Bodypart of the month: the foot and its common injuries

This month our bodypart of the month is the foot and so we’ve asked our foot & ankle specialist, Stuart Mailer, to tell us about to tell us about two elements of the feet and their common injuries:

Achilles Tendon

The Achilles tendon is an extremely thick and strong tendon that attaches the calf muscles, Gastrocnemius and Soleus, to the heel. It aids in providing propulsion during walking as well as running and any explosive activity. The Achilles tendon has to endure high forces during jumping, hopping or running and it regularly absorbs 2 x body weight during running, thus it is not surprising to hear that it can be injured.

Achilies Tendonitis

Common injuries are tendonitis, a short period of increased inflammation due to overloading. This can cause some swelling and pain but normally settles quickly.

Achilies Tendinopathy

Longer-term injuries are known as tendinopathies where one has had long periods of microtraumas and the tendon has failed to recover. This tendon becomes more degenerative and disrupted without the inflammatory response tendonitis has. This will present with stiffness and will ease after light activity but be painful after prolonged activity.

Treatment and Recovery

Rehabilitation of either tendon injury involves flexibility and strengthening exercises that are suitable for the health of your tendon at that time. This may involve strengthening your hips and gluteal muscles as well as your foot and ankle musculature.

Unfortunately, tendinopathies can take a long time to recover as tendon regeneration may take more than 3-4 months to occur. Full recovery taking more than 6 months is not uncommon, so patience and diligence are the keys to getting back.

Plantar Fascia

The tight band of fibrous tissue underneath the foot is known as the plantar fascia.

Plantar Fasciitis and Plantar Fasciopathy

Plantar fasciitis (short term) or plantar fasciopathy (longer term pain) is a condition whereby the plantar fascia becomes injured. This typically presents as pain at the heel area of the foot and is categorised as a sharp pain with the first step in the morning but reduces as we start to move. This injury progresses gradually over time and as it becomes more problematic it can then can be painful wearing flat shoes or unsupported footwear or standing for a long period of time.

There can be many contributing factors such as high arches or flat feet, change of footwear or increasing exercise volume too quickly to having tight calf muscles.

Treatment and Recovery

Treatment normally consists of stretching and strengthening the foot and surrounding musculature if there are imbalances. This can then help address the underlying weaknesses or biomechanical issues that may have contributed.

There have been many other interventions utilised that can assist such as orthotics, that can help reduce pain at the plantar fascia and improve your walking by giving the appropriate support your foot requires.

Night Splints, Shockwave therapy, acupuncture and cortisone steroids are all other common interventions, however each has a specific time to be utilised depending on your contributing factors and foot health. It is advisable to first undergo a course physiotherapy intervention and podiatric assistance to help determine causes, start an appropriate rehabilitation plan and aid your recovery.

If your feet are causing you pain or other issues, call us on 02030 12 12 22 to book an appointment with one of our foot & ankle specialist physios.

Words by Stuart Mailer.

Andy Murray’s famous hip

Andy Murray’s famous hip

Over the last six months or so there has been quite extensive media interest in Andy Murray's hip injury. It has been quite well known for a couple of years that Andy suffered from hip issues which at times was very evident to see during his matches, yet still he was able to compete at the highest level and win the games’ biggest prizes.

Andy first underwent surgery back in January 2018, an arthroscopy which is more commonly known as 'keyhole surgery'. This minimally invasive surgery is designed to repair any damage to the hip joint, maybe repair the labrum (a cup like cartilage structure which helps stabilise the hip joint) and more often than not, some bone is shaved off from the ball (of the ball and socket) to allow for more clearance and less impingement of the joint. Whilst Andy managed to get back to paying he was still suffering with pain and couldn't get back to the level he was competing at before. This lead to a second operation earlier this year, a more extensive type of surgery which involved placing a metal cap on top of the ball and a metal surface on the socket side of the joint. The hope is that this will allow Andy to return to tennis, but perhaps more importantly lead a more comfortable life where normal activities of daily living are manageable.

Tennis is an extremely dynamic sport, involving lots of twisting and turning. As the distances are relatively small, but the changes in direction are often sharp and repetitive, this places a lot more stress on the joints than it does on the muscles compared to say a larger area sport, like football. Combined with predominantly hard surfaces, this increase the impact forces through a joint.

The hip joint is by nature a stable joint and, being a ball and socket joint, allows it to cope with such levels of rotation but it also has its limits. Having worked in professional tennis, I know first-hand how much the hips are used. They are often a source of stiffness in tennis players as they recruit so much muscle energy to stop and start, the muscles around the hip get tight and this then stiffens up the joint. There is also a lot of repeated bending forward/lunging, and this means a lot of pressure on the front of the hip joint. If there was already a congenital deformity of the hip which caused impingement, this would easily aggravate it, but equally there is the opinion that that this repetitive nature can also lead to the changes. Even just the action of serving which is performed thousands of times a season is extremely load bearing for the hip. Tennis players do take preventive measures to allow for joint protection by having strict strength and conditioning programmes, as well as having mobility and flexibility routines.

It was definitely the last hope for Andy to try and return to top level tennis. Having been privileged enough to spend time with him during my time working with James Ward, it's no surprise to say that he is one of the most dedicated professionals I have met and he has a great team around him to give him the best possible chance. The jury is out and it could go either way but I know that everyone who follows tennis and sport around the world will be hoping to see him compete again at the major events.

Good luck Andy!

If you’re experiencing hip pain call us on 02030 12 12 22 to book an appointment with one of our hip specialists: Paul Martin or Alex Manos.

Words by Alex Manos.

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: 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.

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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.