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Cauda Equina Syndrome

Posted on 17th November 2017 by

As trained, healthcare professionals, an absolutely crucial part of the role we play in assessing and treating people who come to see us, is identifying when people need to be referred on for additional tests and care.

If we’re not happy with something you’re presenting with or want a second opinion, we make sure we point you in the right direction, armed with information to help you in the best possible way.

Thankfully, serious conditions are very rarely seen in the clinic, although they do sometimes occur. Our team are highly trained to spot any worrying signs or symptoms. One such condition, that we may pick up on when people come to us with back pain, is Cauda Equina Syndrome.

What is Cauda Equina Syndrome?

The spinal cord extends from the brain down through a canal inside the vertebral column. At each level of the spine nerves branch off from your spinal cord (nerve roots) and are responsible for sending signals to and from the muscles and other structures throughout your body. The spinal cord finishes just above your waist, below this is the group of nerves called the Cauda Equina. The nerves of the Cauda Equina supply the muscles that control the bladder, bowel and the legs. Cauda Equina Syndrome is the symptoms which occur when the nerves of the Cauda Equina are compressed.

What causes Cauda Equina Syndrome?

Numerous causes of Cauda Equina syndrome have been reported, the most common being, very large disc prolapse or spinal stenosis (a narrow spinal canal). Less common causes include tumour, infection, or trauma. Cauda Equina syndrome is rare but when it does occur it tends to be in adults of any age.

How is it diagnosed?

Initially the diagnosis of Cauda Equina Syndrome is made from the information that you tell the clinician who assesses you. The examination findings are useful in that they give an indication of how urgently the problem needs treatment.

Treatment

If Cauda Equina Syndrome is confirmed on the scan, urgent spinal surgery is indicated, to prevent permanent damage to the nerves which supply the bladder and bowel.

Symptoms

Cauda Equina Syndrome presents as one or a combination of the following symptoms. Most commonly these symptoms develop suddenly and may worsen rapidly, within hours or days. However, some people develop symptoms gradually.

  • Saddle Anaesthesia

    Saddle anaesthesia
    Saddle Anaesthesia
  • Loss of feeling between the legs
  • Numbness in or around the back passage and/or genitals
  • Inability to feel the toilet paper when wiping
  • Bladder disturbance
  • Inability to urinate (pass water)
  • Difficulty initiating urination (urinary hesitancy)
  • Loss of sensation when you pass urine
  • Inability to stop or control urination (incontinence)
  • Loss of the full bladder sensation
  • Bowel disturbance
  • Inability to stop a bowel movement (incontinence)
  • Constipation
  • Loss of sensation when passing a bowel motion.
  • Sexual problems
  • Inability to achieve an erection or ejaculate (Males)
  • Loss of sensation during intercourse

If you suddenly develop any of the above symptoms then it is strongly recommended that you contact your GP as an emergency or an accident and emergency department.


Self Care Week 2017

Posted on 12th November 2017 by

Self Care Week is an annual national awareness week that focuses on establishing support for self care across communities, families and Self Care Week 2017 generations.

More needs to be done to support people to better look after their own health. Empowering individuals to self care has many benefits for their short term and long term health and this is important since people are living longer.

Embracing Self Care for Life is about living well and being healthy. Being active, eating healthily and learning when to self treat common ailments are all ways to embrace self care.

Many long term conditions such as type 2 diabetes, heart disease, and COPD (chronic obstructive pulmonary disease) are avoidable. However, numbers are still increasing. It is important to embrace self care, making healthy life choices now in order to look after ourselves in the future.

There are some really simple changes you can make to help avoid getting a long term condition.

  • Move more! If going to the gym isn’t for you, try walking part of the way to work, taking the stairs or having a dance to your favourite songs! This is something at goPhysio we continually encourage and support – it’s the core of what we do!
  • Stop smoking! One of the best things you can do for your health is to stop smoking. Ask your local pharmacist about stop smoking services.
  • Sleep. A good night’s sleep is essential to good physical and mental health so don’t burn the candle at both ends, make sure you get at least 7 hours sleep a night!
  • Eat well. It is vitally important that we get the nutrients we need and avoid excessive amounts of salt, fat and sugar. Try swapping chocolate and crisps to nuts and fruit for healthy snack options. Ask your pharmacist for advice on managing your weight.
  • Relax. We have such busy lives that we sometimes forget to take time out to relax, but it is essential for our physical and mental wellbeing. Find time in the day to be still and quieten your mind. Consider mindfulness or yoga as these can be helpful.

During Self Care Week, and always, make time to think about the positive steps you can take to embrace Self Care for Life. Let’s make Self Care a life long habit.

When we see people at goPhysio, a huge part of our input is educating people about their injury and steps and changes they can make so that they are empowered to invest in themselves and have an active part to play in their recovery and future preventing of injury.

Read a recent blog we wrote on the principles of being well.

Be well goPhysio


Breaking the injury cycle: Calf Tear in a Runner

Posted on 3rd November 2017 by

We were recently asked some advice from a regular recreational runner. It’s a story that we hear a lot of here at goPhysio (not always calf related, but the same principles apply), so we thought it warranted a little blog post!

The runner in question was concerned, as they’d picked up a calf injury when out for a run a few weeks previously. Nothing major, but felt a bit of a tug on the calf when they had to move suddenly during the run. The calf was painful, so they did what they thought they should and rested for a week from running. The calf then felt fine, so they went back to running. Since then, the calf pain comes and goes. They don’t only feel it when they try and run but can feel it driving, going up & down stairs and first thing in the morning.

The dilemma is……….what is the best thing to do? Carry on running (because they love it and it they were progressing so well!)? Stop running (because it’s making the injury potentially worse)? Exercise? Ice? Heat? Strapping? New trainers? Taping? See their GP? Have a sports massage? Ask a friend? Use a foam roller????????? So many questions?

This is a really common story that we hear a lot in physio. A simple calf tear should take 3-6 weeks to repair itself, however its easy to get stuck in a cycle of tear, rest, repair, tear again, making the recovery much longer and much more frustrating.

How do we break this cycle?

Whilst rest is important it is not enough to adequately repair our damaged muscle to take the strain of running again, which is why it keeps being re-irritated. If we continue to do this we cause a lot of scar tissue to form in the healing muscle. Scar tissue is neither as strong nor as flexible as normal muscle fibres which make it easy to re-tear when stressed by anything more than day to day activities.

In the early stages of recovery from an injury, relative rest is important to help with healing. What that means is avoiding any activity which aggravates the injury, but trying to do alternative activities or modified activities so that you aren’t resting totally.

However, the important thing is to rehabilitate the calf muscle during the ‘rest’ period – gently stressing it with progressive strengthening exercises and stretches to regain its normal strength and elasticity. Ready to run again!

Physiotherapists are experts at guiding you through this process, making sure you are exercising at the optimal level for your stage of healing. They will make sure you are doing the right exercises (technique, loading, reps etc. all carefully worked out) and that you progress them at the right stage – all tailored to you individually and your own goals.

A programme for a minor calf tear for an ultra marathon runner would look very different to a programme for a severe tear in a Saturday morning Park Runner. There isn’t a one size fits all approach and although ‘Dr Google’ or Joe Bloggs at running club who also had a calf injury can be useful resources, relying on such information won’t always give the best long term outcome!

In addition to a specific exercise programme, Physio’s can also carry out a range of other treatments such as hands-on therapy, ultrasound and taping which can help to speed up your recovery. They an also advise on treatments you can do at home, such as foam rolling. A crucial part of your recovery is obviously returning to running at the right time. We know taking time out of running can be very frustrating, so we limit this as much as possible, guiding you with your return programme so you don’t do too much too soon and risk re-injury. If you have a specific event or race coming up, this is factored in.

So, if you love running and are worried about a calf injury, don’t hang about, book in to see an expert to guide you out of the injury cycle and back to running!

Here are two great simple exercises for a calf tear

Calf raise exercise Heel raises – standing on both feet, slowly rise up onto your tip toes then lower back to the ground. If you can manage 20 or more of these try doing it just on the injured leg, holding onto a support for a little balance, remember slow and controlled is key!


Calf stretch – stand in a long stride position with the injured Calf stretch exercise leg behind. Bend the front knee and gently press the back heel down towards the ground until you feel a stretch in your calf. Take it to where you feel a mild to moderate stretch (but not pain!) then hold for 30secs.


More information

Treatment of calf pain in runners

Top Pilates exercises for runners

Top tips for injured runners

Get your running back on track

How to warm up for running 

 


Speak Up and Speak Out About Stress

Posted on 1st November 2017 by

This Wednesday is National Stress Awareness Day, we take a look at what stress is really doing to our  National Stress Awareness Day bodies and how we can both recognise it and combat it.

What is stress?

Stress is anything which exerts pressure on us beyond our individual ability to cope. It has traditionally been thought of as a flight or fight response; increasing our alertness, muscle tone and heart rate to respond to a perceived threat. However modern-day stress can come in many forms such as workplace pressures, relationship issues, juggling family commitments or looking after a sick relative, which can all take their toll.

What happens when we are stressed?

When we are stressed our body releases chemicals such as cortisol and adrenaline. These hormones are imperative for our survival, however if their levels are sustained for a prolonged period they will start to impact on our physical health and affect many different organs in our body.

Symptoms of stress

Symptoms of stress can include:

  • Anxiety
  • Depression
  • Irritability
  • Indecisiveness
  • Headaches
  • Insomnia
  • Chronic muscle pain
  • Over or under eating
  • Increased blood pressure
  • Reflux
  • Increased risk of diabetes, heart conditions and stroke
  • Increased susceptibility to colds and viruses

Can exercise help with stress?

Yes! Exercise helps lower our blood pressure, reduce the levels of stress hormones in our body, improve our mood, our muscle flexibility and tone, as well as distracting us from other stressors and helping us to get a good night’s sleep.

Great forms of stress-busting exercise include classes such as Pilates, tai chi and yoga, which focus on breathing and flexibility of the body. They also give us the opportunity to ‘check in’ with ourselves and become more aware of how we are feeling physically and mentally. Whilst this gives us some much needed me-time, classes can also be a great social opportunity which is perfect for boosting our mood!

The ISMA (international stress management association) has come up with 7 positive ways to influence stress

1. Change the thought – Change the outcome

This is the starting point, reprogramming your brain by replacing an unhelpful negative thought or belief with a new positive one. Use your imagination to visualise or ‘show’ your brain what you want. The power of the mind cannot be over-estimated!

2. Self-belief starts with you

This is an empowering way of taking more control in your life rather than relying on others to make you feel good. Do something fun or caring for yourself today!

3. Don’t just do what you did last year

Repeating what you always do will bring you the same outcome unless others change & this is not in your control. So if you didn’t like all that happened last year make plans & set new goals, do something different!

4. Deal with difficult decisions now, not later

“Never put off until tomorrow what you can do today” We all know this but positive action is required to make it happen. Prioritize & do the difficult tasks first in the day so you have a clear focus for the rest of the day making you less stressed & more productive!

5. Find reasons to say “yes”

“I would love to but….” here comes the negative reason why you can’t! It can be a really positive experience to just say yes, if it is possible & what you want, then try to find ways that will allow you the opportunity, maybe you need others to persuade you, take control & decide for yourself!

6. Renegotiate

Stuck with what you have always had & now want a change? Look at learning to develop & use your assertive skills, ask for what you want, discuss your changing needs, expectations with yourself & others to reach the deal that works for you!

7. Flip it!

There are always two sides to every situation, sometimes more. Take time to look at all your options, don’t just assume, maybe ask others & make informed choices based on facts!

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