Articles

The Physio Rooms are the bees knees at taping!

Kinesiology tape and sports tape is a thin, stretchy, elastic cotton strip with an acrylic adhesive and it is almost identical to human skin in both thickness and elasticity. In this article we discus the methods used in taping. There is a vast array of taping methods available today, of which many can be used for problems with different anatomical locations. The exact application of each technique may be different depending on the reasoning process of the person who applied the tape. Because of the scant scientific evidence on this area and because each individual is different, there is no truly 'correct' method of applying tape, as each patient has a different problem.

If the tape is being applied by a chartered Physiotherapist then a thorough examination of the problem would have been undertaken, with the clinician then applying the tape with the aim of limiting unwanted movement at a joint or offloading specific anatomical structures where a weakness has been identified. Because there are a huge number of structures that could require support there is no single definitive taping technique. Therefore working with a Physiotherapist who can accurately diagnose and identify structures that might be a potential source of pain is key. Appropriate taping techniques can only be applied with this knowledge.

Literature describes taping in the treatment and prevention of several musculoskeletal conditions such as ankle sprains, patellofemoral pain, wrist sprains and shoulder injuries. Research methods include randomised controlled trials, retrospective and prospective cohort studies, biomechanical lab base studies and correlational epidemiological studies. The scientific evidence for the effectiveness of taping for these problems is mixed, but the clinical use of taping techniques is widespread. The ankle is the most commonly taped joint in football.

The type of taping technique and the choice of material used is largely based on the athletes preference, with this decision largely based on custom, superstition and comfort (both physical and mental). Ankle tape is also appropriate following acute ankle sprain. As well as immobilisation, a compression bandage can help to limit swelling. In the recent study by Barton et al 2105 BJSM physiotherapists advocated taping as a major component of the management of anterior knee pain. It was found that a combination of taping, manual therapy, appropriate exercise prescription, gait analysis had the most improved results for patients with anterior knee pain.

Here at the Physio Rooms we follow all methods of taping and where necessary are advocates of its usage. If you have any questions on taping or are experiencing a pain which could be alleviated by taping then please dont hesitate to contact us on 01273 667826 and we would be happy to share our knowledge.

 

Has an Anterior Cruciate Ligament injury brought you to your knees? - a very common knee injury discussed

Untitled

Untitled

The anterior cruciate ligament (ACL) is a strong ligament which runs diagonally through the middle of the knee. It prevents the femur (thigh bone) from sliding out in front of the tibia (shin bone) and gives rotational stability to the knee.

The ACL is one of the most common knee injuries that occur in sport. Most ACL injuries occur during non-contact running, jumping, and landing tasks with inadequate neuromuscular control of the lower limb. That is when you slow down very quickly, change direction rapidly, or land incorrectly from a jump. This is commonly due to decreased knee flexion (knee bend), increased knee valgus (knee collapsing in), and internal rotation at the hip during landing and cutting movements. It can also happen through direct contact or collisions such as a football tackle.

Horsley (2015) outlines the risk factors that influence the alignment through the lower limb:

Weak muscles: gluteals, quadriceps, foot supinators

Over recruitment: hamstrings, hip adductors, trunk flexors

Decreased proprioception (joint position sense)

Reduced dorsiflexion of the ankle

Reduced tibial internal rotation

Usually you will know if you have injured your ACL as you may hear a ‘popping’ sensation in the knee. You may also feel the knee ‘give way.’ There is often severe pain and inability to continue with sporting activity, the patient is often unable to weight bear. Swelling begins quite quickly within a few hours as the ACL has an abundant blood supply.

There are different severities of ACL tear ranging from a grade one tear (the ligament is mildly damaged but is still able to keep the knee joint stable) to a grade three tear (the ligament has been snapped in two and the knee joint is unstable).

Treatment for an ACL tear will depend on the severity of the damage to the ligament and the patient’s individual needs. For example the young athlete involved in agility sports will most likely require surgery to return safely to sports, versus the less active individual that could be managed with non-surgical intervention.

Surgical treatment involves removing the ACL and replacing it with a graft (often a section from the patella tendon or hamstring) which is then screwed in from the femur to the tibia to replicate a new ligament. Rehabilitation from surgery is vital for return to sports and daily activity. A physical therapy programme will focus on regaining knee strength, movement, and stability. It usually takes 6 months to a year to make a full recovery from ACL reconstruction; however this is very dependent on the individual and how closely you follow the programme and advice from your therapist.

If you are suffering with knee pain or want to know more about the treatment for ACL injuries please get in touch with one of our highly trained Physiotherapists or contact us on 01273 667826 at one of our clinics.

Wimbledon is here! - Exercises for both competitive & recreational tennis players to try

This series of exercises are good to strengthen and mobilise the lower body for both competitive and recreational tennis players. Using a variety of functional strength, stability and control you can use the set as an ideal warm up programme that can be followed before playing tennis. Due to the versatility and lack of any major equipment they are the ideal set of exercises for tournament play. Keep your eyes pealed for any lunges at the side of the courts!!

Single leg squat maintain your hip knee ankle alignment by engaging your core and lateral glutes, lower to a seated position

Squat initiate movement through sit, maintain a wide knee position, keeping your back straight

Lateral lunge transfer your body wait on to the lunge leg, at a 90 degree angle, sit down as far as possible, keep your back upright

Lateral leg raise stabilise your core, maintain an upright position

Lunge rotation keep your feet hip width apart, control the movement through your pelvic floor & your core activity

Check out our You Tube channel to see the videos in full and subscribe to keep an eye on lots more to come...

The fustration of sport injuries - A tennis case study with Keelan Oakley

It is the peak of the tennis season, the French Open finals have been played and Wimbledon is round the corner - now is the perfect time to highlight some of the work we do with some of Sussex's top ranked tennis players. With that in mind we asked long time college and ITF professional tennis player Keelan Oakley to share his experiences working with The Physio Rooms team. Keelan is an ITF professional tennis player, with a career high ranking of 997. He currently tours the ITF circuit playing challenger events across Germany, Egypt, Cyprus, Great Britain and many other international venues. Keelan is coached by Barry Fulcher (@BF_Tentrade) out of Preston Lawn Tennis Club who has recently achieved number 1 ranking in men's over 35 tennis. Keelan also works closely with Brendan Hayes (@theconditioning) and has a long term working relationship with The Physio Rooms team, namely clinical lead Tom Goom.

In Keelan's own words...

"Throughout the 2102 season I struggled with low back pain. This pain gradually got worse with symptoms spreading to my left leg. By the end of the year I was having difficulty walking. After a MRI it was discovered that I had severe intervertebral disc damage that would require surgery. In Feb 2013 I had back surgery on a disc bulge L4/L5, the surgeon predicted it would be a few months or so at least before I would be back on court even to do the absolute basics of hitting for a light hour with minimum movement.

At that time I was having physio twice a week and we managed to halve the recovery time and I was back on court in about 4/5 weeks. This was great as I was able to prepare well for a summer of competing and I reached a career high ranking of 997 ATP in the next 6 months.

Unfortunately I had another flare up at a tournament in Cyprus. It didn't require surgery but I was out for another 9 months. During the 9 months I had physio once a week and could do some really limited stuff on court and bits in the gym. Tom had the idea of getting my 'team' together (physio Tom, Fitness trainer Brendan, coach Barry) so we could all discuss the best way of getting me back on court as soon as possible.

This really helped speed up my recovery as everybody was working towards the same goals, we covered everything from what Tom and Brendan would be doing with me (a lot of hamstring work!!) and a detailed breaking down of my footwork and technique to find a way to prevent a complete blow out whilst in competition. This involved extensive video analysis of my technique. Going back to basics with footwork drills and agility. We built strength and control through gym sessions.

On court we worked endlessly to build new movement patterns, it really felt like I was learning to play tennis all over again which in essence is what we were trying to achieve to prevent further break downs. We would (and still do) meet every 2/3 months to keep on top of my programme and see if there are any ways we can improve it and so far so good! A few exercises from Tom and a massage once a week, enjoying IP sessions a lot more than rehab!!"

If you are suffering with a sports injury and getting frustrated missing out on the activity you love, then The Physio Rooms are here to help. For any advice or to book an appointment please contact us at one of our clinics.

How's your posture? Dont' suffer in silence with neck pain

Our lifestyles have changed dramatically in the past thirty to forty years. We are spending more and more time sitting down at computers or mobile devices, watching television and driving and this means we are seeing neck pain becoming increasingly more common. Neck pain has now joined lower back pain as one of the two most common pain locations in the body. Acute neck pain (pain that manifests abruptly) generally has little to do with this change in our society, but can be caused by sudden jerky movements of the head and neck, or by trauma injuries from sporting accidents and falls.

Whiplash occurs when the head is suddenly moved backwards and forwards, causing the muscles and ligaments of the neck to strain and in some cases tear. Whiplash is commonly experienced in rear-end car collisions and can produce pain and aching to the neck and back, referred pain to the shoulders and often headaches.

Simple neck pain implies pain that arises due to relatively minor problems with the muscles, ligaments joints and nervous systems of the neck. Simple neck pain can come on after a minor injury or sprain but in many cases no injury can be identified. It can arise after something as simple as sleeping badly in bed at night. This type of pain comes about because the sprained tissue becomes irritated and sometimes inflamed which causes pain signals to be sent to the spinal cord.

However, most neck pain that is not caused by whiplash or trauma and has a postural component as part of the underlying problem. Sitting in front of a computer for long periods with static seating frequently leads to muscular, joint and neural pain in the neck, back and shoulders.

It is estimated that 45% of the working population is affected by neck pain. Therefore it is very important to understand the different aspects of poor posture that contribute to this type of pain in order to prevent and manage it.

A common cause of postural neck pain is the forward head and shoulder posture. This occurs when the neck slants forward, placing the head in front of the shoulders (this can be observed while working at a computer, laptop, ipad, iphone etc.) This position places undue stress on the vertebrae of the lower neck. The muscles of the upper back are also continually overworked to counter-balance the pull of gravity on the forward head. Forward shoulders and a rounded upper back with increased extension of the cervical spine often accompanies this position. This leads to very tight pectoral muscles and causes a lot of tension between the shoulders as well as contributing to the neck pain.

Physiotherapy assessment and treatments such as manual therapies, massage and stretching can help ease symptoms. Postural re-education is key. A patient specific exercise program to help mobilise and strengthen the back, neck and shoulders in order to pull the shoulders back into a neutral position, can alleviate some of this tension and pain. Stretching before and at intervals during the working day can also do wonders for tight, tired muscles.

Another way to minimise the risk of developing postural neck pain, or to manage it if you already suffer from it, is to adjust your workspace around you so that you can work comfortably.

Desk

  • Most desks have a fixed height; therefore it is important to ensure you have an adjustable height chair so that your arms can operate the keyboard comfortably

Chair

  • Always sit as far back as possible in the seat so that your lower back is well supported

  • The back of the chair should be high to support the middle back

  • Your chair height should let you type with your forearms placed horizontally on the keyboard

  • Try to keep your feet flat on the ground, if your feet dangle off the ground when you’re sitting fully back in the chair, using a foot rest is a good idea

Keyboard

  • Pull up close to your keyboard

  • Position it directly in front of your body

  • Wrist rests can help maintain a neutral wrist position when you are taking a break from typing but are not recommended for use during typing as typing in this position may cause carpal syndrome in the wrist

If you are suffering with neck, shoulder or upper back pain please get in touch with one of our highly trained Physiotherapists or contact us on 01273 667826 at one of our clinics.

How can we improve your running efficiency?

Ever since athletic competitions began coaches and athletes have strived to make their running more efficient. Despite this there has been considerable debate over what techniques actually create a more efficient style. Classically an 'Endurance Template' has been recommended:

While this has been widely used there is minimal evidence to suggest it's a recipe for success or a running style we should all aspire to. Recent research from Cardiff Metropolitan University has highlighted that multiple factors can affect efficiency but a key factor appears to be how a runner pushes during propulsion. Dr Isabel Moore and her team identified that as a runner's economy (a measure of efficiency) improved, their leg position at toe-off changed; the knee was slightly more flexed and the ankle slightly less plantar flexed:

Moore et al
Moore et al

Source: Moore et al. (2016) Open Access

Let's look at this with 2 runners as an example:

Running Example 1
Running Example 1

If we can improve push off we can, in theory, improve efficiency and potentially make someone faster. The challenge is determining how we might do that with each individual. We would hope that the right running cue could help the runner on the left change her position at toe-off and become less 'bouncy'. Recent developments in mobile technology allow us to measure vertical oscillation in clinic and determine if this 'bounciness' changes with gait-retraining. In the case of the lady above she was running with an ankle injury which may well have affected her gait and would also need to be addressed to help efficiency.

It's important to recognise with running that there are many factors that interlink and influence performance and load on the tissues. There's no one-size-fits-all approach! They key is finding what works best for each individual runner. This was highlighted recently by a patient advised to increase his cadence (amount of steps per minute) to reduce injury risk. While this can indeed be good advice for some it certainly isn't a cure-all! In this gentleman's case it lead to a stuttered running style with very little length in the stride (picture on the left below).

Running Example 2
Running Example 2

A final, crucial point to consider is that video alone cannot tell you what style is best for you. It's really important to see how changes to your running gait feel and whether they actually feel easier. It often takes time to adjust to changing your running and it can feel difficult initially but if a running cue feels like a lot more effort it's probably too big a change.

For more information on running gait analysis or to arrange an appointment please get in touch with Tom one of our senior, highly trained Physiotherapists or contact us on 01273 667826 at one of our physio clinics.

Have I got Sciatica? - this complicated diagnosis in detail

Sometimes back pain causes pain in the legs which doctors often refer to as ‘Sciatica’ because the sciatic nerve, which runs down the back of the leg, is most commonly involved. Pain can actually be felt in the buttock, back of the thigh, calf or into the foot. There is nothing wrong with the leg itself, but the pain is caused from an injury on the spine irritating the nerve. These symptoms are often described as referred pain. You may also experience numbness or pins and needles in the legs and feet. Do I have Sciatica?

Your physiotherapist can perform certain clinical tests to give an indication as to whether symptoms in your leg are coming from your back (referred pain) and whether the is nerve root irritation (radiculopathy /radicular pain) which along with your clinical history might also point to a more specific problem. If your physiotherapist thinks there is a specific structural problem they may refer to your doctor accordingly, but this is very rare.

Why am I getting pain?

Sciatica 1
Sciatica 1

Your back is made up of 24 bones known as vertebra sitting one on top of the other. Where each vertebra meets another 3 joints are formed that include: 2 bony (facet) joints at the back and a soft inter-vertebral joint formed by the discs at the front of the spine. The discs act as shock absorbers and the facet joints control movement of the spine. At each joint there are also ligaments and muscles that attach to the vertebrae to control and assist the movement of the spine.

Sciatica 2
Sciatica 2
Sciatica 3
Sciatica 3

What can help?

Physiotherapy!

A physiotherapy assessment can identify reasons why your pain is persisting and ease your pain. Your physiotherapist may choose to perform massage, spinal mobilisation or manipulationand show you some pain relieving exercises. Whether you have stiffness, weakness or instability, these exercises and treatments will help you return to your normal activities sooner. You may also gain a better understanding of what causes your pain and how to prevent the frequency of future episodes and manage them independently, if they do occur. If you find symptoms are persisting and you are not returning to normal activities, to reduce pain and improve your function your physiotherapist may develop more specific conditioning exercises for you based on your presentation.

Medication

Over-the-counter pain medication like paracetamol and ibuprofen are very effective for initial pain symptoms. Don’t wait until you have severe pain before you take pain medication. If the pain is limiting your ability to move and exercise it could also affect the time it takes for you to recover. If you have any other medical conditions you should always consult your doctor before taking any pain medication.

Exercise

Your physiotherapist can also guide you on the most effective way to ease stiffness and pain. Exercise is important as your pain eases for improving muscular control, strength and stamina, general fitness, flexibility and improving your mood. If pain persists, the lack of normal movement can cause muscle to become idle and make it more likely that you could reinjure your back again in the future. So it’s important that you don’t rest for too long and you do as many of your normal activities as possible. If you are in so much pain that you need prolonged bed rest try to make sure that you gently move your back as pain will allow.

Do I need to see the doctor?

If you are in severe pain or prolonged pain that doesn’t resolve after 4-6 weeks then you may need to see a doctor. Also if you notice weakness of the muscles in your leg, especially if you can’t pull your foot up towards you, you should see a doctor. You should also seek medical advice immediately if you lose control of your bladder or bowel function or you have numbness or pins and needles in both legs.

(Sources are available on request)

If you are suffering from any of these symptoms or you think you might have Sciatica please get in touch with Guy one of our senior, highly trained Physiotherapists or contact us on 01273 667826 at one of our clinics.

Gait Analysis can be complex but the benefits are running ahead! - How we do it at The Physio Rooms...

Tom Goom, our Clinical Lead at the Physio Rooms, is a Running Injury Specialist and expert in gait analysis. He teaches other Physiotherapists around the country on his extremely popular Running Repairs Course and has been consulted by leading researchers on the topic. Today he shares his views with us on running gait analysis. Analysing how someone runs is a complex process. It takes an understanding of biomechanics, injury, tissue load and performance. The whole gait cycle, from initial foot strike through to the end of the swing phase, needs to be assessed with a top-to-toe analysis. It's very easy to be tempted to examine just one area, such as the feet, which you often see done in shoe store gait analysis, but it's essential to see how the arms, trunk, hips, knees and pelvis are moving. Slow motion video-capture is essential as the whole gait cycle takes less than a second!

Taking the video really is only half the challenge. Once you've recorded someone running interpreting your findings and providing running cues to make effective changes takes considerable expertise. With the right approach runners can see significant benefits in terms of reducing pain and improving performance. Changes can occur within a single session (please see the picture below) but require follow up sessions and strength and conditioning work for best long term results.

unnamed (2)
unnamed (2)

In the example above we see a runner with a narrow stride accompanied with increased hip adduction (leg moving towards the midline) and right sided pelvic drop. This increases the stress on the hip, knee and shin and can lead to issues such as runners knee, ITB syndrome and 'shin splints'. Using the right cues and drills we can see an immediate increase in stride width and an improvement in position of the hip and pelvis. Removing unnecessary lateral movement like this is likely to improve performance too, leading to a faster, more comfortable runner!

The gait analysis we provide is based on the very latest research and training techniques and yet is included as part of your physiotherapy treatment. This offers excellent value with analysis included within a £45 session,  we have seen this service priced at £180 elsewhere. Here at The Physio Rooms we endeavour to keep our gait analysis affordable yet ensure that you the patient gets the very latest evidence based gait analysis without any of the gimmicks.

Call us on 01273 667826 and speak to one of our helpful team about our gait analysis services and how this can add benefits to your running.