Neck Pain

By Aaron Woolley, Physiotherapist.

Neck pain (NP) is a prevalent condition that affects a significant portion of the global population. Studies suggest that approximately two-thirds of the population will experience neck pain at some point in their lives. The prevalence of NP varies across different studies, with mean reported estimates indicating 7.6% for point prevalence and 48.5% for lifetime prevalence. This condition is more commonly observed among women, individuals suffering from anxiety or depression, and office workers with poor ergonomic positions. To effectively address neck pain, it is crucial to understand its anatomy, potential causes, and available physiotherapy treatments.

Anatomy of the Neck

The neck is a highly complex structure composed of bones, joints, muscles, tendons, ligaments, and nerves. It consists of seven bones, C1 to C7, which make up the cervical vertebrae. These bones articulate with each other with the intervertebral disc at the front and facet joints at the rear.

There are numerous large and powerful muscles supporting the neck, including the trapezius, sternocleidomastoid, levator scapulae, splenius capitis and cervicis and deep neck flexors. These muscles facilitate gross motor movements in the neck as well as provided postural control and support. Any condition involving these muscles and tendons can be a strong pain generator and severely impact cervical spine mobility.

The cervical spine nerves, a set of eight nerves (C1 to C8), provide functional control and sensation to various body parts based on their respective spinal levels. Compression or irritation of these nerves can lead to pain and tingling sensations, often felt in the upper limb or shoulder girdle.

Common Causes of Neck Pain

1. Muscle Pain: Overuse of neck muscles due to poor posture, prolonged sitting, or incorrect ergonomics is a leading cause of neck pain. Strained neck muscles can be painful and restrict motion.
2. Muscle Imbalance: Focusing excessively on training the upper trapezius muscles, neglecting the lower and mid traps, may lead to overstimulation of the upper traps, resulting in neck pain.
3. Osteoarthritis: As we age, the neck’s joints can become worn down, leading to conditions like osteoarthritis. Deterioration of cartilage between vertebrae and the formation of osteophytes can impact range of motion and cause pain.
4. Nerve Compression: Herniated disks or osteophytes in the vertebrae can press on the nerves branching out from the intervertebral foramen, causing pain and discomfort.
5. Injuries: Motor vehicle accidents and sporting injuries, especially those resulting in whiplash, can strain the soft tissues of the neck, leading to pain and reduced mobility.
6. Diseases: Certain diseases like rheumatoid arthritis, meningitis, or cancer can also contribute to neck pain.

Managing Neck Pain

At Robina Physio on the Gold Coast, we offer effective strategies for managing neck pain and improving the overall health of the neck and surrounding structures. Here are some essential physiotherapy techniques:

1. Therapeutic Exercises: A physiotherapist can design a personalised exercise programs to strengthen weak neck muscles, improve flexibility, and correct muscle imbalances. These exercises may include neck stretches, range of motion exercises, and strengthening routines.
2. Manual Therapy: Hands-on techniques, such as massage, joint mobilisation, and trigger point therapy, can help alleviate muscle tension and therefore pain and mobility.
3. Postural Correction: Proper posture can play a crucial role in reducing pain. A physiotherapist can assess your posture and provide guidance on maintaining correct alignment during various activities.
4. Ergonomic Recommendations: For office workers, optimising workspace ergonomics is essential. A physiotherapist can suggest adjustments to your workstation setup to reduce strain on the neck and promote better posture.
5. Heat and Cold Therapy: Applying heat or cold packs to the affected area can help reduce inflammation, relieve pain. If you have a spasmed muscle, opt for heat most of the time.
6. Dry Needling and Acupuncture: Dry needling has been shown by research and in the clinical setting to be highly effective for managing pain. The main aim of this technique is to release your tight muscles and restore pain free range of motion as quick as possible.

Neck pain is a prevalent condition that can significantly impact an individual’s quality of life. With the help of a skilled physiotherapist, like those at Robina Physio on the Gold Coast, you can implement a personalised treatment plan to alleviate your symptoms, improve mobility, and prevent future occurrences of neck pain.

The Physiotherapists at Robina Physio on the Gold Coast are experts with additional training in the management of neck pain and dysfunction. If you’re struggling with neck pain please don’t hesitate to Contact Us on (07) 5578 7233 or BOOK ONLINE.

Dry Needling and Acupuncture

By Leigh McCutcheon & Dr Wayne Hing, Physiotherapist.

The effectiveness of western acupuncture and dry needling is seen every day in clinic, so it’s good to see the growing evidence for its use. In the past year since Leigh McCutcheon of Robina Physio on the Gold Coast and Dr Wayne Hing of Bond University on the Gold Coast collaboratively wrote Physio ‘dry needling’ and acupuncture – what’s the difference and what does the evidence say? for The Conversation, almost 400 RCTs in dry needling have been published and almost ten fold of that for acupuncture directly influencing clinical practice and associated outcomes.

Physiotherapists are increasingly offering needling therapies in addition to their standard care. Many Australian physiotherapists in private practice now offer dry needling or Western medical acupuncture as part of a treatment approach.

Is it just a fad or does science support it?

Needling, three ways

Physiotherapists can be trained to use dry needling, Western acupuncture and/or traditional acupuncture.

Dry needling involves penetrating the skin with needles to altered or dysfunctional tissue in order to improve or restore function. This often involves needling muscle trigger points to activate a reflexive relaxation of the muscle.

Western acupuncture uses traditional needling meridians (the ancient idea of energy channels through the body) and trigger points. But these ideas are applied to Western understandings of anatomy. In Western acupuncture, points are stimulated to create local tissue changes, as well as spinal and brain effects. The goal is to trigger pain-relieving chemicals, muscle activation or relaxation.

Even though traditional acupuncture points are used with this style of needling, Western acupuncture is not viewed as traditional Chinese medicine.

Traditional acupuncture uses meridian lines or other points based on traditional Chinese medicine assessment methods and approaches.

A traditional Chinese medicine acupuncture chart from the 1800s. Wellcome Collection, CC BY

All physiotherapists trained in either acupuncture or dry needling meet safety standards which are viewed as within scope by the Australian Health Practitioners Regulatory Agency and the Physiotherapy Registration Board. These standards cover the level of training required, registration to practice and safety standards that include needle safety and hygiene to protect the public.

Minor reported side effects related to acupuncture including pain and bleeding or bruising from needle insertion are fairly common. But major adverse events – pneumothorax (collapsed lung), excessive bleeding, prolonged aggravation – are rare.

What’s needling good for?

Research into the effectiveness of acupuncture and dry needling is variable. Some studies show comparable results between dry needling and acupuncture, while others show more favourable results for one or the other depending on the condition being treated.

A review that assessed the effects of acupuncture and dry needling for the treatment of low-back pain found that it is a useful add-on therapy when combined with manual therapy, activity modification and exercise prescription.

For migraine and tension headaches, experts say acupuncture seems to reduce the frequency and intensity of attacks – though more research is needed to compare it to other treatments.

Acupuncture and dry needling may reduce pain and improve function for people with neck pain. A systematic review found significant differences between acupuncture and “sham acupuncture” (which is performed away from acupuncture points) when used to treat certain types of chronic pain. However, some research only shows small and temporary relief for neck pain with dry needling.

Results from randomised control trials support the use of needling for shoulder pain, tennis elbow and osteo arthritic knee pain. But a recent systemic review of research reported only weak evidence to support needling to treat plantarfasciitis and chronic ankle instability.

Not just for sporting injuries

Similarly, small randomised control trials have shown acupuncture and dry needling might reduce problematic jaw pain (temporo mandibular disorder) and improve mouth opening.

Systematic reviews have reported needling and acupuncture were safe and effective recommendations for the treatment of broad conditions of tendinopathy (the breakdown of collagen in tendons) and fibromyalgia (chronic pain in the muscles and bones).

For women’s health, acupuncture has been shown to be effective for reducing pain with periods, compared to no treatment or non-steroidal pain relief medications – but the research had design limitations.

Though widely used in pregnancy, research into the use of acupuncture to induce labour reports it may increase satisfaction with pain management and reduce pain intensity. But it may have little to no effect on the rates of caesarean or assisted vaginal birth.

In summary, it appears needling techniques – whether dry needling or acupuncture – generally show positive effects over no treatment or “sham” treatments, but more research and high quality trials are needed.

Just one part of a treatment program

Needling may be useful as part of multimodal care – that is, when more than one treatment is used in conjunction to treat a problem.

Physiotherapists may combine needling therapies with exercise prescription, hands-on care including massage, mobilisations and manipulations, and taping techniques. They may also employ therapies that apply external energy such as ultrasound, laser, transcutaneous (under the skin) electrical nerve stimulation and biofeedback.

Finally, while the various needling techniques all use a filiform needle (with a solid filament as opposed to a hollow bore needle), the styles with each can be quite different. Ask what style of needling is being employed to treat you, and if you have a history of finding one style works better for you, discuss this with your practitioner.

Are you struggling with pain and ready to try adding Dry Needling and Acupuncture to your treatment? The Physiotherapists at Robina Physio on the Gold Coast are industry leaders in providing Dry Needling and Western Acupuncture treatments as well as training other health professionals in it use clinically. Please don’t hesitate to Contact Us on (07) 5578 7233 or BOOK ONLINE.

TMJ Physio

By Aaron Woolley, Physiotherapist

Continuing with the Robina Physio blog series, we now delve into Temporomandibular Joint (TMJ) Dysfunction and the role of TMJ Physio. This intricate joint plays a vital part in essential daily activities like breathing, eating, drinking, and speaking, making it undeniably significant. Often, we overlook its importance until we encounter TMJ dysfunction and the ensuing pain that arises when something goes amiss. Understanding the complexity and importance of the TMJ can help us appreciate the need for specialised care when addressing any issues related to this crucial joint.

TMJ pain often presents with the following symptoms:

• Jaw and/or ear pain
• Neck, shoulder and upper back pain
• Headaches
• Clicking, grinding and popping of the jaw
• Locking of the Jaw
• Limited ability to open and/or close the mouth
• Clenching and grinding of the teeth
• Change to your bite
• Dizziness

Problems with the TMJ can be both acute and chronic in nature, are often painful and can be very debilitating for the individual suffering with TMJ dysfunction. So, let’s dive a bit deeper into what the Temporomandibular joint is and ways to manage TMJ dysfunction.

What is the Temporomandibular Joint?

The TMJ (Temporomandibular Joint) acts as a vital connection between your mandible and the temporal bone of your skull, forming your jaw joint. It is categorised as a condylar, synovial, and hinged-type joint. This classification indicates that the TMJ articulates with the condyles of the mandible and temporal bone, has a joint capsule encompassing the joint, filled with synovial fluid, and is equipped with an articular disc (and retrodiscal tissue). The movement of this joint is akin to a hinge, allowing for proper functioning and mobility.

https://www.physio-pedia.com/File:TMJdisc.jpg

In addition to its complex structure, the TMJ relies on essential ligaments to provide joint stability. Moreover, the TMJ is supported by crucial muscles, including the Masseter, Temporalis, Medial Pterygoid, and Lateral Pterygoid muscles. These muscles play a vital role in facilitating the proper functioning and movement of the TMJ.

As a TMJ Physio, it is crucial to focus on the relevant anatomy that impacts the joint’s well-being. This includes considering the elements contributing to joint stability, such as ligaments, the articular disc, and retrodiscal tissues, which are often associated with pain in various TMJ conditions. Additionally, the surrounding muscles play a pivotal role in TMJ function.

Among the listed muscles, special attention is given to the Lateral Pterygoid muscle due to its unique significance. Cadaver studies have revealed a direct connection between this muscle and the anterior portion of the joint capsule and articular disc, suggesting it may play a substantial role in TMJ dysfunction. Understanding and addressing these anatomical aspects are fundamental in providing effective treatment and management for TMJ-related issues.

Causes of TMJ Dysfunction

There are many possible causes of TMJ pain and dysfunction some of the more common causes include:

1. Inflammatory Conditions: This can involve inflammation of the articular disc (discitis), synovial capsule (synovitis), retrodiscal tissue (retrodiscitis) and muscles and/or tendons. Although technically speaking, when the tendon is involved, this is not actually considered inflammatory and would be termed a tendinopathy. This occurs as a result of chronic teeth grinding (bruxism), clenching, heavy chewing or prolonged mouth opening e.g. during a dental procedure. But can also occur acutely from a direct trauma including a whiplash injury.
2. Joint derangement: This involves displacement of the articular disc. This also occurs as a result of chronic teeth grinding (bruxism), clenching, heavy chewing or prolonged mouth opening e.g. during a dental procedure. But can also occur acutely from a direct trauma.
   • Displacement with reduction – is when the articular disc displaces anteriorly (forward), bunching up within the joint. At a particular point in the opening cycle the disc will reposition or reduce causing an audible and palpable clunk in the jaw. The jaw often deviates to the affected side when this occurs.
   • Displacement without reduction – is a more severe circumstance where the disc does not reduce often causing significant pain and loss of range (ability to open). This is called a closed lock. There typically isn’t associated clicking or clunking with this type but patients do report a clunk at the time the lock occurred.
3. Muscle Spasm: Once again, this also occurs as a result of chronic teeth grinding (bruxism), clenching, heavy chewing or prolonged mouth opening and is heavily affected by cervical (neck) posture. This condition is commonly referred to as Trismus (lock jaw) and can be very painful and cause severe limitation to the movement of the jaw even though structurally the TMJ is not affected. Thankfully a properly trained TMJ Physio like at Robina Physio on the Gold Coast can make a big difference to your pain and dysfunction.
4. Hyper-mobility: Can be related to laxity of the articular ligaments, joint capsule and articular disc. This laxity often leads to excessive movement of the articular disc, resulting in deviation of the jaw (often away from the affected side). Long term hypermobility can lead to degenerative type changes to the articular disc which can lead to a failure of the disc reducing during closing, causing the TMJ to become stuck open. This is called an open lock and more often occurs after very wide opening such as yawning or very long dental procedures.
5. Degenerative Arthritis: This is often due to age related degeneration but can also occur prematurely due to a traumatic injury at a younger age. These changes are visible on X-ray as a flattening of the condylar head of the mandible. Joint crepitus is often felt and heard during opening and closing.

Assessment of TMJ Dysfunction

The TMJ Physio’s at Robina Physio on the Gold Coast regularly work very closely with your Dentist and/or Maxillofacial Specialist. This is especially important to help protect your teeth from and any new or further damage and to arrange additional treatments including occlusal splints and in some more severe cases Botox injections or surgery.

When you visit a TMJ Physio at Robina Physio on the Gold Coast, you can expect to undergo a comprehensive assessment. This will include taking a detailed history and conducting a thorough examination. During the examination, we will assess your posture, jaw position, and tongue placement. We will also palpate the TMJ, muscles, and ligaments, looking for any signs of tenderness, swelling, spasms, or hyper-mobility.

The quality of movement of your neck and jaw will be carefully evaluated, with specific attention given to your bite, range of opening, and any deviations observed during opening and closing. Additionally, we will briefly examine your tongue and cheeks for any indications of clenching, such as scalloping, as well as signs of teeth grinding.

In some cases, further investigations may be necessary, and we may recommend scans of your TMJ using OPG X-rays and/or an MRI of your jaw.

At Robina Physio on the Gold Coast, our TMJ Physios work closely with your Dentist and/or Maxillofacial Specialist. This collaboration is especially important in protecting your teeth from any new or additional damage and in arranging additional treatments like occlusal splints. In more severe cases, interventions such as Botox injections or surgery may also be considered. Our aim is to provide comprehensive care and support to address your TMJ issues effectively and improve your overall well-being.

TMJ Physio Treatments

Thankfully TMJ Physio can be highly effective when targeting TMJ dysfunction and pain. At Robina Physio on the Gold Coast we use a number of modalities with very good results for our patients. Treatment modalities we use include:

1. Soft Tissue Release: This includes manually releasing the muscles around the head, neck and jaw through massage and trigger point therapy. We will also teach you how to do some self-trigger point release at home.
2. Dry Needling: This involves inserting acupuncture needles to very specific muscles in the neck and jaw. Including the key muscles mentioned earlier in this blog, the Masseter, Temporalis, Medial and Lateral Pterygoid muscles.
3. Muscle Strengthening and Postural Correction: It is important we strengthen the muscles that support your head, neck, scapula and jaw. This involves some very small specific exercises for your jaw and more global exercises for your neck and back. We will also give you extensive advice about ways to help improve your jaw, head and cervical posture.
4. Adjunct Treatments: These would include treatments from other health professionals including Dentists, Maxillofacial Specialists, GPs and Psychologists. The need for each does vary from patient to patient but its importance cannot be underestimated. For example, in some cases stress may be a major factor, therefore additional support from your GP and/or psychologist will be helpful in addition to your TMJ Physio. We would also consider treatments such as anti-inflammatory medications, occlusal splints and in some cases Botox injections depending on the case.

TMJ Physio Gold Coast

I hope you found this information helpful. The Physiotherapists at Robina Physio are one of the few Physiotherapists on the Gold Coast with additional training in the management of TMJ dysfunction and pain. If your struggling with TMJ issues please don’t hesitate to Contact Us on (07) 5578 7233 or BOOK ONLINE.

Osgood-Schlatter Disease

By Jonathan ‘Yona’ Dorfzaun, Physiotherapist.

Osgood-Schlatter Disease (OSD) is a common cause of anterior knee pain in adolescents and young adults who are still skeletally immature. OSD usually develops during adolescence between ages 10 to 15 years for males and 8 to 13 years for females. It is more common in boys than in girls and it often presents during significant growth spurts.

OSD (Osgood-Schlatter’s Disease) usually manifests without any specific trauma or injury. Instead, it develops as gradual anterior knee pain, often accompanied by tenderness at the bottom of the kneecap and on the bony area at the top of the shin, where the patellar tendon attaches to the tibial tuberosity (refer to the picture below). The condition is typically a result of repetitive stress activities like jumping and sprinting. Common sports associated with Osgood-Schlatter’s include Athletics, Netball, Basketball, Volleyball, Gymnastics, Tennis, and various Football codes. Additionally, in 20% to 30% of patients we see in clinic, symptoms can affect both legs.

Beyond rapid growth spurts, other factors that can contribute to the condition are poor flexibility of the quadriceps and hamstrings muscles, as well as incorrect alignment of the knee during activities such as walking, running, jumping, kicking, or cycling.

What will you feel?

Most cases of Osgood-Schlatter’s Disease (OSD) are characterized by increased anterior knee pain, with or without swelling, which intensifies during physical activities like running, jumping, cycling, kneeling, walking up and down stairs, and kicking a ball.

One significant indicator of OSD is tenderness upon touching the bony part at the top of the shin, known as the tibial tuberosity. In certain instances, the tibial tuberosity might undergo growth, leading to the noticeable presence of a lump. It’s crucial to note that the size of this bony prominence does not necessarily correlate with better or worse outcomes of the condition. Additionally, individuals with OSD may experience tightness in the front and back of their thighs and could even feel a sense of heaviness in their legs by the end of the day.

OSD predominantly arises as an overuse injury, often becoming apparent after activity or an increase in physical demands. The repetitive strain and microtrauma endured during these activities lead to irritation of the growth plates situated at the top of the shin, specifically at the bony part called the tibial tubercle apophysis. Pain typically indicates irritation of these growth plates. While severe cases may occasionally result in partial avulsion or fracture, such occurrences are rare. X-rays are not routinely necessary, but in severe cases where a fracture or avulsion is suspected, they might be considered.

It’s essential to recognise that Osgood-Schlatter disease can present similarly to several other knee injuries, including Sinding-Larsen-Johansson Syndrome, Patello-femoral Joint Syndrome, and Patella Tendinopathy. Hence, if your child experiences new-onset knee pain, seeking professional medical advice from reputable practitioners like those at Robina Physio on the Gold Coast is highly recommended. An accurate diagnosis made early on and a well-structured treatment plan can ensure effective management of the condition.

Treatment

At Robina Physio on the Gold Coast, our comprehensive treatment plan would typically encompass various approaches to effectively manage your symptoms. We may utilise techniques such as massage, stretching, dry needling, and/or ice therapy to alleviate discomfort and promote healing. Additionally, we would focus on activity modification to minimise activities that aggravate your condition, allowing your body the necessary time to heal through relative rest. Our goal is to provide you with a tailored and holistic treatment plan that addresses your specific needs and facilitates a smooth recovery.

During your physiotherapy sessions at Robina Physio on the Gold Coast, the primary goal is to discover the optimal balance, that “sweet spot,” where you, as an athlete, can engage in your desired activity or sport with minimal to no pain. Our focus is on effectively managing your running and jumping load in the short term, allowing you to continue participating within the injury’s limits, facilitating the healing process. Complete cessation of activity may not always be the best long-term solution.

We have achieved great success in managing our patients by implementing a comprehensive lower limb mobility, strengthening, and progressive loading program. This approach addresses any stiffness or weakness that contributes to the irritation of the tendon over your kneecap and shin. However, the most crucial aspect of your journey is determining the appropriate level of activity that your body can handle before pain arises.

An essential message we convey to our patients regarding Osgood-Schlatter disease is that it follows a natural progression and is a self-limiting injury. This means that with proper pain management, you can continue with your regular physical activities. Our role is to help you identify the suitable intensity and frequency while also reducing your pain, ensuring a smoother recovery process.

The good news!

Osgood-Schlatter Disease has an excellent prognosis! The condition is self-limiting and acute periods usually recover within a month. However, if unnoticed or untreated pain may persist up to 2 years or when you have stopped growing!

The Physiotherapist’s at Robina Physio on the Gold Coast are here to help with any of your knee injuries, including Osgood-Schlatter Disease. Contact us on (07) 5578 7233 or BOOK ONLINE.