A few weeks ago, we published a blog about Long-Covid, what it is and how physiotherapy can help you.

In this follow-up, I describe how we as physiotherapists can use our experience and skills in Western Medical Acupuncture to help alleviate the symptoms of Long-Covid.

A quick recap: The umbrella term Long-Covid is used to describe the persistence of symptoms for longer than 12 weeks. Some common Long-Covid symptoms include:

• Shortness of breath
• Fatigue
• Insomnia
• Headaches, confusion, or seizures
• Reduced concentration or "brain fog."
• Joint or muscle pain
• Chest Pain or tightness
• Cough
• Loss of Smell (anosmia)

As many of us are advised to stay at home during the COVID-19 outbreak, we have to become inventive with regards to our fitness and exercise.

Thankfully, there are plenty of activities which can be done from the comfort of our own home, which can keep us fit and healthy during this testing time. All we need is some space, imagination and most importantly- motivation!

I have provided some tips and ideas to get us going.

Let me start off by answering - almost definitely....I’ll tell you why.

I often hear golfers swooning over the effortless-looking swings of pros and low amateurs. You hear the go-to phrases often wistfully uttered after a long drive, or a dialled in a wedge.

“They make it look so easy”

“Wouldn’t you love to be able to hit the ball like that?”

“I’d hurt myself if I tried to do that”

This is then, in the majority of cases, followed up by a wild slice and a pattern of footprints on the tee box that would confuse a Russian ballerina.

CBD is all the rage these days and becoming known as a ‘miraculous’ compound. But is it really as amazing as it sounds?

CBD, also known as cannabidiol, is one of many cannabinoids found in the hemp and cannabis plant. It was discovered in the 1940’s and was initially thought to be psychoactive i.e causes changes in brain function.

Since then, it’s popularity has been rapidly growing with researchers all around the world investigating its effects and is now known as one of the few cannabinoids that turns out to be non-psychoactive, particularly if extracted from the hemp plant. This makes it potentially safer and easier to use.

It is thought to have many therapeutic effects such as anti-seizure, antioxidant, anti-anxiety, antipsychotic, anticancer, analgesic and anti-inflammatory properties.

But does it really work and how?

CBD works by binding to certain receptors in our cells which then lead to a series of chemical reactions to cause a specific effect.

It has an affinity for activating some important receptors in such as:
-Serotonin receptors (specifically 5-HT1A) which control anxiety and mood
-Vanilloid receptors (TRPV1) which influence the pain experience
-Adenosine receptors which control sleep
-Endocannabinoid receptors (indirectly) which control appetite, memory, mood and pain.

One of the most well known effects of CBD is on anxiety and mood. It has been described to instantly give a lift in mood and a feeling of calmness. It impacts activity of the limbic and paralimbic systems in the brain(1) and binds to the 5-HT receptors that control the release of neurotransmitters such as serotonin, which influence stress, anxiety and mood and pain perception. Because of this, it is being researched as a natural anti-depressant.

There are many terms to describe various injuries to tendons which can be confusing to understand.

In simplified terms:

Tendinopathy refers to an overuse injury of a tendon.

Tendinosis refers to a non-inflammatory degeneration of a tendon, this term is often used instead of tendinopathy to mean more of less the same thing, especially during the later stages.

Tendonitis refers to inflammation of a tendon, this may occur in the early stages of a tendinopathy.

Tendon partial and complete rupture refers to tears in the tendon, these are more likely to occur in a tendon in which tendinopathy or tendinosis has occurred, but not always.

Let’s focus on tendinopathies as this is what we see most often in the clinic.

What are the Intervertebral Discs in the Spine?

They are fibrocartilaginous cushions between each vertebral body and play a major role in shock absorption and mobility of the spine. They are composed of the annulus fibrosus (outer layer) and nucleus pulposus (inner layer). They are a common cause of low back pain.

How are they injured?

Excessive twisting of the lower back and forward bending can cause a ‘torsional’ stress on the disc, resulting in a tear in the annulus fibrosus. A tear will stimulate an inflammatory response and can predispose to an outward bulge of the the inner nucleus pulposus.

Compression injuries result from excessive weight bearing forces and may be initiated by fractures of the vertebrae. This can lead to degradation of the nucleus and increase load on the annulus fibrosus, which produces pain.

What does a disc injury feel like?

• Acute sudden onset of pain
• Can be triggered by a relatively minor movement e.g. bending over
• Pain may be central, on one side or across the lower back
• Pain radiate to buttocks as a ‘deep seated ache’, hamstrings, or lower leg
• May get sharp pains down the leg indicative of nerve root irritation
• Often aggravated by bending forwards and may be eased by leaning backwards

What is Osteoarthritis?

Fast approaching is The British Medical Acupuncture Society foundation course that I will be attending in London next week. In preparation, I decided I wanted to do a bit of an investigation to see what the general consensus was of acupuncture.

From speaking to the clients here in Mount Merrion Chartered Physiotherapy, I got the impression they really found acupuncture a great addition to treatment, and when used alongside manual therapy and exercise and they leave the clinic feeling more relieved from their pain compared to when acupuncture is not used.

I recently attended a further education course on low back pain run by Dr Johnson McEvoy, a practising musculoskeletal physiotherapist in Co. Limerick. He presented us with the latest research regarding the assessment, diagnostic criteria and treatment for lower back pain. Given clients with lower back pain make up a large proportion of those who come to the clinic for treatment, I had a particular interest in furthering my skills and knowledge in this area. I immensely enjoyed this course and have gained valuable knowledge in treating this area of the body.

Here are a few of my learning highlights:

The temporomandibular joint (TMJ) is located in the face where the temporal bone (cheek bone) and the mandible (jaw bone) meet, often simply referred to as the jaw.

We have a TMJ on each side of the face and these can sometimes become sources of pain. When this occurs it is often referred to as ‘TMD’ or temporomandibular joint dysfunction. This is a catch all term which includes both intra-articular (joint and disc) and extra-articular (usually muscle, but also ligament and tendon) sources of pain.

TMD can be treated with many different physiotherapy techniques including manual therapy, electrotherapy, exercise and medical acupuncture (sometimes referred to as dry needling).