Don't let Resolutions get you down

I’m not the biggest fan of New Year’s Resolutions. Most people make themselves ridiculous goals that they have no chance of keeping like never eating chocolate or to stop drinking alcohol entirely. It’s all too easy to get caught up in the Resolution Mayhem and not actually sit and think about what goals you would like to achieve in the next year.

I like to break my goals down into sections: professional, personal and running. Obviously, my professional goals include things I want to learn in the upcoming year, clinic ideas and marketing of the clinic. Personal goals include things I want to learn independently, books I want to read and travel goals. The running goals I keep separate as I see them as different challenges. It may be a desired distance, race or number of races I want to complete in the next year.

Breaking your goals down into sections is a good way to start without overwhelming yourself. Also, write them down or put them in a spread sheet, this is a good way to chart what you need to do to meet your goals. For instance, I try to read a specific number of journal articles in a year for my professional goals. So, I keep a list in my spreadsheet of which one I read and what knowledge I obtained from it. I also like to list my book list for personal goals and check them off once read, truthfully, I do the same with my race list for running.

Once you’ve sectioned off your goals, you can break them down further. For instance, if your goal is to lose weight first, decide how much you may need to lose (you should see your GP for an idea of your ideal weight, don’t just guess it as it may be too low). Once you know what you need to lose break it down by week or month. Then make your exercise plan, a personal trainer will be able to help you with this part as it is often difficult to decide what exercises to do when. Plus, we often choose not to put the things we really don’t like on the list. Once you have your exercise plan, think about your diet. What can you eat less of? What should you eat more of? If you’re a chocoholic like myself, it is hard to give it up, however, you can decide to eat less of it or eat dark chocolate in small doses. If you’re not sure of what you need to eat find a good nutritionist either in person or online and they can help you plan and determine what you need to eat based on your activity level and goals.

By putting your small goals into a checklist of the bigger goal you can see your results much easier. This may be in the form of a spreadsheet or an app on your phone. Either way it is important to track your progress and don’t be disheartened if you have a bad week occasionally, just get yourself back on track as soon as you can. This is especially important for anyone who has had a sports injury, nothing is worse than the setback, however if you get appropriate rehab and advice you can be back in a healthier state.

So, if you have already set your goals or if you’re not sure just remember to break them down and track them. If you have any questions about sports injuries or rehabilitation, please email me: sara@prestigesportinjury.co.uk

Who do I see, a graduate Sports Therapist or a Sports Massage Therapist?

Often as a graduate sports therapist I get mistaken for being a Sports Massage Therapist. It’s a tad frustrating as having completed a three-year BSc it’s safe to say I’ve had a significant more amount of educational and in-clinic training than a Sports Massage Therapist/Soft Tissue Therapist.

So, what’s the difference?

Sports Massage Therapist/Soft Tissue Therapist:

A Sports Massage/Soft Tissue Therapists will have the scientific knowledge of and manual therapy skills to address specific of soft tissue injuries, their function, and the result of manual therapy on injured and uninjured tissues. They will have experience in anatomy, principles of health & fitness, principles of soft tissue dysfunction, sports massage treatment

Sports Massage is a Level 3 course focusing on injury prevention and performance enhancement through manipulation of the muscles, ligaments and fascia (debatable – will blog about next year).

Most high-quality Sports massage courses will be ITEC/BTEC/VTEC Level. Many Sport Massage/Soft Tissue Therapists are registered with the Sports Massage Association of as part of the Complimentary and Natural Healthcare Council. However, there are other bodies they can be members of, and there is no statutory requirement.

It is also important for the therapist to have attended a course approved by a professional body above, as there are many "fast track" courses out there which are not always providing quality courses.

Here is a brief summary of ITEC/BTEC/VTEC Levels:

3: Sports Massage Therapist - qualified to work on non-injured tissue.
4: Sports Massage Therapist - qualified to work on injured tissue
5: Sports Therapist/Massage Therapist - qualified to work on injured tissue, recognise sports injuries and prescribe rehabilitation exercises
6: Sports Therapist (can be diploma or graduate) - qualified to do all the above and diagnose soft tissue injuries using clinical reasoning.

Graduate Sports Therapist:

First, the title of sports therapist is not a protected title, so you’ll find most of us who are graduates us the term “graduate sports therapist” or put our degree qualifications on all our paperwork.

I’m not going to get into the nitty gritty of who is better a  diploma or a graduate sports therapist as it depends on the practitioner not the qualification.

Diploma level 5 sports therapists often do courses on the weekend with coursework and exams during the course process and graduates spend 3 years developing the required skills while being assessed throughout.

A graduate Sports Therapist will have an undergraduate diploma and would have completed a course verified by one of the sports therapist professional bodies: Sports Therapy Association, Society of Sports Therapists or the Sports Therapist Organisation. There is no statutory requirement for regulation, but it’s best to find someone who is registered with one of these professional bodies to ensure they are practising at the correct level and attending CPD courses.

Graduate Sport Therapists focus on the assessment, diagnosis and rehabilitation of soft tissue injuries. While courses may vary, a graduate Sport Therapist will have courses in anatomy, ethics, biomechanics & gait assessment, fitness testing, injury prevention, sports massage, clinical assessment and decision making, advanced manual therapy, sports nutrition and first aid/sports trauma skills.

Both professions are helpful for people who participate in sport and need to have appropriate insurance for their profession. Both can provide sports massage for recovery, but only Level 6/Graduate Sport Therapists can assess and diagnose injuries using clinical reasoning, and Level 5's can recognise sports injuries and prescribe appropriate rehabilitation exercises. This becomes very important if you have an injury as Level 3 Sports Massage/Soft Tissue Therapists should not be working with injured tissue, diagnosing injuries or prescribing exercises.

Sadly, many CPD providers are teaching techniques which are beyond the remit of lower level qualifications. This can cause problems for the therapist as they will likely not be insured for those techniques, and therefore, should not be using them in their practice or advertising them on their website.

It is important to know the qualifications of your therapist, if you're not sure just ask them. They are not always noted on their website and some therapists may be advertising abilities beyond their qualification level. If you're looking for a non-injury related sports massage a Level 3 will be suitable, however if you are having pain or are injured you should book in with a Graduate/Level 6 Sports Therapist for an assessment and rehab program. 

If you have any questions about sports massage and sports therapy, please do not hesitate to email me: sara@prestigesportinjury.co.uk

Exercise is the cure for what ails you!

We all want to live forever, right? Well, sadly while that’s not possible, we can live longer, happier and more productive lives through the magic of exercise.

Yes, I said exercise. There have been many news articles recently telling of all the advantages of a healthy, active lifestyle. Many of us sit at work, and then sit at home living almost sedentary lives. This lack of exercise is giving rise to obesity, type 2 diabetes and heart disease, as well as increases in dementia and mental health problems.

So, why is it that exercise is so good for us?

Over 30% of children in the UK are overweight or obese, so it’s important to make time for exercise in your child’s day. Exercise in children stimulates bone, muscle, joint, heart and lung development. Exercise also helps children maintain their weight, allows them to develop friendships with other children and reduce the chances of anxiety and depression.

For adult’s exercise improves cardiovascular health and lowers bad cholesterol which in turn reduces the likelihood of stroke and heart disease. This is best achieved with at least 15 minutes per day of walking at a brisk pace or any other activity that can be done at a brisk rate like cycling, rowing or running.

Muscle and bone health is also improved with exercise. By using resistance (strength) training you improve the function of muscles and allow the bones to remain strong and healthy. This will lead to fewer fractures, injuries and falls later in life. If specific exercises are used strength training can also reduce low back pain.

If you already suffer from osteoarthritis, it is important to continue to exercise to keep the joints moving and strong. This can be done through walking, swimming or cycling to reduce pain.

The C word, cancer. If you exercise regularly you are less likely to develop cancer. This is due to the advantages that exercise has on weight management. Maintaining a healthy body weight reduces the likelihood of bowel and breast cancer as obesity is a major risk of developing cancer.

Diabetes effects 3.2 million people in the UK, by reduce weight through exercise you can reduce the likelihood of developing type 2 diabetes. Regular exercise can also keep blood glucose levels within ideal range and lower blood pressure.

Improvements in mental health. Regular activity can reduce your chances of developing depression and help reduce its symptoms in those already diagnoses. This is due to the chemicals in the brain, dopamine and serotonin, which are affected positively by exercise. This improves your mood and thinking. A good place to start is with an outdoor running group, parkrun or just taking brisk walks with friends. People diagnosed with mental health conditions are also at a greater risk for respiratory and heart disease, so exercise will help reduce the likelihood of both.

The greatest benefit of exercise is weight management. Being overweight predisposes you to a variety of diseases. IT’s important to also eat a well-balanced diet and allow yourself to recover after exercise.

How do we know how much exercise to do?

According to the NHS and Public Health England the aim is to be active every day for at least 150 minutes per week of activity. This means moderate activity of at least 10 minutes or more such as brisk walking, cycling, running or swimming. Public Health England also advised of at least 2 or more days of strength training of the legs, hips, abs, chest, shoulders and arms. The addition of balance training can also help reduce the likelihood of falls in older age.

So now you know the whys and the how’s there is no excuse to get off your laptop or smartphone and go out in the outdoors and exercise.

If you would like to know more about how exercise can help you and what you can specifically do for your sport please contact me sara@prestigesportinjury.co.uk

Before you up that mileage, you need to get stronger!

Everyone knows that resistance training is good for running, right? Then why is it that so many runners choose not to incorporate strength (resistance) training into their program? Part of the answer may lie in the fact that many runners do not know the benefits of strength training can add to their running. Running itself is not enough, using weights can help reduce the effects of muscle loss as we age (8% every decade after 40 years of age).

So, what can strength training do for runners? First off it reduces overuse injuries by strengthening the tendons, ligaments, muscles and fascia. Next it can help stabilise the joints through increase muscle strength. Finally, it can help tissue capacity which leads to a higher tolerance to load, speed, range and endurance changes. But it is not just the muscular system that benefits, strength training also improves bone health, inflammation and anxiety. All these changes lead to a better performance and running economy – good right!

So, what is resistance training, well in the short it is exercise that requires the muscles to hold against and applied force or weight. It can be done is many ways such as dumbbells, resistance bands, kettlebells, power bags, medicine balls or even body weight. As a sports therapist, I often incorporate resistance training into my rehabilitation programs for those with overuse musculoskeletal conditions.

But general resistance training is not what runners need. Runners benefit from single-leg loading, posterior chain strength, hip stabilisation and core strengthening exercises.

Single-leg loading exercises such as Bulgarian splits, step ups and lunges help reproduce the conditions of running. It is basically a sport-specific exercise that will help the body adapt to the requirements of running.

Posterior chain (lats, erector spinae, glutes, hamstrings and calves) strengthening helps with shock absorption, propulsion and power. Weakness in the posterior chain can affect running mechanics and lower limb kinematics. Ineffective body form may cause excessive body movement leading to hip and knee injuries.

Hip strengthening, including quadricep strengthening, has been known to reduce patellofemoral pain and prevent overuse knee injuries. Hip stabilisation is beneficial for low back, sacroiliac, hip, knee and ankle pain as well as improve performance.

Core strength (not just your abs!!!) helps improve performance through better movement. NO single muscle helps with spine stabilisation it is the combination of all muscles during specific movements.

There have been many myths about resistance training and running and it is important to realise that you will not get bigger, injures, slower or tighter through strengthening. You will only get healthier and perform better.

If you are interested in starting a strength program it is important to seek the advice of a graduate sports therapist, sports physio or knowledgeable personal trainer to assess your function first and determine which exercises will be best for you. They will also ensure you start at the appropriate level and progress appropriately and safely.

TO summarise, resistance (strength) training is a good thing for runners that should not be avoided, especially as you move into longer distance running (half marathon and above).

If you have any questions about resistance training, please feel free to contact me sara@prestigesportinjury.co.uk

Are the "Jack of all trades" all they're made out to be?

So what's better someone who is a "jack of all trades" or a specialist?

I began asking myself this question as I pondered over the variety of CPD courses I could take over the next year. Do I expand my portfolio into coaching or perhaps a personal training qualification? There are many options for sports therapists and other therapists out there to choose from. But what is best?

My dad used to say he could fix anything except the crack of dawn and a broken heart. And I reckon he could, except for a vacuum cleaner once. He was a skilled mechanic and, even though he had no degree, an excellent engineer. He used his decades of experience to fix cars, planes and pretty much anything with an engine. He had skills that could translate to other areas without changing his occupation. And for me his advice led me to the decision to expand my sports therapist skill set rather than take on a new skill.

I have a tiny aversion to people who try to do everything all the time. I think it's great that they're ambitious, but to me it just means that some skills may be lacking or not fully developed. For example, if you train to do osteopathic techniques, hypnotherapy and personal training is it possible to stay highly skilled in all those areas without letting one slip? We are all allotted the same 24 hours in a day, but I can't imagine anyone is using all their skills all the time or even giving each skill the same amount of work.

Some skills work well together such as sports massage, acupuncture, mobilisations/manipulations, strength & conditioning and rehabilitation exercises. Those are skills that can be used in a variety of settings and can be honed, in some cases, at the same time. But other skills would require a different setting or in some cases could cause a conflict of interest.

I once came across a rugby club whose coach was also their physio. To me this is a blatant conflict of interest as he had no way to separate his desire for his players to play and his need to think of their health and welfare. There were many players that should not have been playing that day, but still did even after suffering concussions. I feel the same way about personal trainers who also do sports massage or sports therapy, and continue to be a personal trainer. Is it not feasible that one could make their clients work out harder than prescribed so they're sore and then suggest they see them for a sports massage? I'm not saying these things happen, but these are the things I think about when deciding my own CPD pathway. Could my clients perceive a conflict of interest in what I do?

For me the welfare of my clients is the most important part of my clinic. This means providing them with quality, knowledgeable information with regards to sports injuries and ways to treat their injuries. So this is where I will focus my future CPD endeavours.

I have already attended a Movement Screening & Strength Training for Runners course in order to provide my running clients with better analysis and techniques for their rehabilitation. And the best part about this course is that the instructors (both physios) had specialisms. One is a hip/running specialist and the other is a strength & conditioning specialist.

I am also a firm believer in the referral. If a client comes in and I feel acupuncture might help or perhaps they would like advise on a personal trainer I am happy to refer to other professions. I think it's important to collaborate with other sport injury professionals so that we can all provide the best care with the best techniques for our clients. If an injury is out of my skill set I have a responsibility to refer onwards.

So, why be a "jack of all trades, master of none" when you can be the best sports therapist, osteopath, chiropractor, physiotherapist, sports massage therapist or personal trainer that you can be for your clients!

If you have any questions on CPD, sports therapy or conflict of interests  please feel free to email me on sara@prestigesportinjury.co.uk

Can sports injuries really be prevented?

As a sports therapist reducing the likelihood of an injury is just as important as injury diagnosis and rehabilitation. As stated above, no injury is 100% preventable there are guidelines that we can follow to attempt to reduce the likelihood of an injury occurring in any given sport.

The first rule is to know your sport. This seems like a no brainer, but it is important to understand the biomechanical, external and internal factors that exist within any given sport. For instance, I work with a local rugby team so a variety of players will be sprinting, tackling, scrummaging and rucking on an outdoor surface in a variety of weather conditions.

When identifying risk factors, we must first look at the athlete(s) internal risk factors such as age, gender, body composition and fitness level. In my sport the risk factors associated with a forward will be very different when compared with a back. There are modifiable (body composition, fitness level) and non-modifiable (age, gender) risk factors. When targeting any intervention, we need to look at both factors. Modifiable risk factors such as fitness level can be improved, and thus keep the player from sustaining injuries due to exhaustion. Non-modifiable risk factors such as age, cannot be changed, however, we can use methods to help reduce the risk of injury (see later below).

The next risk factors to identify are external risk factors such as playing outdoors or on a court. If participating in sport out on a pitch when it’s been very dry can be very different then when it is very wet. Knowing how to adjust your interventions will help keep your players safe. In my experience I’ve had players sprain their ankles on hard ground more than soft. And the likelihood of injury when tackling or jumping is increased.

The final piece is knowing the mechanism of injury (MOI). This is learned through experience and research. For a sports therapist it is often the MOI that is the key to what the injury likely is. As before with ankle sprains the key note is a plyer will tell me “I rolled over on my ankle”. I then perform the normal ankle joint, muscle, ligament and special tests to confirm my diagnosis. But this is also useful with overuse injuries. For instance, an athlete might tell you “The pain has become worse over time” or they’ll not no actual injury incident occurred.

As a sports therapist involved with team sports we need to map all the risk factors and MOI’s and use a variety of techniques to reduce the likelihood of injury, which may include the following:

Warm up: A simple warm up plan may reduce risk to injury by 50%. And while there is little research on the duration or intensity of a warm up it is best to allow the players to determine it individually. Some benefits of a warm up include increase ROM of joints, relaxation and concentration and speed of nerve impulses and a decrease of muscle stiffness. All those factors that can potentially reduce the risk of injury, especially in older players. A very good example of this is the FIFA 11+ program which uses a structured warm up of 10 exercises 1-2 times per week and has been proven to reduce injuries in football.

Taping/Bracing: In rugby we use tape frequently. It is often used to restrict undesired movement such as inversion of an ankle or to protect the acromial clavicular joint from injury during tackles. This often applies to players returning from an injury after a thorough rehabilitation program.

Protective equipment: This includes helmets for cycling or horse-riding and mouth guards for collision sports, common sense really!

Suitable equipment: It is imperative that your athletes are wearing appropriate equipment, even for running. A trail runner will not be wearing the same trainers as a road runner or sprinter. It also includes ensuring racquets for tennis or squash are of the right grip size otherwise an athlete may over grip the racquet and incur an overuse injury.

Recovery: This is the biggest issue I see in my clients. It is important to allow your muscles to recovery after any strenuous activity. The can include using active recovery and walking for ten minutes after a hard run, using cold water immersion, massage and eating properly after exercise.

When starting a new training program, it is advised to get appropriate advice from your GP first, then a professional such as a sports therapist or personal trainer for exercise guidance. Graduate sports therapists can perform an injury prevention screening which uses functional tests to measure any biomechanical dysfunction and if any adjustments are required, will issue you exercises, stretching or other methods to help improve any dysfunction. After a screening it would be advisable to see a personal trainer to introduce you to exercises at the proper level of your fitness.

Sports therapists can also perform sports massage which is an excellent way to recover after hard training sessions.

If you have any questions about injury prevention or other services that sports therapist can provide, please do not hesitate to contact me.

Sara Green, Sports therapist, BSc (Hons)

sara@prestigesportinjury.co.uk

www.prestigesportinjury.co.uk

Don't let back pain be a pain in the you know what!

Low back pain is one of the highest complaints I get in the clinic. Sometimes from my rugby players, sometimes from new clients. Many clients think that they need to rest, but, mobility is what will keep back pain at bay. If one stops moving the muscles will weaken and tighten, restricting movement further.

Below are some ways to help ease your back pain:

Get those endorphins going! Natural endorphins in the body can be as strong as pain medication and help block pain signals from reaching the brain. Endorphins also help ease anxiety, stress and depression. Some great ways to release your endorphins is to participate in cardio exercise, massage therapy or meditation.

Sleep. Yes, I know that back pain can help cause sleeplessness, but this same lack of sleep can make pain and make treating pain difficult. To help get you to sleep be sure the room is quiet, turn off all the lights and put your phone away from you. Quiet meditation before bed can then be added to help you drift off to sleep. I recommend the head space app to help you on your meditation journey.

Strengthening your back and “core”. Now I hate the word “core”, mainly because most people just think of their abs. But the “core” is also you low back muscles. You can start working on it very simply by sitting upright on a stability ball, the key is to start off gently then progress further. Pilates is also very good for strengthening the low back and abs.

Ice/Cold therapy. Use cold for inflammation, as the cold will slow down the nerve impulses and stop spasming. Use heat to stimulate blood flow and reduce the pain messages being sent to the brain. You can use a hot bath or hot water bottle to ease the pain.

Get those hamstrings stretched! Sometimes the cause of back pain is tight hamstrings which can cause tightness in the entire posterior line. I have a video on my you tube channel to help you ease hamstring tightness.

Keep the back moving. Easy slow paced exercises to continue mobility are a must and should not be painful.

Participate in activities that make you happy. This might be a slow walk in the woods or a nice cup of tea.

When it comes to back pain the first rule of thumb is to seek some form of treatment. It is important to have your back pain assessed to ensure it is not a serious condition, so a visit to a sports therapist or physio is imperative. If your pain is not serious and can be managed through exercise, as approved by NICE, then a mobility and strengthening program will be a great way to start. If you find your pain has become chronic, there are pain coaches who may also be able to help.

If you have questions about back pain or have any questions about how mobility and exercise can help please email me at sara@prestigesportinjury.co.uk

Get the most from your rehabilitation, and don't lose motivation.

Rehabilitation can be a very stressful time for an athlete. Nothing is worse than not being able to participate in the sport you love. I see it every season with my rugby players, and it never gets any easier. But, there are ways you can make the most of your rehabilitation and stay connected to your team mates.

Volunteer. This is easier said than done, however, if you volunteer to help the coaching staff or help to organise equipment it can keep you motivated and reduce the feelings of isolation. Often injured team mates stop showing up at training at it can lead to a lack of motivation and desire to keep pushing during the rehabilitation process. Be sure to attend team events and support on the side lines, staying motivated to continue is a key to the rehabilitations success.

Even if you are not a member of a club or a team the above can apply to any sport. Triathlete and running events are often looking for volunteers to help at drinks stations or to give verbal and moral support to those participating.

Don’t push yourself into pain. Basically, listen to your sports therapist or sports physio and don’t try to force yourself into doing too much. When we prescribe exercises, it is based upon your stage of healing. If you try and push yourself into pain it can often make things worse, especially in the early stages of healing. As a sports therapist, I must ensure the exercises are safe for the client, so moving ahead to soon could cause further injury.

Communicate. Both with your coach, team mates and sports therapist. I am always available for my clients if they have any questions. It is important, for me, to ensure if they’re not sure about something they can always ask. This also applies after rehabilitation is completed. If you’re my client I am available to help answer questions and offer advice. Communication also applies to your coaches, you shouldn’t be afraid to ask them for advice and they should be happy to give it. As a sports therapist, I am in contact with our coach with every injury and advise him of time lines and progress.

Adherence. This is the golden goose. If you don’t adhere to the exercises as prescribed the whole thing falls apart. When you get assessed at my clinic I include a two-week rehab program to get you started, it is important that the exercises and guidelines are followed to ensure safe progress is made. I also offer progressions and regressions to ensure if my client is having trouble, or find the exercises too easy, they can continue their rehabilitation without delay.

If you have any questions about rehabilitation or sports injuries please feel free to email me at sara@prestigesportinjury.co.uk

So, what's the deal with posture?

So, what is the deal with back posture? There has been a lot of debate on whether a person’s back posture is a precursor to injury. Now, to clarify, I am not talking about conditions such as scoliosis, which requires specialist treatment. I am speaking about people’s sitting, standing and normal body position.

Some therapists like to blame posture on all problems. I am not one of these. I look at the facts, which includes taking the history of the problem, prior medical issues and a thorough biomechanical assessment.

My view on posture is that if it is the causation of pain, then let’s sort it out. If it’s not the problem, then leave it.

First off, everyone has a specific posture. If they have sat at a desk, stood at a machine or had basically the same position for the last ten years without any injury, then the likelihood is that their posture is not an issue. If the pain they are feeling is recent, then realistically what needs to be discussed is what recent changes the person has made to their routine.

I have clients who have tight hamstrings or tight shoulders and they ask me if I think it’s their posture. If they’ve never had a problem with their posture before and suddenly it becomes an issue then we look at these recent changes to their workload, stress levels and fitness regime. Maybe they’ve taken on a new workout program, have a higher stress level or changes to their running style. For instance, if they’ve changed from a heel to forefoot running style this can change the body position and combined with postural problems, then we may need to think about trying to adjust it. However, that is not always the case and therefore a thorough assessment is performed during an examination.

Where posture can cause problems is when a person has rounded shoulders. This position is not the optimal position for the humerus to sit in the glenoid cavity, which can cause stress on the rotator cuff muscles. Rounded shoulders are often caused by tight anterior muscles such as the pectorals and weak posterior muscles such as the mid/low traps and rhomboids. Clients who attend with shoulder pain and have rounded shoulders will get exercises to address the postural needs.

In summary, just because a person has a not ideal posture does not mean they will have pain or muscular problems. If a therapist is quick to blame posture before performing muscle and joint testing then it’s good advice to get a second opinion before assuming it’s just postural.

If you have any questions about posture or other sports injuries please do not hesitate to contact me at sara@prestigesportinjury.co.uk

Ouch that hurts! Knowing when not to stop treating a client.

I was originally going to do a post about posture, but after this article in the Telegraph, I thought it was more appropriate to do a post about client care and important factors in treatment.

First and foremost, I don’t know the physio in the story and I don’t know his qualifications. Therefore, I am not going to judge him as a person, I am merely going to state some important factors that I feel are important in any treatment.

As a note, I do not perform manipulations. I am not trained to do them, and personally from what I’ve read in research articles, it’s not that practical to use them. As a graduate sports therapist we are not taught them at University but can learn them after the fact. I choose not to use them, others choose to use them. It’s not right or wrong, it’s personal choice

1)      Clinical reasoning. When we perform treatments, we need to use clinical reasoning, we do this through muscle, joint and neurological testing as well as special tests to help identify the potential cause of the pain. Even when sports massages are performed, I use clinical reasoning. This involves asking the client where, how and when the pain starts then performing some postural and movement tests. It’s using this reasoning to determine if and what treatment should be used. If a client has poor knee flexion due to tight hamstrings then it’s reasonable to perform massage and muscle energy techniques to try and improve flexibility, then prescribing exercises for them to do at home. However, if the client is having pain and numbness it may not be the muscle but sciatic nerve pain caused by the lumbar discs or gluteal structures, at which point further testing to rule out a herniated disc would be performed and alternative exercises and treatment would be prescribed. Clinical reasoning is the baseline at which our treatments are founded upon.

       If a client had attended my clinic with neck pain after lifting an object, and was told by their GP it was muscle pain, I would be inclined to further test him prior to treatment. If there was acute pain in neck extension I would be inclined to send them back to the GP for an MRI. GP's are not always right., they spend very little time with the client and are often pressed to get to the next appointment. Working in rugby I have had players with herniated cervical discs and it is important to find out the level of herniation and then prescribing appropriate exercises or if surgery is required. This often means referring them back out to their GP with a letter explaining what has been tested and your findings, I have done this and it has saved me a lot of problems in the long run.

2)      Informed consent. Informed consent is telling the client what you’re going to do and why. For instance, when clients attend for injuries I explain what I am testing, why I am testing and how I am going to do it. I also ask if they have any questions, as I would rather they ask before I start then after. We obtain informed consent before and throughout a treatment. If I am performing a sports massage  I let them know what I am doing and why then if I need to move the client around or use a new method, I let the client know what I am doing and why. It is so, absolutely, important we maintain verbal contact with our clients and ensure they are aware of what you are doing. Heck, I even ask client if it’s ok to undo their bra while doing a back massage, every time, even if I’ve seen them before! It’s not okay to assume if they were fine with it before that they will be fine with it now. We all know what assumptions do!

I also always, always, always tell my clients to let me know if something is painful. I am not there to hurt people, I am there to help. I ask when I start using deep tissue techniques or stretching techniques to let me know if it’s painful. It’s common sense.

3)      Listen to your clients. What is the point of treating a person if they’re not being listened to? It’s important to listen during the history taking to make sure you understand their pain and what they want from the treatment. It’s important to encourage them to ask questions, I would feel awful if my clients were afraid to ask me a question. The real tragedy of this whole story is that the whole thing could have been avoided if the person had just been listened to. If he asked the physio to stop, he should have stopped. End of.

At the end of the day we are all just people and are not perfect, and we need to understand our own limitations. If I’m not sure how to perform a technique I won’t use it on a client. If my client says something is painful, I’ll stop. If my client doesn’t understand something that I am doing, I’ll explain it to them.

For anyone out there seeking treatment, you shouldn’t be afraid to seek help. My advice to you is to not be afraid to ask questions. If you’re looking for a sport therapist or physio, check out their feedback/testimonials or Facebook reviews. If you’re still not sure, call them! You can get a lot of information from a person by speaking to them. When you call them, you can ask about their experience and treatments they use. If you’re not happy, don’t book with them. Go with your gut if you feel like something isn’t right when you contact them.

Thank you for reading my long rambling post, and if you have any questions about Prestige Sport Injury Clinic or any of the treatments provided please do not hesitate to contact me at sara@prestigesportinjury.co.uk

Considerations and common injuries of the female athlete

First and foremost, I am extremely please at the advancements in women's sport. As a sports therapist and a woman, I am glad to see women's sports being more acceptable and viewable to the public on a wider scale.

But, there are challenges when working with female athletes and the need to understand the physical and physiological difference between men and women is imperative to us who work with sport injuries.

Physical: First, the bones and joints of men and women differ greatly. Women have shorter and smaller limbs compared to their male counterparts, 51.2% v. 56%. Women have a wider pelvis, which is great for centre of gravity, but not always good if it creates a high Q-angle (the angle between the ASIS of the pelvis and the centre of the patella). Second, muscle mass is less in women roughly 20% less than men. Muscle quality is not necessarily different, but strength and power difference occur, for instance women have greater hamstring flexibility. Finally, women athletes have a greater general joint laxity compared to male athletes, potentially due to a decreases muscle mass surrounding a joint.

Physiological: As most of us know, women athletes have a higher fat percentage than men 22-26% v. 12-16%. Females also have a smaller heart compared to men of the same bodyweight, and also have lower blood pressure and smaller lungs. This may lead to a decrease in VO2 MAX of 10-15%.

So what does all this have to do with injuries?

Due to fluxes in estrogen levels, bone density, chosen sport and all the considerations above, it mean female athletes have a higher increase in the following injuries:

Stress fractures

Patellofemoral Pain Syndrome

Patellar Tendonitis

Lateral Epicondylitis

Illiotibial Band Syndrome

Spondylolysis

What can female athletes do?

As with any athlete you need to ensure you are eating properly. Women who go on diets that don't have enough caloric intake for their sport will be at a higher risk of decreased bone density. Eating high quality, low processed foods such as fruits and vegetable along with protein and carbohydrates to power your body through it's sport.

Strength training and cardio. I tell all my clients to have balance. Balance your cardio and strength, don't just focus too much on one. Keeping your heart and lungs healthy through cardio and HIIT increases your VO2 MAX and strength training will keep your muscles strong.

Have regular GP check ups. It is important to ensure you visit your GP for your cervical exam and if you have any menstrual concerns. Women athletes occasionally have a decreased occurrence of menstruation cycle, if this applies to you, it is important to see your GP. Once again, nutrition and exercise can play a big part in irregular menstruation cycles.

If you suffer from a sport injury, it is important to see a sports therapist or sports physiotherapist as soon as possible. The earlier diagnosis of an injury the faster rehabilitation can be started to get you back to your pre-injury self.

In summary, working with female athletes in the sport injury world has a set of challenges all it's own, but it's worth it to see such great women excel in their chosen sports.

If you have any questions about sport injuries and rehabilitation, please contact me at sara@prestigesportinjury.co.uk

Kinesio tape, is it worth the hype?

I

admit, I have a love-hate relationship with kinesio tape and I am by no means a kinesio tape expert, the below is just my opinion on my experience with kinesio tape.

While I would love to believe it has the ability to make a person faster, stronger and generally perform better, I just don't see conclusive evidence.

As a qualified Rock tape 'Rockdoc' I am intrigued by the Pain Gate Theory to help explain why kinesio tape can reduce pain. But, there's a part of me that feels that some of this may be the placebo effect in action.

I do explain the Pain Gate Theory and  placebo effect to my clients when I do use kinesio tape as I do not want to give them false expectations and I want to ensure they are aware the tape may not work.

I do use kinesio tape in my clinic (not often) and on my rugby players frequently, however, this is due to the fact that kinesio tape does provide light support to joints. I don't necessarily feel that it reduces their pain, but it does help to support ankles, knees, shoulders, elbows and wrists. In rugby I use kinesio tape after the early stage of rehabilitation, for instance once the zinc oxide tape used to provide support and protection can be removed I use then apply kinesio tape to help give the player support without reducing range of movement. I have also used in when players have returned to sport to give them peace of mind that the joint is stable and will not 'go' while on the pitch. I have tried to use it on hamstrings and calves to help 'maintain the flexibility' the muscle and reduce pain from tightness, but have found this ineffective in most cases.

I don't want to be a 'witch doctor' in my way of treating clients and players. For me kinesio tape is a mutual decision between myself and the client and they are made aware of all the ugly truth that it might just be pretty coloured tape, but it is an excellent way to support the joints after injury.

If you have any questions about sport injuries  and rehabilitation please do not hesitate to contact me at sara@prestigesportinjury.co.uk

Mindfulness and Exercise: The Perfect Match

Mindfulness and exercise have been studied frequently in the past decade. Researchers are very much aware of the psychological and physical benefits of both exercise and mindfulness but is the average athlete?

The use in mindfulness in yoga has been found to decrease in self-objectification (how one looks) and increase physical self-concept and health/fitness benefit reasons for exercise. Simply put, it made the subjects feel less about how they look and more about how good they feel when exercising.

Another benefit to using mindfulness while exercise is the decrease in heart rate and breath rate. It’s why mindfulness is so great for stress! This decrease in stress also brings about positive health behaviours. You no longer just ‘think’ about exercising, but you actively go out, set goals, then perform the activity. And by being more aware of your body you can potentially reach maximum levels of performance and enjoy doing the activity.

There are many ways in which one can perform mindfulness including the traditional ‘body scan’ or during yoga. But did you know you could perform mindfulness while running, cycling or even weightlifting? Well you can, if you follow a few simple principles.

First, you need to be fully aware of your body and surroundings, and not on autopilot. Second, you should change your activities around so they do not become mundane, making new habits is a good thing. Third, Avoid competition or judgement on your own performance. Just enjoy the activity for what it is. Next, focus on the present, not the past or the future. Finally, when your mind does wander just gently bring it back to focus.

My personal advice is to try some mindfulness activities, there are some good apps out there that can help such as Headspace ©. These apps can give you the basic skills you need to bring mindfulness into your training.  And the first few are normally free (always good)!

The reason mindfulness is so good for you is that you learn to pay attention to your thoughts and feelings, instead of ignoring them or just going into auto-drive. And mindfulness can elicit changes over time, don’t expect things to be perfect overnight, everything takes time and practise.

Below are some ways you can bring mindfulness into your next exercise routine:

Have a purpose: a goal, a calorie count, step count, time duration

Remember why: You want to reduce stress or increase energy and, hey, exercise makes us feel good!

Slow down: your reps while weightlifting, perfect your form or think of your posture while running

Breathe: this is the key to mindfulness and is the best way to reduce stress

Finish on a high: Be sure to take your time cooling down and stretching, end with some relaxation techniques

Taking the time out to exercise our bodies and minds can help bring a calmness to our hectic lives. We often try to turn off our minds with distractions like TV, Internet and video games, which doesn’t help in creating healthy behaviours. If we want to live longer, happier lives with less stress than we must make the effort to do so.

Overuse Injuries - Why me! and how can you prevent them.

I frequently see cases of overuse injuries in my clinic. And the question I get most often is “What is an overuse injury and why did I get one?”

To answer that question, we need to consider the causes of an overuse injury. Overuse injuries are those that happen due to a repeated action rather than an acute injury which happens instantly, like an ankle sprain. But it is not just the sustained action that causes injury, it is the body's inability to respond to the loading of the tendon or muscle. This is often due to faulty technique, muscle imbalances, inflexibility and incorrect equipment, which may prevent tissue adaptation. When combined with excessive overload, or use, may cause microscopic injury and lead to inflammation.

Overuse injuries can present themselves in stages. In the first stage, you may notice discomfort warming up that disappears. The second stage is as before, but then reappears after completion of activity. The third stage the discomfort begins to worsen during activity. And the final stage results in pain and discomfort all the time. Some of the signs that you may have incurred an overuse injury is persistent swelling, heat, redness and impaired function.

There are a variety of overuse injuries that effect all levels of athletes, but some of the more common are: Achilles tendinopathy, tennis elbow, ITB syndrome, shin splints, plantar fasciitis, stress fractures and patellofemoral pain syndrome. This list could go on, but these are some of the most frequent cases that I have treated.

The next question I get from clients is “How can I prevent overuse injuries”? Well, if they’ve come into the clinic with an injury we’re past the point of initial prevention and into the realm of rehabilitation. However, at my clinic, a thorough prevention plan will be explained after rehabilitation, so hopefully I won’t see them again for the same injury!

There are many ways to prevent overuse injuries, all of which involve discipline and consistency. These include:

Thorough warm up and cool down, including dynamic stretching techniques.

Proper equipment – proper running shoes, appropriate sized tennis racquet.

Increase activity slowly - do not increase your activity at more 10% per week.

Practice using appropriate technique, this may mean utilising the services of a personal trainer to get started.

Condition your strength and flexibility, yoga and pilates are very good to help you with this.

Listen to your body! If you have pain, it’s best to seek professional advice and not ignore it. With professional advice identify the cause of pain and start rehabilitation. DO not be an internet physio!!

This is a very brief overview of overuse injuries. If you feel you may be suffering from an overuse injury it’s best to contact a professional such as a sports therapist, physiotherapist or osteopath who has a background in sports injuries.

If you have any questions about the information contained in this post or would like more information about sports therapy, please do not hesitate to contact me.

Sara Green, Sports Therapist, BSc (Hons) sara@prestigesportinjury.co.uk