Mo' mobility, less problems

We’ve all been told that mobility training is good for us, but do we know why?

To start off mobility itself is the ability to control a joint in full range of motion. It is a consistent effort to increase the amount of range of motion in a joint through specialised strength training.

The first reason it is important is if you use the full range of motion from a joint you can execute more power and efficiency in your exercise. This is good news if you’re trying to increase reps or weight during training. It is also good if you’re a rugby player, football player or any other sport that requires explosive powerful movements.

The second reason is injury prevention. If you’re not using a joint in full range, there is the likelihood that you’re compensating both other muscles and joints for the lack of mobility. For instance, lack of mobility in the ankle can lead to stress to the knee, hips and lumbar. Similarly, if you don’t have full range of motion in the shoulder and your humerus is not in the optimal position in the glenoid labrum you can put your rotator cuff muscle at risk of injury.

Finally, mobility is a good way to warm up the joint prior to exercise or events. Warming up the joint is created by movement and the shifting and warming of synovial fluid in the joint. This also works out any restrictions from tight muscles from affecting your event.

The great news is that you don’t need that much time for mobility, 10-15 minutes a day is enough to start reaping its benefits. When you start doing it you may also notice where your weaknesses are in each joint and can make specific changes to your strength training routine to remedy it.

A good way to get started is to choose some full mobility exercises such as: overhead squats (with a lightweight pole or bar), a prayer stretch on a bench and knee-to-elbow bird dogs. There are examples of these on you tube from a variety of practitioners.

If you have any questions about strength, mobility and sports injuries please email me at sara@prestigesportinjry.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