There are a variety of different types of Wry Neck, varying in severity, origin and prognosis, however all these types of Wry Neck are characterized by unilateral (one sided) neck symptoms and pain in the neck region (although pain may also be felt in other areas).
Wry Neck Types
The two main types of Wry Neck we see at Function & Form are Acute and Discogenic Wry Neck. Although we have treated many patients over the years with Spasmodic Torticollis, it is not very common.
Acute Wry Neck
The predominant group that presents with acute wry neck pain are female aged 12-25 years of age. Symptoms present following no specific incident or following a trivial event like sleeping or lying on the couch watching television.
The cause the dysfunction is unknown but hypothesized to be entrapment of a structure at the cervical facet joint whether that be fat pad, meniscus or joint capsule.
For most patients presenting with this type of injury there may be no pain at rest, and can adopt a neck position that does not provoke pain. The resting head position adopted may be slightly rotated (turned) or laterally flexed (bent to the side), to avoid pain. Sudden and sharp pain is felt on active movement of the neck, particularly rotating or laterally flexing to the side opposite the side of pain.
On the positive side, Acute Wry Neck pain, responds well and quickly to treatment, but unfortunately repeat episodes are common.
At Function & Form we often treat this injury with, passive intervertebral mobilizations with rotation or lateral flexion towards the pain free (opposite direction). Massage to the adjacent muscles also assists in achieving pain relief and the ability to return to a more aligned head position. Taping to relieve muscle spasm and assist postural education and provide support. We also send the patient home with exercises specific to their injury and capabilities so that improvements may continue between treatment sessions. Our particular strength is in providing advice and support in modifying daily activities and sport/ exercise so that other elements of health and fitness may be maintain whilst recovering from the specific injury.
Discogenic Wry Neck
Discogenic Wry Neck is most common in those 30- 60 years of age. Whilst symptoms are still unilateral (one sided), they may be felt at the neck and or descending the arm, shoulder and scapular region. Symptoms indicate irritation of the cervical nerve root.
Those patients presenting with this type of Wry Neck often experience stiffness or a limitation in neck movement prior to the onset of pain. For these patients resting pain is often a feature but unlike Acute Wry Neck patients they are usually able to adopt a normal resting head posture.
Without physiotherapy treatment these injuries risk progressing to nerve root irritation or compression. Unfortunately these injuries respond slower to treatment than the Acute Wry Neck and may require regular treatment.
At Function & Form we find that patients who present with this type of injury have had a long history of neck stiffness and many ignored "niggles" in the neck region. These patients have often have participated in sports that have placed their neck under strain through impact, falls and crashes,ie. heading balls in soccer, Others have adopted sub optimal neck postures during their working life with little or no postural strengthening, re-education or re-setting. The last group are the stomach sleeper who sleep in end range neck rotation, compromising nerve roots for long stretches of time.
The mid to low cervical spine is often implicated and specific treatment to this area will incorporate rotation, lateral flexion movements or passive physiological intervertebral mobilisation.
Long term management is our goal with these patients, addressing the causative factors and formulating an exercise plan to improve strength, positioning and postural endurance.
If you are experiencing neck pain book an appointment with our experienced physiotherapist.
A-C Joint Injuries
AC Joint injuries are injuries to the Acromioclavicular Joint or where the part of the Scapular (shoulder blade) called the Acromium meets the Clavicle (collar bone).
AC Joint Injuries Mechanism
Physiotherapists typically talk about the mechanism of injury to assist determine the degree and direction of the forces involved. AC Joint Injuries tend to result from one of two ways:
A fall on the Tip Of The Shoulder
A fall on to the elbow (thus creating an axial load through the humerus)
When AC Joint injuries are more severe they will present with varying degrees of a step deformity. Do note the uninjured side and some people have naturally prominent AC Joints.
In a study used to characterize the patterns of pain caused by selective irritation of the acromioclavicular joint and of the subacromial space.
Hypertonic saline solution was injected 15 times into the acromioclavicular joints of 10 healthy volunteers.
Irritation of the acromioclavicular joint produced pain directly over the joint, in the antero-lateral neck, in the trapezius-supraspinatus region, and in the anterolateral deltoid.
The pattern of pain produced by irritation of the acromioclavicular joint and subacromial space.
Grading of AC Joint Injury
AC joint injuries - separated shoulder - are graded in three levels:
A Grade One Injury involves stretching of the Acromio-Clavicular Ligaments (at the tip of the shoulder).
Grade Two involves a tear of the Acromio-Clavicular Ligaments and stretching of the Coraco-Clavicular Ligaments.
A Grade Three is described as a tearing of both ligaments.
Tests to Indicate AC Joint Injury
How to indicate AC joint injury, here are some tests:
AC Shear Test
Cross Body Adduction Test
Piano Key Test
Resisted Horizontal Extension Test
The management of AC lesions is based on minimal intervention, either surgical or non-surgical, aiming to restore both vertical and horizontal stability.
Femoral Acetabular Impingement
One of the common causes of hip pain is Femoral Acetabular Impingement (FAI). To be diagnosed as having FIA you must have the following findings:
1. Hip or groin pain originating from the hip,
2. Positive findings on scans ie. CT Scans, X-Ray or MRI
3. Positive Tests results for test that evaluate hip strength, range of movement, impingement and functional tests ie. squatting.
The causes of FIA are a mismatch of the pelvis and top of the thigh bone or more specifically the head of the femur (the round dome part) and the acetabulum (the cup part). There is either extra bone growth around the top of the femur or around the acetabulum or at both regions. In xray terms, this is evaluated as either a CAM or PINCER morphology.
The extra bone formation is not uncommon and may be formed in athletic populations as a normal response to loading. The individual with these bony changes may never experience hip pain if they don't engage in activity that takes them into end of range hip movements, ie. deep squats.
So there is no need to rush out and get your hips scanned if you don't have any other signs or symptoms. Although worth noting, CAM morphology is associated with an increased prevalence of Hip Osteoarthritis and need for hip replacement.
If you are thinking that you might have FAI, what are your options?
Obviously surgery may seem like a good solution: remove the extra bit of bone and everything is good? There are not many quality studies assessing surgical effectiveness. For those under 40 years of age, with CAM morphology and not a lot else, surgical outcomes are more favourable. But the hip is not likely to feel or function like brand new again.
A minimum of 3 months of conservative management should be the aim for all patients before considering surgical options. The primary goals are to maintain or work towards a healthy body weight, develop good muscle strength around the hip and trunk area, and participate in regular cardiovascular exercise to enhance fitness and joint load tolerance.
Manual physiotherapy techniques that may be included in the process are traction, deep tissue releases, and joint mobilisations.
Flare ups are a normal course of progression for FAI rehabilitation and working towards exercise progression, functional movement patterns should be the aim of treatment.
Consider specifically strengthening the adductors primarily, the abductors, hip extensors and hip external rotators. Endurance of the trunk muscles ie. the extensors, flexors and lateral flexors, are also important as fatigue in this area may unnecessarily load the hip.
The rehabilitation process may use therabands, powerbands, weighted cuffs, resistance machines, hydrotherapy, cycling and progressive walking program as well as an inclusion of functional movement patterns.
This 3 month process is perfect preparation for surgery if that becomes the final outcome. Improved fitness, muscle strength, mobility and healthy body weight will ensure optimal surgical results.
Runner’s Calf Strain
Sacroiliac Joint Dysfunction
Sacroiliac Joint Dysfunction
The Sacroiliac Joint is an Axial Joint between the bones of the Sacrum (which is a continuation of the spine) and the Ilium (part of the pelvic bones).
Only a small degree of movement, about 2-4 mm in each direction is available in the SIJ, enabling load transfer between the upper body and lower limb.
Dysfunction often occurs in the SIJ for four main reasons:
Inflammation- Inflammatory conditions from autoimmune disorders
Hormonal - During pregnancy the ligaments become lax and create excessive movement and alter the biomechanics of the joint.
Biomechanics- Altered forces around the SIJ due to muscle imbalances, leg length discrepancies, poor ergonomics, foot wear or repetitive and prolonged forces. Injury typically occurs in response to combined vertical forces with rapid compression.
Trauma- A fall onto the buttock.
Sacro-illiac Joint Pain
SIJ pain is noted on palpation of the joint. Pain may be noted as sharp or as an ache. Activities that aggravate SIJ pain are rolling over in bed, lying on the effected side, putting on shoes, bending forward, moving into standing afer prolonged periods of lying or sitting.
Treatment includes rest from the aggravating activities and activity modification, ice, and compression using an SIJ best can be very beneficial particularly for pregnant women. Taping, correct foot wear, addressing possible leg length discrepancies, and strengthening weak areas and stretching tight muscles.
Techniques that may be usefull are: Dry Needling, Muscle Energy Techniques, Pilates, core training and ergonomics.
During an acute episode recovery can take up to 2-3 weeks. Long standing chronic pain may take 3-6 months to address the underlying strength deficits and develop core control sufficient enough to positively effect pain during the aggravating activity particurly if the activity requires significant load transfer.
Failure of conservative management may necessitate the use of Cortisone Injections and in desperate cases- joint fusion
Wrist Pain (De Quervain's Synovitis)
A common cause of wrist pain at the base of the thumb is known as De Quervain's Tenosynovitis. This injury mainly effects the thumb and the wrist and manifest itself as pain on gripping and pinching, and movements of the thumb particularly extending the thumb. Swelling and redness over the effected tendons may be visible.
It is thought that the injury results from either repetitive movements or a direct impact to the outside of the wrist, but it may in some circumstances be idiopathic (no known cause).
The tendons of Abductor Pollics Longus (APL) and Extensor Pollicis Brevis (EPB) are effected. These tendons run parallel to each other and pass under the Extensor Retinaculum ( which is designed to hold the tendons in place at the wrist joint and prevent bow-stringing.
As the tendons become inflammed and thickened through either repetitive movements or a direct blow they become impinged as they pass under the rigid retinaculum.
Pain on movements of the thumb: pinching, wringing, making a fist, moving the thumb towards the base of the little finger, drawing the thumb away from the hand (stretching outwards) and during activities like opening a jar.
The main test used for diagnosis is Finkelstein's Test. The test in performed by holding arm out straight with thumb side up, tuck the thumb into the centre of the fingers and make a fist. Slowly bend wrist towards the floor (Ulnar deviation). A positive test is indicated when pain is felt over the tendons of the APL and EPB.
RICE (An acronym for Rest, Ice, Compression and Elevation). Therefore using ice packs up to 3 times per day for a period of 10 minutes.
Anti Inflammatory medication may be a usefull method of decreasing inflammation, check with your Doctor which one is most suitable. Activity Modification involves reducing the amount of aggravating activity, performing the activity in a different way or taking frequent rest breaks. The use of a Night Splint to the thumb and wrist to rest the tendons is essential.
Soft tissue releases to the involved muscles are usefull physiotherapy techniques A stretching program for the muscles of the thumb and wrist, and finally
A graduated Strengthening Program for the involved muscles.
If the injury is responding well to the conservative treatment regimen, a positive change in pain and function should be noted after 4-6 weeks, permanent task modification may be required with continued use of the splint. Surgery may be indicated if pain continues to be debilitating
Spirit Fingers- Place rubber bands around fingers and open hand (3 Sets, 12 Reps)
Wrist Stretch -Flexion -Bend Wrist downwards assist with other hand. (Hold 10 Seconds, 3 Repeats)
Wrist Stretch - Extension -Bend Wrist downwards assist with other hand. (Hold 10 Seconds, 3 Repeats)
Number Four Sign-Hold thumb towards base of 5th finger. (Hold for 5 seconds, Repeat 5 times)
Wrist Extension Strength- using light weight 1/2 -2 kg , curl wrist upwards beginning in a palm downwards position. (3 Sets, 12 Reps)
Radial Deviation Lowering -using light weight 1/2 kg , in hand shake position, curl thumb side of wrist upwards beginning in a downwards position. (3 Sets, 12 Reps)
Grip- using a tennis ball, or soft ball or theraputty (Hold for 10 seconds, Repeat 5 times)