Body Part Of The Month: The Neck

Body Part Of The Month: The Neck

For the next blog post in our Body Part Of The Month series, our spinal specialist physio Paul tells us about the neck.

The Neck

The neck is comprised of 7 vertebrae. It plays a vital role in providing the immediate base for the head to sit on and the origin point for many muscles of the neck and shoulder girdle. The vertebrae contain and protect the upper spinal cord and brain stem which can migrate down as far as the third vertebrae in certain movements. From an evolutionary perspective, good mobility is vital in the neck as a means of allowing wide range visualisation to spot danger. This mobility is maintained by good alignment of the various joints within the neck which, between the 7 vertebrae, vary considerably.

The joint between the base of the skull and the top vertebrae (atlanto-occipital joint) is shaped similar to the joint in the knee so allows hinge movements - this joint is where a large percentage of nodding (flexion and extension) occurs. The joints between the 1st and 2nd vertebrae (atlanto-axial joint) are much flatter and sloped slightly down which allows for the majority of rotation in the neck (up to 60% of neck rotation occurs at this joint alone).

There are lots of muscles that attach around the lower part of the skull and upper neck joints that when working well allow smooth movement - if they become overloaded or overstretched, this is when movement can become limited and this can have an impact upon the rest of the neck and lower down the spine. The other 5 vertebrae link with progressively steep joint angles as the cervical spine transitions towards the thoracic spine.

When your neck works well

The neck works best when weight is evenly distributed through each of the cervical vertebrae. There should be a mild front to back curve in the cervical spine (lordosis) which is concave to the rear. The head should sit squarely on the top of the neck. To allow this to happen there needs to be good support from the lower back and thoracic spine as the head is essentially balanced on top of a long stick comprised of lots of small parts stacked up vertically. Changing the position of some of the lower vertebrae means the head needs to change position to balance you properly - to test this, sit upright on a chair. Then slowly allow your lower back to bend and your pelvis to rock back - feel the effect this has on your neck (it should feel like it's sliding forwards and poking out your chin).

When your neck doesn't work well

Neck pain can be easily distracted by pain in other areas - often the shoulder and arm. Broad, vague areas of pain in the shoulder or upper limb can be more to do with some stiffness in the neck rather than local shoulder pathology. Neck joint or muscle stiffness can contribute to referral into shoulder or upper arm pain and, of course, being where the majority of sensory nerves to the arm originate, neck issues can have wide ranging impact. As well as that, disc issues in the neck can impact basic function downstream such as gait and lower limb power although this is rare. Local muscular spasm and joint stiffness can be very painful and this pain can significantly limit range of movement in one direction - when addressed quickly this can be quickly resolved.

Common neck injuries

Most neck issues we see are fairly mild and tend to be related to postural changes with prolonged sitting. Often neck pains in a whiplash style can occur following a fall where the arm or shoulder breaks a fall but the head keeps going, placing strain on the muscles to the side of the spine. Occasionally there is little immediate neck pain in this scenario, but it tends to creep up over subsequent days. Local muscular spasm is fairly common, often when turning the neck in an awkward way - this can be worse when carrying or lifting a load.

Avoiding neck pain

The key to avoiding neck pain is maintaining a good range of movement (this will vary from person to person) and a good head on neck posture. Whilst the local muscle length is important, a lot of good neck posture starts around the lower back and abdominal muscles that offer a base of support through the thoracic spine to the neck itself. Once this area is improved, local neck management can become a lot more straightforward.

As always, if you have any persistent niggles, aches or pains in your neck or other places, don't soldier on in silence making them worse. Get in touch with us if you need us.

Words by our specialist spinal physiotherapist Paul Martin.

Bodypart Of The Month: The Shoulder

Bodypart Of The Month: The Shoulder

Next in our Bodypart Of The Month series is the shoulder. We asked our specialist shoulder physiotherapist, Nick Smith, to tell us all about it.

The Shoulder

The shoulder, or Glenohumeral joint (GHJ) is a ball-and-socket joint like the hip joint. The hip joint has a ball that sits in a very deep socket making the joint very stable.  The ball of the shoulder loosely fits in a shallow cup (the glenoid). It is very much like a golf ball on a tee. The GHJ has the greatest mobility of any joint in the body, but is less stable than the hip and more prone to injury.

Soft tissue structures helping to stabilise the GHJ include:

• Joint capsule and ligaments.

• Glenoid labrum - a ring shaped cartilage structure that increases the depth of the glenoid by 50%.

• Rotator cuff (RC) muscles, deltoid and long head of biceps.

In the shoulder there are 6 bursa, sacs filled with fluid found between tissues (bone, skin, tendons and muscle), acting as a cushion to decrease the friction and the irritation between the tissues that move between each other.

When your shoulder works well

When your shoulder is working well the rotator cuff (main function is to keep head of the humerus centred in the glenoid as the shoulder moves, and to lift and rotate the shoulder in the many directions) muscles are working together allowing your shoulder to function without pain and you can participate in your chosen sport or activity.  

When your shoulder doesn’t work well

When your shoulder is not working well this can lead to soft tissue inflammation and possible damage. Injuries include rotator cuff tendonitis and tears, Sub acromial pain (impingement), SLAP (labrum) cartilage tears and bursitis.

Common shoulder injuries

Shoulder dislocation, often due to trauma and falling on an outstretched arm, is a common injury I see in clinic. Most dislocations respond well to physiotherapy and rehabilitation. Occasionally surgical stabilisation may be required if you sustain bone and soft tissue trauma during the dislocation.

Rotator cuff tears are also a common injury and are caused by injury, overuse and degeneration. The treatment of rotator cuff tears depends on the size and location of the tear. Small tears can be managed with physiotherapy and strengthening exercises. Full thickness tears will require surgical repair and then physiotherapy.

Avoiding shoulder injuries

Don’t over load your shoulder too hard too quickly. Build up your strength, resilience and tolerance to load. Ensure you have to correct technique for your chosen sport and activity.

Got shoulder pain or niggles? Call us to make an appointment with Nick on 02030 12 12 22.

Words by Nick Smith.

Body Part Of The Month: The Spine

Body Part Of The Month: The Spine

For the next blog piece in our Body Part Of The Month series, our spinal specialist physio Shari tells us about the spine.

The Lumbar Spine And Lower Back Pain

At some point in our lifetime 80% of the population will suffer from lower back pain. There are a number of different causes of lower back pain and if your pain is persisting it is always recommended to seek the opinion of your health care professional.

Causes of Lower Back Pain

Sometimes the cause of back pain can be a muscular strain from being in an awkward posture after gardening or a long flight, and other times the cause may be from a structural problem.

Below are listed some of the common things I see in practice:

• Non-specific lower back pain

• Discogenic lower back pain

• Radicular pain-caused by neural impingement and often experienced as symptoms in your thigh or leg, be it pain, numbness, pins and needles or weakness

• Facet joint pain

• Spondylolisthesis: forward slip of the vertebrae

• Fractures

• Osteoarthritis

• Stenosis: narrowing of the space in your spine where the nerves are present, and associated with arthritis

• Rheumatological conditions - auto-immune conditions

• Sacro-iliac joint pain

• Pregnancy related pain

• Hypermobility associated pain

Assessing Lower Back Pain

When treating my patients initially I will take a thorough history of your condition, and ask about your past medical history, your current symptoms, medications, activity levels, stress levels, occupational requirements and goals. Then a physical assessment will be undertaken to determine your diagnosis. Occasionally scans and investigations are needed, and you may be referred to a specialist consultant doctor.

Following this we will formulate a treatment that will best address your issues whether it be improving the mobility of your spine, your pain or strength deficits.

 Treating Lower Back Pain

Exercises that address the flexibility of your spine and the surrounding joints such as your upper back, as well as your hips and pelvis can also be beneficial, as can exercises that address the activation and strength of your stabilising muscles, to help get you back to the activities that you enjoy.

Sometimes taping and belts can be helpful in the acute stages of pain or where stabilisation is needed such as in pregnancy. Occasionally medication may also be necessary to reduce the inflammatory pain in your spine so that you can undertake the prescribed exercises.

In severe cases of pain spinal injections by a specialist doctor are needed to reduce inflammation, which then can enable patients to be able to undertake their exercise rehabilitation.

In most cases it is best to maintain your mobility and activity levels as long as this isn’t aggravating your symptoms.

Words by our specialist spinal physiotherapist Shari Randall.

How To Stay Injury Free Whilst (London) Marathon Training

How To Stay Injury Free Whilst (London*) Marathon Training

With the London Marathon* coming up at a rate of knots, we asked Stuart, our lower limb and sports injury specialist physio, to give us his advice on how to stay injury free whilst training for a marathon:

Runners, joggers and walkers view the marathon as the ultimate fitness test and challenge with a record number of people now participating globally. Many will have never completed this kind of run before and are also not seasoned runners. However, this does not stop many of us trying to complete this challenging and arduous task and getting that medal for the 26.2. 

Training for a marathon can be a daunting task as many people are worried about being injured and how they will react if this is the first time they have ventured into the higher mileage brackets. It has been viewed in the evidence that most people who do participate in the marathon will suffer from some injury during their training or the race. For example, it has been seen that novice runners sustained 30-38 repetitive strain injuries per 1000 hours of running while marathoners running more than 200 minutes per week sustained less than 10 RRIs per 1000 hours of running.

There are many ways to help reduce the likelihood of injury such as good preparation/warm up, having a good base level of strength and stability monitoring your build up gradually and of course having rest days:

Warm up:

The purpose of a warm up is to increase core body temperature, muscle activation, joint mobility and prepare the body for activity. The ability of the muscle to contract efficiently can benefit greatly as the quadriceps can help reduce up to 60% of the load through the knee joint when landing during a run thus being warmed up appropriately can prevent any knee injuries.

For the ideal warm up we should incorporate a high number of dynamic tasks such as lunges, calf raises, toe walks, leg swings. The evidence has been shown that a Dynamic Warm Ups performed pre training can also enhance and improve performance.

Strength and Stability Exercising:

A base level of strength and stability is required to undergo any exercise or physical task. For example if we are running and have a cadence speed of 140 then we are impacting 70 times on each leg every minute that requires the ability of the body to absorb force and propel us forward while trying to maintain good kinetic chain control and stability.

Resistance training has shown improvements of up to 8% following a period of resistance- or strength-based training during a normal running training plan. This can be attributed to improving running economy and improved neuromuscular control. When we consider that any small improvement can impact running economy the benefits may have a larger impact on long distances such as a marathon. 

Training plan: 

It is a advised that you don't increase your mileage by more than 10%. The 10% rule is one of the most important principles to adhere to help prevent injuries. As most running injuries are overuse in nature the 10% rule can help prevent this. It may be a long and slow process by only increasing the 10% but it will help keep you running safe and for longer.

Rest Days: 

Having rest days helps not just your body to recover but reduces the likelihood of injury. It has been seen that less than two days rest in endurance runners had an increase of 5.2 fold of overuse injuries. Every day that we exercise causes microdamage to muscles and without adequate rest we don’t repair. Build in a few rest days each week to help recharge, reduce injury and then improve your training and performance.

If you experience any prolonged niggles or pain during your marathon training period, don’t ignore it. Get expert advice and help. Call us on 02030 12 12 22 to book an appointment with one of our specialist physios.

* Other marathons are available.

Words by Stuart Mailer.

Body Part Of The Month: The Hip

Body Part Of The Month: The Hip

This month our body part of the month is the hip and so we’ve asked our hip and groin specialist, Paul Martin, to tell us about to tell us a little more about the hip:

One of the more important muscles around the hip is gluteus medius - shown in red in the image above. It’s not the biggest muscle in and around the hip and pelvis but its effects are wide ranging and having it function well is important for healthy functioning in many areas, the hip, lower back and knee to name but three.

When it’s all going well

What happens when it all works well for the lower back? When it works well (i.e. it is strong enough to bear the load and operative at the correct time to absorb the work), it is able to stabilise the pelvis on the hip. When we stand on one leg, gluteus medius works to keep the pelvis level providing a level base for the lower back to sit upon.

What happens when it works well for the hip? Gluteus medius plays a large role in keeping the ball of the hip squarely in the socket. It plays a key role in moving the leg away from the midline of the body but it also contributes to both internal and external rotation of the hip (i.e. rolling inwards and outwards) so will control excesses of these movements as well

What happens when it works well for the knee? Due to the control of rotation around the hip, when functioning well it can limit shear and rotation of the femur (long thigh bone) on the tibia (shin bone) which reduces risk of overload in other muscles to control this movement.

When it’s not going well

So what happens when it’s not working well? The opposite of the above. The pelvis will provide a less level base for the spine to support itself from, single leg standing (e.g. during gait) will likely be accompanied by some form of hip or pelvis on hip rotation depending on which parts of the muscle aren’t playing ball which means that a number of rotational forces will resolve themselves around the knee.

Sounds catastrophic! How can we possibly survive without gluteus medius functioning? The body has a phenomenal ability to create compensatory movements or actions that mean that we can still function if a few muscles aren’t doing what they should when they should. However if these things get out of control it can lead to tight muscles on the outside of the leg and Runner’s Knee, or tightness in the back muscles or even back pain.

How to get it going well

Keeping on top of this little muscle won’t cure all your ills, but it can certainly help keep some nasty aches and pains away.

The video in this link gives five good gluteus medius exercises and also shows progressions too. They are:

1. Side-lying abductions

2. The pelvic drop

3. Single leg deadlift

4. Single leg squat

5. Side bridge (or side plank).

Are your hips causing you concern? Call us on 02030 12 12 22 to book an appointment with one of our hip and groin specialist physios.

Words by Paul Martin.