Sunday, 9 April 2017

How to deal with an acute injury

It's all about the M.E.T.H!

RICE (Rest, Ice, Compression and Elevation) is a term that is used to supposedly help with treating sports injuries. Ice has been used for many years and helps to relieve pain from the injured area. But the evidence from Bleakley et al, 2004, found it to have an insignificant effect on soft tissue injuries. Athletes that used ice for longer than 20 minutes then returned to sport afterwards actually would be at a disadvantage due to a decrease in performance (Bleakley et al, 2012). Ice stops the inflammatory process and we need this process to happen to improve the healing of soft tissues. Ice and rest may delay healing time so therefore, we need to do the opposite, movement and heat!

Ice is no good for acute injuries like this ankle sprain!



What is the METH-od then?


MOVEMENT – controlled movement of the injured limb can increase blood flow, improve recovery and decrease the number of misaligned bits of collagen fibres (scar tissue) that is formed during the healing process.

ELEVATION – Bring the injured part higher than the heart to assist the movement and allow gravity to help remove the swelling. This will reduce the pressure of the swollen tissue and reduce pain.

TRACTION – This helps to move the fluid and help take the pressure off the injured part. Depending on where the injured part is, a therapist may have to do this part for you. It can help reduce pain when dealing with muscle spasms and compressed joints.

HEAT – Inflammation is the body’s natural response to injury so by applying heat, this will allow to speed up this process. A study was done on the effects of cold vs heat on people with acute low back pain, they found significant evidence that heat wrap therapy and heated blankets decreased pain immediately after application (French et al, 2006). A smaller study demonstrated the same results where pain from DOMS had decreased and function had improved after wearing heat wraps compared to cold wraps (Mayer et al, 2006). 

A long hot bath can alleviate acute symptoms and can aid in healing soft tissue injuries.




When you damage your tissues either by an injury or through DOMS (delayed-onset-muscle-soreness), you are healed by inflammation and other processes. Your body sends inflammatory cells to the recently damaged tissue to help heal them. These cells are called macrophages and release a hormone called Insulin- like growth factor into the damaged tissues. Applying ice to reduce swelling delays the macrophages from releasing the hormone to help with healing.
Inflammation needs to happen as this is how the body protects itself following an acute soft tissue injury. It does this by removing the damaged tissue and then the healing process can begin. The inflammatory process improves blood and lymphatic flow to and from the injured tissues. This is what helps bring healing nutrients and the chemical mediators to help clear out the damage tissue. Some of these mediators will help limit the amount of swelling, which causes an increase in pain sensitivity. Once this fluid is filled up with waste products, it can then be drained via the lymphatic system. The lymphatic system relies on muscles to contract and relax properly to help flush the waste away.

5 signs of inflammation

1.      Swelling
2.      Redness
3.      Heat
4.      Tenderness
5.      Loss of function

So, RICE isn’t good?


Rest doesn’t inspire tissue repair. Inactivity causes muscle weakness and therefore less lymphatic drainage which will not help in the inflammatory phase of healing. It also causes abnormal scar tissue formation which can cause further issues in the other phases of healing. Cross-friction massage can help with this and can be done by a sports therapist.

There isn’t much scientific evidence that ice helps. Ice slows down the removal of waste products and inhibits the development of new cells. Compression isn’t bad but needs to be done at the right time. Compression can be done by using a voodoo floss band (as used by Dr Kelly Starrett). It has been shown to help remove the blood with the debris and bring fresh new blood with those healing properties to the injured tissue. You can floss any part of the body but will need a Sports Therapist to help with this treatment technique. Here is a video on flossing the knee: 


Take home points

  • Inflammation is a GOOD thing. Without it, there’s no tissue repair.
  • Too much rest causes muscles to waste away. The body needs to undergo a mechanical change by doing exercise.
  • Icing before sports and activity has been shown to have negative effects on sports performance e.g. strength, speed, power and agility.
  • Massage, elevation and compression are effective ways to reduce swelling.


References


Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251–261.

Bleakley CM1, Costello JT, Glasgow PD. Should athletes return to sport after applying ice? A systematic review of the effect of local cooling on functional performance. Sports Med. 2012 Jan 1;42(1):69-87.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976). 2006 Apr 20;31(9):998-1006.

Mayer JM, Mooney V, Matheson LN, Erasala GN, Verna JL, Udermann BE, Leggett S. Continuous low level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehabil. 2006 Oct;87(10):1310–7.

Thursday, 16 March 2017

The pelvis and its role in functional movement

What is functional movement?

Functional movements are movements based on real life situational biomechanics. For example, squatting and lunging. Your body is an integrated system. This means your muscles do not work in isolation. They work together with other muscles to produce movement. For example, the biceps muscle flexes the elbow, but there will be other muscles acting as synergists (pecs and deltoid muscles) to help control the movement. Other structures in the joint such as ligaments also play a role in helping to create movement by providing stability through certain movement patterns. A dysfunction in these movement patterns can cause a decline in athletic performance and therefore injury and pain.


back pain



4 important sling systems of the pelvic region

1.      Anterior oblique system – external and internal obliques and opposing groins, along with the intervening abdominal fascia. This is involved in stabilisation of the lumbar spine, thoracic spine, rib cage, pubic symphysis, and hips. It also helps with whole body pushing movements and helps transfer forces between the upper and lower body (Lee, 1999).

2.      Posterior oblique system – the lats, thoracolumbar fascia and opposing glute maximus and medius. This involves stabilisation of the lumbar spine and sacro-iliac joints. It helps to turn out the kinetic chain, helps with whole body pulling movements and helps transfer forces between the upper and lower body. This system is most commonly seen in gait because of its fight to control rotation of the pelvis which occurs in the gait cycle (Lee, 1999).

3.      Lateral system – gluteus medius and minimus, groins and opposing QL (lower back muscle). This helps to provide lateral stability in the pelvis, for example, walking and climbing stairs etc. It deals with single leg movement patterns and whole body frontal plane (sideways) movement. It also helps transfer forces between the upper and lower body. A weakness in this system can lead to hip pain, knee pain, ACL injuries and ankle sprains (Lee, 1999).

4.      Deep longitudinal system – spinal erectors (lower back), thoracolumbar fascia via sacrotuberous ligament, biceps femoris (hamstring), head of fibula, peroneals and tibialis anterior (shin muscles). This system helps to create stability of the lumbosacral complex and the foot and arch complex. It helps to control supination and pronation of the foot from heel strike through to mid-stance of the gait cycle. During high intensity activity, it provides a communication for proprioceptive information about ground reaction forces (Lee, 1999).

As a population, the focus is more pointed towards “posterior chain” work because of tight hip flexors and quads. Sometimes, this isn’t the case with athletes and the development of exercise programs should be dealt with more profoundly. Understanding the mechanics of the body is an important part of creating better exercises for better pain free movement.
The components of fitness are extremely important for optimum health. Many people workout to become stronger for their sport, run quicker, lose weight, improve mobility, increase stamina and for the general feel-good factor. These are all great reasons to train, but there is so much more to training then this. We need to think about training our neuromuscular system! What about balance, co-ordination, agility, power and reaction time? These components are just as important as strength training or endurance training. If you do strength training in the gym or you do long runs and keep getting aches and pains, maybe you need to think about adding in some of these to help improve your overall health and fitness.

References:

Lee, Diane, “The Pelvic Girdle: An approach to the examination and treatment of the lumbo-pelvic-hip region”: Churchill Livingstone, 1999, Toronto, Canada

Monday, 13 February 2017

Achilles Tendonitis: The awkward “ACHe in the Achilles”!

That really puts the ache in the Achilles!

The Achilles tendon is the largest and strongest tendon in the body. The Achilles tendon is responsible for absorbing shock when subjected to loads and it takes the load before the rest of the body does. The tendon is attached to the heel bone and the calf muscle which helps to push the foot off the ground when moving. The tendon begins on the heel bone and attaches into the middle of the calf. Most runners and sports players are susceptible to Achilles tendon injury due to the high stress and repetitive loads during running and jumping.

Achilles tendinosis


Sever’s disease is heel pain in adolescents because of growth spurts. The heel bone grows quicker than the Achilles tendon, which results in a tight tendon. Over time, repeated stress and impact on the tendon causes the tendon to pull on the growth plate, resulting in inflammation. This condition can resolve with just rest, however some sports massage and kinesiology taping to the calf muscle can help with recovery.

Tendinosis is degenerated tissue whereas Achilles tendonitis is inflammation of the tissue. The difference between the two is tendonitis lasts for a few weeks or less, tendinosis is more chronic. Research has shown that when there is constant and chronic pain, the tendon is degenerative (tendinosis), with thickening, scar tissue and possibly partial tearing. The pain may be in the lower part of the calf, spread along the tendon or at the lower part of the tendon where it attaches to the heel bone. There is pain with activity and when starting to walk after periods of rest.



The main causes are:
  •         Amount of mileage ran
  •          The alignment of the foot (high arch, low arch)
  •          Rotated Pelvis (normally longer leg would reveal thickened Achilles because of impact)
  •          Tight calf muscles and muscular imbalance between calf and shin muscles.


Tendons have a longer healing time compared to other tissues because of their poor blood supply. So, going out running or playing sports and adding repeated amounts of stress on the tendon is going to slow this healing down. Therefore, it is important to rest from these repetitive activities and high impact sports because it will cause more thickening and scar tissue to form. Instead, try low impact aerobic exercises like the cross-trainer, rower or the stepper to help maintain fitness.

60% of athletes benefited from an intensive, heavy load eccentric heel drop exercise routine alone (Maffulli et al, 2008). Therefore, the heel drop exercise will be an integral part of the rehab program for treating tendon pathology. Eccentric loading promotes a greater reduction in Achilles tendon thickness immediately after exercise (Grigg et al, 2009). Most studies show that eccentrically controlled exercise is better than concentric exercise for the recovery of tendons. The 12 week program consists of 3 sets of 15 heel drops with the knee straight and the knee bent. Watch the video below to find out how to perform this exercise.



The treatment is very clear and successful but there can be several other causes contributing to Achilles tendon pain, especially when the pain keeps coming back. It could be poor calf and/ or foot strength, poor movement patterns, unfitting footwear or weakness in the glutes. The glutes eccentrically control foot pronation, if the glutes lack control, it means increased pressure on the Achilles. Nothing works in isolation. Your glutes AND hamstrings help to extend the hip. All muscles and fascia work together to create movement. But if something goes wrong e.g. if your glutes do not extend the hips, the calves will do the movement instead.


TOP TIPS

  •         Wear a brace if walking is difficult and painful.
  •         Avoid repetitive exercise and sports to allow time for tissue healing.
  •     Ice and Heat program (for acute tendonitis).
  •          Gentle calf stretching, including gastrocnemius and soleus (early phase).
  •          Get some sports massage on the calf muscle and cross friction massage to the tendon (later stages, after inflammatory phase).
  •          Foam rolling to the calf muscles (there is a trigger point in the lower calf that can refer pain into the Achilles).
  •          Start the eccentric heel drops to help regenerate and improve the blood flow to the area.



References:

Maffulli N, Walley G, Sayana MK, . Eccentric calf muscle training in athletic patients with Achilles tendinopathy. Disabil Rehabil 2008; 30: 167784.

Grigg NL, Wearing SC, Smeathers JE. Eccentric calf muscle exercise produces a greater accute reduction in Achilles tendon thickness than concentric exercise. Br J Sports Med 2009; 43: 2803.

Tuesday, 17 January 2017

FASCIA and why it’s important to YOU!

DO YOU FEEL ACHY AND SORE BUT DON’T KNOW WHAT’S CAUSED IT? 

Fascia is a sheet of connective tissue made up of dense protein fibres. It weaves through the body like a spider’s web and interlinks with just about EVERYTHING! It helps support your bones, muscles, joints, tendons, nerves, ligaments AND organs! You have 6 times more sensory neurons in fascia than any other tissue of the body (except skin). This webbing helps all the body tissues to communicate with each other, for example, that feeling of needing to stretch in the morning or that feeling when you get out of your chair and need to move about. Ideally, your fascia should be supple, can glide, slide and twist easily like thin sheets of rubber. When something goes wrong, signals from the nerve endings are silent and confused and this is when your brain interprets it as pain or discomfort.
Think of fascia like a sponge, when it dries out it goes hard and inelastic. It can be easily broken with a bit of force, for example, twisting your back and bending at the same time to reach for something under the car seat. You haven’t done this movement in ages so all those stiff fascial tissues are more susceptible to pain and discomfort due to being like that hard sponge. We all need to strive for our fascia to be like the wet, hydrated sponge because it has more resilience and flexibility. You can squeeze it and twist it, but it will not break.

 There is a superficial layer that covers fat, nerves, blood vessels and other connective tissue, then there is deep fascia surrounding muscle, muscle sections and individual cells. When fascia becomes hard and thick, this is when trigger points can develop. Trigger points are extremely sore spots in muscles that send pain to other areas of the body. Trigger points are formed by sudden muscle overload, sustained low-level static contractions, eccentric contraction (when a muscle contracts and stretches at the same time), gross trauma, chronic muscle tension, overuse, or a sustained rapid movement. Examples of this can be holding your phone to your ear for too long, typing quickly on a computer keyboard, sitting at a desk with your head too far forwards, repetitive tasks or movements at work, slipping on ice, falling on your shoulder or hip, or simply increasing volume in a short amount of time working out in the gym.

If you are not quite there and not in need of trigger point therapy yet, here are some TOP TIPS on how to keep your fascia hydrated and well! But if you do want a trigger point therapy session then you can find us here.

 • Drink enough water. For every kg of body weight drink 30ml of water. So a 70kg individual will need 2.1 litres of water a day. If exercising, add 0.5-1.0 litres for every hour of exercise.

• Make sure you MOVE differently every day. Vary your gym routine every 6-8 weeks and try a mixture of physical activity e.g. walking, weight training and cardiovascular fitness. Change the intensity of training too.

• You can’t stretch fascia. Ever tried stretching your IT band? Nope, can’t be done! It takes a lot of force to create a stretch. But you can stretch the muscle that fascia can cling on to. Slowly stretch first thing in the mornings before you get up out of bed (check out this video on loosening your back). Stretching is important to help elongate the muscles, so make sure you do a good muscle stretching routine every day.

 • Go to a foam rolling/ mobility class. Foam rolling is a self- help tool where you can help de-sensitise the fascia and get rid of those low-level aches and pains. Want to book a place on the next foam rolling and mobility class? Click here to find out more about how to book on a class!
Foam rolling and mobility class

• Let the therapist handle it. If you think you don’t have the time to do all these self-help tips to keep your fascia healthy. Let me take care of it for you. You can now book myofascial release sessions for the whole body and get everything treated!

To see what else we can help with - click here.

Tuesday, 20 September 2016

The Forgotten Core

It is really important to know what each of your abdominal muscles do as they all have different roles. The rectus abdominis and obliques help move and stabilise the trunk and pelvis. The TRANSVERSE ABDOMINIS is only a stabiliser. It is part of the inner core muscles (transverse abdominis, multifidus, pelvic floors).

It doesn’t move a part of your body, but when activated compresses the abdominal cavity and supports the lower back and pelvis. That’s why Pilates teachers refer to it as the “corset” muscle. It wraps around the sides and front of the abdomen and attaches to the lower ribs and pelvis.



The Transverse Abdominis (TVA) needs to be trained differently to the other abdominal muscles as this is a postural muscle rather than a mover muscle. Postural muscles need more endurance than power. And mover muscles such as the other abdominals need more power over endurance. The TVA needs to be trained with light loads, slow and high repetitions. But it must also be trained in a variety of different ways e.g. in 3 planes of motion and different degrees of hip and arm range.

The proper way to contract your TVA is by pulling the abdomen in, bit like a vacuum. This creates intra-abdominal pressure and stability. Other muscles help out with this contraction include the small muscles in the back (multifidi), pelvic floors and the diaphragm.  

The diaphragm is a muscle that helps with breathing. When you inhale properly, it flattens out and allows air flow into the biggest part of the lungs. When you exhale, it pushes your stomach out. As we age, we forget how to breathe properly and so intra-abdominal pressure decreases and means less stability. To activate your diaphragm, lay on the floor, and put your hands on your chest. The aim is to keep the chest still and breathe with the stomach. When you breathe in, your stomach will rise, when you breathe out, it will lower.

The pelvic floor muscles also co-contract with the TVA and this helps get a better contraction. To activate your pelvic floors, it’s like holding it in (a wee that is!). This is contraction of the pelvic floor muscles.


Lack of stability in some of the deeper core muscles means a loss of power, technique and increased risk of injuries. The point of having good core stability is to allow better movement and power. You need good spinal stability for movement, injury prevention and recovery from injury. Here are some exercises that will help activate the above muscles. Muscles work together so why not try activating them together. Try activating your pelvic floors, TVA and see how you feel. Before you try this program, try some diaphragm breathing first.

Core Stability Program
1.      Tummy Vacuum – 10 seconds and repeat 5 times.
2.      TVA Cuff – 10 seconds and repeat 5 times.
3.      Bird Dog – 10 second holds, 8 times on each side.
4.      Swiss ball roll outs – 3 sets of 10, hold for 5 second on each set.
5.      Anti-rotation and anti-lateral flexion – 20 second holds 4 times on each side.
                                           Video for Tummy Vacuum and TVA cuff exercises
                                           Video for Bird Dog and Swiss Ball Rollouts
Anti-lateral flexion band exercise
Anti- rotation band exercise

This program will help anyone from runners to gym goers, by improving the aerobic capacity, performance and recovery from injuries, but also reduces the risk of injury. You can also do this routine in the gym before big compound movements such as squats and deadlifts. You can also ask your sports coach to add these in at the end of a training session. These exercises are great for co-ordination and balance, and therefore help improve function. So add this program into your training routine and start enjoying your gym sessions. If you are doing it as a warm up or at the end of your gym session, then one circuit will be fine. If you just want to focus on this program, try two to three rounds of it with no rest. Be careful if you have a lower back stiffness, you will need to practice some pelvic tilt and knee rolls to improve mobility. 

Friday, 20 May 2016

5 Ways To Help Plantar Fasciitis

Have you ever had pain in the arch of your foot? Are you getting pain in the heel when standing all day? Well you may have plantar fasciitis. This is inflammation of the thick connective tissue that runs along the arch of the foot, from your toes to your heel. With prolonged misuse, this tissue can develop small tears and become inflamed and lead to chronic heel pain.

plantar fasciitis

It occurs mainly in runners who increase their mileage too quickly or start running on hard surfaces. Although it can affect others especially those who spend all day on the balls of their feet and using their calf muscles. If the calf and Achilles are not stretched regularly, it can put excessive strain on the plantar fascia. It is important to change your footwear during the week and avoid wearing the same shoes all week. This will stiffen up the ankle joint and cause more issues further down the line. Other athletes involved in sports that require repetitive jumping also have a high risk of developing this injury. 

5 ways to help plantar fasciitis

  1. Take a break from running and jumping. Put your feet and relax! Rest is crucial for recovery of this injury. 
  2. Get some sports massage on the calf muscles and plantar fascia. Use a foam roller on the calves and a trigger point ball on the plantar fascia. Do each muscle 30 seconds at a time and do 3 times a day. Be careful not to overdo it on the pressure though as it will be very painful to begin with. 
  3. Ice will help reduce inflammation and decrease your pain. Use it when you are at home and relaxing, try keeping the foot up too. 
  4. Stretching your calf and Achilles against a wall and on a step will help relieve tension. Stretching your big toe on the wall and then going into a calf stretch will also help relieve some tension in the plantar fascia. 
  5. Consider buying a new pair of shoes that feel COMFORTABLE! Wearing the same shoes all the time is not great for your feet. Also when buying a pair of running shoes, avoid going for the pair of shoes that are for your foot type. Go with a pair that feel comfortable to run in. You will need to go to a shop where you can try a few pairs on and give them a try on their running machine. 

Plantar Fascia Rolling
Calf Foam Rolling

Would you like to feel pain free and comfortable? Want to get back to what you were doing before you had heel pain? Book your HALF PRICE injury consultation here - https://sportscorrectivetherapy.co.uk/contact-us/



Wednesday, 13 April 2016

Effects of Massage in the Workplace

Effects of massage on job performance

The great thing about massage is that it feels awesome, it’s very good for your health and it’s great for business!

Research never lies! Here are a few reasons why massage is good in the workplace, your business and for YOU!





Massage has been shown to decrease cortisol levels in the body, cortisol is known as “the stress hormone”. It helps us deal with stress by shutting down functions that are not a necessity at that specific time, for example, the reproductive system and the immune system. This is so that the body can deal with one stress at a time in short bursts. But as we all know, this isn’t the case as stress can be a chronic problem. Have you noticed the constantly stressed people are always ill? Cortisol helps with making new glucose and the breakdown of glycogen stored in the liver and muscle cells. Cortisol also stops insulin from transporting glucose into cells. So this causes too much glucose in the blood, which makes it impossible to calm the body down. It can also affect bone and muscle growth due to inhibiting the uptake of amino acids into muscle cells which means less fuel going to the muscles. It can affect the formation of bones due to stopping the calcium absorption. So chronically stressed people who want to join the gym should really begin with some massage therapy sessions!

Did you know that massage can cure stress and anxiety? It has been proven that a massage on a regular basis in the long term can increase happy, feel good hormones (dopamine and serotonin) and decrease our over-excited hormones (norepinephrine and epinephrine). If our happy hormones are too low for a long period of time, this can cause depression. If our over-excited hormones are too high it can cause anxiety and panic attacks. So think twice about going to the gym on 3 hours sleep, are you really going to benefit from it? Probably not! Don’t get bogged down with too much project work, it’s best to set yourself realistic goals and use time more efficiently. We’re only human!

So how can massage help people in the workplace?

It helps by keeping those happy hormones happy, this means better blood flow and better movement. This allows for better posture sitting at a desk and less pain in general when moving around too!

There are a number of studies that have demonstrated if the core muscle transverse abdominis is not activated and lacks motor control, this can lead to lumbar spine instability therefore can increase the risk of lower back musculature getting injured or becoming painful. Another study looked at how to decrease this risk of lower back pain by taking the muscles through 3-D movement patterns. It found that people in the workplace who were lifting all day had a lower risk of low back pain if they practiced moving the trunk in 3 different dimensions. They are bending over and arching back, side bending each way and rotating to each side. Have you tried moving in 3D? Try bending forwards, sideways with a slight rotation all at the same time. Videos on our channel coming soon!

So if you want a pain-free, happy driven life then book in your corporate massages now for your employees at 20% off the normal price! They don’t have to be deep they can be soft too! If you're not sure about the corporate deals, then why not try one for HALF PRICE?