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Patient Guide to Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one or two years.

Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that affects the mobility of your arm — such as a stroke or a mastectomy.

Treatment for frozen shoulder involves stretching exercises and, sometimes, the injection of corticosteroids and numbing medications into the joint capsule. In a small percentage of cases, surgery may be needed to loosen the joint capsule so that it can move more freely.

SYMPTOMS OF FROZEN SHOULDER

Frozen shoulder typically develops slowly, and in three stages. Each of these stages can last a number of months.

  • Painful stage. During this stage, pain occurs with any movement of your shoulder, and your shoulder’s range of motion starts to become limited.
  • Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and your range of motion decreases notably.
  • Thawing stage. During the thawing stage, the range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting normal sleep patterns.

CAUSES OF FROZEN SHOULDER

The bones, ligaments and tendons that make up your shoulder joint are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting its movement.

Doctors aren’t sure why this happens to some people and not to others, although it’s more likely to occur in people who have recently experienced prolonged immobilization of their shoulder, such as after surgery or an arm fracture.

RISK FACTORS OF FROZEN SHOULDER

Although the exact cause is unknown, certain factors may increase your risk of developing frozen shoulder.

Age and sex
People 40 and older are more likely to experience frozen shoulder. Most of the people who develop the condition are women.

Immobility or reduced mobility
People who have experienced prolonged immobility or reduced mobility of their shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:

  • Rotator cuff injury
  • Broken arm
  • Stroke
  • Recovery from surgery

Systemic diseases
People who have certain medical problems appear to be predisposed to develop frozen shoulder. Examples include:

  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson’s disease

TESTS AND DIAGNOSIS:

During the physical exam, your doctor may ask you to perform certain actions, to check for pain and evaluate your range of motion. These may include:

  • Hands up. Raise both your hands straight up in the air, like a football referee calling a touchdown.
  • Opposite shoulder. Reach across your chest to touch your opposite shoulder.
  • Back scratch. Starting with the back of your hand against the small of your back, reach upward to touch your opposite shoulder blade.

Your doctor may also ask you to relax your muscles while he or she moves your arm for you. This test can help distinguish between frozen shoulder and a rotator cuff injury.

Frozen shoulder can usually be diagnosed from signs and symptoms alone. But your doctor may suggest imaging tests — such as X-rays or an MRI — to rule out other structural problems.

TREATMENTS AND DRUGS:

Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible.

Medications
Over-the-counter pain relievers, such as aspirin and ibuprofen (Advil, Motrin, others), can help reduce pain and inflammation associated with frozen shoulder. In some cases, your doctor may prescribe stronger pain-relieving and anti-inflammatory drugs.

Therapy
A physical therapist can teach you stretching exercises to help maintain as much mobility in your shoulder as possible.

Surgical and other procedures
Most frozen shoulders get better on their own within 12 to 18 months. For persistent symptoms, your doctor may suggest:

  • Steroid injections. Injecting corticosteroids into your shoulder joint may help decrease pain and improve shoulder mobility.
  • Joint distension. Injecting sterile water into the joint capsule can help stretch the tissue and make it easier to move the joint.
  • Shoulder manipulation. In this procedure, you receive a general anesthetic so you’ll be unconscious and feel no pain. Then the doctor moves your shoulder joint in different directions, to help loosen the tightened tissue. Depending on the amount of force used, this procedure can cause bone fractures.
  • Surgery. If nothing else has helped, you may be a candidate for surgery to remove scar tissue and adhesions from inside your shoulder joint. Doctors usually perform this surgery arthroscopically, with lighted, tubular instruments inserted through small incisions around your joint.

PREVENTION OF FROZEN SHOULDER:

One of the most common causes of frozen shoulder is the immobility that may result during recovery from a shoulder injury, broken arm or a stroke. If you’ve had an injury that makes it difficult to move your shoulder, talk to your doctor about what exercises would be best to maintain the range of motion in your shoulder joint.

CURE YOUR FROZEN SHOULDER TODAY! CALL +65 6471 2744 OR EMAIL TO: info@boneclinic.com.sg TO SCHEDULE FOR AN APPOINTMENT

Achilles Tendonitis

Achilles tendinitis

Achilles tendinitis is when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It is used for walking, running, and jumping.

Causes

There are two large muscles in the calf. These muscles are important for walking. They create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel.

Heel pain is most often due to overuse of the foot. Rarely it is caused by an injury.

Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.

Achilles tendinitis may be more likely to occur if:

  • Suddenly increase the amount or intensity of an activity
  • Your calf muscles are very tight (not stretched out)
  • You run on hard surfaces such as concrete
  • You run too often
  • You jump a lot (such as when playing basketball)
  • You do not have shoes with proper support
  • Your foot suddenly turns in or out

Tendinitis from arthritis is more common in middle-aged and elderly people. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.

Symptoms

Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning.

The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.

Exams and Tests

The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.

X-rays can help diagnose bone problems.

An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.

Treatment

The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.

Try putting ice over the Achilles tendon for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb.

Changes in activity may help manage the symptoms:

  • Decrease or stop any activity that causes you pain.
  • Run or walk on smoother and softer surfaces.
  • Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.

Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon.

They may also suggest the following changes in your footwear:

  • A brace or boot or cast to keep the heel and tendon still and allow the swelling to go down
  • Heel lifts placed in the shoe under the heel
  • Shoes that are softer in the areas over and under the heel cushion

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can help with pain or swelling. Talk with your health care provider.

If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon.

Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.

Outlook (Prognosis)

Lifestyle changes usually help improve symptoms. However, symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.

Possible Complications

Achilles tendinitis may make you more likely to have an Achilles rupture. This condition usually causes a sharp pain, like someone hit you in the back of the heel with a stick. Surgical repair is necessary, but difficult because the tendon is not normal.

When to Contact a Medical Professional

If you have pain in the heel around the Achilles tendon that is worse with activity, contact your health care provider for evaluation and possible treatment for tendinitis.

Prevention

Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.

CURE YOUR ACHILLES TENDINITIS TODAY! CALL +65 6471 2744 OR EMAIL TO: info@boneclinic.com.sg FOR APPOINTMENT

Patient Education of Back Pain

Back pain is a common complaint. Most people in the Singapore will experience low back pain at least once during their lives. Back pain is one of the most common reasons people go to the doctor or miss work.

On the bright side, you can take measures to prevent or lessen most back pain episodes. If prevention fails, simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul. Surgery is rarely needed to treat back pain.

Symptoms of Back Pain:

Symptoms of back pain may include:

  • Muscle ache
  • Shooting or stabbing pain
  • Pain that radiates down your leg
  • Limited flexibility or range of motion of the back
  • Inability to stand up straight

When to see a doctor
Most back pain gradually improves with home treatment and self-care. Although the pain may take several weeks to disappear completely, you should notice some improvement within the first 72 hours of self-care. If not, see your doctor.

In rare cases, back pain can signal a serious medical problem. Seek immediate care if your back pain:

  • Causes new bowel or bladder problems
  • Is associated with pain or throbbing (pulsation) in the abdomen, or fever
  • Follows a fall, blow to your back or other injury

Contact a doctor if your back pain:

  • Is constant or intense, especially at night or when you lie down
  • Spreads down one or both legs, especially if the pain extends below the knee
  • Causes weakness, numbness or tingling in one or both legs
  • Is accompanied by unexplained weight loss
  • Occurs with swelling or redness on your back

Also, see your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.

Causes of Back Pain:

Back pain often develops without a specific cause that your doctor can identify with a test or imaging study. Conditions commonly linked to back pain include:

  • Muscle or ligament strain.Repeated heavy lifting or a sudden awkward movement may strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back may cause painful muscle spasms.
  • Bulging or ruptured disks. Disks act as cushions between the individual bones (vertebrae) in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve. The presence of a bulging or ruptured disk on an X-ray doesn’t automatically equal back pain, though. Disk disease is often found incidentally; many people who don’t have back pain turn out to have bulging or ruptured disks when they undergo spine X-rays for some other reason.
  • Arthritis. Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
  • Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain, but generally only if the scoliosis is quite severe.
  • Osteoporosis. Compression fractures of your spine’s vertebrae can occur if your bones become porous and brittle.

Risk Factors of Back Pain:

Anyone can develop back pain, even children and teens. Although excess weight, lack of exercise and improper lifting are often blamed for back pain, research looking at these possible risk factors hasn’t yet provided any clear-cut answers.

One group that does appear to have a greater risk of back pain are people with certain psychological issues, such as depression and anxiety, though the reasons why there’s an increased risk aren’t known.

Test and Diagnosis of Back Pain:

Anyone can develop back pain, even children and teens. Although excess weight, lack of exercise and improper lifting are often blamed for back pain, research looking at these possible risk factors hasn’t yet provided any clear-cut answers.

One group that does appear to have a greater risk of back pain are people with certain psychological issues, such as depression and anxiety, though the reasons why there’s an increased risk aren’t known.

Treatment of Back Pain:

Most back pain gets better with a few weeks of home treatment and careful attention. Over-the-counter pain relievers may be all that you need to improve your pain. A short period of bed rest is OK, but more than a couple of days actually does more harm than good. Continue your daily activities as much as you can tolerate. Light activity, such as walking and daily activities of living, is usually OK. But, if an activity increases your pain, stop doing that activity. If home treatments aren’t working after several weeks, your doctor may suggest stronger medications or other therapies.

Medications
Our doctor is likely to recommend pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs, such as ibuprofen. Both types of medications are effective at relieving back pain. Take these medications as directed by our doctor, because overuse can cause serious side effects. If mild to moderate back pain doesn’t get better with over-the-counter pain relievers, your doctor may also prescribe a muscle relaxant. Muscle relaxants can cause dizziness and may make you very sleepy.

Education
Right now, there’s no commonly accepted program to teach people with back pain how to manage the condition effectively. That means education may be a class, a talk with your doctor, written material or a video. What’s important is that education emphasizes the importance of staying active, reducing stress and worry, and teaching ways to avoid future injury. However, it’s also important for your doctor to explain that your back pain may recur, especially during the first year after the initial episode, but that the same self-care measures will be able to help again.

Physical therapy and exercise
Physical therapy is the cornerstone of back pain treatment. A physical therapist can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises that may help increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help prevent pain from returning.

Injections
If other measures don’t relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than a few months.

In some cases, your doctor may inject numbing medication and cortisone into or near the structures believed to be causing your back pain, such as the facet joints of the vertebrae. Located on the sides, top and bottom of each vertebra, these joints connect the vertebrae to one another and stabilize the spine while still allowing flexibility.

Surgery
Few people ever need surgery for back pain. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you may benefit from surgical intervention. Otherwise, surgery usually is reserved for pain related to structural anatomical problems that haven’t responded to intensive conservative therapy measures.

STOP YOUR BACK PAIN TODAY. CALL +65 6471 2744 OR EMAIL TO: info@boneclinic.com.sg FOR APPOINTMENT

PATIENT GUIDE TO SHIN SPLINTS

The term “shin splints” refers to pain along or just behind the shinbone (tibia) — the large bone in the front of your lower leg. Medically known as medial tibial stress syndrome, shin splints occur during physical activity and result from too much force being placed on your shinbone and connective tissues that attach your muscles to the bone. Shin splints are common in runners and in those who participate in activities with sudden stops and starts, such as basketball, soccer or tennis.

The risk of shin splints is no reason to give up your morning jog or afternoon aerobics class. Most cases of shin splints can be treated with rest, ice and other self-care measures. Wearing proper footwear and modifying your exercise routine can help prevent shin splints from recurring.

SYMPTOMS OF SHIN SPLINTS:

If you have shin splints, you may notice:

  • Tenderness, soreness or pain along the inner part of your lower leg
  • Mild swelling in your lower leg

At first, the pain may stop when you stop running or exercising. Eventually, however, the pain may be continuous.

When to see a doctor
Consult your doctor if rest, ice and over-the-counter pain relievers don’t ease your shin pain. Your primary care doctor may refer you to an orthopedist. Seek prompt medical care if:

  • Severe pain in your shin follows a fall or accident
  • Your shin is hot and inflamed
  • Swelling in your shin seems to be getting worse
  • Shin pain persists during rest

CAUSES OF SHIN SPLINTS:

Shin splints are caused by excessive force (overload) on the shinbone and the connective tissues that attach your muscles to the bone. The overload is often caused by specific athletic activities, such as:

  • Running downhill
  • Running on a slanted or tilted surface
  • Running in worn-out footwear
  • Engaging in sports with frequent starts and stops, such as basketball and tennis

Shin splints can also be caused by training errors, such as engaging in a running program with the “terrible toos” — running too hard, too fast or for too long.

RISK FACTORS OF SHIN SPLINTS:

You’re more at risk of shin splints if:

  • You’re a runner, especially just beginning a running program
  • You have flat feet or rigid arches, causing your feet to roll inward when running
  • You increase the intensity of your workouts by doing more high-impact activities
  • You play sports on hard surfaces, with sudden stops and starts
  • You’re in military training

TEST AND DIAGNOSIS OF SHIN SPLINTS

Shin splints are usually diagnosed based on your medical history and a physical exam. In some cases, an X-ray or other imaging studies can help identify other possible causes for your pain, such as a stress fracture — tiny cracks in a bone often caused by overuse.

PREVENTION:

To help prevent shin splints:

  • Choose the right shoes. Wear footwear that suits your sport. If you’re a runner, replace your shoes about every 350 to 500 miles (560 to 800 kilometers).
  • Consider arch supports. Arch supports can help prevent the pain of shin splints, especially if you have flat arches.
  • Lessen the impact. Cross-train with a sport that places less impact on your shins, such as swimming, walking or biking. Remember to start new activities slowly. Increase time and intensity gradually.
  • Add strength training to your workout. To strengthen your calf muscles, try toe raises. Stand up. Slowly rise up on your toes, then slowly lower your heels to the floor. Repeat 10 times. When this becomes easy, do the exercise holding progressively heavier weights. Leg presses and other exercises for your lower legs can be helpful, too.

It’s also important to know when to rest; at the first sign of shin pain, take a break.

GET PROFESSIONAL OPINION AND TREATMENT ABOUT YOUR SHIN SPLINT. CALL +65 64712744 or SMS to +65 92357641 FOR APPOINTMENT

Top 10 Sports Injuries

The most common sports-related injuries primarily are overuse injuries. As the name implies, an overuse injury results from wear and tear on the body, particularly on joints subjected to repeated activity.

Certain types of injuries plague sports participants. Most of them, however, are minor. Knowing the early signs and what to do can help prevent them from becoming nagging problems.

Here’s a look, from head to toe, at the Top Ten sports injuries you’re most likely to face:

Muscle Pull
Probably the most common sports injury is a muscle pull, which can happen to almost any muscle in the body. No matter how diligently you warm up and stretch, or cool down and stretch, you may pull a muscle from overuse, fatigue or taking a fall. There is little you can be done to prevent a muscle pull except to stay limber and work your muscles regularly.

A muscle pulls when a sudden, severe force is applied to the muscle and the fibers are stretched beyond their capacity. If only some of the fibers tear, that is a muscle pull. If most of the fibers tear, that is a muscle tear.

Neck Pain

A pulled muscle or a muscle spasm in the neck can happen when a tennis player looks up to serve or hit an overhead smash. The pain is on one side of the neck, and the neck may be pulled over slightly to that side. It is particularly painful to turn the head in the direction of the pain. That is, if the pain is on the left side of the neck, the player can turn to the right, but not to the left.

Cyclists who use racing handlebars may also feel neck stiffness. With your back bent low over the handlebars, you have to tilt your neck up to see ahead. After a long ride, the neck muscles may tighten up and go into spasm from this awkward position.

Shoulder Impingement
The shoulder bones are held together by a group of muscles known as the rotator cuff muscles. These muscles (supraspinatus, infraspinatus, subscapularis and teres minor) are responsible for the shoulder’s fine movements, such as throwing a ball. Because of the shoulder’s shallow socket and lack of ligament strength, any weakness of the small, rotator cuff muscles makes it easy for the head of the shoulder to slide around in the joint.

If the shoulder joint is continually stressed with the arm in an overhead position, as it is in softball, tennis, volleyball, swimming and weight training, the small rotator cuff muscles begin to stretch out. This allows the head of the joint to become loose within the shoulder socket. If the head of the shoulder is loose, when the arm is extended backwards over the shoulder the head will slide forward, catching the tendon of short head of the biceps between the ball and the socket. The same thing happens when the arm is raised to the side above parallel to the ground. The head will drop in the socket and the tendon of the long head of the biceps or the supraspinatus becomes impinged.

This impingement causes the tendons to become inflamed and painful. Tennis players feel the pain when they try to hit an overhead or serve. The same thing can happen to golfers in both the backswing and the follow-through when their shoulders are above parallel to the ground.

Lower Back Strain
Almost everyone who participates in sports experiences lower back strain at one time or another, usually from twisting awkwardly, lifting a heavy weight or doing some unpracticed activity. Virtually all lower back injuries are due to weak or tense muscles or muscle strain. Suddenly overloading muscles may pull or tear muscle fibers, sending the back muscles into spasm and causing pain.

Weightlifters, golfers, martial artists and tennis players are prone to back injuries because these sports involve unilateral motions. A golfer rotates the lumbar spine in only one direction, which is the equivalent of lifting weights with only one side of body. Martial artists generally have one dominant leg and kick with that one more than the other.

Tennis Elbow
Tennis elbow is really an inflammation of the muscles of the forearm and the tendon that connects the muscles to the bones in the elbow. These muscles bend the wrist backward and cause the wrist to turn the palm face up. When the muscles and tendon become inflamed from overuse, the pain is felt on the outside of the elbow (lateral epicondylitis).

A tennis player most often aggravates the elbow by hitting the ball late on the backhand side, straining the forearm muscles and tendon. Constantly turning the wrist to put more spin on the serve also can cause pain.

Golfers also suffer from tennis elbow, but on the non-dominant side, that is, a right-handed golfer will feel the pain in the left elbow. Pulling the club through the swing with the left wrist causes irritation in the left elbow.

A second type of tennis elbow is known as medial epicondylitis. This causes pain on the inside of the elbow. It is most often seen among golfers, baseball pitchers, tennis players who hit topspin forehands and weight lifters.

Runner’s Knee
The most common cause of knee pain is runner’s knee, known medically as chondromalacia patella. This is due to misalignment of the kneecap in its groove. The kneecap normally goes up or down in the groove as the knee flexes or straightens out. If the kneecap is misaligned, the kneecap pulls off to one side and rubs on the side of the groove. This causes both the cartilage on the side of the groove and the cartilage on the back of the kneecap to wear out. On occasion, fluid will build up and cause swelling in the knee.

Runners are not the only ones who develop runner’s knee. Pain can develop around the back of the kneecap or in the back of the knee after participating in any running sport.

Shin Splints
Shin splints are pains in the muscles near the shin bones. They can be caused by running or jumping on hard surfaces or simply overuse. They occur most often in people unaccustomed to training, although they can also plague experienced athletes who switch to lighter shoes, harder surfaces or more concentrated speed work.

The pain occurs on the inner side of the middle third of the shin bone. The muscle responsible for raising the arch of the foot attaches to the shin bone at that spot. When the arch collapses with each foot strike, it pulls on the tendon that comes from this muscle. With repeated stress, the arch begins to pull some of its muscle fibers loose from the shin bone. This causes small areas of bleeding around the lining of the bone, and pain.

If the irritated area is about the size of a 50-cent piece or smaller, or shin pain suddenly increases, you may have a stress fracture. The twisting of the tibia can cause the bone to crack. A stress fracture may not show up on an x-ray, and therefore a bone scan is indicated.

Ankle Sprain
The most common ankle sprain happens when the foot rolls to the outside and sprains the ligaments on the outside of the ankle. The outside of the ankle swells up and throbs, and may turn black and blue around the injury.

When a jogger steps gently off a curb and “twists” an ankle, this simply stretches the ligaments, with no real tearing, and is considered a mild sprain. When a tennis player lunges out over a poorly planted foot, partially tearing the fibers of the ligament, that is considered a moderate sprain. When a volleyball player jumps and lands on another player’s foot, twisting and forcing the ankle violently to the court, most or all of the fibers tear, and this is a severe sprain.

If weight-bearing is possible on the ankle after a sprain, the ankle probably is not broken. If you feel pain on the inside of the ankle, then it should be x-rayed to rule out a hair-line fracture.

Achilles Tendinitis
The Achilles tendon in the back of the ankle is the largest tendon in the body. It transfers the force of muscle contractions to lift the heel. Achilles tendinitis is an inflammation of the tendon, usually due to overuse, such as frequent jumping in basketball or volleyball. The most common cause is excessive pronation of the ankle and foot, which causes the Achilles tendon to pull off center.

The pain of a torn Achilles tendon feels like a gunshot in the leg. A partial tear is harder to spot. If the width of the injured Achilles tendon is smaller than the healthy one, or you feel intense pain when standing on your toes, see a doctor for treatment, and possibly surgery.

Arch Pain
The elastic covering on the sole of the foot–the plantar fascia–runs the length of the foot and holds up the arch. When this shock-absorbing pad becomes inflamed, this is called plantar fasciitis, causing a dull ache along the length of the arch.

The ache is due to over-stretching or partially tearing the arch pad. This happens most often to people with rigid, high arches. They feel the pain when they put weight on their foot or when pushing off for the next stride. Pain is particularly intense upon arising or after sitting for a long while.

Plantar fasciitis is particularly common among middle-aged people who have been sedentary and who suddenly increase their level of physical activity. Runners are most susceptible, but almost any sport that keeps the athlete standing can lead to arch pain. Inappropriately fitting shoes or a weight gain of 10 to 20 pounds can also contribute to the condition.

Singapore Sports Injury Specialist Clinic. Call +65 6471 2744 or Email to info@boneclinic.com.sg for Appointment

You don’t have to Live with Joint Pain!

Most people assume that having pain in the joint is a normal process of ageing, and they just have to learn to live with it. All too often, instead of seeking professional advise, many turn to pain killers or assume the pain will just go away.

The causes of joint pain are diverse and range from inflammation, traumatic injuries, infections, overloading or even genetic factors. It is also commonly perceived that severe joint pain comes with age. However, this is not necessarily true as people in their twenties and thirties can also start to experience joint problems.

Take 35 years old Ling, an administrative executive, as an example.

As a running enthusiast, Ling jogs regularly and leads an active lifestyle. So, when she felt stiffness and aches in her knees, she thought it might be due to long periods of sitting at work or over exercising.

After many visits to the general practitioner and consistent taking of pain killers, her condition worsened and affected her daily life as she gradually found difficulty to get out of bed. She visited a specialist for advice when she noticed some swellings in her wrists and knees. From the results of a blood test and x-rays, she was told that she was suffering from Rheumatoid Arthritis.

“Rheumatoid Arthritis is not a benign joint disease and this inflammation usually occurs in joints in a symmetrical fashion. If left untreated, it can cause her to develop cartilage and bone damage leading to joints deformities and may also cause an early death” In Ling’s case, by seeking timely professional treatment, she was able to prevent disability.

Arthritis is a catch-all term that simply means inflammation of the joints. However, it is not a simple diagnosis as generally perceived. There are many different forms of arthritis and getting the right diagnosis and treatment are crucial in helping sufferers to minimise discomfort and prevent permanent damage to their joints.

While medications can relieve pain, they may also cause side effects such as stomach intolerance and kidney problems. Some other medications used to prevent further progression of the disease can also affect blood counts or the liver systems.

It is therefore recommended that sufferers of joint pain have a doctor monitor their condition regularly throughout the treatment process. Other than taking medications, they will also need to make some changes to their lifestyles by exercising and losing weight if they are overweight. They can work with a physiotherapist, who can develop an exercise programme that will aid them to improve strength and relieve pain.

Some joint aches and pains should not be overlooked as they can signal more sinister conditions. They can be related to connective tissue diseases such as Systemic Lupus Erythematosus, Sjogren’s Syndrome or underlying inflammatory muscle disease. These autoimmune disease may also be associated with inflammation or other organ systems such as the kidney, lung, brain and heart. However, with early detection and diagnosis, the sufferer can receive appropriate treatment and reduce the risk of serious complications.

Although usually non-threatening, it is important to seek help from a specialist when one experiences any kind of persistent joint pain or other unusual symptoms, for instance, prolonged joint stiffness which lasts through the day or persistent swelling of a joint as these can be features of an inflammed joint.

Get your Joint Pain treated today! Call +65 6471 2744 for Appointment

Exercise – Getting Started

So, how much is enough?

Many people believe that only vigorous exercise or playing sport counts as physical activity. However, you can get considerable health benefits from regular activity without needing special equipment or sporting ability – you don’t even have to get very hot and sweaty.

The recommended healthy level of physical activity is at least 150 minutes of moderate exercise, or 75 minutes of vigorous intensity activity throughout the week. Doing more than this can give extra health benefits. Moderate means your breathing is faster, your heart rate is increased and you feel warmer. At this level of activity, your heart and lungs are being stimulated and this goes towards making you fitter.

You can achieve your exercise target through short bouts of 10 minutes or more during the week. You can also do a combination of moderate and vigorous intensity activity.

You should also include two weekly activities to strengthen your muscles, such as resistance exercise.

Where do I start?

Getting active is easier than you may think. You can include everyday activities or structured exercise or sport, or a combination of these. Adapt your weekly routine to fit in with your own personal circumstances – some ways of doing this are described below.

  • Walk or cycle to work.
  • Take all small opportunities to be active – use the stairs, do manual tasks.
  • Play a sport, go to the gym or go swimming two to three times a week.
  • At work, walk over to speak to colleagues instead of sending an email or phoning.
  • Walk instead of drive for short journeys or getting off the bus one or two stops earlier than usual
  • Organise a lunchtime exercise or walking group.
  • At the weekend take longer walks, go for a bike ride or do some DIY or gardening.
  • Park at the furthest end of the car park.
  • Play with your children in the garden.
  • Take a walk in the park.
  • Join an organised bike ride or run.

If you’re not used to doing exercise, you can start by exercising for a short period of time and gradually increase this by five minutes until you achieve your target. Don’t try to do too much too quickly because you may lose motivation and stop.

What’s stopping you?

If something is preventing you from becoming active, think about what you can do to resolve the issue. It’s important that you choose an activity that you enjoy. If it’s your children keeping you busy, why not exercise with them, such as going on a family bike ride. Below are some ideas that can make starting to get active easier.

  • Set a date to start and stick to it.
  • Talk to your friends about starting and see if they are interested in joining you – it’s always easier to have someone else to do activity with.
  • Find out what facilities are available in your area. You may want to join an exercise class, go swimming or visit the gym.
  • Set goals.

Once you have started exercising, you will need to slowly increase the amount and intensity of activity that you do. This will help to increase your fitness levels.

Goal setting

Setting goals is important. Short-term goals will help to keep you motivated when the going gets tough and give you something to work towards. Create realistic goals that help to improve your fitness levels – try using the SMART process to do this.

  • Specific – say exactly what you will do.
  • Measurable – if you can’t measure your goal, you won’t know if you have achieved it.
  • Attainable – your goal should be something you can and are willing to do.
  • Realistic – something you can do with the resources you have.
  • Time-based – give yourself a time frame in which to meet your goal.

Once you have set your goals, it’s important to stay focused. This will help you make lasting changes to your exercise routine and it will become part of your lifestyle. You may find some days are more difficult than others but try to stay motivated.

Sticking with it

You can make it easier to stay motivated in several ways. Choose an exercise you enjoy, and that is convenient, affordable and fits into your lifestyle. This will help you stick to your goals. If you don’t know what activity you enjoy, try a few until you find one or two that are suitable. Make sure that you put time aside in your week for exercise.

Writing a diary of your exercise routine can be helpful and improve your motivation. You can note the duration, type and difficulty level of the activity and how you felt doing it and afterwards. This will give you an idea of when you can increase your activity levels so you see your improvements.

Some tips for staying motivated are:

  • listening to music
  • exercising with your friends
  • varying your exercise – for example, try taking different routes when you do walking or running
  • setting goals and rewarding yourself with something you enjoy when you achieve them

Action points

  • Do at least 150 minutes of moderate activity throughout the week, or 75 minutes of vigorous activity.
  • Include exercise into your daily routine, such as household chores, walking up moving escalators and walking up stairs instead of getting the lift.
  • Create goals that will help to improve your fitness levels and keep you motivated.
  • Choose an activity that is fun and enjoyable and you will stick to.

Swimming and Lower Back Pain

In many cases, swimming can be a very helpful exercise for back pain sufferers. Athletes commonly become injured, and swimming is a great way to keep active since it usually does not put excess strain on a swimmer’s back. However, that’s not to say that swimming can’t cause back pain or injuries as well. Sometimes lower back pain can be caused from swimming when the muscles in the lower back become hyper extended, or over stretched, during the breaststroke or other forward stokes. In addition to hyper extension of the lower back, the cervical spine, or upper spine and neck, can also become injured while swimming. Repetitive jerking motions of the head during frontward stokes could also seriously injure the area.The neck and cervical spine are particularly prone to injury while swimming. The anatomy of this area of the spine is very complex and is composed of seven vertebrae surrounding the spinal cord, which extends downward from the brain. Stretching outward from the spinal cord are nerves which travel to muscles and other tissue throughout the body.To prevent back pain while swimming, it’s crucial that you use proper form and techniques. Unnatural or awkward movements while swimming can easily damage tissue through the back, so it’s important to maintain the correct stokes and movements. In addition, swimming with sidestrokes or backstrokes can also minimize stress on the back when compared with frontward strokes. When doing the front crawl or other forward strokes, make sure to roll your body when taking a breath and avoid jerking the head backwards so that you can reduce strain on the neck. Using a snorkel can also help reduce the awkward movement of the neck by reducing the need to adjust the head when taking breaths. Wearing a mask or goggles can also reduce unintentionally jerky head movements while trying to get water out of the eyes. Boards, life vests, or other types of floatation devices can also help maintain proper form while swimming.

If you are actively involved with swimming and are experiencing neck or back pain, seek the advice of a coach or more experienced swimmer. If they spot you while swimming, they may be able to determine if something is wrong with your strokes and can advise you on proper technique.

Specific strokes can cause their own unique problems. The next page discusses some items to be aware of when doing certain strokes and several methods to help relieve back discomfort.

In many cases, swimming can be a very helpful exercise for back pain sufferers. Athletes commonly become injured, and swimming is a great way to keep active since it usually does not put excess strain on a swimmer’s back. However, that’s not to say that swimming can’t cause back pain or injuries as well.Specific swimming strokes can cause their own unique back injury problems. Here are some items to be aware of when doing certain strokes:

  • For the freestyle, make sure you do not rotate your head too much when taking breaths. In addition, do not let your head move up too much or deviate from the axis along the length of the body. Deviating from this axis, or over rotating the head, can easily lead to neck and back injury while swimming. Also, when you’re not going up for breathes make sure you keep your head looking downwards. As already mentioned, rolling too much can easily lead to damage.
  • With the backstroke, muscles along the front of the neck tend to become fatigued if you have not done that stoke in a long time. Make sure to ease into this stoke and avoid over doing it.
  • When doing any flipturns, tuck your head in and don’t have it extended outward from your body.
  • For the breaststroke, keep your head and neck still, while gently raising the head and back to take breathes.

When back pain becomes a problem there are several methods to help relieve discomfort:

  • Stretching, icing, and using over the counter medications such as ibuprofen are also very conservative ways to help reduce discomfort with mild cases of back pain.
  • However, with more serious pain, more serious forms of treatment may be required and seeking the help of a chiropractor or physical therapist may be more beneficial. With chiropractic manipulations, pain can often be relieved in many instances, but not necessarily for everyone.
  • Physical therapy is a common treatment for back pain ailments. Physical therapists design specific exercises and routines that are intended to both strengthen the tissue in the back while increasing flexibility, helping to minimize back pain.
  • Back braces are also a common way to treat back pain since they help to limit awkward movements and aid in the treatment of injured tissue.

If swimming continues to be painful it’s important to stop and seek the advice of a physician in order to stop back pain. By continuing to swim despite continual or worsening pain, the condition affecting the back may become worse and more serious forms of treatment may be required to reverse discomfort. Only in rare cases is surgery required to reverse ailments that affect the back. However, there are still instances where surgery may not be enough to completely reverse back pain conditions.

In many cases, swimming can actually help back pain. Swimming is an activity that is good for you, and it also does not usually strain or add significant weight to the back. This makes it a great alternative for those looking for an exercise that won’t aggravate their neck or back, as well as any other conditions that may be affecting their bodies. However, repetitive or awkward movements in the pool can lead to injury, so it’s important to learn the proper safety methods and techniques to avoid injury to the back.

Low Back Pain: What can you do?

Lower Back Pain: How Exercise Helps

You may feel like resting, but moving is good for your back. Exercises for lower back pain can strengthen back, stomach, and leg muscles. They help support your spine, relieving back pain. Always ask your doctor before doing any exercise for back pain. Depending on the cause and intensity of your pain, some exercises may not be recommended and can be harmful.

Avoid: Toe Touches

Exercise is good for low back pain — but not all exercises are beneficial. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor. Some exercises may aggravate pain. Standing toe touches, for example, put greater stress on the disks and ligaments in your spine. They can also overstretch lower back muscles and hamstrings.

Try: Partial Crunches

Some exercises can aggravate back pain and should be avoided when you have acute low back pain. Partial crunches can help strengthen your back and stomach muscles. Lie with knees bent and feet flat on the floor. Cross arms over your chest or put hands behind your neck. Tighten stomach muscles and raise your shoulders off the floor.  Breathe out as you raise your shoulders. Don’t lead with your elbows or use arms to pull your neck off the floor. Hold for a second, then slowly lower back down. Repeat 8 to 12 times. Proper form prevents excessive stress on your low back. Your feet, tailbone, and lower back should remain in contact with the mat at all times.

Avoid: Sit-ups

Although you might think sit-ups can strengthen your core or abdominal muscles, most people tend to use muscles in the hips when doing sit-ups. Sit-ups may also put a lot of pressure on the discs in your spine.

Try: Hamstring Stretches

Lie on your back and bend one knee. Loop a towel under the ball of your foot. Straighten your knee and slowly pull back on the towel. You should feel a gentle stretch down the back of your leg. Hold for at least 15 to 30 seconds. Do 2 to 4 times for each leg.

Avoid: Leg Lifts

Leg lifts are sometimes suggested as an exercise to “strengthen your core” or abdominal muscles. Exercising to restore strength to your lower back can be very helpful in relieving pain yet  lifting both legs together while lying on your back can make back pain worse. Instead, try lying on your back with one leg straight and the other  leg bent at the knee. Slowly lift the straight  leg up about 6 inches and hold briefly. Lower leg slowly. Repeat 10 times, then switch legs.

Try: Wall Sits

Stand 10 to 12 inches from the wall, then lean back until your back is flat against the wall. Slowly slide down until your knees are slightly bent, pressing your lower back into the wall. Hold for a count of 10, then carefully slide back up the wall. Repeat 8 to 12 times.

Try: Press-up Back Extensions

Lie on your stomach with your hands under your shoulders. Push with your hands so your shoulders begin to lift off the floor. If it’s comfortable for you, put your elbows on the floor directly under your shoulders and hold this position for several seconds.

Try: Bird Dog

Start on your hands and knees, and tighten your stomach muscles. Lift and extend one leg behind you. Keep hips level. Hold for 5 seconds, and then switch to the other leg. Repeat 8 to 12 times for each leg, and try to lengthen the time you hold each lift. Try lifting and extending your opposite arm for each repetition. This exercise is a great way to learn how to stabilize the low back during movement of the arms and legs. While doing this exercise don’t let the lower back muscles sag. Only raise the limbs to heights where the low back position can be maintained.

Try: Knee to Chest

Lie on your back with knees bent and feet flat on the floor. Bring one knee to your chest, keeping the other foot flat on the floor. Keep your lower back pressed to the floor, and hold for 15 to 30 seconds. Then lower your knee and repeat with the other leg. Do this 2 to 4 times for each leg.

Try: Pelvic Tilts

Lie on your back with knees bent, feet flat on floor. Tighten your stomach by pulling in and imagining your belly button moving toward your spine. You’ll feel your back pressing into the floor, and your hips and pelvis rocking back. Hold for 10 seconds while breathing in and out smoothly. Repeat 8 to 12 times.

Try: Bridging

Lie on your back with knees bent and just your heels on the floor. Push your heels into the floor, squeeze your buttocks, and lift your hips off the floor until shoulders, hips, and knees are in a straight line. Hold about 6 seconds, and then slowly lower hips to the floor and rest for 10 seconds. Repeat 8 to 12 times. Avoid arching your lower back as your hips move upward. Avoid overarching by tightening your abdominal muscles prior and throughout the lift.

Lifting Weights May Help

Done properly, lifting weights doesn’t usually hurt your back. In fact, it may help relieve chronic back pain. But when you have acute (sudden) back pain, putting extra stress on back muscles and ligaments could raise risk of further injury. Ask your doctor whether you should lift weights, and which exercises to avoid.

Try: Aerobic Exercise

Aerobic exercise strengthens your lungs, heart, and blood vessels and can help you lose weight. Walking, swimming, and biking may all help reduce back pain. Start with short sessions and build up over time. If your back is hurting, try swimming, where the water supports your body. Avoid any strokes that twist your body.

Try: Some Pilates Moves

Pilates combines stretching, strengthening, and core abdominal exercises. Under the instruction of an experienced teacher, it may help some people with back pain. Be sure to tell your teacher about your back pain, because you may need to skip some moves.

Best Stretches for Arthritis Morning Stiffness

For many people with arthritis, morning is the most difficult part of the day. Waking up with stiff joints or joint pain is a common complaint. Although it may seem like the hardest time of day to get moving, doing a few stretches in the morning can give you a more limber start to your day.

It only takes a few minutes to stretch and warm up your muscles and joints. But for the best results, the key is to do arthritis stretches every day. Taking a warm shower before or after stretching can also help you feel more flexible and limber.

Stretches for Arthritis in the Back, Hips, and Knees

These three basic stretches will help loosen your back, hip, and knee joints. You can do all three of these stretches right in bed. Or, if you prefer, you can do them on the floor. These stretches should be gentle enough for everyone — including people who have had knee or hip surgery. But if you have any questions, ask your doctor.

Hamstring stretch: Lie on your back with your left knee bent and your left foot flat on the bed. Bend your right leg and place your hands behind your right thigh. Lift your right leg into the air and straighten it as much as you can, using your hands to gently pull your leg toward your chest. Hold for about 30 seconds and then slowly release. You should feel the stretch in your lower back and the back of your leg. Repeat this stretch on the left leg and then repeat 2 to 3 times on both sides.

Single knee to chest stretch: Lie on your back and bend both knees. Your feet should be flat on the bed. Take hold of your right knee with both hands and gently pull the knee toward your chest. You should feel a stretch in the back of your leg and lower back. Hold for about 30 seconds and then slowly release. Repeat this same stretch with the left knee and then repeat 2 to 3 times on both sides.

Piriformis stretch: Lie on your back with both knees bent and your feet flat on the bed. Cross your right ankle on top of your left knee. Wrap your hands behind your left knee and gently pull your knee toward your chest. You should feel a stretch in the back of your right leg. Hold this stretch for about 30 seconds and then slowly release. Change sides and repeat this stretch with your left leg crossed on top of your right knee. Repeat 2 or 3 times on both sides.