Achilles Tendinopathy


Also Known as Achilles Tendonitis or Achilles Tendinosis

This article is by Zak Buttle the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic. Zak has a keen interest in sport related injuries and is a cyclist with the Islington Cycling Club and cycles regularly both locally and in the Alp’s.

Achilles Tendinopathy, Achilles Tendinitis or Achilles Tendinosis is a very common condition characterised by pain and/or swelling in the Achilles - the soft tissue connecting the calf muscle to the calcaneus (heel bone).


Cause:

Many different factors can contribute to Achilles tendinopathy such as:

• Increased activity
• Change in activity
Weight
• Age
• Diabetes
• Tightness in the calf muscles
• Tightness in the plantar fascia
• Instability in controlling muscle groups

All of the above contribute to an increase in the loading of the tendon and therefore can cause undue strain on its tissue. This causes the strained response and the tendon becomes symptomatic.

Due to the many factors that can lead to an Achilles tendinopathy, both athletic and non-athletic individuals can develop this pathology. It does not usually involve a single injury when the individual may feel it ‘go’, but the pain may first be felt coming on during or after a single day, run, cycle etc.

So far, research has proved inconclusive as to what the physiological cause of Achilles tendinopathy may be. Swelling, microtears within the tissue, and increased water content have all been theorised as to being the reason for symptoms, but none have been proven conclusively.

Symptoms:

Local pain - This is normally felt in weight bearing positions, whereby would weight is put through the foot, and an increase in demand is placed through the Achilles. It will likely increase when powering off of the affected foot, increasing the tension placed through this tendon further. Pain can also be felt after such activities.

Radiating pain - less commonly, pain is felt to radiate into the calf and/or the sole of the foot.

Swelling - thickening and swelling of the Achilles can often be felt and occasionally observed.

Stages:

Recent research (Cook and Purdam, 2009) categorises tendons into the below categories that, once diagnosed, direct us towards the treatment that is required.

Reactive tendinopathy - This is more common in the individual with an acute change in the amount of strain placed tough the tendon.

Tendon disrepair - This stage follows the reactive tendinopathy if the Achilles is not properly treated. Its clinical appearance is similar, but symptoms tend to be more severe.

Degenerative tendinopathy - More common in the older athlete/individual. Structures within the soft tissues have changed and are unable to deal with the load placed through.

Diagnosis:

This is most commonly made via clinical assessment; observation, reproduction of the symptoms via palpation and assessment of the surrounding structures can confirm or deny the presence of Achilles tendinopathy. This is normally enough to diagnose an Achilles tendinopathy with a high degree of certainty.

An ultrasound scan or an MRI scan can also be used to rule in or out any other potential conditions if a there is any scepticism of over the diagnosis of an Achilles tendinopathy.

Treatment:

Identifying the correct stage is important as it directs treatment. Choosing the wrong treatment can make it worse!

Rest - This is often needed to reduce the loading of the tendon to avoid disrepair.

Strengthening the Achilles - This can be done in many different ways. Different programmes such isometric, concentric, and concentric/eccentric programmes are all appropriate at different times/stages, but should be discussed with a qualified physiotherapist.

Soft tissue massage - This can be used to settle symptoms by moving the swelling and desensitising the tissue

Acupuncture - Facilitates the increase in proliferation of the tendon to allow for greater healing. Pain can also be reduced by hyper stimulation using acupuncture needles.

Activity planning - A solid plan to rest and then a graded increase in the activity back to sporting activities is recommended.

Stretching - this is often recommended by physiotherapists but can actually increase symptoms.
 

If you have been inspired to start cycling by watching the Tour de France or if you have upped your mileage for the upcoming Ride London and have started to have Achilles pain then an appointment with Zak the physiotherapist in Islington may keep you training and not convalescing.

If you have been out playing tennis since watching Wimbledon and have started getting Achilles pain then see Zak at our Islington physiotherapy clinic for treatment and prevent the injury from stopping you entering next years Wimbledon!

If you want an appointment click below or call the clinic on 020 7288 2999

 

 

 


Forget Breakfast, Lunch and Dinner

By Grayce Bartlett, massage therapist in Islington

STOP! Nutrition, the most important thing of our lives, or it should be anyway. We were brought up with the mindset of breakfast, lunch, dinner and two snacks, which for some people just doesn't work!

I have 6 meals a day, consisting of carbs, protein and fat, all the essentials our body needs to function. That does mean I can be eating chicken, sweet potato and veg at 10am! But, it works for me and my body.

We hear at least every day of people who are trying to lose weight, or put on weight/muscle mass, but the common problem is that we just aren't eating enough (of the right things!). Yes, even if you want to lose weight! Trust me!!!

We need to be eating every 3 hours, other wise our body goes into 'starvation mode' and starts storing fat and eating muscle, as it genuinely doesn't know when it's going to get fed again. Most of us go 4/5 hours without eating, then wonder why we are feeling 'hungry' (hungry/angry), and why we always crave something sweet in the afternoon, our body is calling out for food!!! Our sugar levels drop, and our body then stores the fat, just in case we aren't going to eat for a while, it all goes back to cavemen times.

Anyway, the moral of the story is, EAT regularly. Every 3 hours, small meals. Get out of the mind set of "It's lunchtime so I need a sandwich or soup", our body needs feeding, from all food groups. Try to find out what works for your body, whether you respond well to good fats or good carbs. Stick to single ingredient foods, not processed, artificial rubbish, and stay away from sugar.

Good foods include:

Proetein Carbs Fats
Chicken Sweet potato Cashew nuts
Turkey Brown rice Coconut oil
Lean beef mince Green veg Avocado
Lean steak   Nut butter
     
     

Grayce Bartlett is the massage therapist in In Islington but she is also a keen body builder and is looking to compete in a bikini body building competition later this year. she is full of knowledge and is keen to share it so any questions about massage or keeping fit, ask her!


Find out more about Grayce Bartlett and why she is such a motivated massage therapist!

I lead by example, so my life is structured around my own health and wellbeing. I follow a specific nutrition plan and training plan to build muscle and burn fat, in order to potentially compete in a Bikini bodybuilding competition. This means that I understand how important it is for the body to be functioning in the best way possible. When working with my athletes,

I appreciate the fact that massage is highly important not just mechanically but mentally too, I benefit from a treatment massively after a tough training session, as it gives me a chance to help my body recover, but also allows me to talk to others about training and pick up tips! Even for my clients who wouldn't class themselves as athletes, treatments can help with everyday tasks and posture, even those niggles that you think aren't affecting you that much, actually are!!!!

Massages shouldn't be seen as a 'treat', it is a necessity, no matter what path of life we take. It is SO important to look after our bodies as it genuinely is the only one we have. I LOVE what I do, and that comes across through my treatments.

For those who are nervous if it's their first treatment, I totally understand, I had to have my first treatment one time too!!! Even those who have had plenty of massages but are looking for something more technical and specific, even tips on training and nutrition, come and book in for a treatment and we can start making a change to your life.

Aside from the massage and my training, I am a HUGE foodie and enjoy spending my one cheat meal a week somewhere amazing, so any tips let me know! I enjoy travelling, getting out and about for the day and spending time with my friends and family.
 


Physiotherapy for the Cyclist

This article is by Zak Buttle the physiotherapist at the Angel Sports Injury and Physiotherapy Clinic.

Cycling iinjuries can come from a manor of different circumstances. Some would think back to large scales collisions and crashes that can range from flesh wounds to multiple fractures and worse. However, to the keen cyclist, it is often the aches and pains that develop over a number of rides that cause you the most grief.

Many patients that I have treated with cycling related repetitive trauma injuries I have advised that they seek a bike fit - a professional intervention to ensure that your bike is set up to match your own dimensions. However, these unfortunately vary in their quality, and regularly place the importance of power over injury avoidance.

Keen athletes have come into our clinic having had a bike fit recently, but the damage to themselves had been done already - the repeated actions of your legs on the pedals, or the sustained position of your back when on the saddle.

Even as an individual who obsesses over the human body and its mechanics, I struggle to find a part of the human musculoskeletal system that is not used in cycling. Common cycling injuries can include but are certainly not limited to:

• Achilles’ tendinopathies
• Calf strains
• Patellofemoral joint syndrome
• Hip flexor strains
• Mechanical lower back pain
• Postural thoracic pain

But as we look elsewhere in the human body, the acromioclavicular joint, connecting the shoulder to the collar bone, can be compressed, or distracted, depending on your cycling style, causing undue overload and resulting in injury.

An athlete with a wide cycling stance can overly rely upon hip abductors as opposed to his hip flexors and strain the iliotibial band (ITB) – a common injury in, but not exclusive to, runners.

Other patients have suffered problems while on the bike because of a range of causes that originate away from the bike. Postural deficiencies that cause no problem during work and resting time, can be then be altered so drastically by the position that we sit on the saddle that it is only then that we feel symptomatic.

All injuries result from overload. From a huge impact to the clavicle or tibia bones in a crash, to a steep increase in the amount we use our calves while cycling, or a prolonged time we spend with our spine flexed.

Once assessed and the problems are identified, treatment for the variety of injuries will normally always contain of a home-based exercise routine that requires an active involvement from our patients. This may include:

o strengthen the structures that were not ready to be overloaded, or
o stretching regime to take pressure away from the symptomatic region, or
o proprioception/balance programme to avoid a loss of control within isolated parts of each limb, preventing undue stresses and strains.

The large majority of problems will also benefit from some form of hands-on therapy to compliment these, such as soft tissue release and massage, joint mobilisation, or passive stretching. These will always be discussed and offered to the patient.

Physiotherapists are well equipped to treat the ailing cyclist; all of the aforementioned injuries have been treated successfully by my colleagues and I over the years. Chronicity (duration of a current symptom) plays a large role in the prognosis – the ability/time to recover, and the sooner a problem is treated, the less time the human body has to create long-term adaptations that a re harder to treat, hindering a prognosis.

Therefore, I strongly encourage any cyclists with nagging aches and pains to act upon this and seek a resolution as soon as possible!
 


Low back Pain, Tennis and Physiotherapy

This article is by Alex Conty the physiotherapist in London at Islington's Angel Sports Injury and Physiotherapy Clinic.

Back pain is probably the most common problem that I see at the clinic in Islington as a physiotherapist. In the UK it is estimated that up to 80% of us will suffer from low back pain in our lifetime. As a physiotherapist in London I see back injuries from patients participating in sports and I see patients with low back pain from poor ergonomics at work. Despite the fact that 80% of the population will get low back pain, thepopulation is not well educated about how physiotherapy can help their back!

The spine is a complicated structure comprising of joints, vertebrae, discs, ligaments, capsules, nerves and muscles which protect the spinal cord and support trunk and allow mobility. As such there are many structures that are susceptible to injury if the muscular stability is not up to scratch.

The other side of the coin is when there is poor spinal stability form the muscles , long hours sitting at a desk and commuting which is a low intensity activity can lead to overloading spinal structures such as the disc and result in low back pain. As a physiotherapist in London low back pain is a condition that I commonly see and sitting at a desk is often a major factor in the cause.

Andy Murray needs to see our physiotherapist!

Andy Murray retired from the Madrid Maters tennis competition a few years ago due to his ongoing intermittent low back pain. Last year he took off a few months for spinal surgery and he has taken a while to get back to full fitness. Tennis players are susceptible to low back pain as large forces put through the lumbar spine during a game. There is plenty of stopping and starting and changing of direction as well as twisting and explosively rotating the torso to get as much power as possible into the ball.

Why do players on the professional tennis circuit suffer with a high volume of spinal injuries and intermittent low back pain when they have access to physiotherapy?

To answer you first need a small understanding of the biomechanics of tennis. When contemplating spinal loads in the different shots in a game of tennis, the serve is understood to place more stress and higher load on the spinal structures than any other stroke.

When the racket moves over head and behind the body the spine flexes laterally and hyperextends. To smash the ball, acceleration of the racket before ball impact is produced by huge muscular forces bringing the trunk into rapid flexion accompanied by a very high velocity rotation (from right rotation to left rotation for a right-hander, vice versa for the left hander). This corkscrewing motion transfers the force of its torque to all the spinal segments. The repetitive trunk hyperextension we see in the tennis serve is understood to be a predisposing mechanism of lumbar arthritis.

Tennis players may also be at an increased risk of lumbar disc injuries due to the shearing effects of the forces from high velocity rotation from a position of lumbar hyperextension to lumbar flexion. This is as true for a professional at the French Open or at Wimbledon as it is for the average club player at the Islington Tennis Centre in London or at London’s Regent’s Park Tennis Centre. Interesting fact, poor posture at work and a loss of the lumbar lordosis when sitting also creates shearing forces for the disc to deal with and this can eventually lead to disc failure and the legendary ‘slipped disc’.

You can now see why Andy Murray isn’t the only pro tennis player to suffer with low back pain. If muscular control and dynamic stabilization around the spine is not up to scratch, injuries will result. Additionally, an individual could potentially have brilliant core dynamic stability, but other factors such as fatigue or poor endurance of the muscles, general poor health, overload of schedule with long hours spent training and the simple fact there are massive repetitions of the same movement or activity can all lead to spinal dysfunction.

Causes of low back pain in tennis players
In my experience of being a physiotherapist with experience of treating tennis related injuries, Low back pain is common. Frequent issues involved with tennis players suffering from low back pain need to be diagnosed with a thorough history and examination to rule out the following:

• Lumbar disc abnormalities
• Muscular strains secondary to under trained or over loaded muscles
• Facet joint pain
• Pars injuries in adolescents including Pars fractures / Pars interarticularis

My experience as a physiotherapist makes me very aware of the importance of the involvement of lower trunk muscles in tennis and indeed many sports. This reinforces the importance on abdominal and lower back exercises in strength and rehabilitation programmes. The strengthening of the lower trunk muscles will not only improve performance in athletes, but weekend warriors and desk workers will benefit from preventing low back injury and pain by improving trunk muscle strength and stability.

If you want to get better you can!
Strength and rehabilitation programs are not exclusively limited to professional athletes such as Andy Murray, who has his own personal physiotherapist – anyone in London suffering an episode of low back pain can come to see me for physiotherapy at Islington’s Angel Wellbeing Clinic. I will work with you to address the cause of your back pain. Most likely cause of the low back pain will be muscular imbalances / deficiency and poor posture. I will then provide a programme to get you back to full fitness as soon as possible and at the same time try and reduce the chance of recurrence.

It is important to keep active, lying on your back for extended periods when you have back pain can cause more stiffness and increase the length that you have low back pain for. Most individuals respond quickly to treatment comprising of manual therapy from a physiotherapist followed by a tailored rehabilitation exercise programme. The long-term outlook is positive if you have low back pain. You do not have to suffer with constant low back pain however physiotherapy treatment for low back pain isn’t a magic wand as I will want you to put in some effort!

So whether or not you are a tennis player and have a bad back or if you are a keen sports person and have episodes of low back pain, it may be time for you to visit our physiotherapist in London and invest your efforts into building core strength and dynamic stability so you can have a happy spine. If you want an appointment with our physiotherapist in London at Islington’s Angel Sports Injury and Physiotherapy Clinic click below.


Preparing for the slopes

Skiing isn’t unlike other exercise – or is it? Well it really is. Most of us tend to Ski for one week once or twice a year which makes carry over a lot harder for our muscles. It’s also amazing how much harder your body has to work to just stay warm in the colder climate. Go and find a walk in freezer and hold a deep squat position and you’ll see what I mean. Fatigue will set in a lot quicker as your body is having an internal tug of war as to where the blood needs to flow.

During normal exercise the blood flow is directed to the parts of your body most in need of it; the musculoskeletal system and the lungs mainly. When it’s cold the blood flow is directed mostly to the internal organs and away from the peripheries. This is why that first day on the slopes hurts like crazy! But add to that a sedentary lifestyle or de-conditioned muscles then you will need more than the après ski to get you through!

Adequate preparation for a ski trip should start about 4-6 weeks before you fly. If you are not sure what you need to do or what you need to work on then go and visit a physiotherapist or sports massage therapist and they can either assess your biomechanics or the strength / tone of your muscles. Following this you should have an idea of the muscles that you need to work on. Often practising exercises such as squats, lunges, step ups and step downs coupled with general lower limb stretching will be enough to prepare you. However, core stability, balance and proprioception (fancy word for where your body is in space) are all areas that should also be addressed. Ultimately you want your muscles working efficiently and in conjunction with each other.

Whilst training it is a good idea to have a regular sports massage. This allows for better repair of muscles due to an improved blood flow and lymphatic drainage and also enables your muscles to have a chance to regain the right length / tension ratio.

Injuries are unfortunately inevitable in such a sport as skiing. Some of the more common injuries are fractures to areas such as the collarbone and upper arm, ligament ruptures or sprains to the knee or around the collarbone, muscle injuries to the shoulder and wrists and hands. More seriously head injuries and spinal injuries can occur with the higher impact crashes.

Preparing your body will prevent as much fatigue and enable you to be fitter and stronger which will aid your response times. Remember the old saying – failing to prepare is preparing to fail!

Happy skiing!

If you want a sports massage in Islington or you want advice on how to avoid a skiing injury or even if you are remembering how your muscles felt after your last skiing holdiay arrange a session with Mark.


Strapping and Brace Support for Patellar Tendinopathy


1. The patient is sat on the floor with the knee bent to a right angle and the foot flat on the floor. Use under wrap / fixation tape around the knee and under the rigid tape for comfort and sensitive skin. It the leg is hairy you should ideally shave it.

 

2. Twist 1 piece tape twice and place the tape centrally – 1cm below point of patella, repeat with another of the same

 

3. Split 1 piece of tape length ways (so it’s ½ width) and place across tape of the other 2 pieces, repeat.


4. Apply one final wrap of the tape at full thickness around the knee without twisting, to secure the strapping in place.

 

5. This strapping needs to be FIRM AS POSSIBLE without being a tourniquet.

 

6. Alternatively, if you plan on using this style of tapping for a prolonged period, to prevent skin irritation or tearing you may want to consider purchasing a counterforce brace.

 

 


 


Sitting Better at Work


Our physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic looks at the most common cause of back pain : poor posture. Here are some simple tips on improving your posture. It may seem like a lot of effort to change, but that is because you have developed some bad habits which now feel familiar and normal. But they are probably WRONG! Give this a go when you are sitting in front of your computer.

Seated Postural Check

• Feet hip distance, knees always BELOW the level of the hips.

• SIT on (not push into the small of your back) 1-2 folded towels to lift the pelvic height above the knees, pull the butt cheeks apart to sit on a wide base of support.

• Roll forward and backward from the sit bones – thinking of your pelvis as a mixing bowl full of water, spilling water from the front and the back, then settle into the neutral pelvic position.

sitting and good posture by the physiotherapist in Londonsitting and good posture by the physiotherapist in Londonsitting and good posture by the physiotherapist in London

• Hinge forward and backward from the hips to find the position of least muscle tension in the crease at the front of the hips and along the back of the spine / small of your back.

sitting and good posture by the physiotherapist in Londonsitting and good posture by the physiotherapist in Londonsitting and good posture by the physiotherapist in London

• Soften around the sternum to give you the slightly convex curve that your thoracic spine should naturally have.

sitting and good posture by the physiotherapist in Londonsitting and good posture by the physiotherapist in Londonsitting and good posture by the physiotherapist in London

• Think of a ship on either shoulder facing outward, sailing away from each other, to broaden across the front of the shoulders without squeezing across the upper back. Or imagine a cut rubber band, with an end attached to the front of each shoulder. Broaden shoulders to take up the slack on the band, without putting tension on it or squeezing the upper back otherwise you will develop a tight thoracic spine.

sitting and good posture by the physiotherapist in Londonsitting and good posture by the physiotherapist in London

• Helium balloon from the base of skull, floating your head tall, keeping a gentle chin nod / tuck position.

sitting and good posture by the physiotherapist in Londonsitting and good posture by the physiotherapist in Londonsitting and good posture by the physiotherapist in London

• By now, you should have noticed all the tension across the lower back, upper back shoulders and neck should have dropped away – if it hasn't, start from the beginning and reset again because if this is done properly, your spine essentially will maintain its happy posture perfect position without any excess muscle activity. So if you are feeling tension then chances are you've not set up right.

• Breathe wide into the sides of the ribs, underneath the arm pits. Imagine the base of the lungs (not the upper chest and shoulders) filling with air on each breath.

• When you are at your computer, ensure you are not leaning toward the screen from your hips, nor poking the chin forward.

sitting and good posture by the physiotherapist in London

Think about ergonomics and repeated office activities

Your key board should be as close to the front of you as possible, do not lean for the keyboard or have a set of notes between you and the keyboard. The mouse pad should be directly next to the key board so you aren’t reaching for this either.

If you use the phone a lot, keep the phone close to the keyboard on the opposite side to the mouse. Minimise holding the phone between your shoulder and ear – use your hand or a head set.

Elbows should ideally hang next to your side, not too far forward of the shoulders. Wrists should be straight when typing on keys – if you are arching the wrists up you need to increase the height of your chair or lower the table.

Set a reminder on the computer / phone etc to periodically reboot your posture, until it becomes automatic. The reminder will mean that you will regularly be correcting your posture so you DON'T get that tightness / achey-ness in your back. If you get that feeling, then you've probably left it too long in between rebooting your posture.

If you are having or have had repeated back or neck pain at work it is time to do something about it. To make an appointment with Jo Knock the physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic in Islington click below. The clinic will provide a thorough assessment of your posture as well as looking at the ergonomics in the workplace.


Standing Postural Check List

Our physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic looks at the most common cause of back pain : poor posture. Here are some simple tips on improving your posture. The more you practice, the sooner it will become an automatic way of standing. Give this a go when you are standing in line for your coffee or bus!

• Rock forward and backward from toes to heels to place weight through the centre of your arch. Roll to the inside and outside of the foot to find a natural arch. Think tripod support – ball of the foot, lateral border of the foot and centre of the heel.

standing and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in London

• ALWAYS stand on two feet with even weight bearing – don’t hang off to one side.

• Unlock and soften the knees, without bending too much otherwise you’ll risk walking like a thunderbird.

standing and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in London

• Think of the pelvis like a mixing bowl and tilt forward and backward to find neutral – if this isn't working for you to think of the movement, then just imagine a seedy person gyrating their hips on the dance floor and you should be able to get the movement.

standing and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in London

standing and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in London

• Soften around the sternum and think of broadening the shoulders as per sitting posture check list.

standing and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in London

• Helium balloon at the base of the skull stretching the back of the neck long and creating a little chin tuck.

standing and good posture by the physiotherapist in Londonstanding and good posture by the physiotherapist in London

• Once you are in this position you should notice that all the tension across your upper shoulders, neck and back should have dropped away.

• Walking or standing, continue to drop as much muscle tension as possible and breath wide into the base of the ribs.

It is time to do something about your constant neck niggle or back ache. To make an appointment with Jo Knock the physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic in Islington click below. The clinic will provide a thorough assessment of your posture as well as looking at the ergonomics in the workplace.


The Health Risks from too much Smartphone use

 

This article is by Jo Knock the physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic and looks at how hand held devices cause localised pain and postural adaptations that can lead to long term problems such as back pain and RSI.


As a member of the Chartered Society of Physiotherapy (CSP) and the Senior Musculo-skeletal physiotherapist at London Islington’s Angel Wellbeing Clinic, I completely agree with the BBC’s report in which the CSP are quoted. And I will see them and raise them children and gamers!!!


Lengthening the working day can shorten your height!

The BBC‘s article states that office workers have become screen slaves who continue to work on tablets and smart phones after they leave the office. While this plays a big part in the postural pain in necks and backs that I see in my patients, another consideration are those who sit on the tube on their way to and from home. They aren’t actually working, rather looking down at their weapon of choice playing games for hours on end to pass the dreary journey home. This constant flexion of the neck creates excessive strain on the muscles in the neck, leading to overload and inevitably pain.

When a few links in the chain aren’t functioning well, the entire loop is affected. Think of a bike chain: If you have even one link which is dodgy, the whole bike performs inefficiently, and the cyclist has to work much harder to make the bike work / move / function. Your spine is the same.

"I bet you are reading this right now sitting slumped in your chair!!! If you need a little refresher on posture go to my postural cues". Jo Knock, physiotherapist in London

Any area of the spine in poor posture has the potential and strong likelihood to detrimentally load the rest of your spine. In this case your spine is forced to compensate for the woeful posture (just like the bike chain) and makes it harder to work / move / function. These factors all lead to strain… then pain. I bet you are reading this right now sitting slumped in your chair!!! If you need a little refresher on posture go to my postural cues.

Children get back pain too

Now - don’t even get me STARTED on those children that sit looking straight down (more neck flexion) at their hand held devices, i.e. PSP and Nintendo DS, never coming up for air. Those kids will eventually develop a large lump at the base of their neck, where the cervical spine meets the thoracic spine. In technical terms we call it a Dowager’s Hump. But for all intents and purposes you may as well just refer to it as the Hunch Back of Notre Dame.

Don’t kid yourselves though, it is not just children at risk of developing a Dowager’s Hump or any form of spinal pain related to posture. As adults who spend hours on end at a desk, poking your heads forward toward the computer screen and slumping in your seats, you too are at risk, as the CSP so kindly reminded you today in the article published by the BBC.

It was well before smart phones, portable gaming devices and tablet computers came out that individuals have suffered with spinal pain. But as a Physio in London at Islington’s Angel Sports Injury and Physiotherapy Clinic I can tell you know there has been a dramatic increase in the amount of patients I see, young and old, with posture related pain. Perhaps the cause has just been revealed….
Watch out – you could be the next Quasimodo

This article is by Jo Knock the physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic. At work you may develop poor postural techniques over time, which will lead to dysfunction and pain. Most commonly I see neck / back pain and wrist / elbow pain as a result of poor positioning and RSI from using a mouse (and now smart phone!). If you are concerned about your risk of developing an injury you can make an appointment with the physiotherapist in London by clicking below.
 


Shin Splints

This article is by Jo Knock the physiotherapist in London at Islington’s Angel Sports Injury and Physiotherapy Clinic. Our physiotherapist in London looks at shin pain, how it is diagnosed and how it is treated.

Pain in the front of the shin is often referred to as Shin Splints. It’s correct name is Medial Tibial Periostitis, or more plainly said, inflammation of the medial part of the shaft of the tibia bone. Two theories have been proposed to account for this injury: tibial bending and fascial traction. I will address the more common theory and the one which I believe to be the cause - fascial traction.

 

As tension in the muscles (tibialis posterior, flexor digitorum longus, and the two calf muscles : gastrocnemius and soleus muscles) which lie along the postero-medial aspect of the shin increases, so too does strain in the tibial fascia. Simply put, this means there is a direct link between increased tightness of the posterior lower leg muscles and medial tibial periostitis aka shin splints. Do not be fooled though, simply stretching the calf and lower leg muscles will unfortunately not be enough alone to ‘heal’ you of this condition.


What causes Shin Splints

• Sudden increase in impact activities
• Not an adequate warm up before impact activity
• Too much training / training overload, especially on hard surfaces
• Over pronation of the foot in dynamic activity resulting in overload to the tibia
• Inappropriate or incorrect foot wear
• Tight calf muscles preventing correct movement of the foot during all phases of the gait / running cycle
• Poor recovery time / not enough recovery time in between workouts.
• Biomechanical deficits further up the chain such as poor gluteal and lateral pelvic stabiliser strength (see the video section for some fantastic gluteal strengthening exercises)

Signs and symptoms

• Pain and tenderness on the inside of the shin, when palpating along the medial tibia
• Pain at the commencement of impact activity, which usually decreases once you are warmed up, then returns (often worse) once you have finished activity or the following day.
• Pain worse with a harder or tilted (sand, side of the road) surfaces
• Constant tightness in calf muscles or muscles of the lower leg despite loads of stretching

Treatment

Initial period of rest plus / minus the use of anti inflammatory treatment including the use of ice and non-steroidal anti inflammatories (always be guided by your GP or pharmacist for medication). You will need to ensure you undertake stretching for all lower limb muscles, especially the calf muscles.

Manual therapy by your London Physio and guided rehabilitation comes into play after the initial period of rest. With your guided rehabilitation you will begin reconditioning the muscles with cross training and non-weight bearing activity then have a gradual return to weight bearing and impact activity as pain and symptoms permit

In addition to physiotherapy treatment, footwear can be assessed and changed as appropriate and sports massage can be very beneficial to relieve muscle tension and off load the fascial stress that can create shin splints.

In old school treatments there used to be a suggestion of strapping or taping the shins to reduce the stress, however current AAA standard research and reviews of scholarly articles shows no benefit at all in strapping the lower leg. This is to say there is no evidence to support either the use of braces or strapping for shin splints, so don’t waste your money on them!

If you are experiencing these symptoms and it is preventing you from enjoying your activities maybe you should see our physiotherapist in London. If you want to make an appointment with the physiotherapist at our London clinic click below.


Knee Pain and Patellar Tendinopathy

This article is by Jo Knock the physiotherapist in London at Islington’s Angel Sports Injury and Physiotherapy Clinic. Our physiotherapist in London looks at knee pain and why there has been a change in name from patellar tendonitis to patellar tendinopathy. Our physiotherapist looks at how this cause of knee pain is diagnosed and how it is treated.

It is tennis time again with the French Open on the go in Paris and with Wimbledon starting on the 25th June. There has already been some drama at the French Open with Andy Murray suffering low back pain and back spasms in his second round match and needing urgent courtside physiotherapy. Hopefully he will be fully recovered by Wimbledon and he wont be requiring the physiotherapist in London for the event.

Rafael Nadal has already been severely hampered by his ongoing knee injury this year. In 2012 he pulled out of the Sony Ericsson Open and he also retired early from 2010 Australian Open.

He also frequently appears on court with strapping below both knees to help decrease his knee pain. It is safe to assume that he has a travelling physiotherapist with him and I am sure he too will have his physio with him in London for Wimbledon.

This is a man who is only 26 (a happy birthday to you Rafa for the 3rd of June!) yet has been playing tennis for 23 years – beginning at age 3!! Now it is really no wonder his body is falling apart and that he needs a physio for his knee pain. He has incredible foot-work and is lightening fast on the court, however this has taken a heavy toll on his knees.

Rafa Nadal and Knee Pain

Rafa suffers with Patella tendinopathy, also known as jumpers knee and formerly known as patellar tendonitis which is a condition that isn’t unusual for me to see as a physio in London dealing with runners and joggers.

“Formerly known as patellar tendonitis as health professionals thought it was an inflammatory problem, it is now referred to as patellar tendinopathy, and is due to a failed adaptation to load.” Jo Knock, Physiotherapist in London.

This injury is seen commonly in:
• Running
• Basketball / netball
• Field events in athletics e.g. high jump, long jump and triple jump
• And of course tennis

What is patellar tendinopathy?

In its very early stages, it can be an acute inflammatory problem, and if you catch it early rest, ice and anti-inflammatories will help. But the majority of patellar tendinopathy’s are as a result of overuse and overload, hence being now known as a failed adaptation to load. It is a degenerative condition occurring at the base of patellar (or knee cap).

There are in fact THREE types of common patellar tendinopathy’s:
1) Mid substance patellar tendinopathy
2) Infra-patellar pole tendinopathy
3) Insertional tendinopathy

It is very important to have your knee accurately assessed by a physiotherapist to determine which type of tendinopathy you are suffering with as the treatment varies for each.

If you are concerned about a painful knee and think it may be a tendinopathy, come in for an assessment with our physiotherapist. This knee injury is similar to shin splints (see my article on Shin Splints) in that it is rarely an acute injury. That is, it is not an immediate obvious injury and does not happen all of a sudden like a torn hamstring in sprinters or an Anterior Cruciate Ligament rupture in kicking sports, but rather it is a build up over time.


The knee pain from patellar tendinopathy is due to any number of factors occurring independently or together such as:
• Constant, repetitive high loading and impact to the tendon
• Change in foot wear
• Change in technique
• Sudden increase in activity without sufficient pre-season training

Diagnosis, Signs and Symptoms of patellar tendinopathy

The diagnosis of patellar tendinopathy is primarily based on a physiotherapist’s assessment in the clinic. As a physiotherapist in London I have access to the latest imaging techniques such as ultrasound and MRI and these can provide additional diagnostic value where a thickening and swelling of the tendon is often seen.

Patellar Tendinopathy is characterised by a very agitated tendon. There will be pain at bottom of patellar where the tendon feeds into the bone or in the tendon itself (depending on the type of tendinopathy), tenderness when palpated, a pain / ache during and after exercise and it can range from mildly to horrendously debilitating. There will often be a visible area of swelling, and it can feel thick and boggy to the trained touch as well as crunchy or creaky (what we call crepitus).

Treatment for patellar tendinopathy

Treatment will vary depending on which type of tendinopathy you have, hence the importance of an accurate assessment by your physiotherapist, in London you can arrange an appointment with me at the Islington clinic.

• In the most basic form, initial treatment will consist of rest from aggravating activity, ice to help pain & strapping or the use of a counter force brace (see STRAPPING AND BRACE SUPPORT FOR PATELLAR TENDINOPATHYS) to offload the tendon
• Manual physiotherapy
• Sports massage is very effective at helping to realign the new collagen fibres which the body sends to the injury sight for healing. Without massage to this soft tissue, you are at risk of the new collagen fibres forming scar tissue.
• Exercise Rehabilitation then forms the most important part of your treatment for patellar tendinopathy and follows this path

Exercise rehabilitation for patellar tendinopathy

o initial isometric load of the tendon at inner range
o moving into eccentric load of the tendon to strengthen the tendon and muscles
o then performing sport specific and functional activities to load the tendon as it would be in your chosen sport with gradual return to full fitness
o stretching of lower limb muscles


Prevention of patellar tendinopathy

As I physiotherapist in London with a number of weekend worriors as patients I know that prevention is better than having to treat an aggrevated tendon. The first thing to do is to identify any biomechanical problems that may increase the risk e.g. pronated feet, poor lower limb mechanics, tight ITB(ilio tibial band) / TFL(tensor fascia lata).

If you are not sure, seek professional help and advice from your physio. Effective stretching and good flexibility of all lower limb muscles especially the quads is essential – if you are a woeful stretcher a regular massage can help keep you in check.

If you are a "weekend warrior" and feel that you would rather avoid developing this condition or you have knee pain and want it diagnosed and treated properly then click below to make an appointment with the physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic in Islington.


Low Back Pain and the Woes of Andy Murray

 

This article is by Jo Knock the physiotherapist in London at Islington's Angel Sports Injury and Physiotherapy Clinic.

Back pain is one of the most common presenting problems that a physiotherapist will see on a day to day basis. UK figures show that up to 80% of us will suffer from an episode of low back pain in our lifetime. Being a physiotherapist in London I get to see patients with low back pain from playing sports and I get to see patients with low back pain from poor ergonomics in the workplace. Despite this statistic the general population are not well educated about their back or how a physiotherapist can help!

The spine is a very complicated structure comprising of many joints, segments, discs and muscles which all protect the spinal cord and support trunk mobility. As such there are many anatomical structures which are susceptible in high intensity activities if one's muscular stability is not up to scratch. On the flip side, long hours sitting at a desk and commuting are what I'm sure we can all agree are low intensity activities, however again a lack in muscular stability can lead to overloading spinal structures, inevitably resulting in low back pain and patients seeking physiotherapy. As a physiotherapist in London low back pain is a condition that I commonly see.

Andy Murray needs to see our physiotherapist!

Recently, Andy Murray retired from the Madrid Maters tennis competition due to his ongoing intermittent Low back pain. There are large forces put through the lumbar spine during any sporting activity, even more so in a sport such as tennis.

Why do players on the professional tennis circuit suffer with a high volume of spinal injuries and intermittent low back pain when they have access to physiotherapy? To answer you first need a small understanding of the biomechanics of tennis. When contemplating spinal loads in the different shots in a game of tennis, the serve is understood to place more stress and higher load on the spinal structures than any other stroke.

"the serve is understood to place more stress and higher load on the spinal structures than any other stroke." Jo Knock, Physiotherapist in London

When the racket moves over head and behind the body the spine flexes laterally and hyperextends. To smash the ball, acceleration of the racket before ball impact is produced by huge muscular forces bringing the trunk into rapid flexion accompanied by a very high velocity rotation (from right rotation to left rotation for a right-hander, vice versa for the left hander). This corkscrewing motion transfers the force of its torque to all the spinal segments. The repetitive trunk hyperextension we see in the tennis serve is understood to be a predisposing mechanism of lumbar arthritis.

Tennis players may also be at an increased risk of lumbar disc injuries due to the shearing effects of the forces from high velocity rotation from a position of lumbar hyperextension to lumbar flexion. This is as true for a professional at the French Open or at Wimbledon as it is for the average club player at the Islington Tennis Centre in London or at London’s Regent’s Park Tennis Centre.

You can now see why a lot of pro tennis players suffer with low back pain. If muscular control and dynamic stabilization around the spine is not up to scratch, injuries will result. Additionally, an individual could potentially have brilliant core dynamic stability, but other factors such as fatigue, general poor health, overload of schedule with looooonnnnnngggg hours spent training and the simple fact there are massive repetitions of the same movement or activity can all lead to spinal dysfunction.

Causes of low back pain in tennis players

In my experience of being a physiotherapist with experience of treating tennis related injuries, Low back pain is common. Frequent issues involved with tennis players suffering from low back pain.

• Lumbar disc abnormalities
• Muscular strains secondary to under trained or over loaded muscles
• Facet joint pain
• Pars injuries in adolescents including Pars fractures / Pars interarticularis

As a physiotherapist I am very aware of the heavy involvement of lower trunk muscles in tennis and indeed many sports. This reinforces the importance of abdominal and lower back exercises in strength and rehabilitation programmes. The strengthening of the lower trunk muscles not only will enhance performance, but both athletes and weekend warriors alike can benefit from preventing low back injury and pain. And as a clinical Pilates practitioner and physiotherapist I know how to get the trunk muscles and low back muscles to function better!

So for Andy Murray fans (I myself am one – I just want to see him lift that grand slam winner's trophy over his head one day, come on Andy you can do it!) it is not time to despair. We can be confident that he is surrounded by some pretty special sports physiotherapists and sports physicians who would be working around the clock on his treatment, which would no doubt involve rehabilitation exercises to build dynamic muscular stability to support his spine. And who knows, coming up we have Roland Garros, Queens and Wimbledon so watch the space for some trophy lifting!

If you want to get better you can!

Fear not, these strength and rehabilitation programs are not exclusively limited to those professional athletes – anyone in London suffering an episode of low back pain can come to see me for physiotherapy at Islington’s Angel Wellbeing Clinic and I will be able to work with you to address the cause of why your back has broken down – 9 times out of 10 this is due to muscular imbalances / deficiency and poor posture – then provide a program to get you back on your feet in no time, significantly reducing the chance of recurrence.

If you haven't already deduced by now, LONG gone are the days where the physiotherapist would suggest lying flat on your back for an episode of low back pain. It is important to keep active, lying on your back for extended periods can actually stiffen your spine more and lead to prolonged low back pain and maybe sciatica too. Most individuals respond famously to treatment comprising of manual therapy from a physiotherapist followed by a tailored rehabilitation exercise programme including clinical Pilates.

The long-term outlook is positive! You do not have to suffer with constant low back pain however it is not a magic wand trick. As a physiotherapist in Islington I know only too well how important the patient’s attitude is. I may be as good a physiotherapist as London has to offer but I cannot click my fingers and heal your back, I will guide you with your rehabilitation and it will involve co-operation and discipline on your part, by participating regularly in your exercises. These rehabilitation exercises are core and Pilates based movements and functional exercises – going to the gym and pumping iron nor 500 sit ups a day won't cut it!!

Other relevant articles

Tennis and shoulder injuries

Why is tennis good for you?

So whether or not you are a tennis player and have a bad back or if you are a keen sports person and are constantly troubled with low back pain or you notice that you get a niggle in your spine every time you increase you activity levels, it may be time for you to visit our physiotherapist in London and invest your efforts into building core strength and dynamic stability so you can have a happy spine. If you want an appointment with our physiotherapist in London at Islington’s Angel Sports Injury and Physiotherapy Clinic click below.


 


A few Common Myths about Low Back Pain


This is adapted from an article by a wonderful physio friend of mine from back home in Australia, Emma Esslemont and this is my first article as the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic. Sharing is Caring.

1. “I can't lift any objects”
Repetitive lifting can put undue stress on our lower back and predispose to injury. However this can be avoided if the correct lifting technique is used. Lifting should come from the legs - bend the knees and keep the back straight.

Use your quads and buttocks; they are after all two of the biggest muscles in our bodies!! If you have knees which sound like an old wooden door missing its oiling for years, then bend with the 'golfers bend' – video to come!

2. ” I always sit with good posture so I shouldn’t get back pain”
While having good posture is imperative, even a perfect ergonomic setup won’t reverse the detrimental effects that hours and hours of sitting can have on our spine. As a physiotherapist in London I am very aware that sitting places stress through our discs which are the shock absorbers of the spine

When sitting for extended periods, our hip flexors are in the shortened position thus pulling the lumbar spine into greater lordosis, and makes our deep abdominals – the CORE - lazy, particularly when you slouch. Are you slouching right now? I thought so…. See my posture tips for correct sitting and standing positions and imagery.


3. “I do 500 sit ups a day & 5 minutes of plank so my back should be nice and strong”
Unfortunately it takes a lot more than 500 sit ups a day to achieve a strong spine. And the plank will give even the STRONGEST of backs a bit of curry. Ideally you need a good core stability program. 'Core' is a completely overused and totally misunderstood term.

Core muscles are the deepest layer of abdominals consisting of the transversus abdominis, lumbar multifidus, pelvic floor and diaphragm. These muscles help to provide a corset and give support to the discs and joints of our spine. As one of the few physiotherapists in London that is also a clinical Pilates instructor I know what I am talking about!


4. ” When I have back pain I should lie flat on my back in bed till it goes away”
Rest is essential in an acute episode of back pain – that is REALATIVE rest. This means rest from aggravating activity, not all activity. This does not, however, mean days on end lying flat on your back.

Exercise is the best thing for speeding up your recovery. You should consult your physiotherapist for appropriate exercises that will be safe for you in the acute phase and as your pain resides these exercises can be progressed and become a long term maintenance program for your back to prevent reoccurrence.


5. “Sleeping position doesn’t really impact our backs”
For all the tummy sleepers our there it’s time to ditch this terrible habit… The best way to sleep is on your side with a pillow between your knees (the lazy S). This position maintains the natural curves of your spine.

When you are pregnant this is the BEST way to sleep, so why not get into the habit now – there will be enough changes to contend with when you are pregnant, so why add another one when the time comes round! Make the change now. And for all those males out there pffting and saying this doesn't apply to you – it does.


6. “Other health factors don’t affect my chance of developing back pain”
Incorrect. There are several health factors that actually increase our chances of suffering from back pain and if you choose me as your physiotherapist in London I will cover all bases with respect to back pain:

• Smoking: the chemicals in cigarettes actually dehydrate our inter vertebral discs and speeds up the process of degeneration. Research indicates that smokers will take 6 months longer to fully recover from disc related back pain.

Extra body weight: carrying extra kilos will place excessive undue load on the shock absorbers in our spine and also increase the load through the weight bearing joints causing them to wear out faster.

• Hydration: our inter vertebral discs are made up of around 70% water. The amount of water will depend on the amount of load applied through the disc ( this will differ at night – discs tend to rehydrate over night as we sleep) when a disc is dehydrated its mechanical properties are altered significantly and can no longer absorb stress as efficiently.

• Fatigue : when you are tired you are much less likely to be concentrating on your beautiful posture or core activation, and more likely thinking about your next coffee hit. When tired and fatigued you will definitely notice your points of vulnerability and for most of us, that is our lower backs, necks or shoulders. If you're really fortunate, you'll get the trifecta.

• Poor general health : it is a known fact that when you are sick or have been suffering with poor health you will have a much higher incidence of musculo-skeletal breakdown and this will nearly always be at the points of vulnerability which were mentioned just above.

Jo Knock BSc , MSc (Physiotherapy), MCSP

Clinical Pilates Practitioner

If you are looking for a physiotherapist in London because you have back pain and are concerned about your spine or you just need some general guidance for rehabilitation exercises, please don't hesitate to contact  me  as your physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic. If you want to make an appointment click below.


Spondylolisthesis can be a training injury and can be a cause of low back pain

This article is written by the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic. This article looks at how a spondylolisthesis causes back pain.

• What is a spondylolisthesis
• What causes a spondylolisthesis
• Symptoms of spondylolisthesis
• Grading of spondylolisthesis

What is a spondylolisthesis

Spondylolisthesis can cause back pain in Islington. The most common spondylolisthesis is an anterolisthesis. This is when one vertebra slips forward on the vertebra below. This is most common at the fifth lumbar vertebra when it slips forward on the first sacral segment.

Anterolisthesis is graded as 1-4, a grade 1 anterolisthesis is when there has been a slippage of 25% forward, a grade 2 is a slippage of 50% etc.

 

A retrolisthesis is less common, this is when the vertebra slips backwards on the vertebra below.

Types of spondylolisthesis

Type 1: dysplastic spondylolisthesis occurs secondary to a defect with the facet joints at L5S1 resulting in gradual forward slipping of the vertebra.

Type 2: this occurs when there is a defect in the pars interarticularis. Slippage of the vertebra may occur. If there is slippage it is called an isthmic spondylolisthesis. If there is no slippage and if there is just the pars defect it is known as spondylolysis.
This type of spondylolisthesis is most associated with hyperextension injuries and micro stress fractures of the pars.

Type 3: this spondylolisthesis is not associated with a pars defect but with degeneration of the lumbar facet joints and is common in the elderly but doesn’t result in more than a 30% slippage.

Type 4: this is a traumatic spondylolisthesis and occurs when there is fracture to the posterior elements of the vertebral body.

Type 5: this is a pathological spondylolisthesis and is associated with a tumour or other disease process causing weakness to the posterior elements.

What causes a spondylolisthesis

• Hyperextension injuries such as in gymnasts
• Tumours or pathology
• Degenerative changes
• Traumatic
• Congenital

Signs and symptoms of spondylolisthesis

There are often very few symptoms of a grade 1 spondylolisthesis other than a bit of back pain and nothing more than in the rest of the population. As the percentage of slippage of the spondylolisthesis increases so the symptoms may increase. Low back pain may increase and there may be pain into the buttocks and legs. There may also be increased muscle spasm in the lumbar spine and in the buttocks and tight hamstrings.

 

The symptoms may be activity related and on cessation of activity symptoms of low back pain and muscle spasm may go away.

Other back pain related articles

Do discs slip?

Piriformis syndrome causing back pain and sciatica

Spinal stenosis and back pain

What is spondylitis and why does it cause back pain

If you have low back pain and want to rule out a spondylolisthesis as the cause of your low back pain arrange to see our physiotherapist in London at the Angel Sports INjury and Physiotherapy Clinic, Islington. For an appointment click below.


Osteoporosis as the cause of back pain

 

This article is by our physiotherapist in Islington from the Angel Sports Injury and Physiotherapy Clinic and looks at the causes of the sudden onset of back pain.

• Osteoporosis
• Symptoms of osteoporosis fracture
• What happens when osteoporosis causes back pain

Frequency of osteoporosis causing back pain

The sudden onset of back pain in anyone over 50 a compression fracture has to be ruled out. Experts recommend that women over 45 with sudden onset of low back pain and a history or a susceptibility to osteoporosis should be investigated for a vertebral compression fracture. Women are four times more likely to have back pain form osteoporosis than men. In the UK, one in two women and one in five men over the age of 50 will fracture a bone due to osteoporosis.

National osteoposis society

 

 

 

 

Symptoms of osteoporotic fracture causing back pain

Back pain may or may not be a symptom so there may be other symptoms, such as loss of height, difficulty in movement such as twisting and bending forwards and backwards. There may or may not be associated spinal deformity.

• Loss of vertebral height
• Backpain
• Spinal deformity
• Pain on twisting and bending forwards and backwards

Commonly the back pain associated with a vertebral compression fracture occurs during a routine activity such as bending or lifting but in extreme cases the back pain can occur following sneezing or a minor stumble or trip.

What happens when osteoporosis causes back pain

In an osteoporosis compression fracture there is a decrease in the density of the bone in the vertebra and this leads to a collapse to the front part of the vertebral body producing a wedged shape vertebra. Due to the collapse of the front of the vertebra there is rarely any neurological involvement and this differentiates it from a vertebral collapse due resulting from a pathological fracture.

 

These fractures can lead to a decrease of up to 20% in this anterior vertebral body height back pain caused by an osteoporosis fracture of the thoracic spine. This is most common area of the back for a compression fracture and may lead to an increase in the thoracic kyphosis and the development of a 'dowagers hump'. These fractures are easy to pick up on x-ray and do not require any more specialist imaging technique.

 

 

 

 

Other relevant articles

Rib problems causing back pain and chest pain

Do discs slip?

Spinal stenosis as a cause of back pain

What is spondylitis and why does it cause back pain

 

If you are in your 40's, 50's or older and you have noticed back pain on bending and twistng or bending forward or backwards. Or maybe there is a change in your posture or you have noticed the onset of mid back pain, it may be a good idea to get a diagnosis. The Angel Sports INjury and Physiotherapy Clinic in Islington has it's own onsite x-ray facilities and this can aid the diagnosis for this and a number of other conditions.

If you want to make an appointment with our physiotherapist in Islington to diagnose your back pain click below to make an appointment.


Knee kinematics and kinetics in former soccer players with a 16-year-old ACL injury--the effects of twelve weeks of knee-specific training.


von Porat A, Henriksson M, Holmström E, Roos EM.
Source

Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden. anette.vonporat@telia.com
Abstract


BACKGROUND:

Training of neuromuscular control has become increasingly important and plays a major role in rehabilitation of subjects with an injury to the anterior cruciate ligament (ACL). Little is known, however, of the influence of this training on knee stiffness during loading. Increased knee stiffness occurs as a loading strategy of ACL-injured subjects and is associated with increased joint contact forces. Increased or altered joint loads contribute to the development of osteoarthritis.The aim of the study was to determine if knee stiffness, defined by changes in knee kinetics and kinematics of gait, step activity and cross-over hop could be reduced through a knee-specific 12-week training programme.


METHODS:

A 3-dimensional motion analysis system (VICON) and a force plate (AMTI) were used to calculate knee kinetics and kinematics before and after 12 weeks of knee-specific training in 12 males recruited from a cohort with ACL injury 16 years earlier. Twelve uninjured males matched for age, sex, BMI and activity level served as a reference group. Self-reported patient-relevant data were obtained by the KOOS questionnaire.


RESULTS:

There were no significant changes in knee stiffness during gait and step activity after training. For the cross-over hop, increased peak knee flexion during landing (from 44 to 48 degrees, p = 0.031) and increased internal knee extensor moment (1.28 to 1.55 Nm/kg, p = 0.017) were seen after training, indicating reduced knee stiffness. The KOOS sport and recreation score improved from 70 to 77 (p = 0.005) and was significantly correlated with the changes in knee flexion during landing for the cross-over hop (r = 0.6, p = 0.039).


CONCLUSION:

Knee-specific training improved lower extremity kinetics and kinematics, indicating reduced knee stiffness during demanding hop activity. Self-reported sport and recreational function correlated positively with the biomechanical changes supporting a clinical importance of the findings. Further studies are needed to confirm these results in women and in other ACL injured populations.


Cervicogenic headaches

This article is by the Islington physiotherapist at the Angel Sports Injury and Physiotherapy Clinic. This article looks at:

• What is cervicogenic headache
• Where is the pain from cervicogenic headache
• Neck pain as the cause of cervicogenic headache
• Nerves of the neck and where they refer pain

Types of headache

There are a number of different headaches, tension headaches, common migraines, classical migraines, trigeminal neuralgia, and occipital neuralgia, cluster headaches and cervicogenic headaches.

 

 

 

Where does the pain come from

Cervicogenic headaches are caused by referred pain from both the bony and soft tissue structures of the neck and can obviously result from trauma to the neck such as from a whiplash injury or other trauma but also and more commonly from poor postural habits and even front sleepers who spend a good percentage of the night with the head in rotation.

The pain in a cervicogenic headache can mimic that of a migraine or a tension headache and as such diagnosis can be difficult and so the Cervicogenic Headache International Study Group came up with criteria to make diagnosis easier.

Diagnosis of cervicogenic headaches

Diagnostic Criteria for Cervicogenic Headache by The Cervicogenic Headache International Study Group Diagnostic Criteria. (Modified from Biondi DM: Cervicogenic headache: mechanisms, evaluation, and treatment strategies. J Am Osteopath Assoc. 2000;100(9 Suppl):S7-14. Source: Sjaastad 0, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache. 1998;38:442-445.)


Neck related headache must have at least one of the following:

1. The head pain must be preceded by:
Neck movement or
Prolonged awkward head position
Pressure over the upper half of the neck or base of the skull on the headache side
2. Restricted motion of the neck
3. Neck, shoulder or arm pain
If all three are present, the likelihood of neck related headache as the cause is most likely

Characteristics of Neck Related Headache

Often, a history of neck trauma (whiplash, sprain, strain)
One sided headache that does not change sides
Occasionally, the pain may be on both sides
Pain located at base of skull, front of head, sides of head or around the eyes
Pain may last hours or days
The headache usually begins in the neck
The headache is moderate to severe in intensity
The headache is not throbbing
The pain is not sharp

Other features which may be noted:

Nausea
Sensitivity to sound
Sensitivity to light
Dizziness
Difficulty swallowing
Blurred vision on the side of the headache
Vomiting
Tearing on the side of the headache
Swelling around the eye on the side of headache

A good postural evaluation should be carried out with anyone with a headache as it is common for there to be altered neck posture and a decrease in rotation of the cervical spine with pain on passive extension and rotation. There may also be point tenderness over the facet joints on the side towards rotation. Trigger points may also be found at the base of the head in the region of the sub occipital muscles and in the shoulder musculature and these may refer pain over the head when stimulated.

Nerves of the neck and where they cause pain

The nerve roots of the first three cervical nerves can refer pain over the head:

C1 nerve: the sub-occipital nerve innervates the joint between the neck and the skull. Injuring this joint can cause pain over the sub-occipital region or back of the head.

C2 nerve: this supplies the joint between the first and second neck vertebrae. Damage to this joint or surrounding structures can cause head pain over the temples and into the region around and behind the eyes

C3 nerve: supplies the joint between the second and third cervical vertebrae and damage to this joint can cause pain in a similar location to the C2 nerve. The joint between C2 and C3 is the most common area of the neck damaged in a whiplash.

Other relevant articles

Slipped disc in the neck

If you get headaches you may have a problem with your neck. To make an appointment with our physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic click below.


What is piriformis and where does it cause pain

This article about back pain is by the Islington physiotherapy practitioner from the Angel Sports Injury and Physiotherapy Clinic. This article covers:

• What is the piriformis muscle
• Where is piriformis
• What does it do
• What is piriformis syndrome

Where is piriformis

Piriformis is a muscle that runs from the hip to the anterior surface of the sacrum at the base of the spine. The main function of this muscle is to externally rotate and extend the hip. When the hip is flexed the piriformis abducts the hip. Piriformis also crosses the sacroiliac joint and this can be significant when there is a problem with the muscle.

In approximately 85% of the population the sciatic nerve passes between the layers of muscle but in a minority the sciatic nerve pierces the muscle.

 

 

What is piriformis syndrome

Piriformis syndrome occurs when the sciatic nerve becomes pinched by the piriformis muscle. This can cause pain in the distribution of the sciatic nerve and produce sciatica as well as causing deep gluteal or buttock pain. This can occur during episodes of back pain when suffering from a slipped disc as well as other symptoms.

• Deep buttock pain
• Pain down the sciatic nerve
• Pain on sitting
• Pain walking down an incline

Women post childbirth or in the lead up to childbirth can also be prone to piriformis syndrome as the muscle helps to maintain the alignment of the sacroiliac joints by contracting. This sustained contraction can lead to fatigue and contraction of the muscle

 

Other relevant articles

Spinal stenosis and back pain

Spondylitis and why does it cause back pain

Do discs slip

Back pain caused by facet joint injury


If you have back pain and/or sciatica or maybe you have gluteal pain and you require   physiotherapy       in Islington at the Angel Sports Injury and Physiotherapy Clinic. Click below to make an appointment.


Neck pain and slipped discs

This article is by our Islington physiotherapist from the Angel Sports Injury and Physiotherapy Clinic. This article looks at neck pain caused by a slipped disc and trapped nerve in the neck:

• Anatomy of the spine in the neck
• Why we get neck problems
• Signs and symptoms of a slipped disc

Anatomy of the neck

Each vertebra in the spine is separated at the front by an intervertebral disc and at the back by the facet joints. Both the facet joints and the disc are designed to allow the spine to move with different parts of the spine designed to move in different ways. This is facilitated by the variation of these structures as you go down the spine.

Cervical vertebra

The neck or cervical spine can flex and extend, rotate and laterally flex allowing the head, eyes and the ears to be moved independently of the torso, which is clearly of great evolutionary advantage.

The neck is also curved into a lordosis, which is a ‘c’ shaped curve with the opening at the back. This shape plus the discs ability to absorb impact helps keep the head in a nice stable position when moving about. Imagine our ancestors trying to run across rough ground, spear in hand trying to catch dinner whilst having to deal with blurred or shaky vision.

Why we get neck problems

The neck has evolved to enable us to live hunter gatherer lifestyles but hunting and gathering today for a lot of us involves sitting at a desk for eight to ten hours a day and then when we get home form work we often sit in front of a computer again.

If the ergonomics of our desk aren’t correct the seated position can lead to the neck becoming flexed and the head extended where it articulates with the first neck vertebra, C1.

This loss of the cervical lordosis and the loss of the extension of the neck take the discs out of compression, which is the position they are anatomically designed to work in, and creates shearing forces through the vertebrae. Over a period of time these forces plus the rotation of the neck can lead to disc failure and the ‘slipped disc’. Over time the discs and the facet joints slowly wear out and arthritis sets in with pain, discomfort and stiffness the result.

A lot of neck, shoulder, arm, hand and headaches can then be considered repetitive strain injuries (RSI) as they result from faulty ergonomics and posture and tissue failure. It is clearly essential that a full postural assessment at work should be carried by someone with a thorough understanding of clinical biomechanics and with an ability to make a diagnosis for the effective management of the problem and possible solution.

If you want to benefit from our Islington chiropractic practitioner assessing your workplace click the logo at the bottom of the page to arrange a workplace assessment.

Signs and symptoms of a slipped disc in the neck

The pain from a slipped disc occurs when the disc bulges between two vertebrae and puts pressure on a nerve. This pressure to the nerve can cause the neck pain, and arm pain including the symptoms of numbness and tingling. The most common levels where cervical discs herniate are C5-C6 and C6-C7. If there is a herniation of the disc at C5-C6 the disc affects the C6 nerve root.

• C4/C5 Disc herniation: This affects the distribution of the C5 nerve root. It can cause the deltoid muscle to be weak and also can cause shoulder pain. This affects the lateral upper arm. It usually does not cause numbness and tingling.

• C5/C6 Disc herniation: This affects the distribution of the C6 nerve root. It can cause numbness and tingling in the lower lateral arm, affecting the thumb and index finger. The muscles affected are the biceps and the wrist extensor muscles with a decrease in the biceps reflex possible.

• C6/C7 Disc Herniation: This affects the distribution of the C7 nerve root. It can cause numbness and tingling along the 3rd digit (the long finger) and the triceps muscle can become weaker. It can also affect the triceps muscle causing numbness and tingling. A decrease in the triceps reflex can also result.

• C7/T1 Disc Herniation: This affects the distribution of the T1 nerve root. It can cause weakness including the ability to squeeze and hold on to objects. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.

Other relevant articles

Do discs slip

Spondylitis and why does it cause back pain

Back pain caused by facet joint injury

Spinal stenosis and back pain

 

If you have neck pain, headaches or arm and hand pain and you can get to the Angel Wellbeing Clinic in Islington physiotherapy may help. If our Islington physiotherapist is not able to help you they will refer you to a specialist for treatment. If you want to make an appointment with our Islington physiotherapy practitioner please click below.


Spinal canal stenosis and back pain

This article is by our physiotherapist in Islington and looks at how spinal canal stenosis causes back pain. This article covers:

• What is spinal canal stenosis
• How does it cause back pain
• Causes of spinal stenosis
• Trapped nerves and spinal canal stenosis
• Signs and symptoms of spinal canal stenosis
• Cauda equina syndrome

What is spinal canal stenosis

Spinal canal stenosis occurs when the diameter of the spinal foramina is reduced and this can then ‘choke’ the spinal nerves. This is most common in the lumbar spine but it can occur in the cervical spine where it is a lot more serious.

Spinal stenosis can result in ischaemic stenosis where it impacts upon the blood supply to the legs on activity and/or neurogenic claudication which can cause pain in the nerves in the lower limb. This pain is different from the pain down the back of the leg due to sciatica or a pinched or trapped nerve.

How does it cause back pain

As the spinal canal slowly narrows the nerves slowly get pinched. The most common reason for this is the narrowing of the spinal canal. This is commonly due to a decrease in intervertebral disc height and hypertrophy of the ligamentum flavum.

Causes of spinal stenosis

Spinal stenosis is most common in the over 50’s but it and can occur due to a number of conditions other than age:

• Congenital
• Degenerative changes and arthritis
• Hyperparathyroidism
• Paget’s disease
• Ankylosing spondylitis
• Cushings syndrome
• Acromegaly

Signs and symptoms of spinal stenosis

Spinal stenosis often presents with back pain and leg pain. There is also often numbness into the legs. Spinal stenosis is often worse on walking and it is often described as cramping and tiredness into the legs. This cramping often disappears on rest or when the knees are brought up to the chest in the foetal position as the tension of the nerve roots is reduced.

Cauda equina syndrome

This is the most serious manifestation of spinal stenosis and it occurs in the lumbar spine.

The spinal cord ends near the first lumbar vertebra in the low back. At this point it forms the conus medullaris. The bundle of nerve roots below the conus medullaris is named the cauda equina . Compression of of these nerve roots can cause symptoms of pain, change to reflexes, decreased muscle strength, and decreased sensation.

Cauda equina syndrome is considered a surgical emergency because if left untreated it can lead to permanent loss of bowel and bladder control and paralysis of the legs.

Other articles about back pain

Do discs slip

Spondylitis and why does it cause back pain

Back pain caused by facet joint injury

 

If you have back pain and require physiotherapy in Islington click below to make an appointment.


 


Skiing Injuries

This article is by the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic and it looks at knee injuries from skiing and this will be followed by an article on ‘get fit for skiing and prevent injury

• Mechanism of injury
• Classification of ligamentous injury
• ACL
• Medial and Lateral Collateral ligaments
• Meniscal tears

skiing injuries to the knee can be treated at the angel sports injury and physiotherapy clinicSkiing for most is a once a year event and unless we have been consistent over the year with respect to exercise and maintaining fitness there is a risk of injury as the skiing holiday progresses.

There are numerous skiing injuries that can be sustained but knee injuries are the most common and can be the most significant. These can be the more severe injuries such as the rupture of the anterior cruciate ligament or to the less severe straining of the lateral or medial collateral ligaments.

Like all ligamentous injuries ascertaining the mechanism of injury is essential and also assessing the individuals’ ability on skis will aid the diagnosis. If you can determine the direction the lower leg went in during the accident you can deduce the tissues injured and if you can determine the velocity of the incident you get an idea as to the severity of the injury.

Beginners tend to do snow plough turns. This can result in medial collateral knee ligament injury as it requires quadriceps strength to maintain control. As the stance gets more exaggerated and the skis get further apart in an attempt to slow down, and we have all done this when starting to ski or have seen it, more and more strength is required form the quadriceps to keep control of the skis. When the skis get further apart and the quadriceps start to fatigue there is more chance that control of the skis can be lost and a twisting injury result.

As the skier improves in technique there is a change towards a parallel turn and skis are kept together or parallel as in a carving turn. This is more efficient than doing a parallel turn but increases the speed of the turn and naturally any injury will be more severe.

Classification of ligamentous injuries

• Grade 1 - No ligamentous laxity on stressing the joint. Minor tears to ligament fibres.
• Grade 2 - Some ligamentous laxity but definite end point joint integrity maintained. Some damage to ligament fibres.
• Grade 3 - Complete give in the ligament. All ligament fibres torn and lack of integrity to joint. Swelling within an hour and blood in the joint
The assessment of the injury and the determination of the degree of ligamentous laxity can be done 5-7 days after the injury and once the initial inflammation has subsided.


Medial collateral ligament sprain

This type of sprain is the most common ski injury making up 25% of all injuries. Most commonly affects beginner and low-intermediate skiers and the injury. With beginner it often results from a ‘snowplough’ when the knees get stressed in an inward direction and falling with the skis crossed or for intermediate skiers the medial collateral ligament gets sprained when the an edge gets caught and forces the leg into external rotation.

Grade one and two sprains should be treated with extension of the knee until the swelling has gone down. Grade 3 tears may need surgical intervention.

Anterior cruciate ligament sprain (ACL)

This injury accounts for 10-15% of all ski injuries. It is often diagnosed late due to other knee injuries and can be missed to miss at the time.

There are three main mechanisms of injury that can lead to ACL damage.

• backward twisting fall
• forward twisting fall
• boot-induced anterior draw

The most common injury mechanism is the forward twisting fall. It is the number one mechanism of ACL injury for those using carving skis. It occurs when the skier moves forwards relative to the ski (such as when catching an edge whilst turning). The resulting bending movement is applied as the affected leg twists and rotates outwards and the forces generated rupture the ACL.

Meniscal tears

These make up approximately 5 –10% of all ski injuries and often occur with other injuries. The lateral meniscus is usually involved due to the internal twist in the weight bearing knee and usually the result of catching an edge at speed.

With the frequency of knee injuries in skiing it is important to rehabilitate old knee injuries and then prepare for the next skiing holiday thoroughly. Our physiotherapist will assess your old injury and look at the function of the knee and prescribe a course of treatment and rehabilitation to strengthen the knee and decrease the risk of injury recurrence.


If you are a skier and have had knee injuries in the past and you want an assessment from a physiotherapist in Islington call the Angel Sports Injury and Physiotherapy Clinic for an appointment or click below.


 


Do discs really 'slip'?

This article is by the physiotherapist in Islignton at the Angel Sports Injury and Physiotherapy Clinic. The article covers:

• Sciatica
• Slipped Disc
• Disc bulge
• Trapped nerve

Educating patients is very important. I want the patient to go away from the session with a specific diagnosis as to what their problem is and to go away with an understanding of the treatment plan I have given them. The number if times I have talked to patients who have seen other practitioners an they have not been told what is wrong with them before consenting to treatment is staggering and hopefully none of my patients would say that after seeing me.

Do discs slip?

Intervertebral disc pain is common. Most patients have some component of disc pain when they present at the clinic even if they do not have nerve root pain. Most commonly the patient will have an inflamed disc on one side and maybe a bulge, this may or may not compress a nerve root. With the unlucky few that have a herniated disc there is no doubt that they have a trapped nerve as they often have shooting pain or sciatic pain down the back of the leg into the foot.

Sciatica

The sciatic nerve isn’t a specific nerve. It is the name given to the fourth lumbar nerve, fifth lumber nerve and the first to third sacral nerves. Sciatica isn’t a diagnosis but is more of a descriptive term but most patients understand it!

Trapped Nerve

This is where it all gets a bit more specific and should be part of the diagnosis. Each of the lumber nerves supplies a specific area of skin, a dermatome. Each nerve goes on to supply a specific reflex and a specific muscle. Testing reflexes, testing muscle strength and determining the area of sensation change provides specific location of the ‘trapped nerve’ and this locates the specific disc. Then you can have a diagnosis and a treatment plan.

If you ever go to see a GP or other practitioner always get a specific diagnosis. An expert will be able to give a specific diagnosis so don’t settle for anything less!

If you have back pain and you think you may have a slipped disc and you require physiotherapy in Islington click below to make an appointment with the the physiotherapist at Islignton's Angel Sports Injury and Physiotherapy Clinic.


What is Spondylitis and why does it cause back pain?

This article is written by the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic. The article covers:

• What is spondylitis
• How spondylitis affects the intervertebral discs.
• Symptoms of spondylitis.
• Spondylitis and facet joints.

• Spondylitis of the ligaments and muscles.

 

What is spondylitis?

Spondylosis is another name for osteoarthritis of the spine and is a degenerative process that involves the spine and the surrounding soft tissues and this can then lead to back pain and back ache. Degenerative changes can occur due to age but can also follow trauma, injury and infection. This degenerative process can involve the cervical (neck), the thoracic and lumbar spine and apart from pain and affects all parts of the spine, the intervertebral discs and the facet joint and can affect all parts of the spine, the intervertebral discs and the facet joints. Symptoms of stiffness and decreased flexibility can be present.

How spondylitis affects the intervertebral discs

There are two parts to the intervertebral disc. The gelatinous nucleus pulposus and the elastic annulus fibrosus that contains the nucleus.

Degenerative changes can lead to the annular fibres becoming weaker which can lead to micro tears and a decrease of the elastic properties. Eventually the micro tears can join together to create bigger tears which can obviously lead to back pain. The nucleus is also prone to degenerative changes and these changes result in the gelatinous nucleus becoming less able to retain fluid. This leads to an inability to absorb shock and impact. As the process of spondylosis progresses the disc height becomes reduced and the propensity to herniation increases and a slipped disc can result.

Symptoms of spondylitis

• Back pain that is intermittent.
• Stiffness in the back in the morning that improves with activity.
• Pain around the joints of the spine.
• Headaches and neck and shoulder pain.
• Low back pain, buttock pain and sciatica down the back of the leg.
• Tingling or weakness in the arms or legs.
• Decreased flexibility.
• Difficulty in walking.
• Increased or decreased curves to the spine.


Spondylitis of the facet joints

Each vertebra has two pairs of joints to join them to the vertebrae above and below them. The facet joints are not major weight bearing joints their function is to guide the movement of the spine. Just like any other joint in the body they have cartilage covering the articulating surfaces reducing friction and allowing the joints to glide over one another.

Spondylosis of the facet joints can lead to a reduction in the cartilage and the ease of movement of the joints. There can also be the formation of bony spurs or osteophytes around the joints and these can push forward and compromise the spinal nerves as well as reduce the mobility of the joints.

Ligaments and muscles and how spondylitis effects them

These structures also are compromised in spondylitis of the spine. Ligaments that help support the spine can weaken and eventually collapse. The small intervertebrtal muscles of the spine can also thicken and be less effective at feeding back proprioceptive information.  

Other articles about back pain 

 

Back pain and facet joint injury

Do discs slip

Study shows spinal manipulation is as effective as surgery

 

If you have back pain and you think it may be spondylitis you need to get a diagnosis so make an appointment for physiotherapy in Islington at the Angel Sports Injury and Physiotherapy Clinic. To make an appointment with our physiotherapist click below.

 


Back Pain caused by Facet Joint Injury

 

This article is by our physiotherapist in Islington and is about how the facet joints in the spine function and how they get injured and cause back pain. The article looks at:

  • Anatomy

  • Function

  • How facet joints get injured and cause back pain.

Anatomy

Vertebrae are joined to each other by the intervertebral disc and by paired facet joints. Facet joints are like most of the other joints in the body and contain cartilage and a capsule containing synovial fluid. The facet joints also have a nerve supply and it is the stimulation of these nerves that can cause back pain to be felt.

 

Function of the joints

Facet joints are not major weight bearing joints but their alignment guides the movement of the spine. In the lumbar spine the joints face form front to back and this allows the lumbar spine to move in flexion and extension. In the thoracic spine where the ribs are the joints sit like slates on a roof and this allows rotation of the spine in this area. In the neck the joints sit more on top of each other and this allow the movement in all directions.

How facet joints cause back pain

The majority of the body’s weight is transferred through the intervertebral discs with only a small amount being transferred through the facet joints. During certain movements such as bending and twisting, more weight can be transferred through the joints than they are able to cope with and the joint gets injured, damaging the cartilage in the joint and tearing the capsule and soft tissues surrounding the joint. Sustained poor posture and poor seating can also cause the joints to fail and cause back pain.

Symptoms of facet joint back pain

There is often a lot of spasm at the level of the involved joint and pain on specific movements, particularly twisting and leaning backwards. There may also be loss of the normal curve in the area of the spine involved. Back pain associated with facet joints can also refer into the buttocks and over the hips and develop following sitting for long periods.

If you have back pain from the facet joints or from a slipped disc it is worth getting an accurate diagnosis. If you want to see our physiotherapist in Islington and find out the cause of your back pain click below to make an appointment.


 


Adhesive capsulitis or Frozen shoulder

This article is written by the physiotherapist in Islington. The physiotherapist from the Angel Sports Injury and Physiotherapy Clinic looks at this common shoulder problem. This article looks at:

• Anatomy of the frozen shoulder
• Signs and symptoms
• Causes

About frozen shoulder

Frozen shoulder or adhesive capsulitis to give it its medical name is a condition that leads to the shoulder joint becoming painful and stiff. This ‘freezing’ phase may take a few days to a few months during which the shoulder joint becomes painful and less mobile and then this gives way to the ‘frozen’ phase. This phase is often less painful but there is stiffness and a very reduced range of motion. There can be wasting of the shoulder muscles during this. This gives way to the ‘thawing’ phase when mobility gradually returns to the shoulder.

Signs and symptoms of frozen shoulder

Most commonly affected movements are internal and external rotation of the shoulder so patients often have trouble putting their affected side hand into their back pocket. Reaching for door handles and combing hair can be some of the tasks that can be affected and the whole process from freezing to thawing may take three years or more.

Women are more susceptible to frozen shoulder than men and in particular the 40-60 year age group. Other underline conditions can increase the likelihood of developing a frozen shoulder such as diabetes, Parkinson’s and thyroid conditions. Frozen shoulder can also develop subsequently to an injury to the shoulder such as a fall.

A small percentage will be unfortunate enough to go on to develop a frozen shoulder in the other previously unaffected shoulder.

Anatomy

The capsule around the glenohumeral joint in the shoulder becomes thickened in a  frozen shoulder.

Causes of frozen shoulder

Frozen shoulder is caused by the inflammation, scarring, thickening, and shrinkage of the capsule that surrounds the shoulder joint. There may be an immune system malfunction that causes the shoulder capsule to be ‘rejected’ and this results in the thickening of the structure.

Other shoulder injury articles

Tennis and shoulder injuries

Rotator cuff injuries

 

If you have shoulder pain or your shoulder joint is restricted and troubling you make an appointment for physiotherapy in Islington at the Angel Sports Injury and Physiotherapy Clinic for an assessment please click below.


 


Rib and Chest pain: Costovertebral Arthralgia

This article by the phsyiotherapist in Islington form teh Angel Sports Injury and Physiotherapy Clinic looks at rib and chest pain or costovertebral joint arthralgia to give it its correct title. This article covers:

• Signs and symptoms of rib pain
• Anatomy of costovertebral joint
• Causes


Signs and symptoms

Sudden onset of chest pain is common but thankfully the majority of times it isn’t anything serious. Obviously if anyone presents at the clinic with a sudden onset of chest pain a number of medical conditions have to be ruled out. Cardiac problems need to be explored with a thorough history and then examination and the lungs need to be listened to. Spontaneous pneumothorax also needs to be excluded.

Most patients with costovertebral joint pain may present with a sudden onset of upper back pain, often between the shoulder blades but anywhere in the thoracic spine is possible. This will often be described as a stabbing pain. This pain is often one sided and often was the result of a particular movement or activity which can aid the diagnosis.

There may be muscle spasm in the paraspinal muscles that run up and down the spine on the affected side and there may be a focal point of tenderness over the affected costovertebral joint. On occasions pain may radiate around to the front of the chest and the sterno-costal joint of the involved rib may also be very tender to touch and it may appear inflamed.


Anatomy of the costovertebral joint

In the posterior aspect of the spine the ribs articulate with the vertebrae at two joints. The costo-transverse joint and the costovertebral joint are the two articulations with the vertebrae and at the front of the spine the ribs articulate with the sterno costal joint. On breathing the ribs move up and down in a bucket handle motion and pivot at the sterno-costal joint. This articulation at the rear of the spine can be damaged or sprained on sudden movement such as from sneezing or through repetitive injury from activity or a sedentary lifestyle.


Causes

Activities that cause this condition may be twisting or lifting and bending activities. From my clinical experience sneezing can also cause this and on examination there may be a reluctance to take a deep breath in as the pain suddenly ‘catches’ at the deepest point of inspiration. A sedentary lifestyle may also contribute to the condition through making the postural muscles lazy and therefore predispose the joints in the spine to injury.


If you have chest pain or pain on breathing in then you may have a costovertebral joint sprain but a thorough examination is required to be certain. If you wish to make an appointment at Islington's Angel Sports Injury and Phyiotherapy Clinic  and see a physiotherapist in Islington please click below.


Rotator Cuff Injuries and Shoulder Pain

 

This article is written by the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic in Islington and looks at common causes of shoulder pain. This article covers the rotator cuff and looks at:

• Anatomy of the rotator cuff
• Mechanism of injury for the rotator cuff
• Signs and symptoms of rotator cuff injury

Anatomy of the rotator cuff

The anatomy of the shoulder is complex and comprises of four joints. The obvious one is the glenohumeral and this allows movement of the arm, then you have the acromio-clavicular joint, the sternoclavicular joint and the scapulothoracic joint/articulation.

Joints of the shoulder:

• Glenohumeral
• Scapulothoracic
• Sternoclavicular
• Acromio-clavicular

Like the hip the glenohumeral joint is a ball and socket joint but unlike the hip, which is designed for stability and weight bearing, the shoulder joint is designed for flexibility and movement. Evolutionary development has allowed the shoulder to provide us with the ability to lift ourselves up, to throw things and catch things and to evolve into successful hunter-gatherers.

The downside of al this flexibility is that the shoulder is prone to injury and one area particular prone to injury is the rotator cuff. The rotator cuff comprises of four muscles that are blended into the capsule of the glenohumeral joint to reinforce the shoulder during movement providing stability to the glenohumeral joint in the process.

Muscles of the rotator cuff

• Supraspinatus
• Infraspinatus
• Subscapularis
• Teres minor

The tendons of these muscles wrap around the shoulder joint, forming a cuff around the ball of your humerus providing stability.

 

Types of rotator cuff injuries

The rotator cuff is susceptible to three types of injuries:

• Rotator cuff tendonitis
• Rotator cuff impingement syndrome
• Rotator cuff tear

Rotator cuff tendonitis

This is caused by inflammation in the tendons of the rotator cuff. It can be acute, following activity and injury or it can be chronic due to repetitive activity or overuse. Acute injuries can occur during sport such as from throwing injuries. Chronic sports related rotator cuff injuries can occur through too much tennis serving practice. Away from sports occupations that rely on repetitive shoulder movement such as painting and decorating or plastering can cause rotator cuff tendonitis.

Symptoms of rotator cuff tendonitis can be sudden pain on lifting the arm up above shoulder height. There may also be pain at night.

Rotator cuff impingement syndrome

The rotator cuff passes under the acromium in the subacromial space. It is here that the movement of the shoulder blade can damage the rotator cuff tendon and this can lead to the tendon tearing. This tends to be a chronic problem and can be secondary to arthritis of the acromium and wear and tear.

Symptoms of rotator cuff impingement are more chronic and follow activities that involve the arm above the head.

Rotator cuff tear

This often starts as sudden onset of pain at the front outside aspect of the shoulder. There is often pain on certain movements such as reaching forward or raising your hand above your head. There may also be pain on movement and restricted movement of the shoulder.

If you have shoulder pain whether it is acute or chronic from daily activities or sport arrange to see the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic and prevent it from deteriorating further. If you want to arrange an appointment please click below.


 


Achilles Tendinopathy

This article has been written by the physiotherapist in Islington from the Angel Sports Injury and Physiotherapy Clinic’s and looks at:


• Anatomy of the Achilles tendon
• Causes of Achilles tendinopathy
• Signs and symptoms of Achilles tendinopathy


Achilles tendinopathy is a common overuse running injury but it is also the most common tendon to rupture. This is more common as a result of jumping and can feel like a sudden kick in the back of the ankle and this needs urgent medical attention.

The Achilles tendon joins the two calf muscles, Soleus and Gastrocnemius to the anklebone, the calcaneus. The action of the Achilles tendon is to contract suddenly on the toe off phase during walking to propel the body forward. At that stage it pushes the total weight of the body away from the ground and therefore takes a lot of force. Obviously the faster this movement takes place the more force on the tendon and the increase in likelihood of injury

Achilles tendinopathy can occur just above the insertion into the anklebone or it can occur higher up the tendon towards the calf muscle. There is no prediction as to where the tendinopathy can appear but it can be acute, follows on during and straight after training or it can be a chronic condition and not go away on rest.


Causes of Achilles Tendinopathy

There are a variety of potential causes of Achilles tendinopathy but like a lot of injuries taking on too much physically too soon is a frequent factor. The chance of Achilles tendonitis just like other injuries can be diminished by a gradual increase in physical activity.


• Increase in level activity
• Not allowing enough recovery between activities.
• Inappropriate footwear during activity.
• Weak calf muscles.
• Tight calf muscles not allowing the ankle to move through its full range of motion.
• Running up hill
• Flat feet or overpronation or instability in the ankle joint during running allowing the feet to roll in.

• Wearing high heels constantly shortens the tendon and calf muscles so when exercising in flat running shoes, the tendon is stretched beyond its normal range causing strain.


Signs and symptoms of Achilles tendinopathy

• Pain and stiffness in the Achilles tendon worse in the morning.
• Pain along the Achilles tendon or in the back of the heel worse during activity
• Severe pain the day after exercising
• Thickening of the tendon
• Bone spur (insertional tendinitis) visible on x-ray
• Swelling that is present all the time and gets worse throughout the day with activity

Other running related injuries

Anterior compartment syndrome and shin splints

The Treatment of Runners Knee or Iliotibial Band Syndrome

Runners knee: the magic cure?


If you suffer from pain in the back of your ankle during exercise or the day following exercise you may be developing Achilles tendinopathy and this may lead to rupture of the tendon. If this is familiar to you arrange an appointment with a physiotherapist in Islington click on the link below for the Angel Sports Injury and Physiotherapy Clinic.


Footbal Knee Injuries and the Meniscus Tear

 

This article is by the physiotherap in Islington from the Angel Wellbeing Clinic in Islington and looks at knee injuries and knee pain and the meniscus. The article covers:

  • What is the meniscus

  • Where is the meniscus

  • Signs and symptoms of a meniscal tear

 

What is the meniscus?

The meniscus in the knee is a ‘C-shaped’ cartilage, thinner in the middle of the knee joint than at the sides. The rubber like cartilage that comprises the meniscus separates the femur from the tibia and acts as a shock absorber and cushions the impact on movement between the femur and the tibia as well as smoothing out the movement in the knee joint on flexion and extension.

Meniscal Injuries

The meniscus can be damaged traumatically through sporting injuries that involve rotation. Tackling in football, rugby and skiing injuries can lead to meniscal tears through rotation of the knee when it is in a weight bearing position. Meniscal tears can also occur through repetitive microtrauma and wear and tear in chronic conditions such as in osteoarthritis. In the traumatic injury there is often the involvement of other knee structures such as the collateral ligaments or the cruciate ligaments.

The meniscus is slow to heal following injury due to its poor blood supply. The lateral aspect of the disc has a good blood supply that is not present in the medial aspect of the meniscus. How the meniscus heals following injury depends on where the tear is.

Symptoms of a Meniscal Tear

How a meniscus tear presents clinically will depend on where in the meniscus the tear is and how bad the tear is.

There can be pain on straightening the leg fully and the full extension may not be possible due to discomfort. Sometimes there can be a fold of torn meniscus or a fragment of torn and detached meniscus preventing the full range of motion that can prevent walking through pain.

Like all traumatic soft tissue injuries there can be swelling in the knee joint and the swelling may not go down completely if the injury hasn’t healed.
Locking of the knee can be common and may be intermittent as the torn or detached fragment causes problems and the leg may need to be moved by hand or ‘flicked’ to unlock it. This locking can go on until the tear is treated.

It is important to have the knee assessed by a physiotherapist experienced in treating sports injuries as surgical treatment can often be required. Physiotherapy can help with the acute phase of care as well as offer help in rehabilitation of the knee pre or post surgically.

Correct management of the initial injury or ‘niggles’ can speed up recovery as well as prevent a recurrence. If you have knee pain and you need a diagnosis make an appointment with our physiotherapist in Islington at the Angel sports Injury and Physioterhapy Clinic. For an appointment click below.


Football Injuries and the Sports or Football Hernia

 

This article is by the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic and looks at:

  • what is a sports or football hernia
     
  • how do you get a football or sprots hernia
     
  • symptoms of a fottball or sports hernia
     
  • what physiotherapy can do for a sports or football hernia
     

Hernias are common football injuries amongst the professionals but they also occur in the amateur player as well. Professionals such as Fernando Torres, Frank Lampard have had to undergo surgery for hernias and currently Steven Gerrard is undergoing rehabilitation for a hernia.

What are the Symptoms of a Hernia

The first thing to look at is what were you doing at the time of injury. Twisting and turning aggressively such as tackling in football or playing tennis or hockey can cause the initial injury. Other things to look out for include:

• Dull ache in the groin area and often accompanied by sharp pains, especially after activity involving hip flexion and/or twisting. Such an activity can be as simple as sweeping or something more demanding such as playing football or tennis or moving furniture.
• Pain is often felt off of the corner of the pubic bone, and can radiate to the testicles.
• This is often accompanied by adductor muscles tightness and often pain in the adductors. It can be difficult and painful to squeeze the legs together because of this.
• Pain can also be felt when twisting, from the pubic bone up to the inguinal ligament. This pain can also refer around to the hip and lower back.
• There can be irritation of the nerves that travel to the perineum and genitals.
• It can be painful to externally rotate your bent leg, but it can also hurt to internally rotate your femur. This is often misinterpreted, as a hip problem attempting to kick a football with the inside of your foot is such a movement that can induce sharp pain. Sitting crossed legged.
• There can be intense pain while trying to get up out of bed, causing the sufferer to need to roll off of the bed as opposed to sitting up first.
• In general, bearing down, as in coughing, can be painful, just as in an inguinal hernia.
• There can be intense pain following activity and stiffness in the groin and hip area, this improves with rest and responds to anti-inflammatory medicine.


It is suggested that up to 20% of athletic and sports injuries are groin related and a sports hernia needs to be ruled out.

Sports hernias occur because of the tremendous force generated when twisting and turning. These turning forces disrupt the muscles (the rectus abdominus muscle which combines with the transversus abdominus to form the conjoined tendon) where they join the pubis. At this location the conjoined tendon pulls up and rotates the trunk, and the adductor longus pulls down and rotates the upper leg. When the forces are excessive and imbalanced, a sports hernia can occur.

Core Muscles

Physical therapy for sports hernia focuses on stretching the low abdominal and lower extremity muscles and tendons. The core muscles oppose the highly developed leg muscles and to prevent them form being ‘torn’ during the contraction of the leg muscles they need to be strengthened to prevent them form pulling away from the pubic bone.

If you suffer from groin pain or any of the other symptoms listed here you should make an appointment with our physiotherapist and get a diagnosis. If you have had surgery for a hernia or are returning to sport, a physical assessment should be undertaken to discover where there are areas for potential injury and what action needs to be taken.

To speak to a physiotherapist in Islington or to make an appointment at Islington’s Angel Sports Injury and Physiotherapy Clinic please click below.


 


Football Injuries: The Sprained or Twisted Ankle

 

This article is by the physiotherapist in Islington form the Angel Sports Injury and Physiotherapy Clinic.

Twisted ankles are extremely common football injuries and can be sustained on the training ground football matches as well s in competitive matches when tackling is a frequent cause.

The injury occurs during inversion of the ankle (turning the ankle in and spraining the outside ligaments) and comprises 40% of sports injuries.

There are three ligaments that provide the stability to the lateral or outside of the ankle: The anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). The fist two are the most common to be injured in a twisted ankle and the PTFL is the least likely unless you dislocate the ankle joint!

There is a classification system to ankle injuries and this dictates the treatment:

• Grade I is an injury without macroscopic tears. No mechanical instability is noted and pain and tenderness is minimal.
• Grade II is a partial tear. Moderate pain and tenderness is present. Mild to moderate joint instability may be present.
• Grade III is a complete tear. Severe pain and tenderness, inability to bear weight, and significant joint instability are noted.

The initial treatment of all joint sprains involves RICE. Rest, ice, compression and elevation. The ice should be applied for about 20 minutes three to four times a day and a compressive bandage should also be applied to help control the swelling. Weight bearing she be avoided initially but encouraged as soon as it can be tolerated.

Grade III injuries are obviously a lot more serious and initial treatment should include an ankle brace to immobilise the ankle joint. Once the patient can tolerate weight bearing the brace should be removed and rehabilitation can commence approximately 48 hours after the injury.

The rehabilitation of a severely twisted ankle from football should be gentle initially with simple range of motion exercises. Stretching of the Achilles tendon and cycling on a stationary bike can then follow this.

Our physiotherapist at Islington's Sports Injury and Physiotherapy Clinic will evaluate you constantly and as strength and mobility improve, isometric exercises for ankle dorsiflexion, plantar flexion, inversion, and eversion are implemented. The isometric exercises are followed by resistance exercises (we use Thera-Bands at the clinic) and then heel and toe raises.

Once the pain and inflammation has gone down and there has been a return to gentle exercise a lot of patients get complacent about the treatment of their ankle. Patients dont realise that they still need treatment to get them back to 100% fitness which is the goal of our physiotherapist.

Our physiotherapist is eperienced in the rehabilitation of footbal injuries and will aid your recovery by providing specific taping techniques to the damage joint to aid it's stability and to help with the proprioception re-education process using a 'wobble board'.

At the Angel Wellbeing Clinic our physiotherapist in Islingtin takes things further and motivates patients to move on to proprioceptive and balance exercises so the weakened ankle returns to full function and this minimises the chance of a recurrence.

If you wish to make an appointment with our physiotherapist in Islington please click below.


Why is Tennis good for you?

This article is by Islington’ Angel Sports Injury Clinic’s physiotherapist and looks at why tennis is good for you. And with the 2011 US Open Tennis Championship underway it seems like an appropriate time!

There have been a couple of articles on this site that have covered tennis injuries, in particular tennis elbow, twisted ankles and of course shoulder problems. Don’t get the wrong idea form this, tennis is a great form of exercise and probably one of the best for all round general fitness as demonstrated by a study sponsored primarily by the Royal by Netherland Tennis Association and written by Babette M Pluim, J Bart Staal, Bonita L Marks, Stuart Miller, Dave Miley.

The research found 96 studies that looked at the effect tennis had on the risk factors and diseases related to a sedentary lifestyle, including low fitness levels, obesity, hyperlipidemia, hypertension, diabetes mellitus, cardiovascular disease, and osteoporosis.

Results

The results showed that those that played tennis had lower body fat percentages a more favourable lipid profile and enhanced aerobic fitness. This all contributed to an overall improved risk profile for cardiovascular morbidity. Also, numerous other studies have shown that tennis players have better bone health not only in tennis players with a long history of playing but also in those who take on the sport in middle-age.

Cholesterol

Tennis is associated with increased plasma HDL-cholesterol levels. The most powerful predictor of coronary heart diseases is hyperlipidemia and more than half the cases of heart disease are attributable to lipid abnormalities. The higher HDL concentrations the lower the risk of cardiovascular disease. The study shows that playing tennis may reduce the risk of cardiovascular disease.

Blood Pressure

Blood pressure response during tennis play is comparable to the response to an acute bout of moderate intensity exercise.

Bone Density

Tennis produced healthier bone density in both genders and across the age spectrum but the extent of the benefit was dependent on the duration of tennis participation and training frequency, being stronger in young starters than in old starters, but maintained despite decreased tennis participation. This was most clearly present in load- bearing bones such as the humerus of the dominant arm, lumbar spine and femoral neck, the most common bones involved in oeteoporotic fractures.

Heart Rate

Doubles play may be sufficient for the middle-aged or senior tennis player, because their maximum heart rate and VO2max are decreased. Doubles play is therefore particularly suitable for these categories. This has the added benefit that it increases the chance that those who play tennis are likely to maintain the sport when they grow older.

Summary

Tennis is a great all round sport helping with general fitness levels as it increases heart rate and strengthens bones which helps the older player. Tennis has also been found to be protective for cardiovascular disease by improving the proportion of healthy lipoproteins found in the blood.

As a physiotherapist it is clear that tennis is great for all ages and benefits are gained even if you play a more sedate doubles match. Tennis is also good for the back muscles and for helping to develop good control of the ‘core’ muscles due to the very dynamic movements involved in playing the sport.

However, if you are watching the US Open Tennis Championship and fancy a game but haven’t played tennis for a while take it easy. Maybe get a couple of lessons in first to help iron out any bad habits that have crept in. Don’t forget to warm up properly too. If you spend all week sitting at a desk your body wont thank you if you suddenly launch into a game of singles with all the bending and twisting involved in a game.

At the Angel Sports Injury and Physiotherapy Clinic we will happily advise you on the best way to warm up or to prevent injury when playing tennis. And if you get a tennis shoulder injury or you get tennis elbow we can sort it out for you.

 

 

 

 


 


Runner's Injuries: Anterior Compartment Syndrome

This article is by Islington's Angel Sports Injury and Physiotherapy Clinic's physiotherapist and looks at:

• anatomy of the lower leg
• signs and symptoms of anterior compartment syndrome
• diagnosis


Anterior compartment syndrome has to be considered when there is pain in the front of the shins. The location of the pain also can indicate a different injury called ‘shin splints’. This is a chronic condition and is the result of over training and is a very different condition from acute anterior compartment syndrome. Compartment Syndromes of the lower leg can be a medical emergency.

The lower leg contains two bones, the fibula which is the smaller bone on the outside of the lower leg that starts just below the level of the knee and extends downwards to form the outside ankle bone. The bigger leg bone is the tibia and this extends from the knee joint to form the medial anklebone.

Anterior compartment syndrome pain is located between the two bones and is due to the expansion of the major muscle in the area tibialis anterior, inside its inelastic fascial sheath. The action of this muscle is to dorsi flex and invert the foot and the muscle is used extensively in activities that repetitively dorsi flex and plantar flex the foot.

Activities such as running up and down hills can overuse the muscle. With an increase in blood and pressure inside the muscle, the muscle can’t expand anywhere due to the anatomical boundaries, laterally and medially are the tibia and fibula.

Signs and Symptoms of Anterior Compartment Syndrome

• Pain which gets to a crescendo type point, induced only by specific activity and often at a specific point in the workout
• Pain and tightness in the shin
• Decreased sensation on the top of the foot in the area above the second toe
• Weakness may be noted on toe extension and dorsiflexion of the foot
• Tingling into the toes
• Decreased dorsal pulse may be noted by a trained practitioner (Supplied by the anterior tibial artery)
• Symptoms disappear once activity ceases

The 5 Ps of Anterior Compartment Syndrome

1. Pain
2. Pallor
3. Paresthesia
4. Pulselessness
5. Paralysis (If not treated)

Tri-athletes and runners are particularly prone to this problem. In cycling the athlete will pull their pedals up with their feet which can tighten the muscles involved in the anterior compartment. In a triathlon once the swim and cycle leg is completed, the athlete will then embark on a pretty long and gruelling run which can induce the increasing pressure in the anterior compartment and lead to the crescendo pain in the shin.

Diagnosis

If you are concerned about symptoms in your leg which sound similar to those mentioned above you need to seek a thorough assessment by a health professional.

A physiotherapist can perform a clinical assessment based on your injury history, and a sports physician can perform a compartment pressure test before and after a bout of physical activity in which the individual knows will bring on symptoms. It is a very tricky condition to manage, but imperative it is diagnosed correctly to prevent permanent damage and paralysis.


If you are a keen runner or suffer from any of the symptoms above don't let it go on for too long. Arrange an appointment with our physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic by clicking below.


Runners Knee Part 2: Is this the Magical Cure?

 

This article has been written by the physiotherapist in Islington from the Angel Sports Injury and Physiotherapy Clinic. This is the second article about the treatment of runners knee. The first article was The Treatment of Runners Knee or Iliotibial Band Syndrome. Areas covered in the article are:

  • Mechanics of the quadraceps
  • Behaviour of the medial quadraceps, Vastus medialis.
  • Exercises to strengthen vastus medialis.
     

If only there was such a thing as a magical cure or ‘golden bullet’ for curing runners knee but there is certainly a lot more to the treatment of runners knee than stretching the ilio-tibial band and general quads and knee strengthening exercises.

Diving into the biomechanics of the quadriceps

The quadriceps gets its name from the four bands of fibres that make up the muscle. Vastus lateralis (which is the biggest part), Vastus medialis and Vastus intermdius. The last component of the quadriceps is the Rectus femoris. The action of the quadriceps on contraction is to straighten the knee and vastus medialis is the biggest contributor to this movement. Vastus medialis inserts on the medial aspect of the kneecap and its action on knee straightening is to pull the kneecap medially.

It is clear that with a tight ilio tibial band and generally tight quads the tracking of the kneecap is going to be compromised and patellar femoral pain a possibility so a coordinated approach needs to be undertaken in the rehabilitation of runners knee or in the treatment of patellofemoral pain syndromes.

How to assess function of vastus medialis

The muscle is often described as having a tear drop appearance on the inside of the bottom of the thigh and it is maximally utilised in the last 10% of the movement that straightens the knee.

 

 


• Sit on a couch or on the floor with your legs out in front of you and a rolled up towel under the injured knee (the knee should be slightly bent)
• put your fingers over the area of VMO (medial inside of thigh above kneecap height).
• Push your knee down into the towel (so that your knee straightens and the foot lifts off the couch)
• you should feel a strong contraction under your finger

To compare the contraction of vastus lateralis and vastus medialis place a finger from the other hand into the vastus lateralis muscle mid thigh height and contract the quads and compare the timing of muscle contraction. If there is a difference between the two parts of the quads contracting a biofeedback approach to rehabilitation may be required.

Electromyographic biofeedback or EMG is probably the best way to focus the rehabilitation on improving the contraction of the muscle but a simpler solution is to maintain finger contact on the muscle during the rehabilitation exercises of vastus medialis and concentrate on the contraction. This is effective in helping you isolate the muscle but you do need to concentrate!

Exercises for strengthening Vastus medialis

Resistance leg extensions: don’t forget that VM only works in the last 10% of extension.

Deep squats: be careful of any existing injuries to the knee or to the back.

Split lunges: manage the back carefully during this exercise.

 

For further information and assessment contact the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic in and arrange an appointment  to make knee pain a thing of the past.

 


Cyclists on the Tour de France are susceptible to Hand Pain

This is an article by the physiotherapist in Islington from the Angel Sports Injury and Physiotherapy Clinic.

This article covers:

• Numbness and tingling (paresthesia) in the hand from cycling
• Ulnar nerve palsy
• Anatomy of the wrist
• Incidence of ulnar nerve palsy in long distance cyclists
• Symptoms of cycling palsy
• How to avoid cycling palsy

The Tour de France is 3,430.5 kilometres of cycling between the 2nd and 24th July with just two days rest. This works out as 171.53 km per day or 106 mile per day as an average. When you consider this average distance includes ‘mountain stages’ it brings it home as to the length of time spent in the saddle.

 

 

Long distance cyclists are prone to injury and over-use syndromes are a problem. In a previous article by the Angel Sports Injury and Physiotherapy Clinic’s physiotherapist the knee was discussed, but due to the position of cycling other areas of the body suffer. The neck, back, feet and hands can all be problem areas. It is worth remembering that the training to get to a level of competitiveness for ‘Le Tour’ means that the total time spent in the saddle from training may be months and months.

Case reports have identified the presence of distal ulnar nerve sensory and motor dysfunction in long-distance cyclists; the actual incidence of this condition, referred to as "cyclist's palsy," is unknown. And a prospective study was carried out in 2003 looking at the incidence of this problem.

Symptoms of Ulnar nerve Palsy

The ulnar nerve supplies the top and bottom of the medial aspect of the hand and sensory loss will cover the little finger and the little finger side of the ring finger, front and back up to where the hand meets the wrist.

The muscles can also be involved and lead to a ‘ulnar claw’ appearance of the hand and they may complain of numbness or tingling in the hand that goes away within a day or two of cycling but then they may have persistent weakness in pinching and fine finger movements.

The Study in the American Journal of Sports Med. 2003 Jul-Aug; 31(4): 585-9.Ulnar and median nerve palsy in long-distance cyclists. A prospective study by Patterson JN, Jaggars MM, Boyer MI. Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University School of Medicine, St. Louis, Missouri, USA found that “Twenty-three of the 25 cyclists experienced either motor or sensory symptoms, or both. Motor symptoms alone occurred in 36% of the hands (11 cyclists) tested; no significant difference in the incidence of motor symptoms was found among cyclists of various experience levels or based on handlebar types (mountain bike versus road bike). Sensory symptoms alone occurred in 10% of hands (four cyclists) tested, with the majority of these being in the ulnar distribution. A significantly higher proportion of mountain bike riders had sensory deficits compared with road bike riders; however, there was no significant difference in the occurrence of sensory deficits based on level of experience. A total of 24% of the hands (eight cyclists) tested experienced a combination of motor and sensory symptoms. These motor and sensory symptoms were equally distributed between road bike riders and mountain bike riders and riders of various experience levels.”


How to avoid Ulnar nerve palsy

· Wear padded gloves to minimize the vibration forces on your wrist and hands

· Avoid direct pressure over the area of Guyon’s canal by avoiding resting the medial aspect of your wrist on the handlebars.

· Avoid letting your wrists rest in excessive extension

· Make sure you have a proper seat height and sitting position. This will help minimize the amount of weight you place on your wrists

· Select a proper choice of handlebar. The type of handlebar can also affect the amount of pressure you place through your wrists.

Other relevent articles

Cycling and knee pain

Video of Top 10 tips to make cycling more comfortable

If you are having wrist and arm pain and you wish to see a physiotherapist in Islington contact the Angel Sports Injury and Physiotherapy Clinic. Our physiotherapist will happily provide a FREE ASSESSMENT for any cyclist that is having wrist pain. We are happy to treat anyone that commutes to work on a bike as well as anyone in the Tour de France!


 


Cycling and Knee Pain

This article was written by the physiotherapist in Islington from the Angel Sports injury and physiotherapy clinic. The article will cover:

• Anatomy of the knee
• Causes of knee pain
• Symptoms of knee pain
• Diagnosis of knee pain
• Treatment of knee pain


Knee pain is a common cycling problem and I am sure that a few of the cyclists on this years Tour de France will have sore knees at the end of the event. Knee pain is sometimes given the non-specific label of patellofemoral pain. This is not a diagnosis but a general description of where the pain is. The patella is the kneecap and the femur is the thighbone and this sits behind the kneecap.

The kneecap has smooth cartilage on the back to allow it to slid up and down a groove in the tibia (the bone that is in the bottom half of the leg) called the patella femoral groove. Simple really!

The quadriceps muscles straighten the leg and to do this the quadriceps wraps round the patella and inserts into the top of the tibia. The kneecap acts as a fulcrum to increase the force of the quadriceps muscle to straighten the leg.

Causes of Patellofemoral Pain

Causes are often multifactorial and it is a condition that needs to be addressed by a physiotherapist if you are a keen cyclist and suffering from knee pain. The ligaments and muscles and tendons around the knee can cause pain as can the bursa or synovial sac under the bottom of the knee. This can become inflamed and painful and is know as ‘house maids knee’! The meniscus inside the knee joint is also an area that can become damaged and painful.

Specific Factors that can Cause Patellofemoral pain

• Overuse of the knee: particularly at times of increased training or increased activity/distance

• Problems with knee alignment or ‘tracking’ of the kneecap in the femoral groove. It may be due to the way the knee has developed. Or, it may be due to an imbalance in the muscles around the knee - for example, the large quadriceps muscle above the knee. If one side of the quadriceps muscles pulls harder than the other side, then the patella may not glide 'true' and may rub on one side and this needs a physiotherapist to assess.

• Flat feet can internally rotate the tibia and change the tracking of the kneecap

• Shoes where the soles are hard rather than springy put more strain on the knee

• Injury to the knee - including history of repeated small injuries or stresses due to sports

• Reduced muscle strength in the leg can contribute, as the leg muscles will be less able to absorb stresses on the knee. Most knee pain can be improved by increasing muscle tone around the knee

Symptoms of patellofemoral pain

• Pain and/or swelling around the knee. The pain is felt at the front of the knee, around or behind the kneecap. Often, the exact site of the pain cannot be pinpointed but is felt vaguely at the front of the knee

• The pain comes and goes. It is typically worse when going up or down stairs or running downhill. Also, sitting still for long periods may bring it on. For example, after going to the cinema or a long drive

• There may be a grating or grinding feeling or noise when the knee moves. This is called 'crepitus'.

How is patellofemoral pain diagnosed?

The physiotherapist at the Angel Sports Injury and Physiotherapy clinic will diagnosis your knee pain from the history and from your symptoms followed by an examination of the knee. Our physiotherapist will also look at your feet and ankle to assess their function. X-rays can be useful and the clinic has its own x-ray facilities or the physiotherapist can refer you out for an MRI scan.
 

What is the treatment for patellofemoral pain?

In the acute phase

• Rest the knee until the pain eases and most of the pain should disappear if the knee is  not over used

• Reduce the inflammation with neurofen or other anti-inflammatory medicine. Icing may be the safest and quickest way to reduce the inflammation

• Improve the strength of the muscles around the knee will ease the stress on the knee. Also, specific exercises and stretching may help correct problems of the tracking of the patella. For example, you may strengthen the inner side of the quadriceps muscle to balance out the lateral quadriceps

• Footwear - arch supports if you have 'flat feet' and getting yourself assessed for some decent running shoes that help to correct the pronation

• Massage to the quadriceps

• Taping of the patella may help reduce pain by changing its tracking. A special brace is another option, which may help reduce pain

• Surgery is not often used for patellofemoral pain. However, it may be helpful in certain situations but a referral to a specialist and having an MRI scan would be recommended.

Other relevent articles

Video of Top 10 tips to make cycling more comfortable

Cycling and wrist pain


If you are having knee pain and wish to see a physiotherapist in Islington contact the Angel Sports Injury and Physiotherapy Clinic. We are offering FREE KNEE ASSESSMENT for July. If you want to make an appointment with our physiotherapist or sports massage therapist click below.

 


 


How Did Andy Murray Strain His Groin and How Did the Physiotherapist Diagnose and Treat It?


Andy Murray is finally out of Wimbledon after being beaten over four sets by Rafa Nadal in the second semi final played on Friday 1st July. Both players went into the semi-final carrying injuries and this is not surprising after two weeks of tennis in a Grand Slam competition on grass courts.

Murray had to have a treatment by the physiotherapist during the quarter final against Lopez as well as having the physiotherapist come out on court during the semi-final against Nadal for a quick chat. Clearly Murray would have been receiving physiotherapy between the two matches and the physiotherapy treatment was clearly successful, as he did seem uninhibited by the minor groin sprain.

What injury did Andy Murray have?

In the quarter final with Feliciano Lopez, Andy Murray picked up a mild groin strain. These injuries can be incredibly painful and debilitating especially when there is a tear, and in some stubborn cases these tears can require surgery.

A sprain, rupture or tear in the muscle usually occurs when sprinting, changing direction or in rapid movements of the leg against resistance such as kicking a ball as in football or the sudden change in direction as in tennis. The likelihood of this increases if a thorough warm-up has not been undertaken first or if there is a sudden unanticipated slip or slide such as changing direction and the weight bearing leg slips.


What is a groin strain?

A groin strain is a tear or rupture to any one of the adductor muscles. There are five adductor muscles, the pectineus, adductor brevis and adductor longus and the gracilis and adductor magnus

The main function of the adductors is to pull the legs together in a movement described as adduction. During normal walking they are used in pulling the swinging leg towards the middle to maintain balance.


How bad is the groin strain?

All muscle strains or tears are graded 1, 2, or 3 depending on how bad they are. Grade one is a minor tear where less than 10% of fibres are damaged. Grade 2 is a moderate tear and can be anything from 10 to 90% of fibres torn. For this reason, grade 2 injuries are often termed 2+ or 2-. Grade 3 injuries are the most serious being either partial or full ruptures.

It is most likely that Murray received a grain 1 sprain as it would be unlikely that he would have played as well as he did against Nadal with anything more severe.

Symptoms of a groin strain

Grade 1
• Discomfort in the groin or inner thigh. This may not be noticed until after exercise stops.
• The groin muscles will usually feel tight.
• There may be an area that is tender to touch
• Walking is normal, discomfort may only be when running or even just on changes in direction.

Grade 2
• A sudden sharp pain in the groin area or adductor muscles during exercise.
• Tightening of the groin muscles that may not be present until the following day.
• There may be minor bruising or swelling (this might not occur until a couple of days after the initial injury).
• Weakness and possibly pain on contracting the adductor muscles (squeeze your legs together).
• Discomfort or pain on stretching the muscle.
• Walking may be affected. Running is painful.

Grade 3

• Severe pain during exercise, often on changing direction suddenly when sprinting.
• Inability to contract the groin muscles (squeeze your legs together).
• Substantial swelling and bruising on the inner thigh within 24 hours.
• Pain on attempting to stretch the groin muscles.
• It may be possible to feel a lump or gap in the muscles.

Treatment for a groin strain

It is important to rest following the injury to allow the injured muscle to properly heal. Allow pain to guide your level of activity; this means that activities that cause symptoms should be avoided.

Gentle stretching of the adductor muscles is helpful, but it should not be painful. Stretching excessively can be harmful and slow the healing process
Apply ice to the injured area in the acute phase (first 48 hours after injury), and then after activities. Ice will help calm the inflammatory response and stimulate blood flow to the area.

Before activities, gentle heating can help loosen the muscle. Apply a heat pack to the groin prior to stretching or exercising. As a general rule of thumb, remember to heat before, and ice after.

The physiotherapist at the Angel Sports Injury and Physiotherapy Clinic is fully qualified and experienced in treating groin sprains as well as being able to offer advice and re-evaluate old injuries to prevent recurrence. With rehabilitation and management old injuries need not cause more problems.

If you have or have had a groin sprain and are in the process of returning to sport make an appointment for a FREE EVALUATION with our physiotherapist.


Prevent injuries at tennis by warming up properly

Mark Grabow, the man used by Brad Gilbert to improve the fitness of Andrew Murray, reveals his essential five-minute start-up session. If you don’t do this you may end up seeing our physiotherapist at the Angel Sports Injury and Physiotherapy Clinic.


Part 1
Dynamic Flexibility Warm-up

Tennis is a skill sport that starts from the ground up. Everything is initiated with the legs. This is the part of the body that should get the first and the most attention, the large muscle groups of the legs. What you want to do first is a very sport-specific (ie specifically for tennis), low-intensity warm-up that will raise the core temperature of the primary muscle groups between the hips and the feet. Your warm-up will mimic the leg movements used during a match, but at a much lower intensity:

A Circle The Square
This is the first movement and should be done very gently and at a low intensity. Basically you're going to jog around your half of the tennis court (the "square") while always facing the net.

Start back at the point where the doubles sideline intersects the baseline. Then slowly jog forward along the doubles sideline towards the net. When you get one yard from the net change direction and glide parallel to the net at the same pace. Your body will still be facing the net as you jog sideways along it. When you reach the other doubles alley, change direction (while continuing to face the net) and begin jogging slowly backwards toward the baseline. Keep at a very easy pace. When you get to the baseline again change direction (while still facing the net) and jog sideways along the baseline to the opposite alley.

B Kick Your Butt
After you've circled the square twice, add this to what you're doing. As you run forward to the net (and then backwards away from it) begin increasing the height of your heel kick. On each step raise your heel up toward your butt as if you were trying to kick yourself in the behind. Don't overdo it. The key to a good warm-up is a gradual increase of movement. This will continue the warming-up of your legs, especially the quads (the fronts of your thighs). Do this for a minimum of one time around the circle.

C The High Stepper
Finally, add this to your Circle The Square procedure after you've done Kick Your Butt. When you are moving forward and backward (toward and away from the net) bring your knees up higher and closer to your waistline - step high. Imagine bringing your knees up to your chest. One time around the circle with this and you're ready to run hard from the first point. If you have time to continue this routine, take advantage of it.

Part 2
Static Flexibility Warm-up

D The Stork
This stretching exercise is easy to remember. You end up looking like a stork. Start out by standing near the net so you can hold it if you need balance. Raise one foot up behind you (bring your heel toward your butt) and grasp the top of your foot with your hand. Very gradually and gently pull your foot closer towards your butt. Don't overdo it. This will continue to stretch out your quads, or thigh muscles.
Do this for 15 seconds on each leg, gradually stretching and releasing, stretching and releasing.

E Bow To The Emperor
Standing with your feet slightly apart, bend over at the waist as if you were bowing to royalty. Keep your knees slightly flexed and your back relatively straight. Let your arms extend down towards the ground. Do this for ten seconds and repeat. You'll feel it in the back of your legs (the hamstrings) and lower back as you bend farther over. Don't force this or any movement. And don't bounce as you attempt to get a full stretch. Never strain while stretching. The movements are gradual, gentle and smooth.

F Pull Your Own Groin
Stand with your feet about 24 inches apart. Gradually transfer your weight over to your right foot (without moving either foot). As you do this flex your right knee (it will move slightly forward) so you can accommodate the weight transfer. Keep your left foot solidly on the ground and your leg straight.
You'll start to feel a pull in your left groin. Gradually move into it and stretch. Hold it for 10 seconds.


Then do the same for the other leg.



Who are the biggest tennis ‘grunters’ and what advantage do they get from it?

According to our physiotherapist at the Angel Sports Injury and Physiotherapy Clinic tennis is great for core stability and this is part of the ‘grunting’.

Every year during the Wimbledon Tennis Championship there is always a distraction from who is the best tennis player and who is the biggest grunter on the tennis court. is it distracting for their opponent and why do they do it?

It seems that the list of biggest grunters do not include any men but does include the women’s top seed, Maria Sharapova. Apparently she has been recorded with the loudest grunt at about 105 decibels! The rest of the list of current and past grunters include Larcher de Brito at 110 decibels, Elena Dementieva, Kim Clijsters, Anna Kournikova, Elena Bovina, Victoria Azarenka, Venus and Serena Williams at 90 decibels, and Monica Seles.

I play tennis regularly and I am proud to say I am not a grunter and I have never played against anyone who is a grunter, but I imagine that playing against a grunter would annoy me and distract me. Maybe grunting isn’t a deliberate act but maybe it is a physical response to the effort of hitting the ball back as hard as possible.

New research from Brunel University claims that controlled grunting has physiological benefits by increasing core stability and strength. Inhaling before hitting the ball and then ‘grunting’ at the moment of impact increases the intra abdominal pressure and braces the ‘core’ muscles, helping to transmit the movement from the hips and trunk into energy at the moment of contact between racket and ball.

I am sure that the process of firming up the core muscles can be done silently but maybe having the grunt as an audible sign that the core muscles are being utilised aids training and allows the coach and player to know when they are maximising their abilities.

Prof. McConnell from Brunel University, whose book “Breathe Strong, Perform Better” examines grunting in depth; believes it is more common among women than men because women's upper bodies are generally weaker, and therefore require stronger control and stability through breathing techniques.

At present, players can have a point awarded against them if the umpire feels their grunting has hindered an opponent and Monica Seles was ordered to turn down the volume in the 1992 Wimbledon final to Steffi Graf.

Former World No 1 Martina Navratilova has previously said that grunting is cheating and called for it to be banned; claiming that it masked the sound of the ball on the racket - something that top opponents read to their advantage.


 


FREE SHOULDER EXAMINATION During Last Week of Wimbledon Tennis Championship

 

During The Wimbledon Tennis Championship we are offering a FREE SHOULDER CONSULTATION with our sports injury physiotherapist. If you have a shoulder problem or know someone that does please get them to call The Angel Sports Injury and Physiotherapy Clinic and arrange an appointment with our physiotherapist Verity Simon.

 

 

 

 


 



Treatment at Angel Sports Injury and Physiotherapy Clinic can Reduce Recurring Low Back Pain

Why Angel Islington’s Sports Injury and Physiotherapy Clinic can Help Treat Low Back Pain and Help Prevent Recurrences

According to Lena Nordeman a registered physiotherapist and researcher at the Sahlgrenska Academy of the University of Gothenburg, low back pain can benefit from prompt treatment at an early stage to prevent the limitations imposed on leisure and work activities by this chronic problem. And with up to 80% of people suffering with low back at some point in their life there is a big impact on family life and on work place productivity.

 

As part of her thesis, she carried out a study in a same-day appointment system with the option of going straight to see the physiotherapist. The effect of receiving an examination and treatment within 48 hours was subsequently evaluated compared to being on a waiting list for four weeks before receiving the same treatment.

60 patients with low back pain for 3-12 weeks took part in the study, which was carried out in primary health care in Södra Älvsborg, south-west Sweden.

Both groups improved after the treatment ended. The group that had been given early access to an examination and individualised treatment maintained their improvement after six months, while the group that had been held on a waiting list were more likely to suffer with recurring back pain

Lena Nordeman draws the conclusion that early examination and treatment by a physiotherapist as soon as a patient asks for care could be important for reducing low back pain in the long term.

The thesis involved the investigation of 130 women who had suffered with low back pain for more than three months and who among others had undertaken a walk test. These women were followed up after two years at it revealed that the walk test was a good predictor of both future ability to work and limitations in everyday activities.

It is recommended that patients with long-term widespread pain or fibromyalgia be given education and a physical exercise programme to help alleviate their symptoms. Nordeman's thesis also looked at which patients benefit most from this treatment. 166 patients with widespread pain or fibromyalgia from Gothenburg, Uddevalla and Alingsås were randomly divided into two groups, the first of which was given a six-session education programme and 20-week pool exercise programme supervised by a physiotherapist, while the second was given just the education programme.

The group that received both the education and the physical exercise programme showed the greatest improvement in perceived health, and that patients with moderate symptoms benefitted most from exercise.

Low Back Pain

Low back pain affects up to 80% of people of working age at some time in their lives, though most will recover. Low back pain can be recurring, and some people will continue to suffer with some degree of pain. In 85-90% of cases the pain cannot be attributed to a specific illness or injury.

Verity Simon at Islington’s Angel Sports Injury and Physiotherapy Clinic’s physiotherapist can help treat your acute back pain or chronic back pain to provide a long term rehabilitation plan to help prevent a recurrence and get you back to sport and work as quick as possible.


 


Islington's Angel Sports Injury and Physiotherpay Clinic’s ‘Glastonbury Discount’

It is that time of year when you get on the tube and sitting next to you is a wellington boot clad individual complete with budget tent from Millets and a sleeping bag and you can’t think why they look like they are going to work on a farm. And then you remember, its Glastonbury! With the weather as it has been all I can say is good luck!

A trip to a festival may seem like fun but there is a more serious side. After the E. coli, sunburn and hangover problems there are a number of physical injuries that you can succumb too as this paper by A. Walker from the Airedale NHS Trust proves.

Background:

Although crowd surfing is not a new activity, it is increasingly popular at music festivals. In the rest of the world, there has been concerns over injuries and deaths at these events, but there is little documentation of the injuries sustained in this manner in the UK.


For those who aren’t familiar with what you are letting yourself in for or don’t know quite what your son or daughter or even your husband is up to this week then read on.

 

Crowd surfing: involves launching oneself over the heads of the crowd in front, and chiropractic treatmetn can help with glastonbury injuries‘surfing’ on supporting heads towards the stage.
Moshing: involves shoving and pushing people in the pit (at the front of the crowd).
Stage diving: Trusting the crowd implicitly, you climb onto the stage without security staff noticing, then launch yourself onto the top of the crowd.

These results were from an observational study carried out at a three day music festival with an attendance level of over 60,000 in August 2000.

Results:

• A total of 1511 patients were seen throughout the festival at first aid stations.
• 43 injuries from crowd surfing over the three day period.
• Most crowd surfing injuries were from in-front of the main stage. Eight patients or 19% of crowd surfing injuries occurred during one bands set.
• Two patients, the crowd surfer and one crowd member were taken to A & E with suspected neck injuries. No bony injury on x-ray and both were released the same day.
• One crowd surfer was crushed by the crowd and was hyperventilating but not seriously injured.
• Injuries to the crowd were predominantly neck injuries and to the surfer leg injuries.
• The majority of injuries were contusions.


For the week following Glastonbury Islington’s Angel Wellbeing Clinic which includes Islington’s Angel Sports Injury and Physiotherapy Clinic, Angel Chiropractic Clinic and Angel Osteopathy Clinic will be offering a special ‘Glastonbury Discount’ so if you injure yourself at Glastonbury festival please come and see us for an initial consultation price of £25.


During June we are offering a FREE SHOULDER CONSULTATION with our sports injury physiotherapist on a Wednesday evening. If you have a shoulder problem or know someone that does please get them to call The Angel Sports Injury and Physiotherapy Clinic and arrange an appointment with our physiotherapist Verity Simon.


Tennis and Shoulder Injuries

 

This article is by the the physiotherapsit in Islington at the Angel Sports Injury and Physiotherapy Clinic. The article looks at:

• About tennis and the shoulder

• Rotator cuff tears

• Shoulder impingement injury

• Signs and symptoms

 

This is the second piece about tennis related injuries and it seems very appropriate with Wimbledon starting in about two week’s time. There is a love of tennis for two weeks of the year and there is always a sudden rush of individuals to the local tennis courts and of course if you are not used to playing tennis during the rest of the year you may be prone to injury, and in tennis the shoulder is a common place to get a problem.

The shoulder and tennis

Tennis requires a lot of high velocity movement from the shoulder and during a game you subject the shoulder to a lot of acceleration and deceleration. This is of course most apparent during the serve. If you dont try and play like Nadal and stick to an underarm serve you will be fine!

Behind the ‘shoulder pain’ lurks muscular damage. Some of the muscles will weaken and some will tighten creating an imbalance. This imbalance is complicated in the shoulder due to the vast range of motion a shoulder can move through and due to the complexity of the shoulder joint anatomy that allows the shoulder to move with the freedom that it does and in particular the rotation of the joint.


Rotator cuff tears: the rotator cuff provides stability to the shoulder joint during rotation and can either be acute or chronic.

• Pain on overhead activity such as throwing or racket sports.
• Pain when you bend the arm and rotate it outwards against resistance.
• Pain on the outside of the shoulder possibly radiating down into the arm.
• Pain in the shoulder which is worse at night.
• Stiffness in the shoulder joint.

 

 

 

Impingement injury: this is when the tendons of the rotator cuff become trapped in the shoulder joint. Repeated impingement can lead to inflammation and thickening of the tendons, which in turn will result in more impingement and trapping of the inflamed tendons.

Signs and symptoms

• Pain in the shoulder when the arm is lifted above the horizontal.
• Pain is often present when the arms are raised up and out to the side in a 60 degree arc between the angles of 70 and 130 degrees - worse at around 90 degrees.
• Pain if the arm is lifted quickly forwards and upwards by the therapist.
• Pain when the arm is lifted forwards and upwards as far as it will go with the arm rotated inwards.
• If the condition becomes chronic there will often be pain when the athlete is at rest, especially at night.

These are just two of the most common shoulder injuries that arise from tennis but equally any throwing sport or weight lifting activity can cause a shoulder injury. If left untreated they can develop into something more completed and the rehabilitation then becomes a longer process.

 

 

 

 

 

 

 

 

 

Other tennis related articles

Tennis elbow

How Andy Murray goes about treating his twisted ankle

How to prevent tennis injuries

How did Andy Murray strain his groin and how did it get treated

Why is tennis good for you

During June we are offering a FREE SHOULDER CONSULTATION with our sports injury physiotherapist on a Wednesday evening. If you have a shoulder problem or know someone that does please get them to call The Angel Sports Injury and Physiotherapy Clinic and arrange an appointment with our physiotherapist Verity Simon.

If you have shoulder problems and you need physiotherapy in Islington click below to make an appointment with the physiotherapist at Islington's Angel Sports Injury Clinic.
 


Will Your Mobile Turn You into a Hunchback?

By Claire Coleman of the Daily Mail

How many people do you see walking down the street with their head held high these days? The answer is virtually none.

 

Whether they’re choosing a song on their iPod, tapping out a text message on their phone or checking an email on their Blackberry, you’re more likely to see the top of their head than their eyes.

New technology might make communication easier — but is it turning us into hunchbacks? In a word ‘Yes’, says Kirsten Lord, managing director of the Edinburgh Physiotherapy Centre and a chartered physiotherapist.

‘Our bodies are a product of what we do on a daily basis and the change in lifestyles is definitely changing our bodies,’ she says.

‘If you’re constantly looking down, you develop a forward curvature that rounds the whole spine.

For the full article click here.

 

 

 

 


 


How Does Andy Murray Go About Treating His Twisted Ankle?

 

This is the second article about tennis injuries. The Roland Garros tournament is currently taking place in Paris and Andy Murray has qualified for the semi-finals and he is due on court tomorrow against Rafa Nadal. Incidentally, they have met head to head 14 times with Rafa leading 10:4. So it looks like the odds are in Rafa’s favour.

Andy Murray is playing some great tennis and he is moving very well. This is surprising since he sustained a nasty twisted ankle in the game qualifying him for the quarterfinals. Maybe this injury has fired him up or maybe he knows he has to play better tennis so he doesn’t have to run about more. Or maybe he is being shown a bit of charity by his opponents, this does seem a bit unlikely! You would have thought he would have been tested more with drop shots so lets see what Rafa does tomorrow.

 

Twisted ankles are extremely common and not just in athletes. You only have to remember what the pavements were like along Upper Street before they were replaced to realise how easy it is to go over on your ankle. So it is no surprise that amongst athletes twisted ankles are the most common injury. These inversion injuries (turning the ankle in and spraining the outside ligaments) comprise 40% of athletic injuries.


There are three ligaments that provide the stability to the lateral or outside of the ankle. The anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). The fist two are the most common to be injured in a twisted ankle and the PTFL is the least likely unless you dislocate the ankle joint!

There is a classification system to ankle injuries and this dictates the treatment:

• Grade I is an injury without macroscopic tears. No mechanical instability is noted and pain and tenderness is minimal.
• Grade II is a partial tear. Moderate pain and tenderness is present. Mild to moderate joint instability may be present.
• Grade III is a complete tear. Severe pain and tenderness, inability to bear weight, and significant joint instability are noted.

The initial treatment of all joint sprains involves RICE. Rest, ice, compression and elevation. The ice should be applied for about 20 minutes three to four times a day and a compressive bandage should also be applied to help control the swelling. Weight bearing she be avoided initially but encouraged as soon as it can be tolerated.

Grade III injuries are obviously a lot more serious and initial treatment should include an ankle brace to immobilise the ankle joint. Once the patient can tolerate weight bearing the brace should be removed and rehabilitation can commence approximately 48 hours after the injury.

The rehabilitation of a severely twisted ankle should be gentle initially with simple range of motion exercises. Stretching of the Achilles tendon and cycling on a stationary bike can then follow this.

As strength and mobility improve, isometric exercises for ankle dorsiflexion, plantar flexion, inversion, and eversion are implemented. The isometric exercises are followed by resistance exercises (we use Thera-Bands at the clinic) and then heel and toe raises.

Once the pain and inflammation has gone down and there has been a return to gentle exercise a lot of patients get complacent about the treatment of their ankle. Patients dont realise that they still need treatment to get them back to 100% fitness. Our physiotherapist is eperienced in this rehabilitation process and will aid your recovery by providing specific taping techniques to the damage joint to aid it's stability and to help with the proprioception re-education process using a 'wobble board'.

At the Angel Wellbeing Clinic our physiotherapist takes things further and motivates patients to move on to proprioceptive and balance exercises so the weakened ankle returns to full function and this minimises the chance of a recurrence.

Taping by our physiotherapist can aid stability as well as provide a feeling of security when returning back to sports followng a twisted ankle.


Tennis Elbow

 

This is probably my favourite time of the year the Roland Garros or French Open tennis competition is on television and the former Stella Artois tournament but now renamed AEGON tournament is only a few weeks a way. And then Wimbledon is here!

 


As a clinician I don’t see vast numbers of tennis elbow caused by tennis. This is probably due to lightweight rackets and a more relaxed technique taught now. But tennis elbow does still appear at the clinic and the most common cause of it is the computer mouse.

 

 

Symptoms of Tennis Elbow

• Pain about 1-2 cm down from the bony area at the outside of the elbow or lateral epicondyle.
• Weakness in the wrist with difficulty doing simple tasks such as opening a door handle or shaking hands with someone, using a corkscrew or screwdriver.
• Pain on the outside of the elbow when the hand is bent back at the wrist against resistance.
• Pain on the outside of the elbow when trying to straighten the fingers against resistance.
• Pain when pressing just below the lateral epicondyle on the outside of the elbow.
• Painful trigger points in the forearm.


The typical mechanism of injury for tennis elbow or lateral epicondylitis, to give it its correct name, is sustained extension of the wrist and gripping at the same. The exact thing you do sitting at a computer all day with a mouse in your hand.

Therapy should start with the simple and conservative before progressing to the more invasive therapies. The object of therapy for tennis elbow is to relieve pain, microbleeding and inflammation, promote healing, rehabilitate the injured arm and try to prevent recurrence.

 

 

Treatment for Tennis Elbow

• rest from the activities that cause elbow pain
• correction of incorrect postures and motions, workplace ergonomics, ergonomic mouse
• assess neck function
• ice or medication such as oral or topical non-steroidal anti-inflammatory drugs (NSAIDS) to reduce the inflammation
• exercise regimen such as eccentric and concentric strengthening,
• soft tissue work on tendons and muscles of forearm
• if sports related assess technique and racket grip size
• tennis elbow brace and measured return back to full activity

Recent research has shown that corticosteroid injections are not recommended and can result in tissue failure of the tendons in the elbow so stay with the conservative approach. Pick a good practitioner, be patient and enjoy the tennis on the television. Lets face it, this is the time of year where tennis fans watch tennis and don’t enter into the seasonal rush for tennis courts!

We can provide the correct treatment and advice at the Angel Wellbeing Clinic with our Osteopath, Chiropractor and Sports Physiotherapist.


The Treatment of Runners Knee or Iliotibial Band Syndrome

This article is by the phjysiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic. The article looks at:

• What is Runners Knee or Iliotibial Band Syndrome

• What are the symptoms of Runners Knee or Iliotibial Band Syndrome

• Treatment of Runners Knee or Iliotibial Band Syndrome

The media love’s to trend topics. You would have to have been on the moon not have heard superinjunctions mentioned and in recent years we have had swine flu and ADHD in the health industry. So what I the latest health trend?

Iliotibial band syndrome or ITB syndrome or maybe the more friendly ‘runners knee’ is beginning to trend, or should I write #runnersknee! It has been around since we started running but since everyone can have a go at running without a major outlay in finances the incidence of runners knee is on the up.

What is Iliotibial Band Syndrome or Runner Knee?

Runners knee is inflammation and irritation of the lower part of the iliotibial band as it rubs against the outside of the knee or lateral femoral condyle of the long bone in the thigh, the femur. This happens during flexion and extension of the knee and this occurs every-time you take a step.


If you are susceptible to runners knee this action will irritate the ITB and the bursa (friction reducing pad separating the bone form the ITB) under the ITB every-time you take a step. The inflammation builds up in the ITB until it causes pain and you have to stop the pain inducing activity.

Do you think you may have Runners knee?

It is possible to have all the symptoms but more likely one persistent symptom may recur after running a certain distance and it is most common in those that have increased their millage or are training for marathons. There is always an increase in the presentation of runners knee in the last six to eight weeks before the London marathon as the novice runners start to run over twenty miles in their training.

• Swelling at the location of discomfort
• A snapping or popping sensation as the knee is bent
• Pain on the outside of the knee joint
• Tightness in the iliotibial band or outside of the thigh

• Pain normally aggravated by running, particularly downhill.
• Pain during flexion or extension of the knee
• Weakness in hip abduction.


Treatment of `Runner Knee’

The problem needs to be looked at in two ways. Firstly, stop running and address soreness and the easiest way to do this by icing the painful area on a regular basis.. secondly, address the tightness in the ITB through stretching and massage by an experienced sporst massage therapist. it is easy to overdo the massage.

Ober’s stretch is good but generally it easiest done with help from a friend or therapist.


Alternatively, foam rollers are terrific and let you work on the ITB yourself but make sure you don’t overdo it. With anything that is inflamed there is a balance to be reached between treating the painful area and aggravating the area. Don’t forget to ice afterwards!

 

Stretching and icing are a start but the factors that lead to runners knee also need to be addressed.


• Hip flexors – the gluteus medius may be weak
• Trigger points – glutius medius wont work effectively if it is in spasm.
• Training route – is it uphill?
• Leg length inequality
• Pronation of feet.

 

Other running related articles

Runners knee part 2

These last points need expert assessment and this is where Verity simon our Angel Wellbeing Clinic’s sports physiotherapist and Julie Curran our sports massage therapist can help.

Runners knee is common and it is painful and if you want to get back to training you need it treated properly and you need to monitor your return to training carefully.

To arrange an appointment or a Free Assessment click below.


 


The Therapeutic Benefits of Climbing

 

I am often asked by patients “what is the best exercise to do” or “what should I do to help prevent back pain”. As a chiropractor with 16 years of experience working at the Angel Wellbeing Clinic in Islington I know there is not one specific exercise or sport to help prevent back pain and even if there was, getting someone take up a new sport and stick with it would be hard. I always ask my patients what do they enjoy doing and go from there.

It is far easier to get a patient to improve their technique with a sport they enjoy than to start afresh. A recent article in Spine 15 May 2011 - Volume 36 - Issue 11 - p 842–849 has pointed to the benefits of climbing as a therapeutic exercise for back pain. This study looked at 28 patients with chronic low back pain over a four-week period and considered the physical as well as psychological benefits.

Why is this study worth mentioning? North London is lucky if you are into climbing or are thinking about climbing. I bet that you are now trying to think hard about where the nearest mountain range is to the Angel Wellbing Clinic in central Islington. We are really talking about indoor climbing and Islington has The Castle Cimbing Centre and The Westway Climbing Centre. Both of these centres are about 20 minutes from the clinic so no excuses. Both of the centres run a good range of introductory courses at the weekend and in the evenings and in no time at all you will be climbing like a mountain goat!

The benefits for climbing are numerous. Firstly there is the obvious improvement in strength, secondly, stamina improves as you slowly work your way up the wall, thirdly, there is a cardiovascular benefit. Fourthly there is a tremendous improvement in balance and coordination which is very good for the rehabilitation of a dysfunctional spine and similar to the benefits from Pilates but a lot more fun!

The final thing about the article that was interesting was they looked at the psychological benefits. Climbing is sociable as you climb with a partner, it is relaxing and there is a good sense of achievement. But what I personally think is the best psychological benefit from climbing is that is empowers you to get out of your comfort zone and gives you the power to help yourself and of course help your back-pain.

So check out The Castle Climbing Centre or The Westway Climbing Centre.


 


So You Have Just Run the London Marathon!

 

Maybe you did it with some friends to raise money for charity or maybe the reason for doing it was more personal and it was about the challenge. Either way you have done it, you have run the London marathon!

Now that the post race euphoria has subsided and the cold winter evening runs are a dim and distant memory, where do you go from here? Do you keep up with a schedule of training aiming for the next marathon or do you keep on running just to stay fit and for the fun of it? What you should do now is listen to your body.

Now is the time to let yourself recover and it may take a couple of weeks. Plan your post marathon life with the same meticulousness as you planned your training. Your leg muscles have been overworked during the marathon and they have will have suffered from micro trauma and will ache. Definitely do some stretching, maybe some yoga or get a massage.

If you have nasty blisters get them seen by a professional. If you start running with blisters you will change your running style and this will have a negative effect on your biomechanics increasing the risk of injury.

The joints in your legs and back will also have suffered from repetitive micro trauma so don’t be surprised if your knees ache. The same goes with your back, don’t be surprised if you have back stiffness in the mornings. The repetitive impact of running is absorbed by the discs in the spine and they can suffer micro trauma and take time to recover.

Sort out any niggles that have developed during the race as they need to be dealt with before training can recommence. These niggles may also be signs of biomechanical problems with the feet, pelvis and back, so get these problem areas looked at. Tendonitis is a common injury from marathon running and pain at the back of the ankle may be Achilles tendonitis. Similarly pain on the outside of the knee may be an indicator that you have iliotibial band syndrome or ‘runners knee’. Any of these symptoms need the attention of an expert to prevent them from getting worse.

The immune system suffers due to the increase in cortisol production during the marathon and post race you will be more susceptible to colds. So eat well and get plenty of sleep.

If you take this post race period as seriously as your pre-race training and allow yourself to recover, you will build on your existing level of fitness and be a better runner for it.


NICE 2 years on - and only 5% of GPs can prescribe spinal manipulation
by Richard Brown, BCA President on Wednesday, May 18, 2011 at 11:58pm

It is two years since the NICE guidelines advocating treatments for back pain commonly provided by chiropractors, yet most GPs still cannot prescribe treatments recommended in the guidelines, say the results of a survey conducted by the College of Medicine in advance of its inaugural conference today.

Thirty four per cent of GPs were unable to prescribe treatments named in the guidelines, with only 5% having access to prescribe spinal manipulation for their patients with chronic back pain. The College of Medicine's survey involved over 500 GPs. Patients were also polled, with 82% saying they want access to complementary medicine on the NHS.

The findings suggest a 'postcode lottery' with some areas far more fortunate than others in access to effective back pain treatments.

One pilot study performed in the North East Essex Primary Care Trust (PCT) showed that 95% of patients having access to chiropractic, osteopathy or physiotherapy services using the NICE-recommended treatment were delighted with their care. The pilot also demonstrated a 30% reduction in referrals into the orthopaedic department, with fewer patients undergoing surgery.

GP's not utilising NICE guidelines for treating low back painLow back pain not being treated by chiropractors in spite of NICE guidelinesPresident of the British Chiropractic Association Richard Brown, commenting n the latest survey results said, "With the current crises facing the NHS on a number of fronts, it seems nonsensical that patients are being denied access to cost effective care. Back pain is one of the costliest conditions, and NICE have recommended a number of evidence-based treatments. Failure to facilitate access is not in the best interests of PCTs but more importantly is not in the best interests of patients. With waiting lists for NHS physiotherapy spiralling, we are in danger of an epidemic of chroinic back pain sufferers."


Blood Donation Following Acupuncture

Patients who have received acupuncture are still able to give blood providing they meet certain criteria. The National Blood Service guidelines are explained here.
National Blood Service (NBS) Guidelines

1. Patients must not donate (obligatory):
If the condition for which treatment was given is not acceptable to the NBS.
If it is less than 4 months since treatment was completed for that condition.

 

2. Patients may donate (discretionary):
If acupuncture has been performed under the NHS.
If acupuncture has been performed outside the NHS by a qualified Healthcare Professional registered with a statutory body.

The following are statutory bodies:
General Medical Council (GMC)
General Dental Council (GDC)
Nursing and Midwifery Council (NMC)
Health Professions Council (HPC)
General Osteopathic Council (GOsC)
General Chiropractic Council (GCC)

Click here to go to the National Blood Service website


Find out a bit more about Marty our new receptionist

What is your job role? Part Time Receptionist

How long have you worked here? 1 day!

What do you do in your free time? Go to clubs/ bars / restaurants, theatre and socialise with friends.

What is the craziest thing you have ever done? Sea - Para gliding in Cyprus (I'm scared of heights!)

Summer or winter? Summer most defiantly.

What is the last book you read? How could she by Dana Fowley

If you could switch places with any other person for a week (living or dead) who would it be? Beyonce Knowles or Michelle Obama.

If you could go a trip where would that be? The Bahamas

Favourite album of all time? Can't choose just one, but anything by Jay Z.

Most memorable night out? Hawa's wild limo Birthday.

Favourite drink? Jack Daniels

 

 


 


Stretching before running 'does not prevent injury'

Stretching before running does not necessarily prevent injury a US study of over 2,700 has suggested.

But the researchers say runners should maintain their current routine, whether or not they stretch, as it is changing that is the problem.

For the rest of the article clic here http://bbc.in/gV5eIo


The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.

Abstract

BACKGROUND CONTEXT: Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.

PURPOSE: To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician-directed usual care (UC) in the treatment of AM-LBP.

http://bit.ly/b9SNQj


Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

Abstract

Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide treatments that are effective and cost-effective. The purpose of this systematic review was to investigate the cost-effectiveness of guideline-endorsed treatments for LBP. We searched nine clinical and economic electronic databases and the reference list of relevant systematic reviews and included studies for eligible studies. Economic evaluations conducted alongside randomised controlled trials investigating treatments for LBP endorsed by the guideline of the American College of Physicians and the American Pain Society were included. Two independent reviewers screened search results and extracted data. Data extracted included the type and perspective of the economic evaluation, the treatment comparators, and the relative cost-effectiveness of the treatment comparators. Twenty-six studies were included. Most studies found that interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation or cognitive-behavioural therapy were cost-effective in people with sub-acute or chronic LBP. Massage alone was unlikely to be cost-effective. There were inconsistent results on the cost-effectiveness of advice, insufficient evidence on spinal manipulation for people with acute LBP, and no evidence on the cost-effectiveness of medications, yoga or relaxation. This review found evidence supporting the cost-effectiveness of the guideline-endorsed treatments of interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitive-behavioural therapy for sub-acute or chronic LBP. There is little or inconsistent evidence for other treatments endorsed in the guideline.


Stay Safe in the Snow

With temperatures in the UK well below seasonal averages, the effects of snow and ice can pose problems. To ensure everyone can stay safe in the snow and avoid injury, Tim Hutchful, from the British Chiropractic Association, offers some top tips:

Best Foot Forward - It is a good idea to have two pairs of shoes, one for walking in the snow, the other for either driving or walking around the office. A waterproof shoe is preferable for outside, one that gives you support (like a walking shoe), has a grippy sole and can be laced supportively around the foot and ankle. Whilst wellingtons can be practical, they often don’t give you enough support and can be difficult to take off. Avoid walking outside in leather soled shoes and, if you are driving, change your shoes, if possible, so that your feet do not slip on the pedals.

Top Gear - Clothing should be warm and allow you to move freely. Avoid things in your pockets that may do you harm if you do fall. An ideal jacket length should be to just below your waist and on the hips, but make sure it doesn't impede your walking; if you fall, you will be thankful for the extra padding. In addition to keeping you warm, hats and gloves can also act as padding should you fall. Wearing a hat could help decrease the chances of an injury to the head and, likewise, when wearing gloves you are less likely to have your hands in your pockets, which may help you if were to slip.

Falling Gracefully - If you do fall, try and curl up and 'roll' with the fall and stay relaxed, this will minimise any jarring to your body. Whilst it may be an automatic reaction, try to avoid putting your hands out to save you - this may cause wrist injuries.

Keep Your Wits - It goes without saying, try to avoid alcohol. Not only will you be more prone to feeling the adverse effects of the cold (because it causes loss of body heat) but it may also cause you to take risks that you wouldn’t normally do and, of course, make you more unsteady on your feet. Keep topped up with warm drinks to keep your temperature up.

Plan, Plan, Plan - Plan what you need to do, especially if it involves travelling anywhere. Avoid walking too near the edge of the pavement to avoid slipping into traffic. Be patient, don't hurry and watch out for parts of the pavement that may have been in shadow or under trees, where there is more likely be black ice.

Travelling by Car - Getting the car off the drive can be a problem so, if possible, sort out your garage and put the car away. If you do have to scrape the ice off your car, make sure that you have the correct implements. Stand on a stable surface and do not over-stretch.

Safe Shovelling - Whilst very satisfying, clearing snow can be a strenuous task. Make sure you bend your knees and keep your back straight. Don't twist too much as any ‘unaccustomed activity’ may cause injury; if in doubt, put some salt or grit down instead.

Remember if you do fall make sure you get checked over as soon as possible, especially if you hit your head. Enjoy the snow but keep warm and try to stay as safe as possible.


Lucy's 30 Second Quiz


What is your role?

Receptionist

How long have you worked here?

Almost 2 years

What do you do in your free time?

Read, go to markets and exhibitions, go for walks, yoga, listen to music……

What is the craziest thing you have ever done?

A bungee Catapult in Crete

Summer or winter?

I like both but probably Summer just because of the cold.

What is the last book you read?

Bill Bryson ‘In to the woods’

If you could switch places with any other person for a week (living or dead) who would it be?

David Attenborough when he’s filming on location.

If you could go a trip where would that be?

India

Favourite album of all time?

Jeff Buckley Grace

Most memorable night out?

Brazil Amonzonas Festival in Manaus.

Favourite drink?

Caipirinha

 



 


Ten Ways To Get Through Christmas - or maybe not!!

 

Christmas is an expensive time for everyone so set yourself a budget and stick to it. Accept that being a good parent or being a good and loving partner doesn’t mean you have to spend a lot of money. It is the thought that matters and if they don’t like the ‘thought’ then they aren’t worth it so leave them. That goes for the children too!

If your child says ‘I can’t live without it’ with reference to a wii game or something similar, they are lying so ignore them!

Hosting Christmas can sometimes feel like a bit of a burden, especially if you're cooking dinner. So to reduce stress get invited to someone else’s and leave before it is time to do the washing up..

Look after yourself! If you're feeling stressed, you're not going to have a good time. Make sure that you feel relaxed by having a drink and falling asleep on the sofa when it is time to wash up.

Don't be afraid to ask for help, if you delegate properly you will have next to nothing to do

If you're getting a touch of cabin fever and your family is getting on your nerves go out for a walk to the pub. It is okay to take the children with you if there is an outside play area.

It's easy to underestimate that children may get tired or bored quite early on in the day and so irritate the adults so banish them to their bedroom nice and early. If they put up resistance tell them that if they are bad children Santa has to pass this way on his way back to the North Pole and he can always stop off and collect the presents, it is their choice!

You should try to eat and drink regularly to keep yourself hydrated and alert. Start the morning with a bucks fizz but don’t forget that keeping the fluid levels topped up constantly throughout the day is important so maybe a gin and tonic before lunch may help. Don’t get seduced by the old wives tale about drinking plenty of water.

Don’t worry about over eating on Christmas day and Boxing Day as you can combine a New Year healthy eating campaign with a detox programme from too much alcohol consumption over New Year. Obviously don’t get upset with the knowledge that you make the same New Year’s resolution and it only lasts a week!

Although everyone dreams of the perfect family Christmas, try not to panic if it doesn't work out how you wanted. There is always another one in 12 months time!
 


Starting Running?

Running is one of the easiest and most convenient ways to get fit and anyone can have a go at it no matter what level of fitness they have is running and of course you don’t need any special training! It isn’t like tennis or squash in that respect and you can do it when you want to and you don’t have to arrange up to have an opponent. All of these are why it is great and all of these are the reason why so many running related injuries present at the clinic.

Here are some simple rules to follow when you start running and observing these will help to avoid ending up with having to seek help and of course to have a break from running.

1. Don’t hunt around for your long lost running shoes that are at the back of the cupboard and haven’t seen the light of day for years, get some decent running shoes. The material that makes up the sole of the shoe and absorbs impact decays and most manufacturers suggest that the shoe is replaced every few years. Also, shops that are specialist in fitting running shoes now have ‘gait analysis’ machines so they can record how your feet and ankles function when you run. This helps them decide what kind of shoe you will need.

2. Be honest with yourself and set yourself some sensible training routes, don’t overdo it initially. Overdoing it will increase your likelihood of injury and overdoing it may be such an unpleasant experience you may put you off going running for a while afterwards!

3. Thirdly, don’t solely rely on running, go swimming or play another sport or do another activity for a better all round fitness regime and minimise the risk of injury.

4. Monitor your progress so you have an accurate record of the distance you have covered and how long it took you. There are iphone apps and GPS watches that allow this monitoring.

Be consistent with your training, set yourself a weekly regime that is manageable and that gives you rest days. And of course drink more fluids and eat sensibly allowing for the increase in calorie consumption to sustain your energy levels. Good luck!
 


Pauline's 30 Second Quiz

What is your job role?

Practice Manager.

How long have you worked here?

Coming up to 2 years January.

What do you do in your free time?

Read, gym, yoga, go movies, dim sum with mates.

What is the craziest thing you have ever done?

Marry my husband!

Summer or winter?

Does it matter? So long as there is sunshine and blue skies!

What is the last book you read?

“The Light Fantastic” by Terry Pratchett

 

If you could switch places with any other person for a week (living or dead) who would it be?

Leonardo da Vince. A painter, scientist, musician, mathematician, engineer, inventor…. The list goes on! Driven by his unquenchable curiosity, he was a technological genius, churning out theories and conceptualisations of so much that are common-place in our modern-day world. Inspiring! Great for days when the brain seems to lag behind my body by half a day.

If you could go a trip where would that be?

Shangri-La, although a fictional place described by J.Hilton in his book “Lost Horizon”, wouldn’t it be nice to just stumble upon this place, where it’s people live an almost immortal life of total contentment, in complete isolation from the outside world. In reality, many people have debated where Hilton gained his inspiration. Wherever it was, general consensus seems to be somewhere around Tibet. Sounds like a good place to start an adventure!

Favourite album of all time?

Aaron Neville, “To Make Me Who I Am”

Most memorable night out?

Zhang Yimou’s “Impression Liu Sanjie”, Yangshuo, Southern China. An awe-inspiring out-door staged-show on the Li River, that runs through Yangshuo, with a backdrop consisting of illuminated karst hills. The show has a cast of more than 600 indigenous people – farmers, fishermen and children from surrounding villages. Together, they perform a famous regional love story through folk songs and dances, conducted with lots of lighting, flames, beautiful costumes and gliding around the river on bamboo rafts.

Favourite drink?

Got to be Malibu with coke.

 


Natalie C

What is your job role?

Afternoon/evening receptionist and in charge of social media for the clinic.

How long have you worked here?

Just over 7 months, feels longer though…

What do you do in your free time?

Look after my 2 children, see my friends and clean my house!

What is the craziest thing you have ever done?

Appeared on GMTV for a makeover, lets just say I am not a natural in front of the camera!

Summer or winter?

Winter, I love cold days and crisp mornings and hot chocolate and soups and log fires and cosy coats and snuggling under a warm quilt and Christmas and my birthday….

What is the last book you read?

The secret life of Marilyn Monroe by J. Randy Taraborrelli, it was brilliant!

If you could switch places with any other person for a week (living or dead) who would it be?

One of my children’s teachers at their school to see what my children really are like when I am not around!

If you could go on a trip where would that be?

To see the Northern lights.

Favourite album of all time?

I haven’t got one, my tastes change all the time.

Most memorable night out?

Let’s just say it involved a lot of booze, a bar on Upper Street, a fire extinguisher and being picked up by a bouncer and thrown out of said bar, memorable for all the wrong reasons but one to tell the grandchildren!

Favourite drink?

Champagne………


Are We doing it Right?

Everyone at the Angel Wellbeing Clinic is aware that patients want top quality clinical care and top quality customer service. We achieve the clinical care standard by selecting our therapists carefully and listening to what the patients say about them, and we achieve good customer service results by taking the patients needs very seriously.

Like most things in life we can always do things a bit better but we need your input for that. We do try and see things from the patient’s perspective but we aren’t the patient so please fill in the customer satisfaction form and tell us what you think.

www.surveymonkey.com/s/5DCRR9W

Many thanks.

Brian Bamberger
 


Brian’s 30 Second Quiz

What is your role at Angel Wellbeing Clinic?

I seem to have two roles. Until recently I just thought I was just a chiropractor but now I see myself as the person who has to lead the staff and to create some direction to the clinic. I want to create a clinic that is the best in London for both excellent care and customer service.

How long have you worked here?

Ten years

What do you do in your free time?

I play tennis regularly but miss the more competitive side of it due to work hours. I run regularly and love looking after my son. I enjoy cooking and enjoy having a good time with friends. It goes without saying that I help old people across the road whenever I can and I am doing what I can to save the rain forests!

What is the craziest thing you have ever done?

Buy a property and start a clinic in it! Obviously there weren't any patients initially and I sat in my reception area wondering what possessed me to do it and after three weeks the phone rang. The second craziest thing was to have a baby (obviously in the way that a dad does), it is still something that seems a bit crazy even with Ed being almost 9 years old, but crazy in a very good way!

Summer or winter?

Summer and winter, I like beaches, swimming pools and sun but I love mountains and snow in winter. I would like to think of my disposition as sunny!?

Money or power?

I never seem to have enough money but my staff humour me and give me the impression I am in charge!

Relaxing on a Friday night or partying all weekend?

I seem to be very happy with either right now. Recently I have realised that with having a child and setting up the clinic I have managed to get out of the habit of partying and having fun. I really had forgotten how much fun I can have so I have definitely been working on ‘fun’ in recent months. I do secretly want to go out every night of the week but I am concerned as to where this is going to take me and the effect on my eight o’clock patients!

What is the last book you read?

I have just finished the dreadfully titled The Human Stain by Philip Roth and am now on The Secret Speech by Tom Rob Smith.

If you could switch places with any other person for a week (living or dead) who would it be?

Why would I want to swap places with someone else, I am so amazing!! If push came to shove I think I would like to swap with Neil Armstrong, it must have been the most amazing thing in the world or out of this world to step out of the Apollo space craft and walk on the moon. I hope it isn't too clichéd but being the first person to walk on a planet doesn’t happen every day?

If you could go on a trip where would that be?

I had a great time years ago diving off Heron Island in The Great Barrier Reef so I think with autumn approaching I would like to be on a tropical island with the right company and doing a few dives. But referring to a previous question I would like it to have great night life.
 


Strictly Come Slouching

I would like to make it clear form the outset that I didnt think up the title!
With the autumn nights about to draw in and Strictly Come Dancing starting this weekend, the nation is gearing up to a series of Saturday nights slouched in front of the box.

From now until Christmas, there is an onslaught of weekend entertainment programmes and the British Chiropractic Association (BCA) is warning that we could all be ‘Strictly Come Aching’ as a result.

Research highlights that 28% of the population already spend over 15 hours seated per day Monday to Friday. But for the next three months avid viewers of X Factor and Strictly Come Dancing could spend the equivalent of an extra two days on the sofa watching Simon Cowell and Len Wiseman put contestants through their paces.

Poor posture is one of the biggest causes of back pain, and figures continue to rise, with 32% of the nation currently suffering from back pain and 62% having suffered. This additional inactivity on top of our already sedentary lifestyles means we could be in for a serious case of the Slouch Factor.

Tim Hutchful from the British Chiropractic Association warns: “As a nation we clearly like to sit down and whilst resting is good for our bodies there is almost twice as much pressure on your back when you are sitting incorrectly than there is if you stand up. Sitting for prolonged periods of time as inactivity coupled with incorrect posture lays us open to back pain.”

The British Chiropractic Association has some simple pointers to enjoy Saturday nights in front of the TV safely:

• Sit up! Sit in chairs that provide full support for your spine and make sure your shoulders, hips and knees face the same direction.
• Stand up! Avoid sitting in the same position for more than 40 minutes, less if possible. When you do take a break, walk around and stretch a little.
• Exercise! Compensate for inactivity during the ad breaks by doing some light exercise – anything to loosen your muscles. Using something like the Straighten Up UK exercises would be ideal.

The BCA has also devised a simple three minute exercise routine called Straighten Up UK. This can be incorporated into our daily lives to help strengthen the spine and improve posture. The exercise routine is available to download from www.straightenupuk.org for more information call the BCA on 0118 950 5950 or visit www.chiropractic-uk.co.uk where there is also plenty of practical advice to help avoid back problems and improve posture.


Couch Potato

There was an interesting article on the BBC website last week regarding research querying the link between obesity and inactivity. The study challenged the previous assumption that a lack of exercise causes children to put on weight. Researchers looked at 200 children in the Plymouth area and came to the opposite conclusion: getting fatter makes them inactive. There is a lot more to this than meets the eye so maybe check out the BBC webpages (link at the bottom of this article).


As a parent of an eight and a half year old boy I am very aware that I have a big influence on him both emotionally and physically, and the example of ‘lifestyle’ is the one I set for him. So, perhaps looking at what parents are like is the best way forward as there is no point tackling children’s habits and lifestyle if their parents do not understand what a healthy lifestyle means.


Children generally should not set the rules of the house; they certainly should not have carte blanche over picking what food goes into the shopping trolley or what and when they should eat. I know what my son would pick, given the chance, but he doesn’t get that opportunity!

Again, this is an area of responsibility of the parents and there is a need to set sensible boundaries for your child. Sometimes though, setting these boundaries can be stressful as not all children take ‘no’ as well as mine does. But you have to be firm, consistent and appropriate which is easier said than done! When it comes down to it we, as parents, are only human and have good and bad days as well. However, we have to aim for this consistency and appropriateness at all times for the sake of our children.


Childhood obesity is clearly a growing problem. Addressing this issue is as multifactorial as the cause of it. Clearly though, by educating the parents as to their own health requirements, the benefits of diet and exercise and how good they can feel from this, can set a rock-solid example to their children of a good and healthy “life style”, and put them onto the road to a live-time of improved health and wellbeing. Coupled with this, if the Government enforces stricter labelling of food packaging and limiting the direct marketing of “unhealthy” foods at children in shops as well as on the television would be two steps forward to a better and healthier population.


When it comes down to it, as a parent ask yourself this question: “Do I want an obese and unhealthy child?”


If you don’t, then it’s time to do something about it!


http:/news.bbc.co.uk/1/hi/health/10545542.stm


School Sports Day:Be Careful!

As much as I enjoy a bit of regular exercise, I play tennis a few times a week to a reasonable standard and I go running two to three times a week to not such a good standard, I still feel a compulsion to show my son how fast I am in the ‘Dad’s Race’ at sports day. The reality is I am not a sprinter or a runner of ability.


The first ‘Dad’s Race’ I competed in (note the word ‘competed’!) I tore my right adductor muscle, okay a groin strain, and it was painful for a month or so. So be careful, don’t get too competitive as your son or daughter will still think you are wonderful even if you don’t win. But my son still thinks I was stupid trying to do the ‘Fathers Race’ in flip flops!


The Point of Acupunture

World Health Organisation endorses acupuncture for at least 24 conditions. So we all know what acupuncture is but why does it work?

Acupuncture has an analgesic effect and this is well documented but what biologically happens to bring about this reported effect? The insertion of the needle does not alleviate the pain but stimulation of the needle by either turning it, passing an electric current through it or in some cases heating the needle brings about the desired effect.

It is believed that the pain killing effect of acupuncture is brought about by the release of opioid peptides in the central nervous system as a response to the long-lasting activation of ascending pain tracts in the spinal cord due to the intermittent stimulation of pain receptive nerve endings by the needle. It is believed that Adenosine is the central mediator in this process.

Chiropractic is also successful at treating chronic pain and it is believed that the chiropractic adjustment may act on the pain receptive nerve endings surrounding the joints of the spine.


 


You Think it's All Over

It’s the World Cup so lets all play football! It is great to get enthusiastic about sport, get off the sofa and get more active! But if you are honest with yourself how active and fit are you really? Can your body take a sudden bout of footie?

Chiropractors treat sport injuries as well as injuries associated with back pain and in the maintenance of good spinal function. It is all too common to see patients come in for treatment after suffering an injury from an attack of the ‘lets get active’ attitude. Football isn’t just a lot of running around. It’s also physical so there is an increased stressed on the body to deal with this side of things too.

The most frequent injuries from football are the common garden ankle sprains and the acronym ‘RICE’ is the best way to deal with them:

Rest.
Immobilise.
Compress.
Elevate.

The return to activity has to be carefully monitored and some rehabilitation exercises to improve proprioception will be necessary as well as some strapping. And then the secret is to just take it easy as you get your fitness or activity level back to where it was prior to the injury. Remember: don’t try and start back at football at the same level you were before the injury.


Second Week Back After New Year. So How Are You Doing?


It is still dark, it's cold. There's the end of the month credit card bill to pay and it is still three months to go before the clocks change. So how do you get through the next few months?

Concentrate on the things you like doing; the things that have historically made you feel good. A mixture of sports to shake off the seasonal over indulgence and for the more emotional side spending time with friends and family. It is simple to recharge yourself after Christmas but making a conscious effort to do it is crucial.

So, think about how you feel and about how you want to feel. Ask yourself - what was going on in your life when you were feeling that way? Then implement simple strategies to recreate that point in your life.

 

Good luck!



How Long Before The New Year's Resolution Becomes History?

Most people I talk to make a New Year’s resolution, or at least they have ideas of what they may want to change in the New Year. But how many people actually achieve that goal ? Or if they do, how many actually sustain it? We always think about the obvious ones; stop smoking, lose weight, do more exercise and eat better.

But somewhere along the road, or maybe even by the end of January, that New Year's resolution becomes a weight around your neck. Excuses start to come out and eventually one or two weeks of good behaviour become a distant memory and it is back to the old habits.

One good thing to do is to look at what you want to achieve and then set some sensible goals. Don’t get too carried away - be realistic. If you've joined a gym don’t start off with too punishing a schedule because it will take time for your body and mind to adjust to the changes. Get your diary out, look at the next three or four months, and set your self a sensible pace.


Remember, if it is fun and manageable you are much more likely to stick to it.

Happy New Year, and good luck from everyone at the Angel Chiropractic Clinic.


 


How Long Before I Get Better?

This has to be one of the most commonly asked questions when a new patient comes in for the first treatment. And I can't give a straightforward answer such as two weeks or five visits for example. It's impossible to say - the chiropractic equivalent of how long is a piece of string.

This ties in nicely with a new book I have started to read called 'Outliers: The Story of Success by Malcolm Gladwell'. It asks why do some people achieve more success than others? "Can they lie so far outside the ordinary?" What is the secret of their success?

The simple answer, Gladwell says, is 10,000 hours. From Bill Gates to The Beatles, its the way you spend your time that will make you a success, and that amount of time is 10,000 hours. So back to the original question, how long before my back gets better? Well obviously 10,000 treatments is out of the question! obviously the answer!

Most patients are pain-free within the month, maybe after two hours of treatment. But to make a success of your back and achieve wellness, then maybe 10,000 hours over your lifetime devoted to your health is just about right.

So getting you out of pain can be quick but getting you to a point where your back is working well may take a little longer. Which is okay with us as we are here for the long term and will help you to help your back.

The next Blog is about procrastination. Why it is so hard to change the habits of a lifetime? and why is prioritising your health so low on “the task list of life"!



Is Your Laptop Giving You A Pain In The Back?

Everyone knows the less time you need to spend in the office the better. Most of us are now used to carrying out laptops around with us to give us more freedom. But even the lightest laptop can be quite cumbersome and tiresome to haul around between the office and home. More and more patients are coming into Angel Chiropractic Clinic complaining of an aching neck and shoulder pain from carrying around their computers.


So, the question is what can you do ? You can minimixe the strain on your shoulders by using a wheeled case if you are travelling a long way with your laptop. If you can't do this then make sure you have a bag that hungs the body and has a wide, heavily padded shoulder strao to distribute the weight and reduce shoulder strain as much as possible.

When you are using the computer itself take regular breaks, roll your shoulders and neck around gently to release the build up of tension. Think about invest in a laptop stand which can offer relief by elevating the screen to your eye level.

 


Crunch Time!

Fed up with the doom and gloom that’s in the papers at the moment ? Feeling you might scream if you hear the words 'Credit Crunch' one more time? What about that dreaded ‘R’ word? RECESSION. We may not have any power over the economy but what we do have power over is our own lives.

Sometimes you need to take a long, hard look in the mirror. You need to look at who you are and how you act. What in your personality is stopping you moving forward? That takes personal reflection, insight and honesty.

We can, for example, take personal responsibility for our health. For some, the obvious things to do are to stop smoking or drinking and with Christmas and New Year on the horizon I am sure there will be plenty of opportunity for both! Others might want to take more exercise or to eat better. But for the majority of the patients I see, the biggest problems are more general ‘lifestyle’ problems and in particular issues associated with work.

Many of us spend a third of the day sitting at a desk. In an economic downturn, stress and pressure make everything that little bit harder so it’s more important than ever to look after yourself. My two top tips are to get your spine adjusted to keep yourself well (it only takes 10 minutes and you an even fit it in on your way to or from work) and to create some time and space to do the things in life that you really enjoy.

When it comes down to it you can only enjoy yourself if you are dealing with work and stress in a healthy way. Come and see us and find out how Angel Chiropractic Clinic can help you function better, help your body cope with stress and set you free to gain more from life.

 


 


So, Is He Or Isn’t he?

No, this doesn’t refer to McCain’s mental state in having Sarah Palin as his running mate. I think if he knew as much about her then as he does now and he still chose her then he would clearly be one state short of a majority. This ‘is he or isn’t he’ refers to David Beckham signing for AC Milan after Christmas.

There have been lots of suggestions as to “why AC Milan?” such as “his missus will like the shopping”, “Posh likes pasta and pizza” – well, maybe individual lengths of spaghetti or a pizza the size of a canapé. Or maybe it could be because he will get to

play football with some of the world’s finest players and have his fitness managed by a chiropractor at the Milan Lab!

This period with Milan Lab’s chiropractor Dr Messerman will not do his value as a player any harm and I am sure it will keep the England manager and former manager of AC Milan happy. Maybe this spell will enable him to get to Bobby Moore’s number of caps and maybe this move will even help him prolong his career as a footballer. I am sure that the owners of LA Galaxy wont see it like this as they will prefer him to have a bit of a rest when their season finishes but they are Americans and what do they know about football, sorry, soccer?!

Beckham's move to AC Milan may help him no end, after all Beckham is a great athlete and has kept himself comparatively injury free in his career - there is a chance that he can emulate the other AC Milan pensioner Paolo Maldini who is 39 and contemplating another year on his contract. Maldini is a full six years older and still playing at a top level, albeit as a defender (okay, he has spent a good deal of his career laying on the pitch and rolling around feigning being fouled).

So what has AC Milan’s chiropractor got to offer and why is a chiropractor in charge of fitness and rehab? A complete approach to wellness and injury prevention without the shackles of conventional medicine’s paradigm of health. This complete approach to wellness is what we have here in Islington - an understanding that there is a lot more to health and fitness than treating illness and injuries. It is about making sure that the whole body is David Beckham kicksfunctioning as well as possible.

Here is quote from David Beckham’s chiropractor: "Players are seen every day by the chiropractor," Meersseman explains. "This allows us to prevent numerous injuries, while maximising the player's performance. We apply chiropractic in a subluxation‑centered, wellness‑oriented perspective. We especially place a strong emphasis on the upper cervical area and applied kinesiology allows us integrate the biochemical and mental aspect of the triangle of health, as well as to respond to the specific needs of sports chiropractic."

The figures for Dr Meersseman are very good, he has improved injury recovery time, he has reduced the number of steroid injections the team has over a season and consequently this has allowed AC Milan to have a smaller squad that saves the finances and has kept Maldini going at 39.

All these are the benefits of chiropractic care for a professional footballer, but it doesn’t take a lot of thought to see how the population of Upper Street, Islington and the surrounding areas can also benefit form chiropractic care, especially in these grim economic times. If you are an employer you want the staff you have to work at their best, so looking after them is going to pay off. They will be off work less often and they will feel better at work.

I imagine that a lot of time at Milan Lab is spent looking at how the upper body and neck function in conjunction with the biomechanics of how the ankle, hips, knees and pelvis function when striking the ball. This is no different to looking at how the body is functioning at work sitting in front of a PC. We can assess how your body is functioning and make changes to how your spine functions in response to your working environment and prevent injury and fatigue at work.

So maybe David Beckham and Dr Meersseman are going to increase the public’s awareness of chiropractic? I will let you know when the first male patient comes in to the clinic wearing a sarong!

Read more about the Milan Lab here:

www.worldchiropracticalliance.org/tcj/2006/nov/k.htm and

www.acmilan.com/InfoPage.aspx


‘MBT’s Activate The Whole body’ v ‘just do it’

Will my back pain get better if I spend £150 on MBT’s?

If spending £150 on a pair of MBT’s means that you are going to do a lot more walking then there is possibly a benefit from buying them. But will it cure your back pain? I doubt it.

There is a lot in their advertising about Masai warriors not getting back pain and how the shoes simulate the ground giving way under foot. Here are some of the claims:

 

• Tones and shapes the body.
• Can help with back, hip, leg and foot problem.

• Can help with joint, muscle, ligament and tendon injuries.
• Reduce strain on knee and hip joints.


I have no problems with people buying shoes or trainers to help with a physical activity. You only have to go into one of the big sport shoe shops to see the range of specialist shoes, dedicated running shoes for the aspiring marathon runner, running shoes for cross country running, tennis shoes that come in all sorts of different configurations for the different surfaces, cross training shoes that do a bit of everything and then the more ‘off-road’ type of shoes for running up and down mountains or in my case worn when walking the dog.

So there is clearly a shoe for everyone out there and of course they all purport to help cushion the foot, provide support, prevent fatigue in the foot muscles and of course they all claim to help protect against injury and aid performance. None of them until now claim to ‘activate the whole body’.

Can a shoe activate the whole body? Nothing that is laced to your feet, strapped to your arm playing music or stuck to your shoe to record how far and fast you have run can activate your body. The only thing that can activate the whole body is you and marketing a shoe as the panacea, and this is what it is in this way I feel is unhelpful.

There has been a lot of press coverage in the past about obesity and diet. In particular mentioning that children growing up now are going to be less fit than their parents and even having a predicted lifespan less than their parents. I have a child and this is indeed worrying so how do I address it at a family level? My little boy is keen on walking and having a dog we walk a lot. He enjoys running around with his cousins. We play tennis and throw a rugby ball about; I am getting off the point here. So what is it that I am going on about? It is our choice of lifestyle that causes the problems that we have and not our footwear.

I imagine that a Masai warrior has a very different lifestyle to us, I reckon that one of the reasons the Masai don’t get back pain is because they don’t spend a third of their day sitting at a computer staring at a screen, I imagine they are out and about hunting and gathering to a level that we over here haven’t done for centuries. We are all designed to be hunter-gatherers and actively seek out our food and have a diet of lean meat and fish, fruits and nuts, live an active life and die in middle age. I guess there isn’t much time for back pain.

So back to the original question. Can a shoe activate the whole body? No. Only you can activate the whole body, it is your choice to change your life and look at what you do and of course the effect your choices in life have on you and your health.

So maybe the Nike slogan is best ‘Just do it’.





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