Hawkes Physiotherapy Blog

Amazing! I would never have thought that when I qualified as a Physiotherapist back in 2004 that I would write anything other than my patient notes, never mind write a blog! Yet here I am on my 100th blog post! I must say that I enjoy writing them and it is great doing all the research for every post. What I have found trawling through all the latest evidence is that things change, especially since I trained from 2001 to 2004. I would strongly advise any physiotherapist to take up writing a blog because many times over I have actually disproved some of the theories and ideas that I was taught when I was at University. It seems that a decade is a long time in Physiotherapy! It's not all for me though..... Although some articles are complex and probably more tailored to my fellow professionals I hope that some are useful and helpful to my patients and the general public. If anyone wants to give me any feedback or even tell me something that they want me to cover, then I would ...

Achilles problems are quite common, De Jonge (2011) found that the annual incidence of Achilles tendinopathy is 2.01 per 1000 people. In runners the incidence ranges from 9.1% to 10.9% (Lopes et al 2012). Achilles ruptures typically occur in males in their 30's and 40's who play sport intermittently (Khan & Carey Smith 2010). Now we already know that Achilles tendinopathy needs to be treated with exercise based therapy and the evidence highlights that this is the most effective approach. However we always need a plan B just in case Plan A doesn’t really work or is difficult to achieve for whatever reason. To see the usual care for Achilles tendinopathy click here: http://mathewhawkesphysiotherapy.blogspot.co.uk/2014/02/your-achilles-heel.html?view=flipcard So what acupuncture points are regularly used for Achilles tendinopathy? Local points: Increased collagen synthesis and reorganisation requires that at least one acupoint is anatomical...

Everyone gets a little stressed from time to time but do you know what impact this has on your body? You may have heard about Cortisol in relation to stress. Well Cortisol is actually a Glucocorticoid and stress triggers the release of Glucocorticoid and Catecholamine. These hormones have been found to delay wound and injury healing (Gouina and Kiecolt-Glasera 2011). These hormones have also been shown to reduce local Cytokine production, which is extremely important in the inflammatory process and therefore healing (Broadbent et al 2003). It has also been found that stress reduces important healing related compounds such as Matrix metalloproteinase, which is important for early healing. On the other side of the coin, Oxytocin and Vasopressin have been found to increase healing rate by surpressing Cortisol and there may be a direct impact to healing itself. These Hypothalamic peptides are linked to social bonding (Gouin et al 2010). So this could mean that having s...

Heard of Cubital Tunnel Syndrome? Probably not but you may have heard of Carpal Tunnel Syndrome. Well they are similar but Carpal Tunnel Syndrome is in the wrist and hand whereas Cubital Tunnel Syndrome is in the Elbow. What is Cubital Tunnel Syndrome? Basically it is a compression neuropathy, which means that a nerve is "trapped”. The nerve at fault in this case is the ulna nerve and where it gets “trapped” is in the cubital tunnel of the elbow: See the below picture: How common is it? It is the second most common compression neuropathy in the upper limb (Palmer & Hughes 2009). What causes it? A common cause is frequent bending of the elbow or constant repetitive pressure on the elbow itself. This then irritates the nerve and it is irritated too much then it becomes a “neuropathy”. What are the symptoms? The patient will complain of pain and numbness in the ring and little finger and weakness is common. If left untreated then this ...

Play Golf? No? Well you don’t have to, in fact I don’t think that I have ever seen a sufferer of Golfer’s elbow who actually played golf! Actually, to get Golfer’s elbow as a golfer there must be a flaw in your technique. Amazingly tennis players who generate a lot of top spin on their forehand are a greater risk! What is Golfer’s elbow? Golfer’s elbow is an injury to the common flexor-pronator origin on the Humerus bone, more precisely the Pronator Teres and the Flexor Carpi Radialis origins (Nirshal 1993). Golfer’s elbow is also known as pitchers elbow in the USA but the medical term has always been Medial Epicondylitis although as with all tendon pathologies this has been changed due to evidence on the inflammatory make up of tendon injury.  Immunohistological studies have shown that long-standing epicondylitis is associated with degeneration of the tissue instead of an inflammatory process (Ljung et al 1999). So other names that have been touted things like...

What is Olecranon Bursitis? Firstly you need to know what the Olecranon is and secondly what Bursitis is and then it will make sense: The Olecranon process is a bony prominence at the end of the Ulna bone, basically it is the point of your elbow.  Because of this, it is an area of potential friction on internal structures running over it. In the body where these potential friction areas exist there is usually a Bursa. A Bursa is basically a fluid filled sac designed to reduce the friction between the bone and other soft tissues. So Olecranon Bursitis is basically inflammation of this exact Bursa. What causes Olecranon Bursitis? There are two types of Olecranon Bursitis: Non-septic — this is the most common type and is basically inflammation resulting from various causes including trauma or overuse. Septic — this type is less common and is basically an infection in the bursa. How common is Olecranon Bursitis? It isn’t that common, I’ve seen it ...

The human body is amazing and there is a lot that we know about it but truthfully there is more that we don’t know and a lot of what we do is more down to anecdotal evidence rather than hard evidence. Here are 5 things that may surprise you: 1: It is more important to be nice than to be experienced as a healthcare professional! Yes this one is true, you would think that the more experienced the clinician and the more qualified that they are, means the more likely you are to get better, but the research indicates this simply isn’t true! Physicians who have been in practice for more years may possess less factual knowledge and are less likely to adhere to appropriate standards of care in turn causing poorer patient outcomes (Choudhry et al 2005). Kaptchuk et al (2008) actually found that patients did better if the practitioner was caring, warm, attentive and confident even when they offered placebo treatment. This is also supported by Hall et al (2010), they foun...

Today we are going to look into the evidence behind Pelvic alignment. We will attempt to examine the alignments themselves, how we measure them, how accurate the measurements are and more importantly attempt to answer the question, do they affect injury and pain? Below are the main two Pelvic alignment positions, which are influenced by many factors: Anterior Superior (AS) Ilium: When the PSIS (posterior superior Iliac spine) moves up and forwards It is believed that an anatomical short leg predicts anterior rotation (AS Ilium) of the ipsilateral Ilium (Cooperstein 2010). Posterior Inferior (PI) Ilium: When the PSIS (posterior superior Iliac spine) moves down and backwards It is believed that an anatomical long leg predicts posterior rotation (PI Ilium) of the ipsilateral Ilium (Cooperstein 2010). So what Pelvic alignments shall we examine that influence an AS or a PI ilium? ASIS and PSIS angle of tilt: The angle of the Pelvis usi...