Cervical spondylosis, commonly called arthritis of the neck, is the medical term for these age-related, wear-and-tear changes that occur over time. Cervical spondylosis is extremely common. More than 85 percent of people over the age of 60 are affected.
Osteoarthritis (OA) is a common degenerative process affecting the neck. Degeneration can affect the discs and joints, resulting in reduced disc height, increased bone growth, and sometimes the formation of osteophytes.
In severe cases, the space in which the nerves and spinal cord pass can become encroached, resulting in nerve compression or stenosis.
Postural neck pain is pain which is caused due to poor posture. This pain can come on after prolonged periods of poorly adopted posture. This puts stress on the surrounding structures supporting your head. Postural neck pain can radiate down the back and also into the arm.
An umbrella term used for a group of conditions that cause compression on the nerves coming out of the neck and down the arm. Mainly due to the pinching of nerves between the area of the collarbone and first rib.
Frozen shoulder, also called adhesive capsulitis, is a painful condition in which the movement of the shoulder becomes limited. Frozen shoulder occurs when the strong connective tissue surrounding the shoulder joint (capsule) become thick, stiff, and inflamed.
Degenerative changes also affect the bursa and rotator cuff tendons
It is a stiff and painful condition which occurs in three stages:
Stage 1 – (Freezing) - pain and spasm which prevents movement.
Stage 2 – (Frozen) - pain with loss of shoulder movement
Stage 3 – (Thawing) - predominantly stiffness rather than pain. Poor scapular and shoulder movement pattern.
The condition is called "frozen" shoulder because the more pain that is felt, the less likely the shoulder will be used. Lack of use causes the shoulder capsule to thicken and becomes tight, making the shoulder even more difficult to move -- it is "frozen" in its position.
The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. There are 4 muscles which make up the rotator cuff group of the shoulder (supraspinatus, infraspinatus, teres minor, and subscapularis).
Overloading the complex can result in a strain or tear of one of the rotator cuff muscles. Tears may be partial or complete. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens with use of the arm away from the body.
Impingement is a byproduct of dysfunction or pathology of the shoulder.
The rotator cuff muscles help to stabilise the shoulder joint and also help with shoulder movement. The four tendons of the rotator muscles attach on to the head of the humerus. There is a space underneath the acromion of the scapula called the subacrominal space. The rotator cuff tendon passes through here. Narrowing of this space can cause compression and irritation of the tendons resulting in ’impingement’ pain.
The lateral forearm and elbow pain associated with extensor tendinopathy is more commonly referred to as ‘tennis elbow’.
Extensor Tendinopathy is a condition which affects the area 1-2 cm distal to the lateral epicondyle of the humerus.
The muscles affected are the extensor muscles of the forearm – chiefly the Extensor Carpi Radialis Brevis (ECRB) muscle. When these muscles are overused, chronic degenerative changes can take place. This involves a pathological process called ‘Tendinosis’.
Tendinosis – see page (Achilles, patellar, ECRB, RC)
Tennis elbow usually begins as an irritation and inflammation of the extensor tendons of the forearm where they attach to the humerus.
If these activities continue, then the inflammatory nature of Tennis elbow turns into a chronic tendon problem that is characterised by pain, weakness and degeneration of the tendon. Once this elbow problem is chronic, it can be very persistent and much more difficult to treat.
The medial forearm and elbow pain associated with flexor tendinopathy is more commonly referred to as ‘golfer’s elbow’.
The muscles affected are the flexor muscles of the forearm and the Pronator Teres muscle. When these muscles are overused, chronic degenerative changes can take place. This involves a pathological process called ‘Tendinosis’.
Tendinosis – see page (Achilles, patellar, forearm extensors and flexors, RC)
The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones. Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist via the carpal tunnel.
Repetitive strain injury (RSI) is the aches and pain in your body caused by repetitive movements or poor posture while doing certain activities (including work). It's also called occupational overuse injury and overuse syndrome. RSI mainly affects your wrists and hands.
A contusion with haematoma (bruising) is what is commonly referred to as a ‘dead leg, corked thigh,or charley horse’. Essentially there is trauma-induced internal bleeding of the thigh muscle. Damage can occur to the muscle, fascia and blood vessels.
A hamstring strain is a tear in one or more of the hamstring muscles. The hamstring group is made up of three muscles, the semimebranosus, semitendinosus and biceps femoris. Their main function is to bend your knee and extend your hip, and contribute to the position of your pelvis.
The most commonly strained hamstring muscle tends to be the biceps femoris.
Like most muscle strains, a tear is likely to occur at the musculotendinous junction.
Pain occurring on the outside of the hip and upper thigh or outer buttock may be strained muscles, ligaments, or tendons in the hip area. Shooting pains that radiate into your legs can be a sign of lower back strain or a hernia.
Hip impingement is medically referred to as Femoroacetabular Impingement (FAI). The femoral head is the top portion of the thigh bone. The acetabulum is the socket which the femoral head fits into. Impingement can occur when the femoral head is not quite round, or if the socket covers too much of the femoral heads; this results in pinching.
The Iliotibial band (ITB) is a fibrous band extending from the hip to the outside of the knee. Its purpose is to straighten the knee and move the hip sideways. It is also involved in stabilising the hip and knee, particularly in activities such as running.
The ITB arises from the pelvis and continues down to the bony part on the outside of the knee (the lateral epicondyle of the femur). It is here where it is prone to friction. At an angle of about 30 degrees the IT band flicks back behind the lateral epicondyle, when the knee is straightened it flicks in front of the epicondyle. It is approximately this angle when the foot strikes the ground during running. This can cause pain down the side of the leg and cause friction on the outside of the knee joint. In people who run regularly this may lead to irritation of the ITB – this is termed ITB Friction Syndrome, also known as ‘runners knee’
Osteoarthritis (OA) is a degenerative process affecting the joints. Initially there is mild ‘fraying’ of the cartilage surrounding joint, which if progresses, can develop into loose bodies which float around, the formation of osteophytes (bony growths), and ultimately, areas of cartilage erosion down to the bone.
Snapping or clicking hip syndrome can be divided into 2 types -internal and external.
External snapping hip is thought to involve the tendon of a tight muscle flicking over the greater trochanter which makes an audible clicking noise. Several groups of muscles cross the hip including the tensor fascia lata (TFL), gluteus maximus and the iliotibial band (ITB).
Internal ‘snapping hip’ is thought to involve the iliopsoas tendon flicking painfully over the iliopectineal eminence when the hip is flexed. Internal ‘snapping hip’ syndrome is found more commonly in dancers and is therefore also known as ‘dancers hip’.
Disc irritation, protrusion or herniation can cause low back pain. The disc is a structure which sits between the vertebrae of the spine. The discs act as shock absorbers, and allow the spine to move.
When you bend forwards the disc material gets compressed and pushed backwards. With twisting, a torsional stress is placed on the disc material. If these movements are repeated over time (especially with load) then this can lead to a bulge. The most common disc region to be affected is L5-S1, where the relatively immobile sacrum connects to the more mobile L5 level. Therefore a lot of load is transmitted at this one level.
Scheuermann’s is a condition which affects the thoracic spine. In particular the anterior sections of the thoracic vertebrae where loading occurs are affected, resulting in wedging of the vertebrae. This is caused by a problem with bones ossifying properly and growth plates being affected.
Diagnosis usually takes place in adolescence, with boys mostly affected.
Sciatica is the common term given to pain which is referred from the lumbar spine.
Depending on the level of spine which is affected, the pain can be present in the back, buttock, or down the leg. Pain often runs down the back of the leg, but may also affect the groin, front or side of the leg.
Compression of a lumbar nerve can result in this referral. Nerves can become compressed due to a disc bulge, aggravating chemicals which irritate the nerve or osteophytes which impinge on the nerve.
A torn ACL is a significant injury, especially for sports players. The Anterior Cruciate Ligament (ACL) is a band of fibrous tissue connecting the thigh bone (femur) to the shin bone (tibia). The primary functions are to limit twisting (rotational) forces through the leg, and to prevent forward movement of the tibia on the femur.
The knee has 14 bursae. A bursa is a small sac that prevents friction from occurring between tendon, muscle, bone and skin. If the bursa becomes irritated it fills with fluid and becomes inflamed resulting in ‘bursitis’. The pre-patellar bursa is the most commonly affected bursa of the knee. This is referred to as ‘housemaid’s knee’.
Thick layers of tissue, called fascia, separate groups of muscles in the arms or legs. Inside each layer of fascia is a confined space, called a compartment that includes muscle tissue, nerves & blood vessels.
Compartment syndrome occurs when increased pressure compresses the blood vessels and nerves, resulting in decreased blood flow. Reduced blood supply causes pain and can lead to tissue damage.
There are different types of compartment syndrome:
Acute (following trauma)
Chronic (Exertional) – deep posterior, anterior, or lateral
Chronic which then becomes Acute
Deep posterior compartment of lower leg Contains the following muscles (flexor digitorum longus, flexor hallucis longus, tibialis posterior). The tibial nerve is also contained within this compartment.
Note: the gastrocnemius and soleus (calf) muscles are superficially located and not typically affected.
Anterior compartment of the lower leg Contains the following muscles (tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus tertius). The deep peroneal nerve is also contained within this compartment.
Lateral compartment of the lower leg Contains the following muscles (peroneus longus, peroneus brevis). The superficial peroneal nerve is also contained within this compartment.
Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.
The ligament that runs on the outside of the knee is called the Lateral Collateral Ligament (LCL). It runs from the lateral epicondyle of the femur to the head of the fibula. It can be strained or ruptured (see grades of ligament strain).
The ligament that runs on the inside of the knee is called the Medial Collateral Ligament (MCL). It runs from the medial epicondyle of the femur to the anteromedial tibia. It can be strained or ruptured (see grades of ligament strain).
Osteochondritis Dissecans (OCD) is a condition which affects the knee. The articular cartilage within the joint softens resulting in loose fragments of bone. These fragments may remain in place (stable) or break off and float around causing pain and dysfunction.
Many different terms are used to describe Anterior Knee Pain or pain around the patella.
When the knee bends or straightens, the knee cap glides in a special groove on the thigh bone called the femoral trochlea controlled by the thigh (quadriceps) muscles. Pain occurs when the knee cap strays from this path (maltracking), causing patellofemoral pain.
One or both knees may be affected, and it is more common in girls, particularly adolescents.
The Achilles tendon is the largest tendon in your body. It stretches from the bones of your heel to your calf muscles. You can feel it -- a springy band of tissue at the back of your ankle and above your heel. It lets you point your toes toward the floor and raise up on your tiptoes.
Achilles tendinitis is characterised by inflammation and thickening of the Achilles tendon over a gradual period of time. On palpation and ultrasound assessment of the paratendon, swelling, crepitus and discomfort can be detected.
A tendinopathy is a condition whereby the tendon is degenerative, with loss of normal structure. Abnormal vascularisation also leads the Achilles to being overly sensitive.
There are two types of Achilles tendinopathy – midportion and insertional. The mid portion of the tendon sits 2-3 cm above the heel. The insertion part of the tendon is where the Achilles inserts into the heel.
When Achilles rupture occurs, there is sudden debilitating pain. Patient’s often report feeling as though someone had thrown a rock at their calf or having been shot, which can sometimes be heard at the time of injury. It is possible that one could walk post rupture, but would not be able to walk on their toes.
Flat foot (also called pes planus or fallen arches) is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. An estimated 20–30% of the general population have an arch that simply never develops in one or both feet.
Haglund’s syndrome is a raised posterolateral corner of the calcaneum. Because the posterolateral aspect of the calcaneum is raised, there is a greater likelihood that the surrounding structures (Achilles, bursa) can be irritated.
The “plantar fascia” is an aponeurosis (strong band of connective tissue) that runs from the calcaneus to the base of the toes. The function of the plantar fascia is to provide support for the arch of the foot, whilst acting as a shock-absorber during movement.
Plantar fasciitis is an overuse condition which is similar to a tendinopathy. Inflammation is not typically present.
The back part of the ankle can become pinched or impinged by the overlying tibia (shin bone). This typically occurs with the foot in a plantarflexed or toes pointing downward position.
Posterior impingement tends to appear in athletes who maximally plantarflex their feet such as ballet dancers, sprinters and football players.
In some instances the posterior part of the talus can sometimes form a bony prominence called an os trigonum. This bony growth takes up space in the back of the ankle which in turn affects movement and has the potential to cause pain with plantarflexion.