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