By Stephen Heron – Senior Physiotherapist

When we think of the human body we usually picture our skeleton or perhaps a body of muscles. But the most thorough and plentiful tissue in the body is our fascia.

Our bodies are made up of about 70 trillion cells. All of these cells are in constant motion working behind the scenes to keep us going and fascia is the biological fabric that holds us all together. So what is fascia? Fascia is a layer of fibrous connective tissue which structurally binds us together and it is everywhere both supporting things such as our muscles, skin, visceral organs, nervous system and blood vessels and binding them all together.

Take a look at the video below explanation of fascia where Gil Headley describes fascia as ‘fuzz’.

So fascia connects us together and as the video discusses, when we either experience pain, an injury, or we limit our normal daily movements, the fascia adapts by holding things more rigidly. Often this is helpful in the early stages of healing to offer support while our body heals, however, if normal movement is not resumed at an appropriate time this early adaptive behaviour by our fascia becomes maladaptive and can even lead to pain in areas where you are stiff or even elsewhere in the body.

It is therefore of great importance for us to be aware of healthy movements both within our normal daily routine and especially following pain or injury. When we stretch, exercise and move we are influencing more than just our muscles. Through the fascia our bodies have a wonderful way of adapting to whatever we repeatedly do.

So are you moving healthy?

If you want to know more then get in touch. Moving well doesn’t always need to start after injury. We see people all the time that want to learn how build healthy moving habits.

By Atif Razvi – Director & Senior Physiotherapist

Headaches are prevalent in today’s society. If you one of those people out there or of know someone that suffers from migraine headaches, then you or they are not alone, there are many others out there. According to the Neurological Foundation of New Zealand, about 18 per cent of women, mainly between the ages of 15 and 55, and 12 per cent of men experience them.

Recently I attended the Watson Headache Institue foundation course in headache management. This was a real eye opener for me as a clinician and has very much changed my thinking about how I view and manage headaches.

The Watson Headache® Approach is recognised as a scientifically researched method of examination and treatment. The diagnostic accuracy of the Watson Headache® Approach is unparalleled. It can confirm if disorders in the upper neck are responsible for headache or migraine and determine the exact nature of the disorder as well as which spinal joints are involved. There is no guesswork and no cracking or manipulation. Its unique and powerful feature involves temporary reproduction and resolution (easing) of usual head pain. For further information, go to: www.WatsonHeadacheApproach.com

The most common conditions treated include…

* Migraines (with and without aura)
* Tension headache**
* Menstrual migraine
* Cluster headache
* Migraines from ingestants (food/drink)
* Abdominal migraine
* Vestibular migraine
* Trigeminal neuralgia

Tension-type headache

According to the International Headache Society tension-type headache this is the most common type of primary headache and can occur in up to 78% of the general population.People commonly put the occurrence of this type of headache down to fatigue, stress or dehydration but it can occur without any of these events as well. It is typically described as a tight band, squeezing or compressing in nature and can be continuous or short lived.

People suffering from this type of headache will often report tightness in their neck or shoulders when this headache occurs, which the research can now confirm.

Although you feel that the muscles in your head are wound up tight, during an episode of tension type headache there is no increase in the tension of the muscles of the scalp but a significant increase in the tension of muscles in the neck.

Research has found that the lower brainstem of people who experience tension-type headache is sensitised, even when they don’t have a headache. When the brainstem is sensitised it is sitting waiting for a ‘trigger’ (stress/fatigue/dehydration) to set it off and give you a headache.

The lower brainstem sits inside the joints found at the top of the neck and by gently mobilising these joints you can ‘desensitise’ the brainstem so that it’s response to these normal events (stress/fatigue etc) is not to give you a headache.

What will happen when you come to see for your headache

We will spend one hour with and you will receive a comprehensive assessment to find out just where your headache or migraine is coming from. Once that is known we can proceed to treatment. There should be a significant improvement of your symptoms within the first four – five treatments. You should not have to come in for treatment twice a week for the rest of your life, we will give you strategies to maintain this improvement at home.

So take control and give us a call for your assessment

**North City Physiotherapy offers headache management in two of our clinics. Due to the specialised treatment of the Watson Headache method, only selected physiotherapists can provide this. At this stage we can offer this at Titahi Bay Medical Centre and Johnsonville Medical Centre.

By Stephen Heron – Senior Physiotherapist

From the car, to the desk and back home to the couch. We are spending more and more time being sedentary than ever before. Recent studies suggest that up to 70 percent of people spend more than six hours of their day sitting and this could reduce life expectancy by two years.

Our society has swapped an active agricultural lifestyle to one of comfort. Every aspect of our daily schedule from our morning coffee to our daily commute, our office work hours to our relaxation time at home is targeted towards comfortable sitting.

The problem?

Our bodies are not designed to stay stationary, they are designed to move. It is only in the last 40-50 years that the digital revotion has so drastically changed our lifestyle creating a society that is increasingly inactive. We have known for a while now that sitting for an extended period of time causes the body to shut down at a metabolic level. Within as little as two hours we see significant changes to chemicals in our system, including an increase in cortisol (our major stress hormone) and less endorphins or ‘feel good hormones’.

In fact evidence on prolonged sitting suggests that it:

By Atif Razvi – Director/Senior Physiotherapist

In my many years of being a physio, I have come across countless clients who have been told or self diagnosed with a frozen shoulder. In some cases they are correct and other cases not so.

While frozen shoulder is commonly missed or confused with a rotator cuff injury. it has a distinct pattern of symptoms resulting in severe shoulder pain, loss of shoulder function and eventually stiffness. The more precise medical term for a frozen shoulder is “adhesive capsulitis”. So a frozen shoulder is a stiff and very painful shoulder that has significant and equal loss of both active and passive movement in most directions, but has a normal x-ray.

What is a Frozen Shoulder?
Frozen shoulder is a pathology that is still not fully understood. It is an inflammatory condition that affects the capsular tissue of the shoulder. All frozen shoulders loose significant amounts of movement, as mentioned this is usually in many directions, and can be in differing amounts. Oover head, reaching out to the side, and reaching behind the back are usually the main 3 movements limited. All ‘true’ frozen shoulders are extremely painful, extremely limiting, and extremely disabling.

It may be useful to get an xray to rule out other pathologies. The x-ray is first used to help exclude shoulder joint arthritis or other sinister pathology.

What are Frozen Shoulder Symptoms?
Frozen shoulder has three stages, each of which has different symptoms.

The 3 Stages are:

Freezing – characterised by pain around the shoulder initially, followed by a progressive loss of range of movement. Known as the RED phase due to the capsule colour if you undergo arthroscopic surgery.

Frozen – minimal pain, with no further loss or regain of range. Known as the PINK phase due to the capsule colour if you undergo arthroscopic surgery.

Thawing – gradual return of range of movement, some weakness due to disuse of the shoulder. Known as the WHITE phase due to the capsule colour if you undergo arthroscopic surgery.

Each stage can last on average 6 to 8 months if left untreated.

Who is Likely to Suffer from Frozen Shoulder?
Frozen shoulder is more likely to occur in people who are 35-50 years old.

It can be primary, with no known cause, or secondary, associated with an underlying illness or injury.

There are a number of risk factors predisposing you to developing frozen shoulder.

These include:

shoulder trauma,
surgery,
diabetes,
inflammatory conditions,
inactivity of the shoulder,
autoimmune disease,
cervical cancer, and
hyperthyroidism.
Approximately 20% of people who have had a frozen shoulder will also develop frozen shoulder in their other shoulder in the future!

How do you treat a Frozen Shoulder?

Treatment of a frozen shoulder is very varied from place to place, and from physio to physio! We could just leave them alone altogether and they may well spontaneously resolve, I think that will happen and I have seen it.

Other more invasive treatments for frozen shoulder include:

– intra-articular corticosteriod injections
– high volume hydrodilatation injections.
– manipulation under anesthetic
– arthroscopic release of contractures – this is now viewed as the gold standard.

Physiotherapy which of course I promoting can include:
– massage
– joint mobilisations
– manipulations,
– passive stretching,
– acupuncture,
– exercise

Can You Prevent Frozen Shoulder?
While the spontaneous onset frozen shoulder is of unknown origin, you can prevent frozen shoulder caused by disuse by avoiding long period of shoulder inactivity. e.g. post-surgery or shoulder injury.

If you do have a shoulder or arm injury, it is always advisable to seek the professional advice of someone such as your physiotherapist about exercises to help prevent a secondary frozen shoulder developing. This is especially important if you are in a high risk category.

 

 

I was fortunate enough this year to have been a part of Tawa Rugby’s amazing season and successful Jubilee cup campaign. I want to take this opportunity to reflect on the past season, and to offer a view of the season from the perspective of the team’s physiotherapist.

The thing that really stands out about Tawa, for me at least, can be summed up in one word. Attitude.

From the earliest pre-season training’s, we were getting players coming up to us and looking to sort out injuries that they’d picked up in the off-season, no matter how minor, letting us know about older injuries that might play up going forwards, and making sure that they were managing these properly.

Working as a physiotherapist in a sports environment is quite different than in clinic. Patients we see in clinic are usually coming to us after they’ve sustained an injury; and often these injuries will have been lingering for some time before they become a major issue. We’ll often look at a 2-3 week period off sports to allow for these injuries to heal. We often don’t have that same option when working with a team. A key player being out for 2-3 weeks can be devastating, and can mean the difference between a successful season and a disappointing one.

Recognising and sorting out minor injuries and small niggles before they become more serious is a key part of working with a team, but we’re only able to do that if the players are taking the initiative and letting us know about these things before they become an issue. This, again, comes back to attitude; the players stepping up and taking responsibility for their own fitness.

This permeated throughout the season. We lost some key players to more serious injuries fairly early on, and some of our younger players stepped up to the plate, and took the opportunity to prove themselves at a premier level.

From the key game against Norths to secure a spot in the Jubilee Cup, to the incredible run through the second round after dropping the first three games, the team stepped up every time they needed to.

I thoroughly enjoyed my time with Tawa this season. Everyone, from the players, to the coaches, to the support staff and club management, was fantastic to work with, and all personified the amazing attitude that formed the basis of Tawa’s Jubilee Cup winning season.

To Tawa; Thank you for the fantastic season, and I’m confident that there will be many more yet to come.

Many people have heard of the term but may not know much about it. In my clinical experience, some clients are even nervous about the thought of it too. The following information article is aimed to give you a basic overview of Acupuncture and dry needling.

What is acupuncture and dry needling?
Acupuncture was developed in China thousands of years ago and is a common treatment in Traditional Chinese Medicine. Western medicine has been researching acupuncture for many years now, in order to understand scientifically how and why it works.

Acupuncture treatment involves the insertion of very fine needles into specific points along the body – known as meridians. There is evidence that acupuncture can have a local effect on the tissues around the needle site, including increased blood flow and release of natural anti-inflammatory chemicals.

This is useful for the body to allow it to recover from injury. Acupuncture also has an effect on the pain system of your body. Research shows that during acupuncture, the brain releases more natural pain killers and feel good hormones such as endorphins. The treatment can also help to regulate the pain pathways to and from the brain. These effects on the pain system can therefore help to reduce pain. Finally, acupuncture can have a releasing effect on local muscles. This area of effect is where the concept of dry needling arose from.

Dry needling in simple terms is acupuncture not using specific meridian points. The needles are inserted into areas of tension and tightness in the body or into trigger points. The needles are gently manipulated to allow the muscle to relax and becomes less tight. Many Western acupuncturists will use a combination of both traditional points and dry needling points.

Why is it used in Physiotherapy?
Acupuncture is a specialist treatment that a Physiotherapist will undergo post-graduate training in order to carry out. Physiotherapists commonly use acupuncture in conjunction with a number of other treatments, such as exercise prescription, massage and manual therapy. A physiotherapist who has studied Western acupuncture will only use it as a treatment within the scope of practice of Physiotherapy; for example, to treat injuries to the musculo-skeletal system, to treat pain and improve muscular tightness. There is good evidence to support its’ use, however as with any treatment, it does not work for everyone and some individuals may be more suited to it than other.

What is involved?
Physiotherapists will complete an initial assessment first, to gauge if acupuncture is the most appropriate treatment option for the problem/injury. They will then discuss this with the client and if deemed appropriate will then book the patient in for their first treatment session.

A western acupuncture treatment will typically last 20-30 minutes, depending on the person, the injury and the situation. The needles are inserted into the desired areas using a plastic guide tube. The needles are commonly very fine, only 0.25mm, and therefore don’t often hurt to be inserted (even less than injections!). Depending on the point being used, some needles are then placed a little deeper, for example into the muscle. Some people can experience some mild aching, heat or sharper symptoms at this stage, but some people won’t feel anything at all. Your Physiotherapist will guide you through this part of the treatment. The needles are left to take effect and the client will often just lie and relax. At intervals during the treatment, the Physiotherapists may gently manipulate the needle to stimulate it’s effects.

Dry needling treatments are often much quicker. The needle may only be in the target muscle for 10 seconds. Given this, it is common for Physiotherapists to undertake dry needling as part of a number of other treatments in a session.

Needling at North City Physiotherapy?
At North City Physiotherapy we have several Physiotherapists who are trained in either acupuncture or dry needling. If you think it may be a treatment you’d like to consider or if you would like more information, don’t hesitate to contact us.