What Does My Physio Think: will running ruin my knees?

What Does My Physio Think: will running ruin my knees?

Runners are sometimes told by people (who often are non-runners) that running will ruin their knees. We asked our physios and therapists if this is true:

Stuart, our specialist knee and foot & ankle physio says

“Running can actually improve knee health and stimulates cartilage when impacting through the weight bearing phases. Thus it is beneficial to overall joint health so keep on running if you can!”

Our specialist spinal physio Shari says:

“No, not unless you have been advised not to run by your Specialist consultant and/or orthopaedic surgeon. There are certain pathologies that can be worsened by running, but in general when speaking with Specialist Knee Orthopaedic surgeons 5 -10km maximum running distance is ok in moderation.”

Physio Paul, who specialises in sports injuries, says

“There is every chance of ruining your knees if you run very badly, but maintaining good alignment and control through the lower back/abs, hips, knees and ankles can reduce this risk.”

Emily, our massage therapist, triathlon coach, athlete personal trainer, comments: 

“Knee joints are synovial joints which means they produce lubricant to minimise friction. The cartilage in the knee joint is a very smooth surface that aids gliding. Your knees are supposed to bend forwards and backwards over a lifetime. Assuming there is no structural damage and the surrounding muscles are strong and supporting your joints, there are worse things you can do to your knees than running, for example prolonged sitting.”

So - keep on running! And if you’re worried about your knees, give us a call on 02030 12 12 22 to book an appointment with one of our specialist physios.

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.

Avoiding skiing-related knee injuries

Avoiding skiing-related knee injuries

Many of us will be getting ready to go on our skiing trips within the next few weeks or months and enjoyable as this will be, unfortunately can cause injuries. Skiing does not affect only one anatomical area and injuries can occur to the head, shoulder, wrist, thumb and of course the knee. The knee is the most commonly injured body part in skiing with the evidence indicating 42% in some studies. Further to this, the ACL (Anterior Cruciate Ligament) is the highest injury observed within the knee occurring in all ages, genders and technical levels.

Injuring the ACL

The ACL is one of the knees biggest stabilisers and injury normally occurs from a fall, either forward and with a twist or falling backward. Normally the knee will rotate internally causing knee valgus (knee caves inwards towards your mid line). It is not uncommon to injure the meniscus and the medial collateral ligament (MCL) at the same time as the ACL - this is known as the unhappy triad. Interestingly it has been seen that a lack of fitness is one of the most contributing factors indicating that physical preparation can assist in injury prevention measures.

Exercise Intervention

When we land on one leg the hip muscles help to prevent the knee joints rolling inward (knee valgus) while the quadriceps help reduce forces on the knee joint helping deccelerate the body. The hamstring and calf muscles also work to help reduce knee joint forces, stabilising the pelvis and knee and ankle.

Undergoing a basic injury prevention exercise plan can significantly help in not just reducing injury but also improving your skiing consistency as you can improve, muscular strength, endurance, anaerobic fitness, stability, agility and flexibility.

Muscular strength

Recreational skiing is associated with the high muscular use of the quadriceps, hamstrings, gluteal and calf muscles. Evidence has shown that prolonged skiing causes increased eccentric fatigue of the quadriceps and hamstrings that may contribute to injury. To help reduce this lower body exercise such as squats, lunges and single leg squats are all beneficial in improving your lower limb strength and stability.

Neuromuscular/Proprioceptive training

Undergoing some sports specific training, particularly neuromuscular or proprioceptive training, can be beneficial in helping to reduce technical mistakes while skiing. These are training methods that can involve jumping, landing or pivoting or balance work that can help stabilise your knee and leg. These can be undertaken by using a variety of equipment such as the Bosu, inflatable discs, foam pads, wobble boards and jump mats. Improved joint awareness and ability to stabilise can help in skiing performance and injury prevention.

Mobility/Flexibility

A reduction in flexibility of muscle groups and poor joint mobility can cause increase loading on joints and other tissues due to limitations in our movements. For example, tight calf muscles will reduce the ability to squat without lifting the heels. This may cause knee valgus that can then put higher forces into the knee joint. Maintaining good flexibility of the lower limb muscles can help you move more efficiently and improve muscular activation and proprioception.

How physiotherapists can help

We can perform a musculoskeletal screening to help to find your imbalances, biomechanical dysfunctions and then implement a plan to help address these aiding to your injury prevention and performance.

To book an appointment with Stuart or our other physios call us on 02030 12 12 22.

Words by Stuart Mailer.

Injury of the month: ACL Injuries

The Anterior Cruciate Ligament (ACL) is one of two main internal stabilisers of the knee. Along with the Posterior Cruciate Ligament (PCL), the cruciate ligaments work in concert to reduce shear (to the front and into rotation) of the tibia on the femur. This is only one of many functions of the ACL and is one of the main reasons why the ACL becomes damaged.

The anatomy of the knee

As you can see from the above diagram, the ACL has close links to the medial meniscus (cartilage), which is in turn attached to the medial collateral ligament. Remember this, it will become important later….

Main Functions of the ACL

The main function of the ACL is to reduce anterior translation and rotation of the tibia on the femur. It also has an important role in the brain’s understanding of where the knee is in space.

How Does It Go Wrong?

There are a number of ways ACL injuries occur:

• intrinsic - i.e. occur due to movement or loading of the individual knee in a way that overloads the ACL to the point of damage or

• extrinsic - i.e. trauma caused by a blow causing overload of the ACL to the point of damage.
  

Classically, the ACL becomes damaged during deceleration movements with the lower leg is turned outwards relative to the knee, which is why physios keep banging on about hip, knee and foot being in alignment as this reduces this type of shear. This can come from sudden changes in direction, poor landing from a height or pivoting with a fixed foot.

Extrinsic (traumatic) can be caused by force striking (usually) the outside of the knee. In the most severe cases, due to the close links between the structures, an ACL tear can also involve the medial meniscus and medial collateral ligament - also known as the ‘Unhappy Triad’ injury.

What can I do to reduce the risk of ACL injuries?

Much of this needs to be taken care of through management of well aligned movement patterns. If the resting position of the lower limbs tends towards either knees facing forwards with feet turned out or feet facing forward with kneed facing inwardly, stress on the ACL is increased. There are two main contributors to this, either poor hip and trunk control and/or tightness in the calf (especially gastrocnemius) muscle. There seems to be some unpublished data suggesting a predeterminant of ACL injury can be recent poorly/incompletely rehabilitated ankle injuries which then place more load upon the knee.

Read our blog post on how to avoid skiing-related ACL injuries.

What happens if it goes wrong?

An ACL injury is generally accompanied (but not always) by significant swelling. A feeling of the knee giving way (especially on going down slopes or hills) is also a good indicator, however there is usually a significant loss of range of movement and pain that are more obvious indicators.

What should I do?

That depends upon the severity of the injury and what you would like your lifestyle to include. A surgical opinion is highly recommended, however there is quite a trend currently to eschew surgery and rehabilitation in favour of non-operative management.

In my experience this tends to prolong the inevitable surgery and rehab if you are interested in an active lifestyle with multidirectional sports/activities. Rehabilitation can be a long, frustrating process (between 9 and 12 months) however whilst it won’t ever return the knee to the ‘perfect’ pre-operative state, it will give you a strong, functional knee that will allow you to continue the vast majority of activities with minimal restriction.

If you’re having knee trouble, call us on 02030 12 12 22 to make an appointment with one of our knee specialists.

Words by Paul Martin.

Injury of the month: Returning to exercise following an injury

Injury of the month: Returning to exercise following an injury

Keeping active and mobile is important after injury but needs to be done safely to prevent flare-ups and re-injury. The most common complaint that patients come to see our Spinal Specialist Physio Shari for is lower back pain. When lower back pain is acute, and the pain is constant and triggers twinges of pain with movement in all directions, then it is best to rest from the gym, however walking is still encouraged in most cases. When this acute pain settles down then slowly returning to training can be really important in your recovery. There are some tips below from Shari to help you return to exercise.

1. Exercise should never trigger pain in your back

• If you feel a twinge/sharp pain whilst exercising then stop that particular exercise

• There are 3 main reasons why the exercise might be causing pain:

a) it’s not the right exercise for your back at the stage of your recovery

b) your core and stabilising muscles are not engaged properly

c) your posture/alignment isn’t quite right particularly in your lower back

2. Usually low impact exercise is best to start with

• for cardio swimming or cycling are usually good

• remember to start gently and gradually build up the level you were at pre-injury

3. Slow, controlled movements during exercise is recommended

• When you perform slower, controlled movements this encourages the activation of your deeper stabilising muscles which will protect your back

4. Avoid High Intensity Interval Training (HIIT) initially

• Form can be compromised during HIIT type exercises

• Quick, sudden, unguarded movements can often cause twinges of pain and muscle spasm following injury when you are first recovering

5. Try to exercise in frequent shorter bursts rather than doing longer sessions

• During longer exercise sessions your body is more likely to fatigue when first recovering from injury, which could compromise your form

6. Stay positive, it’s common to have set-backs

• When exercising remember to allow your body some recovery time

• Don’t let muscle pain (Delayed Onset Muscle Soreness, DOMs) and stiffness following exercise de-motivate you, just let your muscles recover, usually a couple of days will do, and then try again.

7. Stretching is important

• Everyone should stretch, but it is even more important when you are recovering from an injury as your muscles and joints will be tight and “guarding” your injured area

• Gently mobilise your joints and muscles before and after exercise as well as daily

• Stretches should never be painful on your injured area

8. Warm-up and cool-down

• This is even more important when recovering from injury as your body will be stiffer than usual

9. If in doubt, see a health professional for guidance

• We can help to recommend and show you the best stretches and mobilisation exercises for your body and injury

• We can also identify areas of weakness in your body, and prescribe you with the best strength exercises for you and your injury

If you’re injured we can help you get back on your feet and back to exercise - call us on 02030 12 12 22 to book an appointment.

Words by Shari Randall.

Injury of the month: Tennis Injuries and how to avoid them

Injury of the month: Tennis Injuries and how to avoid them

Has Wimbledon fortnight inspired you to pick up a racquet? Read our Physio Alex's advice on equipment, fitness and avoiding the most common tennis injuries:

Equipment 

It's vitally important that the racket you use is set up correctly for you. This means ensuring the grip size is appropriate, the weight and style of the racket suits your level and style of play and perhaps, most importantly, the string settings are correct.

Even small adjustments can make a big difference to your game and prevent injuries, mainly to the wrist and elbow and also help overcome existing injuries. It's well worth going to a specialised tennis shop for advice on this. 

Fitness for tennis

Tennis is mainly an aerobic sport in that it is made up of short bursts of energy with rest but repeated often. If you are thinking of improving your fitness levels for tennis, training should replicate this. For example, you could do interval sessions on the bike (as opposed to pedalling continuously for 20 minutes or so). Mixing shorter intense bursts (15 secs up to even 1 minute) with rest would be more beneficial. You could also do the same on treadmills or outside running - short sprint type interval training rather than long moderately paced runs.

Circuits or what is commonly known as HIT (High Intensity Training) is a great way to work the entire body from a strength pint of view and also gaining cardiovascular benefits to give you a better engine during long matches!

Focusing on lower limb stability exercises, with lunges being one of the best exercises is really important in being strong on court and allow for sharp, multidirectional changes of direction. A lot of force goes through the legs so having strong, balanced legs with good ability to safely change direction will help prevent injuries. 

Common injuries 

Unlike sports like football or rugby which are played on bigger pitches, tennis is contained to smaller areas so muscular injuries are less common as people don't often reach maximal sprint pace for prolonged distances. So, tennis places more load on the joints and tendons than other sports due to the quick short change of direction and also the fact that it's mainly played on hard surfaces. Here are four common tennis injuries. 

Lower back pain - it's quite common for tennis players to suffer with painful lower backs. Serving in particular places high loads on the lower back and can compress the joints. The combined forces of quick extension and then rapid rotation and flexion can stress the joints. To try and prevent this it helps to have good mobility in your hips and lumbar spine together with a strong core. Focusing on core exercises which incorporate rotation, almost mimicking certain phases of the serve can really help reduce the risk of injury.

Shoulder injures - rotator cuff strains/pain. The rotator cuff is a group of muscles which surround the shoulder joint to provide stability and strength to the shoulder. It's by nature not a very stable joint as it is so mobile so when it is placed through high loads during ground strokes and more so in serving, it can lead to strains and/or inflammation of these structures. Working on the control and stability of these muscles by doing overall shoulder strength training but in particular lots of lighter rotational work will help prevent injuries. 

Tennis elbow - or as its known clinically as Lateral Epicondylalgia is not exclusive to tennis but is prevalent, especially amongst amateur or club players. As stated above, equipment is key and so is technique on shots. The forearm muscles which moves the wrist and elbow are small and not particularly strong. They are prone to being overstretched whilst under stress (particularly on backhand). Having good technique and also good strength in the wrist and shoulder can reduce the load on these delicate muscles. 

Patellar tendon/achilles tendon pain - as mentioned above, due to the start / stop nature of the sport, these joints and associated tendons take quite a beating! As with trying to prevent most tendon injuries around the body, keeping strong and conditioned in the bigger muscle groups will protect the joints and tendons. If you think of the joints as the area which will take the most force during movements, and the muscle system as the braking mechanism for this, the stronger and more efficient those brakes are to slow down the forces, the less load will be placed on those tendons and joints.

If you have tendon pain already during tennis its important to seek professional advice. Patients often come to us with several months' history of tendon pain as it can be painful but often can be 'played through', and it's true, often with the correct advice and exercises you can continue to play but it needs to be properly assessed first. 

If you think you may have an injury related to tennis or want some advice on any of the above or anything else please feel fee to contact us or book in with one of our physiotherapists. Enjoy the tennis season and the strawberries and cream (but not too much cream!...)

Words by Alex Manos.

Injury of the month: Musicians' Injuries

Injury of the month: Musicians' Injuries

Physio Remedies' Physio Stuart Mailer has worked with world famous bands from the UK and the USA and been on tour with them, so we asked him to talk about injuries suffered by musicians and how to prevent and treat them.

For many musicians injuries can be hugely debilitating and, like any professional athlete, this can cause significant problems when performing.

Musicians can suffer from a range of injuries depending on their instrument of choice. For example, a violinist may suffer from a rotator cuff impingement or cervical pain. A bass player may suffer from elbow dysfunctions or injuries. Even being highly skilled and trained does not mean that the musician is void of injury.

Injuries can occur from trauma or overuse such as increased volume of loading/playing or changing instrument. For example the different action of a guitar or fret width or even changing the seating position on the piano can affect tissue loading .

Drummers go through constantly high loads when performing. For example, in a 60 min performance there may be 5,000 impacts on the bass peddle, their heart rate may be sitting at 75%  or averaging at 140-160bpm - similar to having a long run. This is same as many elite athletes experience. Further to this there is also a high amount of load on their lower back, neck and forearms.

It is not uncommon for drummers to suffer from low back problems such as discogenic injuries or cervical problems. These can be treated and managed well by adapting sitting position or technique and drum kit set up. Also undergoing specific exercises and injury prevention prehab can help reduce the likelihood of injury.

If you play an instrument and suffer from injury it is certainly advisable you see a Physiotherapist to assess and check your biomechanics and playing position to help in assisting your recovery or intervention.

If you'd like an appointment with Stuart or any of our other Physios, please call us on 020 30 12 12 22.

Words by Stuart Mailer.

Injury of the month: marathon injuries

Injury of the month: marathon injuries

With the London Marathon* approaching fast it’s a critical time for participants as they increase their running distances preparing for the gruelling 26.2 miles ahead.  It’s a time when niggles may well turn into more significant injuries so it is key to be aware of some of the common injuries; how to spot them and what to do to try to avoid them progressing and ensure you get to the starting line but more importantly the finishing line!

Here are two of the main injuries we see related to marathon training:

Shin Splints

Shin splints is a bit of an umbrella and non-specific term which refers to pain in and around the shin. There are two main areas which cause problems.

Anterior shin pain located in the muscles at the front of the shin occurs when there is excess load in these muscles and they can become inflamed, as can the fascia (the surrounding tissue around the muscle).  Typically this will be painful when pointing the toes and ankle up and during running, to the point where it can cause you to stop.

The other area is on the inside of the shin, MTSS (Medial Tibial Stress Syndrome). Again the muscles and the fascia become overloaded and inflamed and here the can affect the bone as well. The tension from the soft tissue can place load on the bone which then becomes inflamed and in more severe cases can lead to stress fractures.

Resting pain, pain at night and significant pain to touch the shin may indicate a more severe injury. Poor biomechanics, inappropriate footwear, tight calf muscles, poor stability and excessive training loads are contributing factors.

ITB friction syndrome / runner's knee

Although not exclusive to runners, the above pathology is seen mainly in runners and in particular longer distance runners.  The actual cause of the pain itself is still uncertain but the consensus is that there it is from excessive friction between the tendon on the outside of the knee (Iliotibial Band tendon) and the structures underneath it attaching to the outside of the knee. 

The friction is mainly caused at about 30 degrees of knee flexion which is the approximate angle the foot hits the floor when running.  The pain is very well located to the outside of the knee, can be sharp and stabbing like.  The pain often comes on after a specific time or distance of running and can be severe enough to cause you to stop. As it becomes more intense, it may even be painful to bend the knee and not just be painful with running. 

Again, contributing factors can be, weak gluteal muscles, tight thigh and anterior hip muscles, poor running biomechanics, and inappropriate increase in training loads.

Treatment

For both of the above injuries it is important to get an early diagnosis as this will help prevent the injury from worsening. The quicker earlier intervention is implemented the better the chance that the injury can be managed for the rest of the training until race day.

A physiotherapist will be able to assess the injury and assess what the contributing factors are by having a detailed assessment of the body, the way it moves and also look at external factors such as training methods.

With not long to go, it may well be a case of reducing the training and substituting some runs with some rest and gym sessions to work on problem areas. Marathon runners often over train the running aspect and neglect the strength and gym work which is crucial to maintaining good biomechanics and reducing the load on sensitive structures.

As well as correcting any imbalances with hands on treatment, a physio will put together a rehab plan with exercises and self help advice to ensure all areas are covered.

As always, prevention is better than cure so if you'd like us to check out any issues or if you'd like a pre-marathon sports massage, call us on  02030 12 12 22 to make an appointment.

* Other spring marathons are available.

Words by Alex Manos.

Injury of the month: lower back pain

Lower Back Pain

Research studies show that over 80% of our population experiences lower back pain in their lifetime. In some people this can also be persistent or recurrent lower back pain.

What is lower back pain?

Lower back pain is pain is pain anywhere from the bottom of the rib cage to the buttock creases. Sometimes people with lower back pain may also feel pain in their legs and feet.

What causes the pain?

There can several structures contributing to lower back pain and these include the spinal joints, discs, nerves and the connective tissue such as the tendons/muscles and ligaments.

Why does it occur?

This depends on whether the lower back pain is a new episode, exacerbation, acute pain or persistent pain.

A diagnosis should always be established by your health professional, as causes can sometimes include infection, fracture, inflammatory conditions, malignancy or other systemic illnesses of the body.

However most commonly the cause will be related to sedentary lifestyles or incorrect training technique and posture.

 

How can physiotherapy help?

Your physiotherapist is specially trained to help diagnose your lower back and work with you to formulate the best treatment management plan for your recovery. Often this include hands on treatments such as mobilisations, massage, postural assessment, education on prevention and self-management at home and at work as well as prescribed exercises to assist you with pain reduction, increased mobility and strength.

If you'd like an appointment with either of our Spinal Specialists, Sarah and Paul, please call us on 02030 12 12 22.

Words by Shari Randall.

Nick Smith's Guide to Ski and Snowboard Injuries and How to Avoid Them

Nick Smith, Shoulder Specialist Physio: Having assessed and treated two significant shoulder injuries this month that both required surgery - one from snow boarding and the other skiing - I thought I would  explain some of the the common snow boarding and skiing  related injuries and how they can affect you.

Soft Tissue Injuries

Soft tissue injuries occur when falling awkwardly. The rotator cuff muscles are most commonly injured, resulting in pain, loss of shoulder movement and power. Low grade injuries can be treated successfully with physiotherapy. More significant injuries may require a shoulder specialist referral and imaging, and then physiotherapy. Other structures often injured include the shoulder cartilage, bursa, tendons and chest muscles. Be aware of significant bruising to upper arm and chest muscles and changes in muscle contours.
 

Shoulder Joint Dislocation

Shoulder joint dislocation generally occurs when falling and your arm is away from your body. Acromioclavicular (joint on the top of your shoulder) separation occurs with direct impact to the top of your shoulder. Pain, joint deformity, loss of shoulder movement and swelling usually result. Depending on your age and grade of injury, research indicates physiotherapy is your best choice of treatment.

Bone Fractures

Bone fractures to upper arm, shoulder joint, clavicle (collar bone) and shoulder blade occur with impact injuries either with your arm away from your body, onto your elbow, or direct trauma to the shoulder joint. Be aware of pain, joint deformity, loss of movement.

Wrist injuries

Snow boarders have a significant increased risk of injury to the wrist, hand or thumb. These injuries occur due to falling on an outstretched hand (FOOSH) and trying to break your fall. Wrist guards can be worn to help protect and limit the damage.

Injured?

If you sustain any of the above injuries get them checked out, most low grade injuries respond with physiotherapy!

How to be safe(r) when skiing/snowboarding: 

1. Do not over estimate your own ability/fitness - Altitude can cause fatigue, shortness of breath, headache and nausea within the first 48 hours. Drink more water, avoid salty foods, eat high carb foods e.g. pasta, fruit, vegetables. 
2. Consider the terrain and snow conditions - If you are in a white out or flat light, slow down and use your poles by keeping them in contact with the ground, stay relaxed, look out for markers on the piste, use the correct goggles and keep them clean.  When conditions remain excellent, remember that the risk of avalanche remains high in most places this season.
3. Check your equipment - every day before you ski or snowboard and have any faulty equipment repaired or replaced before you hit the slopes.
4. Avoid excessive alcohol - it's obvious, but before you order that last vin chaud, consider whether it could be your undoing on your ski back from the bar to your chalet.

If you'd like an appointment to see one of our physios, please give us a call on 02030 12 12 22.

Words by Nick Smith.

Injury of the month: Headaches

Is Your Headache Really a Neck Ache?

Headaches are often caused by disorders of the neck or physical and emotional tension. For many people, headaches start as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, forehead or behind the eyes. This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck or muscles can cause referred pain to your head. 

Does this sound like you?

• Pain radiates from the back to the front of your head?

• Headache with dizziness or light-headedness?

• Headache brought on or worsened by neck movement of staying in the same position for a long time?

• Headache which always feels worse on the same side of your head?

• Headache eased by pressure to the back of your skull?

• Headache which persists after your doctor has checked for other causes?

How We Can Help:

Postural neck ache can usually easily be treated with some gentle mobilisations by a   physiotherapist and a stretching programme to prevent recurrence.

Physiotherapists can successfully treat headaches originating from the neck or soft tissues and show you how to prevent the pain from occurring. Even if you think your headache doesn’t come from your neck we can often help to reduce the intensity.

1. Mobilisation

2. Manipulation

3. Massage

4. Relaxation therapy

5. Functional and rehabilitative exercise

6. Encouraging normal activity

7. Postural assessment, correction and advice

8. Muscle activation and re-education

Your physiotherapist can also offer you self-help advice on ways to correct the cause of headaches, such as practical ergonomic tips for work and in the home; adjusting furniture, relaxation, sleeping positions, posture and exercise.

If you'd like an appointment with our Spinal Specialist, Shari Randall, please call us on 02030 12 12 22 or send an email to info@physioremedies.com .

Words by Kara Mulvein.

Injury of the month: hip & groin pain

‘It’s jungle country down there, mate.’ These were the words of a hip surgeon relative of a physio friend of mine when referring to an area of the body known as the femoral triangle. The rationale for this comment was variabilities in local anatomy from person to person can make it very difficult to consistently predict the location of sensitive structures between individuals. The challenge with a lot of hip and groin pain is that there are a lot of structures that can refer symptoms to the area which can lead to subsequent overload of inhibited structures.

Image source - Health Appointments

Within any injury or pain system, whilst there may be a single causative factor or structure it is often the case that there will be an element of affect across muscle and tendons, joints, the nervous system and some connective tissue. Within the groin, there are many muscles, both big and small that affect the hip joint and many nerves and blood vessels that pass through the area to supply the lower limb. Keeping these muscles in balance is part of the approach, however it is often not as straightforward as that.

Tight Hip Flexors?

An often-reported problem for people with groin pain is that they have tight hip flexors. This is all well and good, however it doesn’t explain either why they are tight or what to do about it beyond stretching. Whilst tightness in the front of the hip can be common in groin pain, there might be good reason why this is an overriding finding in that they are often overloaded. One of the major hip flexors (psoas major) originates from the front of the lumbar spine.

View fullsize

Image source: Health Appointments

Weak Hip Flexors?

With poor abdominal control, they are in a good place to offer some stability to the front of the lumbar spine. Often addressing abdominal muscle control and timing is enough to offload these muscles. However, during my time working with elite athletes, we found many of the sprinters would complain of groin pain which we attributed to these mystical tight hip flexors, so we worked on the gluteals and hamstrings which we found were often inhibited. Our problems didn’t get any better until someone suggested that perhaps the hip flexors were weak and needed some strength work alongside appropriate abdominal work. After starting this approach our groin pain reports dropped significantly.

Solution: Restore Control

Much like the shoulder (another interface between limb and torso), the hip and groin areas are complex areas that are links between areas requiring controlled stability and movement. Restoring control of the trunk and effective timing of abdominal musculature can allow pain related to overloaded structures to settle and start to regain balance within this area.

Paul is our hip & groin specialist - if you'd like to book an appointment with him please call us on 02030 12 12 22 or email us on info@physioremedies.com.

Words by Paul Martin.