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.

Pandemic Lessons Learned - Dealing With Uncertainty

Pandemic Lessons Learned - Dealing With Uncertainty

Dear all, I hope that you are safe and well and I think it is just about ok to still wish you a very Happy New Year! 

In June I wrote a blog post with the title “Looking after our mental health in challenging times”. At that point it looked like we might be nearing an end to the pandemic or at least there was some movement in the right direction. Six months later we find ourselves in a national lockdown and it is almost a year from when this first started.  

There is no denying it, this has certainly been a challenging time for a lot of people. Work adjustments, parenting challenges, relationship dynamics changing, social life alterations, sport and exercise modifications and so much more has meant we have had to adapt in the most unexpected of ways. When something is also out of our hands and the changes are enforced upon us, it can seem more challenging as the locus of control is external rather than internal.  

For today's blog post I thought it would be useful to discuss some of the lessons learnt and how we can approach the current situation to best manage life around us. Here are 3 main lessons we can learn:

Lesson 1- Control The Controllables

 “ You cannot control what goes on outside. But you can always control what goes on inside.” Wayne Dyer.

 In life we have a choice to make which although can seem reductionist and too binary, it can serve to let us control how we see life events happening. One is to see them as happening TO us and the other is to see them as happening FOR us. The former places us in a path of accepting that the events which occur which are not initially perceived as positive are almost there as a form of punishment. We demonise the event and see only the struggles we have faced and what we have lost. The latter mindset gives us a sense of opportunity and curiosity. No one can control this virus 100%. Our attempts with all the measures in place , vaccines, lockdowns etc serve to maintain, reduce and hopefully bring closer and end to it. But,  the virus is way more powerful than we are and will live it life as it sees fit. 

We can accept the situation as it is and learn to find elements in our life which we can take more control of,  or we can waste time and energy on gathering even more information, reading more news, hypothesising as to what may or may not happen with the virus. What becomes of the latter? There are thousands of people out there whose job it is to do this, the scientists, doctors and researchers who are paid to spend their time doing this. And yet we get drawn into joining them to feel some level of control over the situation when in reality, not even the experts have the answer.

If we spent more time focusing on what we could control we would undoubtedly have less anxiety, less fear, more time for ourselves, more energy to pursue meaningful endeavours which would serve our own personal development and overall health and wellbeing. Sure, we need to know the basics and what big changes have happened, but other than that, could it be that the time spent mulling over the uncontrollable could be better spent controlling our inside world?

Lesson 2 - Adaptation Not Abolition

“The key to success is often the ability to adapt.” - Confucius.

When something gets taken away from us or becomes more of a challenge we can approach the situation with 2 points, fixed or growth. The fixed mindset can tell us things like: 

• Well that's it, I can't do that anymore so I’ll stop completely until this is all over.

• If I can’t do it like I did before then I’ll just stop it altogether.

• I’m all or nothing so I’ll wait until I can give it my all again.

• It’s pointless just doing a little, the benefits won’t be enough.

I have heard similar principles being said over that least few months. People who, for example used the gym regularly, altogether stop as it’s not accessible. Or people who have less time now to dedicate to their rehab stop. It is our job as clinicians to help you find ways where you can adapt and not abolish all the things you used to do. There has to be a level of acceptance of the status quo and a willingness to adapt in spite of it. Having the above mindset allows you to have ready made excuses as to why you can’t continue doing at least some of the things you did. A growth mindset has the following dialogue:  

• Ok. This has happened, what is possible for me instead?

• I can’t do that anymore, but what could I do?

• Even a small step is bigger than no step at all.

• The skills I learn now could improve my old skill when I get back to doing that.

Let’s take playing tennis as an example, which has at times not been possible. If you were to take all the components of playing tennis down, what could you still work on and perhaps even improve? Perhaps you know that your footwork isn't the best at times. Buy a speed and agility ladder and work on that for a few months, that would no end help your game! Perhaps you've had that niggly shoulder whilst serving that you can't shake. Spend some time working on the strength and stability of that shoulder to allow you better performance when you're back.

 If you dig a little deeper into things, the space and time we have been given can serve as a powerful vehicle to allow you to upskill. It sounds so basic but I often say to patients “Ok, so you can't spend an hour in the gym anymore, can you spend 15 minutes doing a HIIT class?” They often respond with “Well what will that do?”. “ More than doing 0 minutes will” I say. In times such as these, sometimes we have to appreciate that maintaining and ticking over is just fine and that is way more conducive to just stopping.

Lesson 3 - Finite vs Infinite 

“The infinite is in the finite of every moment.” - Zen proverb.

Life can be divided into things which are finite and infinite. Films, sports, a working day, a song, a train journey, a holiday, all these things have a start and an endpoint. It’s easy to conceptualise this and place ourselves in that time frame. What you notice about these things is that they are just that, they are things or events. What isn’t finite in life is our emotions, our development, our intellect, our wisdom, our growth and our experiences of life. It’s very easy to approach this pandemic and more specifically the virus itself as a finite thing. Whilst at some point, yes, Covid-19 will cease to exist, there will not be an end to viruses as a whole for now, or at least perhaps ever, in the life existence as we know it.

 I feel that at the moment so many people are placing such emphasis on dates, numbers, restriction changes to this that they approach it with an end in mind. Like other things in life, if we lead with expectation over appreciation of agreements then this can set us up for disappointment. If our expectations are met (let's say the news aligns with what we hoped for), we gain a momentary sense of relief and some level of freedom may come with it. But what next? Do we then start to set higher expectations? What if they aren't met? What if there is a u-turn like there has been so many times? Do we then continually just ride this rollercoaster of emotions ranging from elation to stress and worry? What actually changes?

 Something which can help in these situations is to actually place yourself way ahead in the future, several years even. Think about a conversation you might be having with someone who either lived through this or perhaps didn't, a niece or nephew or a grandchild.  Hopefully that conversation could go along the lines of “Remember that time when everything was really weird and we had to wear masks and everything was shut, how strange was that? But here we are, still living life.”

 This, like many things, will be a memory in years to come. It will have its place in history like other events. Check in with what is present to you and how the moments you have during this time are approached with a sense of openness and optimism. Ask yourself this one power question to keep present and focused: “How can I approach today different or better than I did yesterday and how will that keep me focused on the infinite approach to feeling and experiencing a different appreciation for the now?”

Thank you for taking the time to read this.

Alex. 

Alex is a physiotherapist with Physio Remedies and also a Life Coach. He works with people to gain greater awareness in any aspect of their life they may be struggling with by allowing them to explore what might be possible with more clarity in their goals and ambitions. Ultimately he aims to provide opportunities to people to lead a more fulfilled and extraordinary life by unlocking their fullest potential. You can get in touch with him at alex@alexmanoscoaching.com and follow him on Instagram at @alexmanoscoaching.

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.

8 Tips To Master Your Mindset Through Injury

8 Tips To Master Your Mindset Through Injury

I hope you are all safe and well and are hopefully coming out of this period in a good place. Although this time has been challenging for many, it certainly has given us some space to reflect on many things which hopefully will serve you well moving forward. 

Today I wanted to talk about how to manage your mindset through an injury. This is such a crucial part of overcoming an injury, and in fact, can be the difference in the time of recovery and also the success of the recovery. Injuries are difficult to deal with as they stop you doing the things you love doing or even more practically can stop you from being able to manage normal daily activities. There is a huge three way connection between the mind, the brain and the body. As an analogy I like to think of it like this. Imagine an oil refinery, the petrol and a car. The oil refinery is the mind, the petrol is the brain and the car is the body. 

Processing     →     Fuel     →     Performance

Oil refinery     →     Petrol     →     Car

Mind     →     Brain     →     Body

Ultimately what we fuel our body with, physically, mentally, emotionally, spiritually, will determine the performance of the car. I know first hand, both having being injured and also having seen 1000s of injuries, just how a person’s mental attitude can help. When I worked in professional football, what amazed me was the difference in how players coped with similar injuries and how this impacted on their recovery. Although we can’t cheat physiology, healing and anatomy on a grand scale, we can certainly change it by altering our brain physiology which has an impact on our perception of pain and function and can lead to a quicker and more successful return to full health. 

Below are 8 tips for managing the energy that goes into overcoming your injury. No matter how big or small your injury is, there is always a place for improving the overall well being of your mind to help your recovery. 

1. Accept and don’t blame - At times of course, our actions may have been a factor in our injury. If we suddenly did something we were completely unaccustomed to then yes, we could look back and say ‘Oh why did I do that?!’. This is ok, but rather than blame ourselves, we should use it as a lesson for the future. We don’t set out with an intention to injure ourselves! We most often have good intentions, to be healthier, fitter, stronger etc, and this enthusiasm can overlook the fact that our body was perhaps not prepared for that change. Accepting that it has happened and moving on to deal with it as best as possible is key. 

2.  Don’t compare - No two injuries are ever the same and they are certainly not the same in how they present in different people. It is important to stay present to your injury and focus on that and that alone. You can certainly draw on experiences of previous episodes you may have had or people you know who have had similar but use that as a check point rather than a strict comparison. You may judge your progress negatively if you compare it to others who have recovered quickly. Stay in your own reality. 

3. Goal setting - This is a really crucial area and it is up to you and your therapist to come up with short, medium and long term goals. The most important of these are the short term goals as they will keep you present. At the start of your rehab your therapist should know what your ultimate goal is as this differs for everyone. Short term goals however are the key to keeping momentum going. You should establish a set of what we call process goals and then little tests you have to pass before you can move onto the next stage of rehab. This really is more for your therapist to do and then give you the exercises to reach those milestones but it’s really important to understand how these process goals will move you closer to your long term outcome. In the back of your mind, have that long term goal in sight, but each day focus on the tasks right in front of you. This is what will cause the mini shifts day in day out and before you know it you’ll be closer to your dream destination!

4. Clean language - The way we describe our injury and how we visualise what is going on in our body is really important. Unfortunately, it is not just patients who use inappropriate language when describing injuries. Therapists can also fall into habits which aren’t beneficial to an a understanding of the pathology of the problem. There is a lot of fear which can creep into a patient’s mind when they are spoken to in language which serves to, at times, catastrophize the problem. Depending on the injury of course, examples of such words are ‘unstable, broken, inflamed, tight, flared up, out of place’. Now in some instances, it may be appropriate to use some of those terms but a lot of the time it just isn’t scientifically right. The two most common misconceptions I hear are “My ITB is tight’ and “My back is out of place”, both of which aren’t really true! Speak to your therapist to gain a good understanding of what’s going on and use better language yourself in describing it. It can be a real game changer in moving forward with your rehab and altering your mindset. 

5. Visualisation - The power of visualisation is very real. You may have seen the images of F1 drivers mentally practising the circuit prior to getting in the car, tennis players getting into the zone during breaks, dancers working through routines in their heads etc. This constant mental imagery closes the gap between the thought and the action and allows the two to be more whole. This can work in rehab too. There are studies which show that adding visualisation can help the recovery from injuries. Sitting there and visualising healing taking place, picturing a healthy joint, muscle of whatever is injured, and looking positively at the recovery can aid both pain and also function. It is almost like a mini hypnosis which can be so powerful. It may sound odd, but talking to your injury verbally for a few minutes a day can help with recovery. 

6. Breathing - Similar to number 5 this is a really simple technique that we can use. The reason breathing properly and mindfully is so important is the effect it can have on the physiology of our body. Although you won’t notice the immediate effect of, say, breathing for 5 minutes a day on your rehab, over time the change is real. Breathing helps to regulate cortisol levels, the hormone which is released during times of stress. Regardless of where the stress is coming from, cortisol will be elevated in this state. During injury, stress may go up. Exercise has the effect of releasing your happy hormones: endorphins which can counteract the stress hormone. So, if your exercises routine has been disrupted and this balance of hormones has been affected, taking just 5 minutes twice a day to focus on some breathing techniques can really help regulate stress. You can try diaphragmatic breathing, box breathing, alternate nostril breathing - there are many forms of breathing out there. Please make sure that you are in good health, have no associated heart or respiratory conditions, are not pregnant and do not have other health issues that could be a contraindication to doing some of these techniques. 

7. Be adaptable - In some instances we have to accept that an injury may force us to reconsider what we can do going forward. I personally know how this feels.  After having had several ankle injures, I have now accepted that I can’t do the things I did 10 years ago which is ok and I have since found new things to help and also keep my enthusiasm up for exercising despite not being able to do exactly the same things. Re assess your current exercise routine, be open to trying things you haven’t tried before, understand that our bodies do change with age - what may have previously worked for us may not be serving us as well now. I am a big believer in having variety in your exercise, unless of course you have a very, very specific sport or event which requires you to train very specially. For example, it would be counterproductive for a 100m sprinter to suddenly take up lots of yoga as they actually rely on an element of stiffness to produce power over a short space of time. Train your body in different ways to ensure good balance of strength, flexibility, power and fitness. 

8. Make sacrifices - Ultimately it comes down to how important an outcome is to you. Your ultimate goal and your lifestyle have to be aligned if you want to see the best and quickest results. Not only can our brain not comprehend conflicting thoughts, nor too can our body. What do I mean by this? Well, if you want to lead a healthier lifestyle and yet keep telling yourself that you love fast food, your brain will become confused and so too will your actions. Similarly, if your goal is to ski after a knee injury and your physio has set you a programme of going to the gym 3 - 4 times a week, choosing to go out socialising on two of those days instead is not going to produce the results you need. It may sounds common sense but it is often not common practice. Your daily habits will, over time, produce the results you want. It’s that simple. Be prepared to sacrifice some things, perhaps only for a while mind you, to focus on what matters most at the time. 

I hope that these points have been useful in identifying some areas you could work in to optimise your rehab. I am a huge believer in mindset and how it affects the body and paying attention to the above can really help shift you in the right direction. 

If you would like to find out more about any on the above then please feel free to contact me at alex@physioremedies.com.

I wish you well in your rehab and I appreciate you for taking the time to read this article.  

Stay healthy, stay strong!

Best wishes 

Alex. 

Words by Alex Manos.

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.