, a painful condition following a typical pattern of symptoms. Most wry necks are classified as one of two different types – facet (joint) or discogenic wry neck. 

Facetogenic Wry Neck:
 
Facet joints are found on either side of the spine and allow controlled rotation and side bending of the neck. An awkward or sudden movement of the neck can cause a part of the joint capsule to strain, tear or get caught in the joint, making it feel locked. The muscles around the area can also become tight and spasm, which amplifies the pain. The pain is usually sharp and can be pinpointed quite accurately to the part of the neck causing the problem, and the pain rarely travels down into the arm. It is usually possible to find a resting position where the pain goes away completely, only having pain when turning in specific directions. The good news about facetogenic wry neck is that your physiotherapist is usually able to help you ‘unlock’ the neck quite quickly with gentle mobilisations. Most of the time, a full recovery can be expected within a week. 
 
Discogenic Wry Neck: 
 
The vertebrae of the neck are separated from each other by fibrous discs, filled with a gelatinous centre. These discs provide support, flexibility and shock absorption. When placed under pressure, these discs may bulge or tear, and the resulting swelling can cause pain and muscle spasm in the surrounding area. It is important to note that in an area as sensitive as the neck, a small amount of damage can result in a large amount of pain. 
 
The development of discogenic wry neck is usually due to a combination of factors, including neck stiffness, poor posture and biomechanics than can contribute to the disc being vulnerable prior to the injury. In these cases, it can be challenging to find a comfortable position, and it is more likely for pain or tingling to travel into the arm.
 
Treatment of discogenic wry neck is focused on reducing pain and muscle spasm with massage, taping, heat and postural education. Further treatment aims to reduce any stress that is being placed on the disc, mobilise any stiff spinal segments and correct any muscle imbalances. While the initial symptoms may settle down quite quickly, it can take up to six weeks to fully recover from discogenic wry neck. In this condition, it is also essential to address all the factors that may cause a recurrence of the issue.

Keeping active can be challenging. For many people, going out for a run or taking time to perform a full workout can be daunting, especially if this is not a part of their usual routine. 
 
There are a few quick and easy ways to add some movement to your day, starting with something as simple as boiling the kettle. As the average kettle takes 2-3 minutes to boil, challenge yourself to see if you can complete these three exercises while waiting for your cup of tea or coffee. You can focus on one each day, or work through a different one each time. 

1. Challenge your balance. 
 
Standing on one leg is something many of us assume we can do, yet rarely take the time to check. This is an essential skill that can deteriorate without being noticed until everyday activities, such as getting dressed, are impacted. Being able to stand on one leg is important for putting on shoes, trousers and reduced balance can be a risk factor for falls. 
 
Start by seeing if you can stand on one leg with your eyes open for the entire time the kettle is boiling. Test both legs, making sure you are close to a bench that you can use to support yourself. To increase the difficulty, try balancing with your eyes closed, then progress to balancing on your tiptoes. If you can balance on your tiptoes, with your eyes closed, then you can ask your physio for more suggestions.
 
2. Heel Raises
 
Start by keeping your knees slightly bent and lift both heels off the ground at the same time. You can begin with repetitions of 5, have a quick rest then repeat. Challenge yourself to increase the speed of your heel raises and see how many you can fit into your waiting time. As you bend your knees, aim to keep your knees over your second toe. If you feel this is a little too easy, you can progress to single-leg heel raises, which will also improve your balance!
 
You can start a daily competition with the people in your household to see who can complete the most repetitions in a set time period.
 
3. Squats
 
Squats are a great exercise to keep your large muscles working. You can start with 5 shallow squats, aiming to slowly increase your number and progressively squat to a lower position. As with heel raises, when you start to find squats to be less of a challenge, you can move to single-leg squats. 
 
Don’t hesitate to ask one of our physios for tips on how else you can stay active at home or in the office. 

Nothing can ruin your enthusiasm for a new workout program faster than the pain and stiffness that sneaks up on you the day after. This delayed reaction from your muscles, known as DOMS (delayed onset muscle soreness), has affected almost all of us at one time or another. While there is no sure-fire cure or prevention for DOMS, here are a few tips to help reduce your symptoms next time you hit the gym

Understand what it is
DOMS is thought to be a result of micro tears in muscle tissue during eccentric exercises in particular. While DOMS is not a sign of a serious injury and usually goes away on its own within 48 hours, it can be very uncomfortable and a deterrent to continue exercising. It can also leave you at a higher risk of injury, and for athletes who are competing in a tournament and need to recover quickly, DOMS can be particularly problematic. 
 
Warm-up and cool-down
By taking the time to let your muscles warm-up, your muscles can operate at optimum flexibility, reducing the tension on muscle tissue during exercise. A cool-down encourages effective blood flow to muscles after exercise, so that any waste products such as lactic acid and calcium can flow back into the bloodstream rather than staying in the muscle tissues. 
 
Get a massage or use a foam roller
By massaging tight and sensitive muscles, you can improve blood flow, promote tissue healing and reduce pain. Both massage and foam rolling can help to relax tight muscles and enhance tissue recovery in the first 24-48 hours after exercise.
 
Stay hydrated
Keeping hydrated allows your body to remove waste, stay flexible, and help tissues heal optimally. The trick is to maintain hydration throughout your day, not just when it's time to exercise. It's also essential not to wait until you are thirsty, as you could already be dehydrated at this point. 
 
Other ideas includes gentle exercise such as 20 minutes on a stationary bike, and mild stretching. If you are particularly brave, ice baths have recently been shown to have mild benefits in pain reduction following intense exercise.

What Are They?
 
Trigger points are what are often thought of as muscle "knots" and can feel like painful, hard lumps located in your muscles. These points can both be painful to touch and refer pain to surrounding areas. It is thought that trigger points form when a portion of muscle contracts abnormally, compressing the blood supply to this area, which in turn causes this part of the muscle to become extra sensitive.  Trigger points are a common source of pain around the neck, shoulders, hips and lower back. 

What Causes Trigger Points?
 
Many factors can cause trigger points to develop. Repetitive stress, injuries, overuse and excessive loads are common examples. Inflammation, stress, nutritional deficiencies and prolonged unhealthy postures may also contribute to the formation of these painful areas. Generally speaking, muscular overload, where the demands placed on the muscle mean that the fibres are unable to function optimally, is thought to be the primary cause of trigger points. This is why you might notice trigger points in weaker muscles or after starting a new training program.

Signs and Symptoms

Pain caused by trigger points can often be mistaken for joint or nerve-related pain as it can be felt in a different location to the site of the trigger point. Trigger points feel like hard lumps in the muscles and may cause tightness, heaviness, aching pain and general discomfort. They can cause the length of the affected tissues to shorten, which may be why trigger points can increase the symptoms of arthritis, tennis elbow, tendonitis and bursitis.

How Can Physiotherapy Help?

Your physiotherapist will first assess and diagnose whether trigger points are contributing to your pain. If they feel that treatment will be beneficial, there are a variety of techniques that can help, including dry needling, manual therapy, electrical stimulation, mechanical vibration, stretching and strengthening exercises. While these techniques may be effective in treating trigger points, it is important to address any biomechanical faults that contribute to their development so they don't keep recurring.
 
Your physiotherapist is able to identify causative factors such as poor training technique, posture and biomechanics and will prescribe an exercise program to address any muscle weaknesses and imbalances.  If you have any questions about how trigger points might be affecting you, don’t hesitate to ask your physiotherapist. 

Referred pain is one of the most complicated processes in the human body. You may have experienced this if you ever saw a physiotherapist for pain in one part of your body, and they started to treat an entirely different area.  The complexity of pain is one of the reason's why physiotherapists conduct such a thorough interview with you and physical examination before being able to determine the exact source of your pain.

Why is pain so complicated?
 
Unfortunately, we still don't understand everything about the way pain is processed.  Usually, when an injury or damage occurs to body tissues, a signal is sent to the brain, which begins to interpret this signal and creates the sensation of pain. Pain is thought to be a warning signal to let you know to avoid danger and pay attention to the injured body part. Occasionally this system goes a little haywire, and pain signals are sent when there is no damage or the location of the pain is misdirected.
 
Referred pain is the term used when pain is felt at a different location to the source of the problem that is sending the pain signal. There are many kinds of referred pain, and some are easier to explain than others.
 
What are the different types of referred pain?
 
In some cases, if it is a nerve that is sending the pain signal, then pain can be felt all along the length of the nerve. This may be described as a sharp burning pain along the skin. One of the most common examples of this is "sciatica", where the large nerve that runs down the back of the leg is irritated around the lower back or buttock. The source of the pain signal is near the spine. However, that pain follows a distinctive pattern down the leg. In other cases, it is the muscles and not the nerves that are referring pain elsewhere. Muscular trigger points are taut bands that develop within muscle tissue that is undergoing abnormal stress. Poor posture, lack of movement, and overuse can cause muscles to develop areas of dysfunction. These trigger points can cause pain that radiates out in distinctive patterns. Trigger points are diagnosed as the source of pain if symptoms are reproduced when a therapist presses on a specific point.
 
If that wasn't confusing enough, we know that our internal organs can also refer pain.  Pain referred by internal organs may be described as a deep ache, and usually not influenced by movements of the limbs or back. Organs often distribute pain in patterns that are very obscure and sometimes don't even create any pain at their own  location. For example, kidney pain can feel like lower back pain. 
 
There are many other fascinating aspects to pain and understanding how it works is an important part of managing your symptoms. To understand how referred pain may be affecting you, talk to your physiotherapist who can help with any questions. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury. 

Osteoporosis is a widespread condition characterized by low bone mass or density. It is primarily a metabolic disorder related to age and general health with a variety of risk factors and causes. The most common and well known consequence of osteoporosis is weakened bones that can break from small forces that would usually be harmless.
 
In osteoporosis, both the matrix of the bone (similar to scaffolding) and the density of the bone are affected. While bone seems like a static part of our body, it is continuously laid down and removed by our bodies. In osteoporosis, there is an imbalance between the growth and reduction in the bone so it becomes progressively weaker. As such, it is a progressive disorder that worsens with age. While the disease process might begin much earlier, symptoms are usually only noticed over the age of 50. 

What are the signs and symptoms?
 
Often called a silent disease, many people with osteoporosis will have no idea that they have it, as there are no visible symptoms. Sometimes the first sign that an individual has osteoporosis is when the first bone breaks. Unfortunately, these bones are also slower to heal than healthy bones which can lead to ongoing complications. Broken bones are not the only symptom of osteoporosis, as bones lose density and strength they can also become compressed and develop wedge fractures under the weight of the body. 
 
When the spine is affected by osteoporosis, people may develop a hunched or stooped posture, which can itself lead to respiratory issues and place pressure on the internal organs. Osteoporosis can severely impact a person's mobility and independence, which can have a distressing impact on their overall quality of life.
 
What causes it?
 
As a metabolic disorder, osteoporosis can be caused by any process that interferes with the body's ability to maintain bone density. This includes gastrointestinal conditions that prevent adequate absorption of calcium (which is required for bone growth); lack of dietary calcium or low levels of vitamin D, which are essential for the absorption of calcium. Some medications can contribute to bone loss as an unfortunate side effect, especially if they are taken for a long time or in high doses. An example is the long-term use of steroids which can be prescribed to reduce inflammation.
 
Inactivity can also predispose a person to osteoporosis as bones respond to force and weight bearing by building more bone. Having a sedentary lifestyle or choosing activities with low levels of impact can mean that without the weight bearing stimulus to make bone, bones are less dense over time. Osteoporosis can occur in elite cyclists and swimmers, who are more likely to develop the condition if they don't include weight-bearing activities such as jogging in their training program.
 
How can physiotherapy help?
 
Physiotherapy can help you to improve your overall bone health, and avoid or recover from fractures. Physiotherapy exercises can direct you to safely increase your weight-bearing, which can help build bone mass. Balance training is also an important factor as this can reduce your risk of falls. Your physiotherapist can also help you to adjust your lifestyle, at home or at work, to protect your bones and improve your posture, all of which are helpful in the overall management of osteoporosis.

Frozen shoulder is categorized as either primary or secondary. Primary frozen shoulder occurs for no clear reason, while secondary frozen shoulder develops following an injury or surgery around the shoulder. 

Frozen shoulder usually follows a typical pattern and can be separated into three stages, freezing, frozen and thawing. The pain begins in the freezing stage as an ache or twinge with movements. The pain gradually increases, and the shoulder begins to lose range of movement. Usually, shoulder movements away from the body or involving rotation  are the most painful and restricted. 
 
As the condition progresses, everyday activities can be significantly impacted, with activities such as dressing, grooming, reaching overhead and behind the back becoming difficult. Lifting heavy objects can be very painful, and the pain is often felt at night time, interrupting sleep. The three stages follow a typical pattern... 
 
Freezing – Pain is present at rest/night, increasing pain and stiffness with shoulder abduction and external rotation. 
 
Frozen- Pain starts to lessen, but the stiffness of the shoulder joint increases.
 
Thawing – Pain reduces to lower levels and movement begins to return.
 
Frozen shoulder will usually resolve on its own without any long-lasting stiffness. However, complete recovery does not always occur. 
 
Frozen shoulder most often affects people over the age of 40 and women are affected more often than men. While no definite cause has been identified, there are some factors that increase the risk of developing a frozen shoulder. These include diabetes, prolonged immobilization, trauma, stroke, thyroid dysfunction, heart disease and autoimmune disease.
 
The early stages of frozen shoulder can mimic other shoulder conditions, and these should first be ruled out by a thorough examination. While frozen shoulder is a self-limiting condition, meaning it will resolve on its own without treatment, this can take up to 2-3 years. Physiotherapy during this time focuses on reducing pain as much as possible and helping patients to cope and adapt to their symptoms during the freezing and frozen stages. 
 
As the condition moves into the thawing stage, physiotherapy aims to help restore strength, movement and control to the shoulder. The entire process can be distressing, so support and education from your physiotherapist as you move through the stages of the condition is an essential part of treatment. 
 
If you have any concerns about shoulder pain that is not resolving, come and have a chat with one of our physiotherapists to see how we might be able to help you.