Ligament Injuries (Sprains)

Ligaments connect bone to bone. Ligaments help stabilise the joint, maximising strength and preventing excess movement. Ligaments are sprained when the joint is stressed beyond its normal range. Common causes of a ligament injury include twisting or landing awkwardly. Most ligament injuries if treated properly can mean a return to normal activities and sport between 4 to 12 weeks. Your physiotherapist is correct, strengthening exercises are important. A physiotherapist is an expert on sports injuries and is best placed to advise on ligament injuries. I will give some general tips here but for more specific and detailed advice, ask your physiotherapist.

 General treatment tips for ligament injuries        

It is essential to rest the injured ligament for at least the first 48 hours. Avoid any activities that could further aggravate it including sports.

Icing the injured area is important for the first 48 hours. Apply ice wrapped in a towel or other cloth to the injury for 15-minute intervals, once per hour on the first day. On the following days, ice the hand for 15 minutes once every 3 hours. The ice reduces inflammation and swelling. After about four days, applying heat to the affected area can help; heat increases blood flow in the area thus reducing inflammation by releasing inflammatory substances from the affected area.

Keeping the injured area elevated higher than the heart ensures blood does not pool around the injured ligament and reduces swelling and allows the injured ligament to heal quicker and correctly. For example, keep the affected hand or ankle elevated during sleep by propping it up using pillows. Try to sleep on your back.

A support or brace may be required to ensure the injured area is kept immobile and in the correct healing position. The brace should be tight enough to keep the area rigid, but not so tight it constricts blood flow. Once the injury is well enough to return to sports, it is important to strap the affected area. The good method of strapping to protect hand ligaments is called “spica” strapping. Your physiotherapist will show you how to do this. There are also youtube videos demonstrating how to do spica strapping. Anti-inflammatory drugs will reduce inflammation, swelling, and pain around the injured ligament. Over-the-counter drugs such as ibuprofen can work effectively.

Alternative treatment

There are no alternative treatments that will cure torn ligaments, however some supplements may help reduce inflammation so may accelerate healing. Alternative treatments are not meant to replace conventional treatment and advice from your physiotherapist. They may compliment conventional treatment. Omega 3 fish oils naturally reduce inflammation so can bring down the swelling of inflammatory injuries like ligament tears. An omega 3 supplement that has potent anti-inflammatory effects is Lyprinol^®. Lyprinol^® comes from the New Zealand Green Lipped Mussel, Lyprinol^® is said to be 200 to 300 times more effective than other fish oils and flax seed. Lyprinol can give relief from other inflammatory conditions like joint pain and arthritis. Lyprinol^® is available from Whelehans.

 Arnica is a homeopathic remedy which has traditionally been used to bring down bruising, ease stiffness and swelling. Some studies have shown it can accelerate healing. Arnica tablets will work better for ligament tears than creams or ointments. Arnica may accelerate healing in injuries such as ligament tears. Other natural treatments for inflammatory type conditions are the herb Devil’s Claw and the natural supplement Glucosamine (which is actually found naturally in our joints). The effectiveness of these two supplements for ligament tears and other conditions is questionable. Whelehans stock a traditional remedy called “The Rub” based on a traditional Irish recipe of herbs passed down for over 100 years. It can give some relief when rubbed into the injured area; however like other alternative treatments mentioned above, it should only compliment conventional treatment.

Whelehans are delighted to announce our new Physiotherapy service. With sessions running in our private consultation room, the clinic is hosted by Sinead Brogan, our fully qualified Chartered Physiotherapist and certified STOTT pilates instructor. Reduced rates for over 60’s and sport clubs. Book a physiotherapy appointment by calling Sinead at 0831722171

This article is shortened for this Health Blog. More detailed information on high sprains is available in Whelehans or www.whelehans.ie

Whelehans Crew 2013

Whelehans Crew 2013

Difference between a chartered physiotherapist and a physical therapist

It could be asked, “are all ‘physios’ the same”? Unfortunately the answer is no. Unlike other medical professionals such as doctors, nurses, midwives and pharmacists, there is no protection in Irish legislation for the title of physiotherapist or physical therapist in Ireland. This means that in essence, anyone can not only assume such a title, but also practice under it.

 There are currently many therapists practicing in the Republic of Ireland in many different settings including sports and leisure using the term “physiotherapists”/ “physio”/”physical therapist” but who have not completed the required courses recognised by the only governing body in the Republic of Ireland called the Irish Society of Chartered Physiotherapists (ISCP). There is currently legislation being drafted by the Government which when finalised into law in the Dail will help clarify this situation for the public. In the meantime, you can protect yourself by ensuring when you require treatment with a physiotherapist; you always check that the person pertaining to be a physiotherapist is a Chartered Physiotherapist. A Chartered Physiotherapist will have the letters MISCP after their name.  This is your protection that you are being treated by a qualified practitioner.

 Ensuring your physiotherapist is a chartered physiotherapist is the only way of ensuring you have the most professionally trained physical health expert. By choosing a chartered physiotherapist, you are in the care of a healthcare professional with a university degree who has demonstrated the highest standard of excellence in clinical care. Chartered Physiotherapists are committed to continual professional development and education ensuring the most up to date knowledge and evidence for your care.

Why confusion can sometimes arise?

The confusion arises because in many countries including the UK and the US, the titles “physiotherapist” and “physical therapist” are protected, and may be used only by therapists with the appropriate qualifications such as four-year full-time degrees. In Ireland, however, physical therapists or sports therapists generally do not have the same qualifications as a physiotherapist, and often gain their qualifications through part-time programmes. To protect these titles and to protect the public, registration with the ISCP has become compulsory for physiotherapists with the appropriate qualification in recent years. This now means it is easier for patients seeking treatment to check if their physiotherapist has appropriate qualifications by simply checking if their physiotherapist is a Chartered Physiotherapist. A simple way of doing this is by going to the ISCP website (www.iscp.ie); by clicking on the section, “Is your physiotherapist chartered?” and when you type in the name of your Physiotherapist, if he/she is a Chartered Physiotherapist, it will confirm this as well as their county of practice. 

 What are the differences?

According to the ISCP, which accredits physiotherapists in Ireland, to be a member of the society and thus a Chartered Physiotherapist, physiotherapists must have completed a three- or four-year degree programme, either in one of four Irish universities or approved international university, as well as undertaking continuous professional development. This training includes three core areas of muscular skeletal, neurology and cardiorespiratory. By choosing a Chartered Physiotherapist, you are choosing a professional who has scientific approach to the assessment, diagnosis and treatment of your complaint. Chartered Physiotherapists are recognised and covered by VHI, Laya Healthcare, AVIVA and other health insurance schemes

A physical therapist, on the other hand, can complete a course on a part-time basis, from 15 months to a three- year term, so the levels of experience and qualifications do differ. Moreover, training for a physical therapist typically only focuses on muscular-skeletal areas and does not take into account other body functions and processes. While the work undertaken by a physical therapist may be legitimate, the ISCP argues that it is essential that the patient should understand exactly what experience and training the person treating them has obtained. Most physical therapists are very aware that they must communicate the difference between their qualifications and that of a Chartered Physiotherapist to patients.

 Only Chartered Physiotherapists are entitled to work in the public sector such as hospitals and health centres, thus it is in the private practice that confusion can arise. According to the ISCP, this grey area is leading to many problems, and it receives many complaints from members of the public who thought they were seeing a trained physiotherapist. Another issue is that there is less comeback when it comes to physical therapists. For example, if a chartered physiotherapist acts in an inappropriate manner or offers inadequate treatment, a complaint can be made to the society.

 Physiotherapy services are available at Whelehans Pharmacy, 38 Pearse St, Mullingar (Opposite the Greville Arms Hotel). Book a physiotherapy appointment with Sinead at  0831722171

Alzheimer's Disease

Dementia is an umbrella term used to describe various conditions which damage brain cells and lead to a loss of brain function over time. Dementia causes a progressive decline in a person’s mental functioning. It is a broad term, which describes a loss of memory, intellect, rationality, social skills and normal emotional reactions. The symptoms of dementia develop gradually over a period of years. The progression of these diseases is largely unpredictable for each individual.

Facts in brief
Dementia has a life changing physical, emotional and mental impact on the affected person and their primary carer and family. There are more than 100 conditions that cause dementia. While the risk of dementia increases with age, it is not a natural part of ageing. Dementia affects approximately one in 20 of people aged over 65 years. This rises to one in five in the 80 plus age group. While it is comparatively rare, dementia can affect younger people. There are approximately 3,800 people under the age of 65 with Younger Onset Dementia in the Ireland. A person with dementia will live for an average of four to eight years, depending on their age at diagnosis. Alzheimer's disease, the most common cause of dementia in Ireland, accounts for more than 50% of all cases; the second most common form is vascular dementia, which may be preventable.

Risk Factors

The risk factors for Alzheimer's disease include increasing age being female, family history, head injury, Parkinsons, hypothyroidism, exposure to dietary aluminium, cardiovascular disease, smoking and high alcohol intake

Health maintenance

As Alzheimer’s disease progresses, various conditions develop that may lead to death, such as septicemia, pneumonia and upper respiratory infections, nutritional disorders, pressure sores, fractures, and wounds. In the early stages of Alzheimer’s disease, health maintenance activities should be encouraged including exercise, the control of high blood pressure and other medical conditions, annual immunization against influenza, dental hygiene, and the use of eyeglasses and hearing aids as needed. In later phases of the disease, it is important to address basic requirements such as nutrition, hydration, and skin care.

Diagnosis

There is no straightforward test for Alzheimer’s Disease so diagnosis is difficult, particularly in the early stages. Diagnosis is usually made by excluding other causes such as infection, vitamin deficiency, thyroid problems, brain tumour, depression and the side effects of drugs which all can produce similar symptoms. Diagnosis involves a variety of medical assessments and observations. Assessment usually includes a mini mental state examination (MMSE). Specialists can only make a probable diagnosis. However, clinicians with experience in memory loss are able to diagnose AD to within 80-90% accuracy.

Medication

Medication can slow down progression of AD but is not a cure. Medication should be used in conjunction with non-drug treatment options. For more information on non-drug options, call into Whelehans or discuss with your GP. Four drugs are approved for treatment of dementia in Alzheimer’s Disease (AD) in the UK and Ireland. These are donezepil (ARICEPT^®), galantamine (REMINYL^®), rivastigimine (EXELON^®) and memantine (EBIXA^®). The first three are cholinesterase inhibitors and memantine is a NMDA receptor antagonist. All of these drugs must be started under specialist care. All these drugs now have less expensive but equally effective generic equivalents. These treatments can help improve a person’s memory and enable the person to retain new information for longer. The most common side effects are nausea, vomiting, diarrhoea and anorexia. These can be a particular problem because many people with AD loose weight. However,these side effects wear off after a few weeks in most people. 

Studies have demonstrated modest improvement in cognitive symptoms with cholinesterase inhibitors. Some studies demonstrated a beneficial effect for up to two years after starting treatment. There are no studies of longer periods of medication but most patients can expect that, in time, they will stop responding to treatment as the disease progresses. If the effect wear off, some prescribers recommend a ‘drug holiday’, for example the drug is stopped for six weeks and then started slowly again.

Donepezil has demonstrated in the short term (six months) a beneficial effect on mood and behaviour. Rivastigmine is licensed to treat dementia in Parkinson’s disease. Exelon 4.6mg/24hr transdermal patch and Exelon 9.5mg/ 24hr transdermal patch have been recently launched. The initial dose is 4.6mg/24hr for a minimum of four weeks, and if tolerated, can be increased to 9.6mg/24hr which is considered the recommended effective dose. The rivastigmine patch is considered to have fewer side effects than the capsule version.  Of the four drugs available memantine is the only one licensed to treat moderate severe AD.

There are no guidelines to recommend one drug over another. Donepezil and modified release galantamine only need to be taken once a day which is convenient. Rivastigimine and memantine need to be taken more often though memantine is often given as a single dose in the morning (ie) 2 x 10mg memantine tablets in the morning. There is also insufficient evidence to support the use vitamin E in AD. Further studies are required to test the benefits of Ginkgo biloba.

This article is shortened for this Health Blog. More detailed information and leaflets is available in Whelehans or check www.whelehans.ie

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie