Hawkes Physiotherapy Blog

What is it? It is a group of inherited connective tissue disorders, which affects the formation of type I and III collagen. The syndrome is named after Edvard Ehlers from Denmark and Henri-Alexandre Danlos from France as they found that it affected the collagen. What is collagen? Collagen is an important in the skin, joints, muscles, ligaments, blood vessels and visceral organs. It gives these tissues their strength and the collagen in connective tissue helps tissues resist deformation. So what happens to these tissues in Ehlers-Danlos syndrome? Basically the abnormal collagen makes everything more elastic and weaker in structures that have collagen. Obviously this will depend on the type of EDS. Classifications: (These are the main types but there are more than just these) Classical types 1 & 2: Type 1 presents with severe skin involvement, and type 2 with mild to moderate skin involvement. It affects 1 in 20,000 to 50,000 people a...

Definition: Symptom complex characterized by pain, parasthesia, weakness and discomfort in the upper limb which is aggravated by elevation of the arms or exaggerated movements of the head and neck’ (Lindegren and Oksala 1995) ‘Upper extremity symptoms due to compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle’ (Saunders, Hammond, Rao 2007) Classification of compression: Incidence: Affects 8% of the population Females are more commonly affected than males (between 4:1 and 2:1) Predominantly occurs between the ages of 20 and 40 Rare in children and but when it does occur it presents most commonly as vascular Thoracic outlet syndrome Neurological is more common than vascular Thoracic outlet syndrome: (98% and 2% respectively) How does it occur: Trauma Brought on by a change in activity Repetitive activity or sustained postures Weight gain or increased muscle bulk Arteri...

The SIJ is not a ‘single entity’ It has an integral relationship to whole kinematic chain (affects the whole body). It is responsible for force/load transfer from the lower limb to the spine and from the spine to the lower limb. Functional activities can have an adverse effect on this joint (Vleeming et al 1989) Functional activities such as throwing, bowling, sitting, driving, prolonged vibration of the pelvis, stepping off a height, getting foot caught in stirrup on a horse all have been shown to produce adverse effects in this joint. Joint itself is derived from first three sacral vert. It is L shaped in nature. Has a short vertical and a longer horizontal arm. Movement occurs as glides along these surfaces. The Iliac surface is first to show degeneration by the 3 rd decade and the Sacral surface shows degeneration in the 4th and 5th decades. Sturesson et al (1989 & 1999) demonstrated that mobility is possible & it is essential for shock absorptio...

Knee pain is rarely caused by isolated events, more commonly they are the consequences of habitual imbalances in the movement system. The one off injury such as the torn anterior cruciate ligament can and does occur, but these are relatively simple as we know what the injury is and what caused it, which makes it easier to treat and prevent re-occurrences. However, physiotherapists are dealing with more complex pain syndromes such as patellofemoral  (knee cap joint) pain, shin splints, and back pain, amongst many others. The issue with these types of conditions is that the cause may be difficult to establish and may be many things. Even more complicated the pain may be coming from another area of the body and not from the site of pain! Equally it may be caused in part by the postures and activities that are performed every day, which could be work related. So the problem then becomes how to you recover and prevent when you are constantly causing the problem every day?...

What is the Brachial Plexus? Brachial Plexus:  C5 – T1 7 cervical vertebrae 8 cervical nerves: 1st 7:  exit above the corresponding vertebrae C8:  exits below the 7th cervical vertebrae What is Brachial Plexus Pathology? Brachial Plexus Neuropraxia, which is commonly called a “Burner” or “Stinger” Definition:  “Transient brachial plexopathy involving the upper trunk” “Temporary episode of unilateral upper extremity burning dysethesia with or without motor weakness” “Stinger” Tingling that occurs in upper extremity after injury. How much of a problem is Brachial Plexus Pathology: Epidemiology:  (specific studies) 50% of a Division 1 American football teams had 1 or more burners per season. 65% of Division 3 players (201) experienced more than 1 burner during their careers.  70% reported additional burners that they did NOT report. Increased occurrence with defensive players due to more tackling. What ...

What is Whiplash? “acceleration-deceleration mechanism of energy transfer to the neck” “from motor vehicle collisions, but can also occur during other mishaps” “result in bony or soft-tissue injuries (whiplash-injury), which may in turn lead to a variety of clinical manifestations called Whiplash-Associated Disorders (WAD)” (Spitzer, 1995) Whiplash is graded as follows: Grade 0: no neck complaints or signs Grade 1: Pain, stiffness or tenderness, no physical signs Grade 2: Pain, stiffness or tenderness, musculoskeletal signs Grade 3: neurological signs with or without musculoskeletal signs Grade 4: fracture or dislocation Late whiplash: symptoms for more than 6 months What are the common symptoms of Whiplash? This depends on what structures are injured. Here is a list of the common injuries caused by whiplash: Facet joints: Haemarthroses, capsular tears/rupture, articular cartilage damage, joint fractures. Often involved in persistent ...

What is Cervical Facet Joint syndrome? Ghormley (1933) first coined the term facet syndrome to describe symptoms associated with degenerative changes of the lumbar spine. Relatively recently, the term cervical facet syndrome has appeared implying spinal pain presumably secondary to involvement of the posterior articular pilars of the cervical spine. A severe acute episode of Facet joint pain may be due to sudden trauma or more often, Facet pain/Facet Syndrome is chronic in nature – with underlying long term changes in the Facet joint that are often associated with degenerative disc disease. It is not synonymous with Cervical Spondylosis. It can occur with other structural sources of pain simultaneously. How much of a problem is Facet joint syndrome? Facet joints have been implicated as a cause of chronic spinal pain in 54-67% of patients with chronic neck pain. These figures were based on responses to controlled diagnostic facet joint blocks performed in ac...