On Being Injured

“Its not the strongest species that survive, nor the most intelligent, but the ones most responsive to change” Charles Darwin

Here’s a little secret; everyone gets injured. Everyone. That person on the start line every weekend? They get injuries. Your gym instructor that is 11 out of 10 on the energy dial all the time? They get injured. Your sports therapist/physiotherapist? They suffer the same as you. With the best will and practices in the world, injuries, aches and pains are one of life’s inevitabilities, alongside death and taxes.

How we deal with injuries, however, is in many ways unique to the individual, with their own aims, goals and commitment levels. Sure, initially it can be frustrating, particularly if you have an event, or a holiday on the near horizon but the key is to take an interest in your rehabilitation. Pain & rehabilitation are not your enemy; this is not wasted time. Pain is our friend – it’s our body trying to protect us; our first line defence system without which we would not survive. Congenital analgesia is a condition where sufferers can not feel pain, and which often leads to a reduced life expectancy. So – whilst it is all relative – knee pain isn’t actually that bad.

When injured, the sensitivity level of this defence system is turned right up. Your rehabilitation is designed to start turning this dial down, by graded exposure to what your nervous system has deemed as perceived (but not always actual) threat. See, those exercises and movements prescribed aren’t always just about stretching, or strengthening.

It can feel lonely, as your friends and colleagues continue with their gym routine, classes, or training, and in some cases there can be cases of comorbidities setting in, such as depression or anxiety, even at a low level. In A Leg To Stand On, Dr Oliver Sacks describes his injury as a “fearful sense of … aloneness”; that he “could not hurry — could only hope”. In his autobiography, Back From The Brink, ex-professional footballer Paul McGrath says of being injured that “the first thing you lose is the capacity to be hopeful”, and that you “crave the open spaces of training…the aggression, even..”.

But getting back training after injury can be hard physically, and also mentally. We should never underestimate the power of apprehension. Avoidance can be damaging in the long term, as we psychologically build what was once a daily occurrence into a terrifying prospect. Gardening changes from a pleasant way to spend an afternoon, to something which could lead to your back “going” again. Your regular running route seems full of threat. Those weights look far more menacing than they did pre-injury.

Your hardest opponent is your own mind; research shows that a happy you will be able to recover from injury far quicker than a stressed you – and a positive attitude goes a long way, as seen in this paper, The Relationship Between Expectations and Outcomes in Surgery for Sciatica, which found that “More patients with favorable expectations….. had good outcomes than patients with unfavorable expectations” (Ref 1). So smile as you go ( 🙂 ); trust in the process; commit to the process; reap the rewards.

Rehabilitation is a road that is rarely linear; we start with what you can do today – post injury – and we end with what you could do before your injury. It can be slow, it can be arduous, and there will almost definitely be setbacks. This is completely normal.

In ‘Legacy’, by James Kerr, the author discusses 4 stages of change, which ties in nicely with rehabilitation;

A Case for Change This is often a need for change; something is causing your discomfort, or pain. If we want this pain to go, we need to change, or address, ‘something’.

A Compelling Picture of the Future To do what we love without the repercussions of pain. People will often say they are prepared to “do anything” to get back training, or be pain free. To paraphrase Nietzsche, “He who has a why, can bear almost any how”.

A Sustained Capability to Change This is where we create an environment that is empowering, engaging and fun. When Rehabs fun, Rehab gets done.

A Credible Plan to Execute Alongside your rehabilitation therapist, this is the development and deployment of a self-reflective, self-adjusting plan that is safe, and graded, taking you from injured, to where you were pre-injury.

So, yes, the secrets out; we ALL get injured.

And here’s another secret; it’s ok. We are robust and adaptable creatures. To go back to Oliver Sacks, “We would have no idea of the resources which exist in potentia, if we did not see them called forth as needed.”

For more information contact Dan@DC-InjuryClinic.co.uk

REFERENCES

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496858/

P.O.L.I.C.E

For decades it has been known that if injured, you follow the R.I.C.E (R) protocol! But times change, evidence moves on, and good therapists admit that patient information needs to change with it!

So what has changed?

R.I.C.E.(R) is;

R for REST. I for ICE. C for COMPRESSION. E for ELEVATION. (R) for REFERAL.

P.O.L.I.C.E is;

P for PROTECT. Protection involves may include use of crutches, casts, braces, taping etc. to help protect the injured area as it heals. This part is designed to prevent excessive loading in the early stages, and so replaces out and out “rest”, which is completely subjective –  we have to be realistic with this and accept that most of us aren’t full time athletes, and so “rest” unfortunately will be relative to your job/daily activities etc. If you are struggling to weight bear you need to make sure you’ve had your injury checked out. Rest should be of limited time, ideally restricted to immediately after trauma. Undue long rest can have negative effects, producing “adverse changes to tissue biomechanics and morphology” (Ref 1).

OL for OPTIMAL LOADING. Research shows that “Progressive mechanical loading is more likely to restore the strength and morphological characteristics of collagenous tissue. Indeed, early mobilisation with accelerated rehabilitation is effective after acute ankle strain. Functional rehabilitation of ankle sprain, which involves early weight-bearing usually with an external support, is superior to cast immobilisation for most types of sprain severity” (Ref 1). What this means is that by optimally loading injured tissue, we can stimulate the healing process as bone, tendon, ligament and muscle all require some loading to start the healing process. Anyone that has been in my clinic will know this fits my biases quite nicely! But what is “optimal”? Of course – as is life – its about finding a balance –“Optimal loading means replacing rest with a balanced and incremental rehabilitation programme where early activity encourages early recovery. Injuries vary so there is no single one size fits all strategy or dosage. A loading strategy should reflect the unique mechanical stresses placed upon the injured tissue during functional activities, which varies across tissue type and anatomical region” (Ref 1).

Do we want to load a broken bone on day one? Maybe not. If in doubt, seek professional medical help to form a structured loading plan.

I for ICE. People are always surprised to hear that the research behind the use of ice is far, far from conclusive – see my blog here. There is certainly a lack of quality research and very little guidance in terms of how ice can be best utilised but as seen in the aforementioned blog, there is evidence for its use. Most of us have a personal experience of using ice, and it can be highly effective for reduction of pain post injury. A bag of frozen peas is my weapon of choice (a tin doesn’t work anywhere near as well….).

C for COMPRESSION. Again, very limited quality evidence to fully support compression, but putting pressure on the injured area can help in reducing swelling. This can be quite a fine line; the more pressure applied, the lower the amount of blood that can pass to the injured limb. However, cutting off the blood supply to the extremity of a limb completely can have negative effects. If the limb goes numb at all, the bandaging should be released. A tubi-grip is your safest bet.

E for ELEVATION. Place the injury so that it is higher than the heart, where possible. Can be combined with non weight bearing movements.

So as you can see, the last 3 have changed very little, other than to admit we know less than we thought we knew. As for pain management, and anti-inflammatories, certainly for the initial acute period (48-72 hours) I do not recommend the need for NSAIDS. If pain relief is needed, then paracetamol and ice should suffice. Impress your mates by telling them you are carrying out Cryotherapy!

If you are suffering from an acute or chronic injury, please contact Dan@DC-InjuryClinic.co.uk.

REFERENCES

Ref 1 http://bjsm.bmj.com/content/46/4/220.full.pdf

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.

 

 

 

Posture

In the Story Of Being Injured, there are many villains that we blame; core stability, over-training, not stretching enough, the wrong shoes(!!), as a few examples. One of the most commonly blamed of these bad guys, is Posture, and there are infinite posture correction therapies and courses out there. So how fair is it to blame our posture? What does the evidence say about the link between “bad” posture, and pain? What exactly is bad posture?

Firstly, it is very tough to blame any issue in the body as being the cause of anything else, usually pain, without a good base of evidence. However, evidence based practice is a game of probabilities and the probabilities are – unfortunately – well stacked against posture being a cause of many musculoskeletal problems. The key reason behind this is that there is simply no gold standard for what is good and bad posture. So what we are basing our “correction” on can actually be a rather arbitrary measure, as we can see here, for Lower Back Pain, and here, for Shoulder Pain, where no link between posture and pain can be found.

Your body’s soft tissues are amazing at adapting to load. When we go to the gym this is precisely what we are asking our tissues to do; adapt to an increased load. These weights/loads will be much greater – and in more extreme joint ranges – than the loads placed upon your soft tissue under the traditional model of “bad” posture. We have an amazing ability to adapt and self-repair. Ergo, surely over time a muscle would adapt, like with the gym work, to the level of endurance required to meet the demands of the task?

So do I think posture is important at all? Yes I do. The key point of our posture, is our time in that posture. For example, the office worker who drives for 2 hours, to sit in an office for 8-10 hours, to drive 2 hours home, and then sit on the sofa for a couple of hours. You may think this is an extreme example, but try keeping a Sitting Down Diary –  it can be pretty terrifying! In the above situation, the long hours in a flexed hip position could easily cause issues somewhere along the line. But this is actually a problem with lack of movement, as much as the posture the body is under.

The saying goes your best posture is your next posture, i.e. keep moving. Research supports this, as seen in this paper, where it is seen that in actual fact, rehab programs designed to change posture can help people out of pain without changing their posture. Again, its the movement that is the “magic”. So don’t sit still for 16 hours straight. If you work at a computer, and bench press in your spare time, try getting those shoulders back for a change. We have almost infinite postures – certainly more than in the graphic at the start of this blog.

As King Julien Says;

For more information, please contact Dan@DC-InjuryClinic.co.uk

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work

 

 

 

 

 

 

Do you Ice right?

People love a fancy name for something, and injury treatment is not different. Why have knee pain if you can have Patellofemoral Pain Syndrome? Why have a modest bruise if you can have a hematoma? And so I often – facetiously – tell people that if they want to jazz up their bag of frozen peas, why not tell your friends that you are partaking in a touch of cryotherapy?

Ice (I mean cryotherapy 😉 ) has always been seen as the go to treatment for decreasing tissue damage, inflammation/swelling and pain after injury. But what does current research say about the efficacy of this?

The application of ice does reduce tissue temperature, which decreases cell metabolism in the area surrounding the injury, and decreases the amount of secondary damage in the tissue surrounding the injury. However there is evidence that ice DOES NOT reduce swelling. The main effect of ice is actually to decrease nerve conduction speed (Ref 1), meaning a reduction in pain from soft tissues. A by product of this analgesic, pain relieving response, is that it allows you – the patient – to perform exercise/movement – and so muscle contraction – which in turn reduces swelling.

For this decrease in nerve conduction speed to take place, the tissue temperature needs to reach 10 degrees (Ref 1). Taking this in to account it seems that the best protocol for application of ice is directly on the skin, completely against the traditional method of wrapping the bag of crushed Ice, or bag of frozen peas in a towel. It goes without saying, that this is only applicable to those who have ruled out any contraindications such as open wounds, circulation issues, DVT etc. (contact me for more information on this; details below). And so because of this lack of insulation, our skin temperature can be reduced to our goal temperature within 5 minutes. There are many variables to this however, for example the depth of the target soft tissue and the build of the patient. There will be injuries at such a depth that no amount of ice will penetrate deep enough. As a rule of thumb, 10 minutes should suit for most.

Interestingly, this paper, Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury (Ref 2) says that “RCTs have shown that heat-wrap therapy provides short-term reductions in pain and disability in patients with acute low back pain and provides significantly greater pain relief of DOMS than does cold therapy”.

So heat or cold? Both have positive effect, it seems. Maybe it depends on what season you get injured – Heat in the Winter, Ice in the Summer? It seems you cant really go wrong…

…as long as you keep moving.

REFERENCES:

  1. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. https://www.ncbi.nlm.nih.gov/pubmed/17224445
  2. https://www.ncbi.nlm.nih.gov/pubmed/25526231?dopt=Citation

For more information, please contact Dan@DC-InjuryClinic.co.uk

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work

Stretching

Stretching: A form of physical exercise in which a specific muscle or tendon (or muscle group) is deliberately flexed or stretched in order to improve the muscle’s elasticity. The result is a feeling of increased muscle control, flexibility, and range of motion. Stretching is also used therapeutically to alleviate cramping.

Alternatively;

Stretching: the most divisive, emotive and inconclusive part of the Exercise Universe.

Because of the second definition, by yours truly, I have put off writing a blog on stretching for as long as I have been writing a blog. But here goes;

In 2015, a paper in Research in Sports Medicine called “Impact of stretching on the performance and injury risk of long-distance runners” came to the conclusion that;

“….the literature suggests that stretching poses no significant advantage to endurance runners. Acute stretching can reduce running economy and performance for up to an hour by diminishing the musculotendinous stiffness and elastic energy potential. Chronic stretching additionally appears to have no advantageous effects. In regards to DOMS, it has been reported consistently in the literature that stretching cannot reduce its longevity or intensity. In relation to injury risk, stretching shows little significance for endurance runners to chronic injury. Endurance athletes are at high risk of overuse injuries such as illiotibial band syndrome, stress fractures and plantar fasciitis,and the literature suggests that stretching cannot reduce the prevalence of these injuries. It appears stretching may hold significance for certain exercise disciplines;
however, it can be concluded that it holds no advantage for endurance runners and is not the solution to improving performance or reducing injury prevalence”

Of course this very much focusses on Running, but is pretty damning stuff. It found no benefit to stretching, and actually some negative effects of stretching. Everyone stop stretching!

But wait….

A study in 2016 called “Acute bouts of upper and lower body static and dynamic stretching increase non-local joint range of motion” found – unsurprisingly if you read the title in full – that stretching had a positive effect, and not just locally. It concluded that lower body stretching increased flexibility in the upper body at the same time – and vice-versa. Praise the lord!

 

 

I’m always asked about stretching, and people will always ‘confess’ to “not stretching enough”. On my Strength and Conditioning For Runners Workshops, we focus almost entirely on Dynamic Stretching, as running is a dynamic activity. This does NOT mean I am anti-static stretching, at all, far from it. Stretching has its place in physical therapy – of course it does.

We can see from the evidence, that science can’t agree completely on its validity as a treatment. However, for some of the people, some of the time, it is essential. But of course, much the same as everything in the fitness and health world, it is not a panacea.

My advice is always to critically appraise your routine; What are you stretching? Why are you stretching it? Is it relevant to your daily activities, or sport? Is the muscle “tight” because it is short, or tight because it is already too long…? If you stretch something, and stretch it, and stretch it, and the symptoms remain, did it need stretching?

For more information, please contact Dan@DC-InjuryClinic.co.uk

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work

 

Hypermobility

Joint hypermobility – or to be ‘double-jointed’ – is a condition where joints are more flexible than they need to be, meaning they can extend past their required range of movement. There are 360 joints in the body and it can affect any of them, but more often than not, just a few.

It is surprisingly common across the board (it is estimated that 20-30% of the population are hypermobile to some degree, in some joints), however, it is most common in childhood and teenage years, and more common in females than males. It does, of course, tend to lessen with age – we’ve all felt the stiffening of the years! In many people joint hypermobility goes unnoticed as it is of no medically significant consequence and there are no symptoms to speak of. Hypermobility can even be seen as an advantage, to some, for example athletes, gymnasts, and dancers (you know your Yoga Teacher who does “those” positions….?). Even musicians might specifically be selected because of their extra range of movement.

Hypermobile?

However, for a small percentage of the population, far from being advantageous, hypermobility is associated with joint and ligament injuries, pain, fatigue and other symptoms. Joint Hypermobility syndrome is thought by many experts to be part of the same spectrum as Ehlers-Danlos syndrome, which is a more severe type of Hypermobility and effects around 1 in 5000 people. Despites its prevalence and symptoms, though, the International Paralympic Committee do not consider it a disability.

What causes Hypermobility?

Where your bones meet at a joint, the ends of them are surrounded by a capsule filled with fluid and held together by strong ligaments, which stop the joint from moving further than it should, and so dislocating. The muscles surrounding the joint are attached to your bones with tendons, allowing you to bend, twist and run. In those affected by hypermobility, the collagen fibres which make up any of these soft tissues is of lower quality and strength, meaning they move beyond their normal range.

How is it diagnosed?

Clinically we use The Beighton Score, which consists of a series of five tests, the results of which can add up to a total of nine points.

  • 1 point if you can place your palms on the ground while standing with your legs straight
  • 1 point for each elbow that bends backwards
  • 1 point for each knee that bends backwards
  • 1 point for each thumb that touches the forearm when bent backwards
  • 1 point for each little finger that bends backwards beyond 90 degrees

If your Beighton score is 4 or more, it is likely that you have joint hypermobility. However, this cannot be used to confirm a diagnosis, because it is important to look at all the joints. Blood tests and scans are sometimes recommended to rule out other conditions.

1 point!

For more information, please visit http://hypermobility.org/

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

If you are suffering with aches and pains, please contact Dan@DC-InjuryClinic.co.uk

Should Sports Massage Hurt?

…it’s all relative. Thanks for reading!

Sports Massage is a popular and much used therapy, recommended by N.I.C.E as a treatment for Low Back Pain. “Sports” Massage is a little misleading, and as a treatment it is fast becoming known as “Remedial” Massage, or Soft Tissue Therapy. Often thought of as being not for the light-hearted, “No pain, no gain” and “If it doesn’t hurt, its not helping!”  are both commonly heard in clinics all over the country.

But how much pain is acceptable? How deep, is deep enough??

Not everything that helps is painful, and not everything that is helpful is painless. But ultimately, Sports Massage does not have to hurt to be effective. Whilst working on a problematic area may certainly cause some discomfort, it shouldn’t leave bruising or cause you to leap off the table! (and anyway – very generally speaking -where the pain is, the problem isn’t…) If you do find yourself consistently bruised after Sports Massage sessions, your therapist may be going too hard and you have every right to ask them to ease off.

Often, people will talk about the “good” pain whilst having a Sports Massage, that sweet point between pain and relief. Is there a skill, as a therapist, to this? I think there is, but I don’t think its so much the skill of the chosen technique, but the skill of communication. I have heard of someone having a sports massage, and when answering “no” to the question Does this Hurt?, the therapist went harder, and deeper. “No pain, no gain”, right? Crazy.

And of course, there is also the “bad pain”, where the person on the couch will involuntarily tense up, or try to move away from their pain. Bad pain is pain beyond a persons individual pain threshold, and is NEVER acceptable as it offers no therapeutic benefit. As mentioned, the person is inclined to involuntarily tense up – the polar opposite, generally speaking, of the appointment. Some people will say they feel better when it has stopped, but that will be….because it has stopped.

Different parts of the body also react differently to sports massage, and pain threshold can change depending on where the therapist is working. Again, communication is the key tool of the therapist. There are certainly some parts of the body that simply should not be worked on.

 

intense-massage

“Does it hurt?”

Massage is a therapy as old as time, and an inbuilt reflex to pain – what’s the first thing you do after banging your knee (ok, second, after swearing)? You rub it better. And often, it feels better straight away, without beating it half to death.

So as I say, “No pain, no gain”, and “If it doesn’t hurt, its not helping!” may both be commonly heard in clinics all over the country, just not from me.

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

Injuries are a pain in the bum! PART 2 – Proximal Hamstring Tendinopathy

Part 2 of the “injuries are a pain the bum” saga!

Following on from the previous instalment, the other common complaint we see in clinic is Proximal Hamstring Tendinopathy (PHT). Similar to groin pain, this is one of those injuries that people are almost apologetic in their embarrassment; some people going as far as mouthing the description to avoid saying it out loud. The most common symptom is pain at the hamstring attachment to its origin, the ischium – as seen in the image (the white tendon at the top of the hamstring muscles).

ham-tendon

Have you got PHT? People often refer to the pain as in the “sit bones”, or similar, and PHT is mostly characterised by buttock pain in the area just under the glute muscle – as the leg turns into the bum! Area of pain is often consistent with the size of the tendon – generally 2 fingers width. Generally, sufferers have pain upon waking in the morning, with the pain decreasing as they start to move throughout the day. However, it can be aggravated by the simplest of things due to its location; sitting – in a flexed hip position – for prolonged periods compresses the tendon (see; desk workers, driving, cycling [highlighting the importance of a Bike Fit]), as do deep lunges and squats, running fast or uphill, and lastly…..stretching! Yes, you read that correct; hamstring stretching will not help PHT. So if your PT or injury therapist is getting you in the below position, please ask them to stop 🙂

hamstring-stretch

This will not help.

What we can do? As we’ve seen, PHT is aggravated by tension and compressive loads. To reduce pain, we need to decrease these loads to a level that is manageable. This means reducing compression from sitting and activities involving hip or trunk flexion; avoiding stretching the hamstring and reducing running or lifting to a relatively pain free level (I aim for below 3/10 on your pain scale). Tendon research has shown changes in muscle function when pain is present; isometric hamstring exercises, such as the Hamstring Bridge – as seen in the below video – can help reduce pain and maintain muscle strength (Ref 1)

Like the achilles and patella tendons, the tendon at the origin of the hamstrings is thick, fibrous, and has a poor blood supply, which can make healing difficult, and slow. Similar to these two more common tendon injuries, tendinopathy of the high hamstrings appears to be a degenerative process, not an inflammatory one, meaning that the fibers of the tendon are becoming damaged, or are ‘spiltting’. In a 2005 paper, Fredericson et al argue that the key to successful rehablititaion of PHT is eccentric strengthening of the hamstring muscle group, improving the ability of the muscle and tendon to manage the load required. This should be graded, and ideally, in a limited position of hip/trunk flexion.

REFERENCES

Ref 1 A meta-analytic review of the hypoalgesic effects of exercise http://www.ncbi.nlm.nih.gov/pubmed/23141188

Ref 2 Fredericson, M.; Moore, W.; Guillet, M.; Beaulieu, C., High hamstring tendinopathy in runners: Meeting the challenges of diagnosis, treatment, and rehabilitation. Physician and SportsMedicine, 2005,

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Injuries are a pain in the bum! PART 1 – Piriformis Syndrome?

Being injured is a pain in the bum, right? But what if the “pain in the bum” is, well, your backside??
This is the first blog of a couple of common derrière based problems.

Piriformis syndrome has been described in literature for over 70 years (ref 1); yet, it remains controversial. To the extent that there are on-going debates as to whether it is over-diagnosed, or under-diagnosed! Confusing? Maybe, but lets start with the things we can agree on;

We can all agree that the symptoms presented both in the general population, and in runners particularly, are:

  • Pain in the buttock, tightness/loss of movement, tingling/pins and needles, and/or weakness/numbness which can sometimes radiate into the lower back and down the backs of your legs, sometimes as far as the toes.

But how do these symptoms manifest themselves? We need to take a look at 2 structures;

The piriformis is a small, relatively short muscle buried deep within the glutes, one of only 2 muscles joining the spine to the legs. It runs from the sacrum (base of spine) to the greater trochanter – the outside of your hip. Because of its position, the piriformis muscle helps rotate your leg outward when your hip is extended, but rotates your leg inward and into abduction when your hip is flexed. During the running gait cycle the piriformis is most active during the stance (foot planted on the ground) – approx. 60% of the cycle.

The sciatic nerve is a very thick nerve which originates from your lower back (L4-S3), through your glute muscles and down the backs of your legs, all the way to your toes…..The sciatic nerve passes directly under the piriformis muscle in most people, however it is thought that in between 15%-20% of the population it passes through the piriformis.

Piriformis

Let us also acknowledge the word ‘syndrome‘; Oxford Dictionary defines a syndrome as “A group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms . Essentially – medically at least – a syndrome is nothing more than a group of symptoms: True cause varies. See; Illiotibialband syndrome, patellofemoral pain syndrome, irritable bowel syndrome.

So whilst we have to accept that there is no universally agreed-upon criteria for piriformis syndrome, a systematic review paper published in 2010 by Hopayian et al (ref 2) defined piriformis syndrome as “sciatica caused by compression of the sciatic nerve by the piriformis muscle.”

Thus, the theory goes; irritated piriformis – irritated sciatic nerve – pain = Piriformis Syndrome (PS)

So what can we do about PS?

As you can imagine with limited conclusive research, and much ambiguity around the true cause of this syndrome, treatment studies are not in abundance. Most treatment modalities naturally treat what is thought to be the causing factor, a problematic piriformis muscle. A conservative place to start would be to stretch the muscle (ref 3). This can be done in a multitude of positions, some of which can be seen in the following video.

It may be that the underlying cause of the pain is less simple that a ‘tight’ pirifomis, and it may be a case that you need to strengthen the muscle, or indeed your hips in general (ref 4). Again, due to the lack of high-quality studies, and the absence of research on treatments specifics, there is limited scope to describe specific advice in a general forum. Befriend your local therapist if symptoms persist!

Anecdotally, other popular methods to address the symptoms include massage, foam rolling and a few lifestyle changes; avoiding doing things that irritate the piriformis muscle such as prolonged sitting (standing desks are becoming more and more popular), and if you are able to still run, avoiding antagonistic workouts such as speed sessions and dedicated hill repeats.

Remember, it is important as part of the diagnostic stage of PS, that other conditions that can cause similar symptoms are identified, either by objective medical tests like an MRI scan (herniated discs or other low back/pelvis issues) or in a clinical setting.

For more information, or to attend a Strength and Conditioning Workshop for Runners, please visit www.DC-InjuryClinic.co.uk

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

—————————-

REFERENCES

REF 1 Benson E, Schutzer S 1999. Posttraumatic piriformis syndrome: Diagnosis and results of operative treatment. Journal of bone and joint surgery

REF 2 The clinical features of the piriformis syndrome: a systematic reviewhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997212/

REF 3 Christensen K 2006. Rehab recommendations for piriformis syndrome. Dynamic Chiropractic.com

REF 4 Tonley, S. C.; Yun, S. M.; Kochevar, R. J.; Dye, J. A.; Farrokhi, S.; Powers, C. M., Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report. Journal of Orthopaedic & Sports Physical Therapy 2010

 

Marathon Training Blog #5

….and it’s done!

Bournemouth Marathon Festival is a great event; on Saturday I visited the race village and managed to see Swindon runner Gary O’Brien finish 2nd in the Supersonic 10k, before the Supernova 5k started – something that the Clayton family hope to participate in next year. The following morning, the half marathon was off at 8am before the marathoners took to the start line for 10am. The marathon route was great – coming from a landlocked town, there is always going to something special about a coastal run. There a few long out and back segments, which allow you to see the elite guys coming back the other way (at the start!), which I like, and I enjoyed the layout of the course; it is described as flat, but there are hills, however there are always going to be over that distance and I think they actually work really well. The ‘main’ hills are at miles 11 and 17, and I found them ok, having ran plenty of hills in training. Hills aside, the race itself didn’t go exactly as planned for me, but I really enjoyed the experience. I’m not commenting on whether or not I will do another one…

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Bournemouth Marathon Altitude Graph

So, things that I have learnt, or that have been reaffirmed:

There is no substitute for time on feet. Emphasis on time, not mileage. If (MASSIVE “if”) I were to do this again, I would definitely do more runs of over 2 hours in duration. Looking at the process as a whole, in my lifetime I have ran for longer than 2 hours less than 10 times. In my lifetime. To run for almost double 2 hours with that background was always going to be tough.

A marathon is not simply two half marathons. I mean, technically it is…… but for me it is so much more. Many a wise man has said that a marathon is a race of 2 parts; a 20 miler and a 6 miler, and for lots of runners, the race “starts” at mile 20. For me, it was a race of 16 and 10. To break it into two half marathons, I ran a positive split (a slower second 13 miles) of 17 minutes. Oops.

You can’t control the elements. Pretty obvious, in reality. I’m not one to look for excuses (ha!), but the weather was warmer than forecast  (to which my wife’s sunburnt nose will attest 😉 ), and this did throw out my fuelling a little. Expect the unexpected; Failure to prepare… etc etc

The crowd really does help. Support is so, so important. I had my DC Injury Clinic T-shirt on (standard!) and had lots and lots of shouts of “c’mon DC”, which was really lovely. Also, seeing lots of Swindon faces in the crowd, hearing their support, really meant a lot and at time when you are physically and emotionally drained it is a great pick me up. Also, seeing friends, my incredibly supportive wife, my two little girls (who were far more interested in the sand than daddy running!) and my parents was amazing. I thank you all. Marathon running is a team event.

Its a psychological battle. At mile 16.5, I was done. Finite. Show me the way to go home. I suffered from cramp in both of my calves, something I had never suffered from previously, and my head literally said “you can not do this” – see the pictures below, courtesy of Greg Wells, and witness a heart breaking.

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Not happy…

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If I am proud of anything from Sunday, it is that after giving myself a few stern talking to’s, I picked myself up and carried on.

When I was 17, I was told that I should stop playing football, and that I was to never run on roads as I had “shin splints”. It took me a while, but on Sunday 2nd October, 2016, I ran a marathon. It didn’t go 100% to plan, but that doesn’t matter. I ran not for a “time”, but for no other reason than I can. Because I get to. Because it is a privilege not afforded to everyone, which is something I see day-in day-out.

And do you know what? I’ll probably do it again.

Song; Chvrches – Make It Gold

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk