Unlocking Relief: How Physiotherapy Can Alleviate Neuropathic Pain and Restore Your Quality of Life

Neuropathic pain is a type of pain that happens when there is dysfunction to the nerves themselves. Unlike the usual pain that occurs when tissues like muscles or joints are injured, neuropathic pain is caused by problems with the nervous system. Nerves send signals to the brain to tell us when something is wrong, but when the body undergoes some form of trauma, the nervous system begins to send excessive signals throughout the body which then leads to increased body sensitivity and discomfort. This type of pain often feels different from regular pain and can be described as sharp, burning, tingling, or even like an electric shock, and it might be constant or come in waves. People with neuropathic pain may also experience hypersensitivity to touch or a feeling of numbness in the affected area. Common causes include conditions like diabetes (which can cause diabetic neuropathy), herniated discs, shingles, osteoarthritis, and nerve compression from being in prolonged positions (such as being hunched over or sitting for too long).

As an example, when someone is feeling a burning or tingling sensation going down to their toes while bending over, it could suggest that they are experiencing neuropathic pain that is originating from their lumbar spine (lower back). More specifically, the nerves that provide muscular function and sensation to the feet and toes are located in the lumbar spine may become irritated and possibly compressed in some way or another. Of course, this is not normal and should be assessed by a physiotherapist to determine an appropriate treatment plan to help treat this neuropathic pain.

 

How Physiotherapists Can Help

 

When you see a physiotherapist for neuropathic pain, we begin by determining how the pain is affecting your daily life, your movement, and your posture. We’ll ask you about the type, intensity, and location of the pain, and the use specific assessment tools and tests to better understand how your nervous system is behaving. This then helps us determine which treatment strategies may work best for you. Here are some common treatment options that a physiotherapist may provide for neuropathic pain:

  1. Intramuscular Stimulation (IMS) and Dry Needling: This technique involves inserting a very fine needle to stimulate specific muscles (next to the spine or into the shoulder, hip and leg areas) or sometimes directly into a sensitive muscle area called a trigger point. This process has been shown to help relieve muscle tightness surrounding specific nerves and to improve blood flow in the area. IMS has also been found to be helpful as it can create a reset (or desensitization) to the nervous system, thus leading to reduced pain in our body.
  2. Manual Therapy: involves hands-on techniques such as soft tissue and joint mobilization, which can help relieve muscle tension, improve movement in the area, and reduce pain. This can also improve blood flow to the affected areas, which may help reduce inflammation and promote healing. In some cases, gentle spinal mobilizations or stretching techniques can also help relieve nerve compression that contribute to neuropathic pain.
  3. Exercise Therapy: when appropriate, guided movements can help reduce nervous system hypersensitivity. Once the nerve tissue irritability is under control, adding gentle and controlled movements can reduce muscle tightness, improve posture, and decrease nerve irritation. Some examples include:
  4. Nerve gliding exercises: specific movements that gently slides a nerve within the surrounding muscles, promoting better movement and less pain.
  5. Core exercises: help improve strength, flexibility, and postural stability which is optimal for nerve tissue function. This can also promote better circulation to the nerves which is essential for healing.

Written by: Chelsea Chua

Strength Matters: How Diabetes and Muscle Loss Are Linked

Diabetes, especially type 2 diabetes (T2DM), is a widespread health challenge that affects millions of people around the world. It’s not just about blood sugar levels; it can also lead to a concerning condition called sarcopenia, which is the gradual loss of muscle mass and strength as we age. Let’s explore the connection between diabetes and sarcopenia, why it matters, and what you can do to keep your muscles and health strong.

The Diabetes-Sarcopenia Connection

Sarcopenia isn’t just an unfortunate part of aging; it can also make managing diabetes more difficult. Here’s how it works: T2DM can speed up muscle loss, and weakened muscles can lead to poorer blood sugar control. This creates a vicious cycle where less muscle mass can lead to  less physical activity, which in turn can worsen diabetes management.

Research shows that older adults with T2DM experience muscle loss more rapidly than those without the condition.

Why Muscle Matters

Muscles play a crucial role in how our bodies use glucose, the sugar that fuels us. Healthy muscles help absorb glucose from the blood, which is especially important for people with diabetes. Unfortunately, when muscle function declines, so does the body’s ability to manage blood sugar, leading to higher levels of insulin resistance.

Key Factors Contributing to Sarcopenia

Several factors can contribute to the development of sarcopenia, particularly in people with diabetes:

  1. Aging: Muscle loss typically begins around age 30 and can increase significantly by age 80, especially in those with T2DM.
  2. Energy Intake: As we age, our calorie intake and requirements decrease leading to increased fat accumulation and further muscle loss.
  3. Physical Activity: A sedentary lifestyle greatly contributes to muscle decline. Regular exercise is essential, especially for those with diabetes, to help maintain muscle mass and improve insulin sensitivity.
  4. Diet: Nutritional factors, like vitamin D and protein intake, are vital for muscle health. Vitamin D is essential for proper metabolic function and muscle health, and inadequate protein can accelerate muscle loss.
  5. Hormonal Changes: Hormones such as estrogen and testosterone play important roles in maintaining muscle mass. Changes in these hormone levels can negatively impact muscle health.
  6. Smoking: Smoking can lead to decreased muscle strength and further metabolic issues, making it harder to manage diabetes.

Taking Action: Managing Sarcopenia and Diabetes

Fortunately, there are effective strategies to tackle sarcopenia alongside diabetes. Here are some key approaches:

  1. Dietary Management
  • Focus on a balanced diet rich in protein (aim for 1.0 to 1.5 grams per kilogram of body weight) to help maintain muscle mass.
  • Incorporate foods with anti-inflammatory properties, like those high in omega-3 fatty acids, to support overall health.
  1. Physical Exercise
  • Engage in Progressive Resistance Training (PRT), which is essential for building and maintaining muscle. Aim for at least 150 minutes of moderate aerobic activity each week, combined with 2-3 sessions of strength training.
  • Regular exercise can significantly improve muscle mass and enhance blood sugar control.
  1. Professional Support
  • Physiotherapists can create personalized exercise programs to improve mobility and strength. A physiotherapist will ensure the exercises prescribed are both effective and safe and address any mobility or injury concerns.
  • Kinesiologists focus on developing fitness plans that emphasize resistance training to counteract muscle loss. Kinesiologists are experts in guiding you through proper exercise technique and will help in injury prevention.
  • Dietitians help create meal plans that ensure you’re getting the right nutrients to support muscle and overall health.
  • General Practitioners monitor diabetes progression and manage any necessary medications.
  • Psychologists can assist with mental well-being and motivation to stick to health plans.
  1. Collaborative Care Approach

Working with a team of healthcare professionals ensures all aspects of your health are addressed, from physical fitness to nutritional needs. This holistic approach can empower you to take control of your health and improve your quality of life.

Conclusion

Managing diabetes and preventing sarcopenia is crucial for maintaining health as we age. By focusing on nutrition, regular exercise, and seeking support from healthcare professionals, you can enhance your muscle strength and overall well-being.

If you’re looking for guidance on managing your diabetes or muscle health, don’t hesitate to reach out to us at Treloar Physiotherapy Clinic. Our team is here to support you on your health journey!

Written by Jordan Yum

Fall into Balance: Transform Your Routines with Clinical Pilates!

September marks the shift from summer to fall. Coinciding with the seasonal change is a tendency to ‘fall’ back into the more regular routines of school, work, sport and exercise.

Come October these new routines tend to be settling into place.

Whether it is the return to the familiar or commencement of the new, it is not uncommon for some aches and pains to accompany these now regular activities.

All activities consist of ‘patterns’ of repetitive postures and movements. The significance on how these influence our complaints often go unnoticed until they impact us negatively. Even then it may not be obvious.

Many of our repetitive postural and movement patterns tend to overload certain areas of the body while at the same time underutilize other regions. This naturally leads to something called an imbalance of function which often plays a significant role in both our inactive and active lifestyle-related complaints.

Correcting these faulty patterns can reduce the risk of chronic overuse type injuries, as well as reduce the risk of acute ones.

This is where Clinical Pilates can be very beneficial. The emphasis on the quality of movement versus the amount of resistance or load is ideal to re-train or reinforce desired patterns.

Some benefits of addressing imbalances and improving our patterns include:

  • improvement of pain/ discomfort
  • injury prevention
  • enhanced performance

We are all humans doing modern human things on a daily basis, many of which include combined bodily movements requiring various direction, speed and control. As a result of ongoing repetition, our body continues to repeat these same movements, thus leading to patterns of imbalance with associated bodily correction (compensation).

But we are also all unique individuals with different presentations and needs. There is no ‘one size fits all’ approach to any type of physical training or rehabilitation, including Clinical Pilates.

An assessment with a Clinical Pilates Physiotherapist can help identify and guide your specific needs, which is especially important if you are managing any discomfort or injury. Some areas they can help you with include:

1. Postural/Movement Analysis

A Clinical Pilates therapist can analyze your lower body mechanics using the reformer to identify issues like overactive hip flexors or weak glutes contributing to knee pain. Targeted Pilates exercises on and off the reformer can strengthen these areas and improve alignment for better function.

2. Exercise/Training Strategies

For runners dealing with knee pain, a Clinical Pilates therapist can evaluate running mechanics on the reformer to identify contributing factors. Specific Pilates exercises can be integrated to strengthen supporting muscles and enhance running performance.

3. Ergonomics/Workstation Set-Up

If you’re experiencing neck and back discomfort from prolonged computer use, a Clinical Pilates therapist can assess your posture and recommend adjustments to your workstation. Utilizing the reformer, they can prescribe Pilates exercises that strengthen postural muscles and improve overall alignment, reducing strain.

In summary, creating positive changes to our day-to-day routines are beneficial. As our ability to move becomes more natural and free of any restrictions and any faulty compensatory patterns, the better we continue to live a pain-free life while engaging in all our daily activities.

Written by Jonathan Poon

Dance Pain-Free: Physiotherapy Tips to Conquer Snapping Hip Syndrome

What is Dance Physiotherapy?

Dance Physiotherapy combines manual therapy & clinical pilates techniques to help artistic athletes – dancers, gymnasts, skaters (and more!) reach their goals. Dance physio is ideal for artistic athletes of any level who are recovering from injury, preparing for pointe work, looking to prevent injury, improve mobility or overall performance.

Dance physiotherapy can help with a variety of conditions including:

  • Knee injuries – for example jumper’s knee & bursitis
  • Back injuries – including spondylolisthesis
  • Foot injuries – for example plantar fasciitis, bunions and achilles tendinopathy
  • Hip pain & injuries – including snapping hip syndrome
  • Chronic or acute ankle sprains
  • Overuse injuries
  • Joint Hypermobility

In this blog post we will be discussing snapping hip syndrome which unfortunately, is very common in dancers, particularly when extending the leg or coming into a grand battement.

What is the snapping or clicking sound? One of the most common sounds is a deep “clunk” when extending the leg. The most likely cause of this is spinal instability and/or over-recruitment and chronic thickening of your psoas muscle (your hip flexor) 

How do I get rid of the noise/ snapping sensation? By working on mobility, stability and then gradually loading the hip. Below are some great exercises to start with!

1. Aikido or “Frog” Mobilization

Come into Aikido or frog stretch position – knees wide on the mat, bottoms of the feet together, arms or forearms resting on the mat. 

Rest in this position for 10-15 seconds, allowing for a gentle stretch in the inner thighs and opening of the front of the hip. 

From here, bring your pelvis into a forward tilt (think about rotating the top of your hip bones towards the mat), and hold for a further 10-15 seconds. Engage your deep core in this position to get an even deeper stretch through the front of the hip! 

Alternate between these positions 4-5 times.

Note: There should not be any discomfort or pain in the hips during this mobilization. If you are feeling any pinching or discomfort decrease how far apart your knees are or consult your physiotherapist before continuing. 

One of the common contributors to snapping hip syndrome is when the outer, or lateral glute muscles have increased tension in them – this can occur when glute med grips to maintain turnout in standing – rather than the deep external rotators. 

 

  2. External Rotation in Table Top

Equipment needed: pillow or small ball 

Lie on the mat, back flat and deep core engaged. Slowly bring both legs up to tabletop position (knees bent at 90 degrees) with the small pillow or ball between your thighs. 

Maintaining inner thigh activation by squeezing the pillow or ball, slowly extend one knee in parallel. Then, from the deep hip socket, externally rotate your extended leg (coming into turn-out). Hold for 2-3 seconds and then come back to parallel and then back to your tabletop position. Continue to maintain the squeeze of the pillow/ball during this entire process. 

Repeat this up to 10 times on each side.

Tip: to ensure the core & deep external rotators are working, check that hip flexors are relaxed throughout this entire exercise.

 

3. Plié Variation targeting deep external rotators

Begin standing tall, in first position. Start with a demi plié and then, maintaining your turn-out (external rotation), slide one leg along the floor (in fondu – one side continues to be in plié, the other knee extends). The foot on the extended leg should come onto the ground. Then, while maintaining your weight over your standing leg (in plié), bend your extended leg while you slide it back to first position. 

During this movement you should be able to feel your inner thighs (extended leg) and deep external rotators (standing leg).

Tip: Place one hand over the outer glutes on your standing leg – these muscles shouldn’t be gripping or over-activating as the turnout should be coming from your deep external rotators.

Note: This exercise can be completed in centre or standing at the bar (or at a counter at home!)

 

Thanks for reading! Consult your physiotherapist if you experience pain or are interested in a personalized targeted program to address your specific goals!

 

Written by Talia Berson (Physiotherapist, Clinic Pilates Instructor).

 

Is Back Pain Holding You Back? Discover a Path to Recovery and Strength through Clinical Pilates