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