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Tennis elbow, medically known as lateral epicondylitis, is a common condition causing pain and tenderness on the outer elbow. It’s often associated with repetitive motions that strain the forearm muscles that attach to the elbow bone. While the name suggests a connection to tennis players, anyone involved in activities that require gripping or forceful wrist extension can develop tennis elbow.

The good news? You don’t have to live with the discomfort. Here at Vitruvian Italian Physiotherapy Center, a leading physiotherapy center in Dubai, we understand the frustration tennis elbow can cause.

The repetitive motions that strain the forearm extensor muscles can lead to tiny tears in the tendons that attach these muscles to the elbow bone. This micro-tearing causes inflammation and pain, the hallmark symptoms of tennis elbow.

Here are some common activities that can trigger tennis elbow:

• Repetitive gripping motions (e.g., using screwdrivers, painting)
• Weightlifting (especially exercises that involve wrist extension)
• Certain racquet sports (tennis, badminton)
• Typing for extended periods

While there’s no magic bullet for a speedy recovery, several effective tennis elbow treatment options can significantly reduce pain and improve function. At Vitruvian Italian Physiotherapy Center, our experienced team will design a personalized treatment plan based on your specific needs and severity of your condition. Here are some common approaches we incorporate:

• Rest: Avoiding the activities that aggravate your symptoms is crucial for allowing the inflammation to subside. Our physiotherapists can advise you on activity modification techniques to facilitate healing.
• Ice Therapy: Applying ice packs to the affected area for 15-20 minutes at a time, several times a day, can help reduce pain and inflammation.
• Compression: Wearing a compression elbow brace can help support the injured tissues and minimize pain during activity.
• Pain Medication: Over-the-counter pain relievers like ibuprofen or acetaminophen might be recommended to manage discomfort.

Tennis Elbow Therapies: Advanced Options at Vitruvian Italian Physiotherapy Center

In some cases, depending on the severity of your condition and how long you’ve been experiencing symptoms, our physiotherapists might recommend additional tennis elbow therapies:

• Ultrasound Therapy: Ultrasound waves can promote healing and reduce inflammation in the affected tissues.
• Laser Therapy: Low-level laser therapy can stimulate tissue healing and pain relief.

Preventing a Comeback: Tips to Keep Tennis Elbow at Bay

Once you’ve recovered from tennis elbow, it’s important to take steps to prevent it from returning. Here are some tips from our team at Vitruvian Italian Physiotherapy Center:

• Maintain proper form: Ensure proper technique during activities that involve gripping or forceful wrist extension. A physiotherapist can guide you on proper form and recommend modifications if needed.
• Warm-up and cool-down: Always warm up your forearms and wrists before engaging in activities that might strain them. Similarly, cool down with gentle stretches after strenuous activities.
• Strengthen your forearms: Regularly incorporating forearm strengthening exercises into your routine can help prevent future injuries.
• Listen to your body: Pay attention to any pain you experience during activities. Take breaks and modify your intensity if necessary to avoid aggravating the condition.

Here’s what you can expect during your initial consultation at Vitruvian Italian Physiotherapy Center:

• Detailed assessment: Our physiotherapist will conduct a thorough evaluation, including a physical examination and discussion of your symptoms, medical history, and activities that might have contributed to your tennis elbow.
• Diagnosis and treatment plan: Based on the assessment, the physiotherapist will diagnose your tennis elbow and create a personalized treatment plan tailored to your specific needs and severity of your condition.
• Open communication: We believe in clear communication throughout your treatment journey. Our physiotherapists will explain the treatment plan in detail, answer any questions you might have, and involve you in the decision-making process.
• Education and self-care: We empower you with knowledge and self-care strategies to manage your condition effectively. You’ll receive guidance on activity modification, proper form during exercises, and techniques to prevent future flare-ups.

Don’t let tennis elbow hold you back from enjoying your activities. Contact Vitruvian Italian Physiotherapy Center in Dubai today to schedule an appointment and take the first step towards a pain-free and active life.

We look forward to helping you overcome tennis elbow and achieve optimal health and well-being.

To learn more about Tennis Elbow Treatment, please visit our dedicated page here: Tennis Elbow Treatment

At Vitruvian Physiotherapy Center, we recognize the impact that lower back pain can have on your quality of life. In this blog post, we will delve into the common causes of lower back pain and why Vitruvian Physiotherapy Center is your go-to destination for effective Lower Back Pain treatment in Dubai.

1. Understanding Lower Back Pain:

Lower back pain is a prevalent issue affecting people of all ages, stemming from various factors such as muscle strain, poor posture, injury, or underlying medical conditions. Understanding the root cause of your lower back pain is essential for developing an effective treatment plan.

2. Why Choose Vitruvian Physiotherapy Center for Lower Back Pain Treatment in Dubai:

Vitruvian Physiotherapy Center stands as a beacon of relief for those seeking Lower Back Pain treatment in Dubai. Our team of highly skilled physiotherapists is committed to delivering personalized care that targets the source of your pain, promoting long-term recovery and a return to an active, pain-free lifestyle.

3. Comprehensive Assessment for Tailored Treatment:

The journey to relief begins with a comprehensive assessment at Vitruvian Physiotherapy Center. Our experienced physiotherapists conduct a thorough evaluation to identify the specific factors contributing to your lower back pain. This in-depth understanding allows us to design a personalized treatment plan tailored to your unique needs.

4. Targeted Physiotherapy Interventions:

Vitruvian Physiotherapy Center employs evidence-based physiotherapy interventions to address lower back pain effectively. From targeted exercises to manual therapy techniques, our programs are designed to alleviate pain, improve mobility, and enhance the strength and flexibility of the lower back muscles.

5. Patient Education for Long-Term Wellness:

Beyond immediate relief, Vitruvian Physiotherapy Center places a strong emphasis on patient education. Our physiotherapists provide guidance on proper ergonomics, posture correction, and home exercises to empower you with the knowledge and tools needed for long-term lower back wellness.

To learn more about Lower Back Pain, please visit our dedicated page here: Lower Back Pain Treatment

At Vitruvian Physiotherapy Center, we understand the impact that tennis elbow can have on your daily activities. In this blog post, we will explore effective Tennis Elbow Treatment options available in Dubai, and why Vitruvian Physiotherapy Center stands out as a premier destination for rehabilitation.

1. Understanding Tennis Elbow:

Tennis elbow, or lateral epicondylitis, is a common condition characterized by pain and inflammation on the outer part of the elbow. Contrary to its name, this condition is not exclusive to tennis players and can affect anyone engaging in repetitive arm and wrist movements. Understanding the underlying causes is crucial for an effective treatment approach.

2. Why Choose Vitruvian Physiotherapy Center for Tennis Elbow Treatment in Dubai:

Vitruvian Physiotherapy Center is a leading provider of rehabilitation services, specializing in Tennis Elbow Treatment in Dubai. Our team of experienced physiotherapists is dedicated to delivering personalized care that addresses the root cause of your tennis elbow, promoting a speedy and sustainable recovery.

3. Comprehensive Assessment and Diagnosis:

The first step towards effective Tennis Elbow Treatment at Vitruvian Physiotherapy Center begins with a thorough assessment. Our experienced physiotherapists evaluate the extent of your condition, identifying contributing factors such as muscle imbalances, overuse, or improper technique. This comprehensive approach ensures a tailored treatment plan that addresses your specific needs.

4. Individualized Physiotherapy Programs:

At Vitruvian, we believe in the power of individualized care. Our physiotherapy programs for Tennis Elbow Treatment are designed to target the specific impairments identified during the assessment. From targeted exercises to manual therapy techniques, our programs are crafted to alleviate pain, restore function, and prevent recurrence.

5. Education and Prevention Strategies:

Beyond providing treatment, Vitruvian Physiotherapy Center is committed to empowering our patients with knowledge. Our physiotherapists educate you on proper ergonomics, stretching exercises, and preventive strategies to minimize the risk of tennis elbow recurrence. This proactive approach is key to ensuring long-term joint health.

To learn more about Tennis Elbow Treatment, please visit our dedicated page here:

To learn more about Tennis Elbow Treatment, please visit our dedicated page here: Tennis Elbow Treatment in Dubai

What is Femoroacetabular Impingement? In recent times the hip joint has been recognised as a significant cause of hip and groin pain in the athletic population. It accounts for approximately 12% of soccer related injuries and is the third most common injury in the Australian Football League.

Groin pain is frequently reported in those with hip pathology attending for arthroscopy, evidenced by 92% of patients with labral tears. The most common site of pain referral in people with labral tears has been reported as the central groin region. Hip pain often coexists with other groin-related pathologies, including pubic and adductor symptoms, which can make tears, most likely due to impingement of the labrum between the bony components of the hip.

Which are the causes of Femoroacetabular impingement syndrome?

Femoroacetabular impingement syndrome (FAIS) is caused by premature contact of the femur and acetabulum during hip motion. The 3 classifications of FAIS are cam, pincer and Mixed impingement. Aspherical deformation of the femoral head occurs with cam deformity, whereas pincer deformity presents with excessive prominence of the outer rim of the acetabulum Mixed is the combination of the 2 types of deformity.

Repetitive abutment of hip structures may damage the labrum and contribute to the early onset of osteoarthritis.

The Physiotherapist assist patients with FAIS using nonoperative or postoperative exercise strategies. Both approaches demonstrate key exercise pillars: postural control (also known as postural positioning), core stabilization (also known as core strength), hip strength (also known as hip strength and motor control), and mobility (also known as functional range of motion [ROM])

Patients with symptoms that lasted 12 to 24 months or longer had worse surgical outcomes. This suggests that surgical intervention may be needed if symptoms have not resolved with nonoperative treatment within 3 to 6 months

Return to sport

Patients who pursue nonoperative approaches often have the same goals as patients who choose surgery: to return to the preinjury or sport performance level after an intervention.

In 6 weeks, the central goals should be to reduce pain in the affected hip to 0 to 2/10 (on a numeric pain scale), improve the range of motion and gradually reload the joint. In 12 weeks nonoperative Patients should be able to walk on varied terrain; jog for at least 30 minutes; and complete sport-specific tasks that involve cutting, jumping, and pivoting. Patients whom undergo for surgery may expect this goal at 13-16 weeks.

The timeline for return to play depends on the procedure performed and varies from patient to patient
Returning to sport is different from returning to the preinjury level of activity, which increases the difficulty of determining timelines for returning to sport. 

Appropriate rehabilitation exercise progressions specific to the patient’s goals and response to therapeutic interventions are needed.

In conclusion

The evidence supporting the best conservative management for FAI is limited. 
Given the rapid increase in interest in this condition, knowledge of appropriate rehabilitation programs will most likely grow in the coming years. 
Conservative management of symptomatic FAI focuses on decreasing adverse hip loads through the implementation of hip muscle strength programs and modification of external joint loads. This may result in a lessening of symptoms associated with this condition.

To learn more about Injury Prevention, please visit our dedicated page here: Injury Prevention Program

The ACL Rehabilitation Protocol has the aim to reduce swelling and inflammation, regaining Range of Motion (ROM) strength and neuromuscular control and gait training.

The later stage of rehabilitation includes full strength and power restoration, sport specific exercises and reconditioning.

The patient must be taught how to manage the pain following each workouts/session.

Ice may be need to be applied if pain, inflammation or swelling appears.

Immediately after surgery, weight bearing status is largely determined by concomitant injuries (e.g. meniscal repair). Isolated ACL reconstructions are typically treated weight bearing as tolerated, using brace and/or crutches until adequate quadriceps muscle strength is restored. We can expect to remove both crutches and move to full weight bearing in the first 2 weeks.

The results of ACL reconstruction are good, but current techniques do pose their own challenges and potential issues. These include decreased hamstrings strength, anterior knee pain and loss of proprioception. There is also significant evidence to suggest that ACL reconstruction does not prevent future osteoarthritis.

Return to run (RTR):

RTR decision-making should be individualized for each patient. No universal timeline to RTR exists.

For many patients, it might be reasonable to expect readiness to RTR around the 8th–16th postoperative weeks, provided there is adequate loading: pain <2 at visual analogue scale (VAS) , 95% knee flexion ROM, full knee extension ROM and no effusion.

The clinician may choose to use a battery of tests for individualized clinical decision-making regarding RTR including; strength tests, qualitative performance-based assessments, with focus on dynamic knee control, and quantitative performance-based assessments such as hop tests.

Post-operative ACL Rehabilitation conclusion:

Multiple types of bracing were evaluated, including knee immobilization, rehabilitation bracing, and functional bracing. Overall, no brace or length of brace wear demonstrated an advantage over another type of brace, another duration of bracing, or no bracing at all. Bracing does not provide any benefit and is not necessary.

Accelerated Rehabilitation has shown no deleterious effects, and it is likely safe for patients to begin immediate postoperative weight-bearing, move the knee from 0 to 90 of flexion, and perform closed-chain strengthening exercises.

Eccentric quadriceps muscle strengthening and isokinetic hamstring muscle strengthening were safely incorporated three weeks after surgery; they may be safe sooner, but further research is needed.

Home-based rehabilitation can be effective. Neuromuscular exercises are not likely to be harmful to patients; however, their impact was small, making them unlikely to yield large improvements in outcomes or help patients return to sports faster. Neuromuscular exercises should not be performed to the exclusion of strengthening and range-of motion exercises.

Neither supplemental vitamin C nor vitamin E appears to be beneficial. Postoperative hyaluronic acid injections may improve some measurable parameters, but their cost must be kept in mind.

Single-leg cycling to maintain cardiac fitness may be beneficial. Continuous passive motion (CPM) is still not recommended. The studies presented in this paper focused on improving rehabilitation following ACL reconstruction, with a goal of safely allowing expeditious return of mobility, strength, and ultimately sport participation.

However, few studies actually measured the ability to return to sports and its timing following the interventions. The availability of such data could strengthen the conclusions of studies and should be considered in future research. Despite the large number of randomized trials, further investigations of the timing of rehabilitation and supplemental rehabilitation exercises are needed to continue to improve the care and function of patients following ACL reconstruction

To learn more about ACL Injury, please visit our dedicated page here: ACL Injury Treatment

The clinical manifestations of Ankle Sprain include the inability to walk or even move the joint, a searing or tearing sensation, pain that increases with mobility, color change and rapid bruising. The intensity of these manifestations depends on the severity of the sprain. Ankle sprain is classified based on clinical signs and functional loss, as follows: grade 1 (mild stretching of a ligament), grade 2 (more severe injury involving incomplete tear of a ligament), and grade 3 (complete tear of a ligament).

An Ankle can sprain in different directions and this will affect different ligaments.

Inversion sprain will affect the ligaments on lateral side of ankle. Eversion will impact those in the internal side and twisting movements can impacts those ligaments that are keeping together tibia and fibula bones

Acute ankle sprain management

It is well-known that all Grade I and Grade II ligament injuries are safely treated non-sugically. The recommended treatment is functional with a short period of rest, cooling (ice), compression and elevation to reduce the edema (PRICE), during the first 1 to 3 days, depending upon the amount of swelling, bruising and pain.

The ruptured ligaments should be protected from distraction and new injuries during healing, using external support i.e. ankle tape or brace to control the range of motion and to reduce the instability. The results after functional treatment of Grade I and Grade II ligament injuries are almost always satisfactory, and most athletes are able to return to sporting, providing they protect their ankle from further injury using external support.

There is still some controversy in terms of the optimal treatment of Grade III ligament ruptures as to whether these injuries should be treated non-surgically, by physiotherapy and early mobilization, or by primary surgical repair followed by immobilization using a plaster cast (either full or hinged).

All these studies have showed that the long-term results are satisfactory in most patients, regardless of the primary choice of treatment i.e. surgical repair, cast immobilization alone for 3 to 6 weeks or physiotherapy. Taken together, approximately 80 to 90% of patients with Grade III injuries will regain satisfactory functional stability after nonsurgical treatment.

Physiotherapy includes short period of immobilization, using ankle tape or elastic bandages. Training of range of motion, peroneal muscles and coordination training is started as soon as pain and swelling have subsided. Weight-bearing is encouraged from the beginning.

It can thus be concluded that physiotherapy is the treatment of choice when dealing with acute ligament injuries of the ankle joint, irrespective of the grade of injury. The remaining problem is how to identify those approximately 10% of patients who will develop chronic functional instability in spite of adequate primary treatment and may need surgical reconstruction at a later stage.

Chronic ankle sprain management

Chronic lateral ankle joint instability will develop in approximately 10% of patients after acute ligament rupture. This ligament instability, irrespective of its aetiology does not always require surgical reconstruction.

The indication for surgical treatment is recurrent ‘giving way’ in spite of proprioceptive training. Non-surgical treatment is therefore always recommended before surgical treatment. Surgical reconstruction is more often needed in athletes with high demands of ankle stability.

Of all individuals who have sustained acute ligament injuries, it is probable that less than 10% will need stabilizing surgery at a later stage. Before deciding on surgical treatment in a patient with chronic ligament insufficiency, a supervised rehabilitation program based on peroneal muscle strengthening and co-ordination training should be carried through.

Approximately 50% of patients with chronic functional instability of the ankle will regain satisfactory functional stability after 12 weeks on such a program.

Patients with high-grade mechanical instability have less chance of regaining satisfactory function by physiotherapy. These patients should undergo surgical treatment.

Return to sport after an ankle sprain

Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing.

Grade I ankle sprain normally takes around 2-3 weeks for the return to play, Grade II can take up 4-6 weeks and for a grade III it can take 3 months or more. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation.

To learn more about Injury Prevention, please visit our dedicated page here: Injury Prevention Program

Can you heavy weightlifting during pregnancy?? Apparently yes but let me explain!A lot of guidelines are suggesting women to be active during their pregnancy, but the intensity is rarely mentioned. Almost all are suggesting aerobic activities like walking, pilates, yoga but what is somebody wants to do some more?Recently this article came out stating that women who lifted heavy during pregnancy showed lower rates of complications like gestational diabetes, gestational hypertenion, perinatal mood disorders. Without any increased risk of pelvic floor disorders postpartum like incontinence.Now that’s a statement…can we send any women to deadlift heavy than?Let’s dig a bit into this; Let’s define weightlifting.

What is Weightlifting?

Weightlifting is something we do regularly in our life. Lifting grocery bags, car seats or babies is part of normal activities of daily living. Therefore also lifting weights in the gym is not that different as long as the weight is moderate. In this article women continued their moderate weightlifting within their first 6 weeks after knowing about their pregnancy.

But in this article was specified HEAVY weightlifting. So we have to do some more considerations
As we increase the weight our body needs to implement some strategies to help us with the lift, one of these is the Valsalva maneuver.
The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, which is normally what happens in weightlifting.
Because it increases the abdominal pressure Doctors normally recommend not to do weitghlifting that requires the valsalva maneuver.
Also another discouraged type of lifting is the one laying on the back (i.e. bench press or some types of leg press) because it increases the blood pressure and might lead to faint.
This article investigate exactly this type of lifting, and it came out that women went back to weightlifting using the Valsavla maneuver between 4.5 and 5.5 months. All of this not only was done with no side effects, but with a lot of benefits too!

So it’s true! All women should do heavy weightlifting. Period. Thanks. Well, no. Unfortunately one study is not enough to safely say this.
First of all, this study have investigated women which were familiar with these exercises and well trained. So these conclusions are not applicable to the whole population.
If we look at further evidence we find out that current guidelines across the globe have, infact, a much milder approach.
Most of them agree that exercises should be a lowered in intensity during the first trimester.

Also the intensity shouldn’t cross 6-7/10 at the perceived exertion scale and is mainly aerobic exercises and not weightlifting.
So what do we do??

2 categories of Pregnant Women

We will have to divide pregnant women in 2 categories;

• Normally active: pregnant women who habitually engage in vigorous-intensity activity or are highly active can continue physical activity during pregnancy and the postpartum period, provided that they keep in mind the reason to stop exercises such as:

• Excessive shortness of breath

• Chest pain

• Painful uterine contractions (more than 6-8 per hour)

• Vaginal bleeding

• Any “gush” of fluid from vagina (suggesting premature rupture of the membranes)

• Dizziness or faintness

• Normally not active: Healthy women who are not already highly active or doing vigorous-intensity activity should get at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity per week during pregnancy and the postpartum period. Preferably this activity should be spread throughout the week.

Conclusions about weightlifting during pregnancy

Apparently weightlifting is not harmful. Women that are used to it are safe to do it starting from 6th week of pregnancy and heavier from at least 4.5 months. However, it is safe to lower the intensity and avoid extreme exertion.

This is valid ONLY for women with a normal gestation and no risk factors. Maintain adequate nutrition and hydration – drink liquids before and after exercise. Know the reasons to stop exercise and consult a qualified health care provider immediately if they occurs.

Healthcare professionals often express their concerns regarding long term exposure to running as a risk factor for development of knee osteoarthritis.

What is osteoarthritis? Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees. With OA, the cartilage within a joint begins to break down and the underlying bone begins to change.

What’s the problem with running?

Running is one of the most common form of exercise in the world. As any other sport can be done for recreational purposes or at elite level.
The concept that running is dangerous for the knee joint comes from the nature of the sport itself. In fact is quite logical to think that the repetitive impact must have a mechanical effect on the joint.
But let’s look at the latest data:
– Amateur/recreational runners have and incidence of 3.5% of knee or hip osteoarthitis
– Sedentary people have 10.2% of knee and hip osteoarthitis
– Professional athletes have an incidence that goes to 13.3%

We can understand couple of things from this study.
1) Recreational running is no harmful for knee joint, quite the opposite, it looks like it may provide a protective effect against development of knee and hip osteoarthritis
2) The fact that elite athletes have a higher incidence of osteoarthritis is suggesting that the problem it’s not the activity of running but the amount of it.

We have to consider also one more thing. Normally elite athlete are more exposed to injury compared to regular people. Muscle strain, joint sprain, bone bruises and the list goes on. So looking at this numbers, when it comes to elite athletes we don’t know if this incidence of osteoarthritis is affected by the injuries that an athlete might have had during their careers.
So, if you don’t have osteoarthritis, continue to run as much as you like! As long as you are managing your symptoms.

What if you already have knee osteoarthitis?

Don’t worry, studies have looked at this too.
Apparently, running doesn’t not appear to accelerate progression of existing osteoarthitis in runners >50 years of age. So you don’t need to give up on running! Pehaps the best way of knowing if you are suitable to run with your knee or hip osteoarthritis is to assess your pain in different moments.

– Pain during the running: is the activity of running already painful during the act of it? Than maybe you should look at the way you run. A running analysis is the best tool to assess your running pattern and identify mistakes or faulty behaviors.
– Pain after running: this probably means that you have run an excessive amount for your current capacity. Your worm up have given you a protective effect against nociception but now that this effect is wearing off and you are paying the price. In this case you might benefit from a reduction of intensity or at least from an interval training where you can alternate running to jogging/walking.
– Pain the day after the running: you definitely have crossed your capacity of load, but not to the point where you created any damage. In this case you can just reduce the intensity of running of a 25-30% and see if the symptoms are gone. You probably should wait to run until the pain has subsided, and you know that is not a big deal if the pain disappears within 24h.

Generally speaking, people with osteoarthritis have a capacity of load of their joint reduced compared to healthy joints. Therefore you should feel safe to run but you may benefit to run less frequently to allow sufficient cartilage recovery between trainings.

A lot of attention has come to this technique in the recent years. Most people have heard of it but never tried. And those who tried it might just love it or hate it. Before you judge here are some things you need to know

What is dry needling?

The treatment technique called dry needling is defined by the American Physical Therapy Association (APTA) as a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairment. 

What is a trigger point?

A trigger point (TrP) is a hyperirritable spot in a taut band of skeletal muscle that is painful on compression, stretch, overload or contraction of the tissue which usually responds with referred pain that is perceived distant from the spot. The nature of the onset is still unclear. It is thought that is due to an excessive release of acetylcholine into the motor endplate. The increased motor plate activity leads to a continual release of calcium ions (Ca +2) that is responsible for the muscle contraction. This leads to a local muscle contraction that is persistent and involuntary because is chemically induced.

Trigger points can be active, passive or latent. Active TrPs cause a reproduction of the patient’s familiar pain with or without palpation. Passive trigger points do not cause pain except when stimulated via palpation. With latent TrPs, the local and referred pain do not reproduce any symptoms familiar or usual to the patient when palpated.

Can Physiotherapist do Dry needling?

Yes. In 2010, jurisdictions sought information from the Federation of State Boards of Physical Therapy (FSBPT) regarding the criterion for physical therapists to be able to practice dry needling. In 2015, the FSBPT, APTA, and seven dry needling experts composed a task force that set forth a final set of competencies for physical therapists for the safe and effective use of dry needling in clinical practice.

How does it work?

The needling hand places the needle and guide tube at the site.. The needle is tapped into the epidural layer of the skin and the guide tube is discarded. The dominant hand is used to insert the needle perpendicular to the muscle superficially to the subcutaneous tissue, or deep into the muscle to penetrate the trigger point. This is known as superficial (SDN), or deep dry needling (DDN/TrP-DN) respectively. The needle can be left in situ for a short period of time (up to 20 minutes) or pistoned in and out of the muscle, causing a twitch response from the trigger point. During a pistoning technique, once the acetylcholine is depleted at the end plate, the twitching will stop and the needle is removed and discarded appropriately in a sharps container.

What should I expect?

Clinicians can apply needles to a number of trigger points during each treatment session. Usually, pain relief lasts 3-4 days after the first treatment session. The duration of the pain relief may be longer following subsequent sessions. Up to three or four treatments may be required initially to eliminate a trigger point, and no single trigger point should be needled more than twice in a week.
The most common adverse effect associated with dry needling is soreness in the first 24 hours post treatment. Another uncommon side effect can be bruising. Application of heat and stretching exercises may minimize this, and aggressive treatment should be avoided until the patient’s reaction to dry needling is known. High quality needles, which are sharper and thinner, may also reduce pain during and after treatment.

What is it indicated for?

Dry needling may be indicated for myofascial pain with the presence of trigger points. Trigger points may lead to impairments in body structure, pain, and functional limitations. Dry needling has been shown to be beneficial in addressing strains, osteoarthritis, and tendinopathies.
Dry needling is a relatively new treatment modality used by physical therapists and other common musculoskeletal conditions seen in athletes. It is a safe, inexpensive, and minimally invasive procedure that carries a low risk. Further studies are also warranted to study the effects of different dry needling protocols for muscular, tendon, and potentially ligament conditions.

To learn more about Dry needling, please visit our dedicated page here: Dry needling

Plantar fasciopathy (also known as plantar heel pain or plantar fasciitis) is an overuse condition of the plantar fascia at its attachment to the calcaneus. The plantar fascia consists of type 1 collagen and has common tendinopathy traits, hence we recommend using the term ‘fasciopathy’ rather than the former ‘plantar fasciitis’ since the suffix “-itis” normally refers in medicine to an inflammatory process which is not always present in this condition. Plantar fasciopathy is the most common cause of plantar heel pain, which has an estimated prevalence of 4-7%. It commonly affects very physically active people (e.g. runners) or people with high amounts of standing occupational work (who may also have a high BMI).

What is the presentation of the symptoms?

The pain related to plantar fasciopathy is usually of gradual onset and felt classically on the inferior medial aspect of the heel. Initially, it is worse in the morning when getting out of bed (referred to as ‘first-step pain’) and decreases with activity, only to return with an ache post-activity.
Periods of inactivity during the day are generally followed by an increase in pain as activity is recommenced. As the condition becomes more severe, the pain may be present when standing and worsen with activity. Some people may also experience atypical pain when non weight- bearing, for example, when they go to bed at night. Examination reveals pain or tenderness along the medial tuberosity of the calcaneus, and this may extend some centimeters along the medial and central components of the plantar fascia. Stretching the plantar fascia via dorsiflexion of the hallux, such as during the windlass test, may reproduce pain and may assist with palpation of the plantar

What is the best treatment?

Recently has been released a systematic review of the literature trying to answer this question. “Management of plantar heel pain” published by Dylan Morrissey Et. At. Came out with The Best Practice Guideline (BPG). Their conclusion was that due to the lack of high quality studies, the only certain approach was based on limited amount of articles and has been divided in 3 level of approaches:

1) The Core approach for 4-6 weeks

2) Shockwave Therapy: If the first approach fails after 4-6 weeks, than probably shockwave can help to reduce the pain and increase functionality. However a gradual re-loading exercise program must follow this method.

3) Orthoses: custom made insoles have shown to be beneficial with a moderate level of evidence.

More studies on Plantar Fasciopathy

That’s it?? Nothing more?
As I said before, this is based on a very rigid selection of studies. However there are many more studies done with different type of approaches, let’s go through them:
1) Strengthening exercises: Moderate evidence. It is important to re-introduce stress around the fascia gradually but progressively. Here is the importance of individualization.
2) Cortisone injection: Moderate evidence. It may be considered for a short term relief (4 weeks), however injecting liquid inside the fascia comes with risk like fascia rupture, fat pad atrophy and plantar nerve injury. Needs to be discussed with the patient before choosing this option.
3) Dry needling: Low level of evidence. Some trials have shown improvements in short term, however the quality of the study is low.
4) Massage: Low evidence. The plantar fascia is a very strong piece of tissue. There is no possible way of stretching it manually. However some people might appreciate some manual release.
5) Silicone heel pads: Unclear evidence. It is ideally beneficial but we have no proofs to support that
6) Self-massage with frozen bottle or trigger ball: No evidence. although commonly used there is no proof of benefit
7) Non-steroidal anti-inflammatory drugs: No evidence. Perhaps the idea of reducing inflammation make sense only in acute phase (within 1 week of onset) later the source of pain is not directly due to the inflammation, that’s why there is no evidence
8) Surgery: Unclear and low quality. Surgical option include plantar fasciotomy +- nerve release, but the level of knowledge on the outcomes is quite low therefore is not advisable considering the risks.