Category Archives: Uncategorized

Sever’s Disease

Despite its potentially nocebic name, Sever’s Disease (which is also know as calcaneal apophysitis, or Sever’s Lesion), is in common terms a fairly common painful heel bone disorder in children, particularly those that are physically active. It is often likened to its knee equivalent, Osgood Schlatters, but is often misdiagnosed as plantar fasciitis.

It most commonly occurs during the growth spurt of adolescence; the (roughly) 2-year period of early puberty when children grow most rapidly. This growth spurt can begin any time between the ages of 10 and 15 for boys and 8 and 13 for girls. Once children reach 15 years of age, the growth plate hardens and the growing bones fuse together into mature bone, making Sever’s Disease much less likely.

Symptoms include;

  • swelling and/or redness in the heel area
  • difficulty/pain on walking
  • discomfort or stiffness in the feet first thing in the morning
  • discomfort or pain when squeezing the heel
  • limping or walking on tiptoes to avoid putting pressure on the heel

So what causes SD? During the growth spurt of early puberty, the heel bone sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. The Achilles tendon is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress (force or pressure) on the already tight Achilles tendon can damage the growth plate, causing the above symptoms of Sever’s disease. High impact sports are often associated with SD – such as running, netball, gymnastics, football.

Once diagnosis is confirmed (and rarely are scans needed to do this), the initial aim of treatment is pain management. The P.O.L.I.C.E protocol is useful, but as the condition can persist for up to 2 years, ideally a structured, graded rehabilitation procedure of strengthening and stretching the relevant tissues will be discussed, with (potentially) a return-to-play plan put in place.

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

 

Osgood Schlatters

Osgood Schlatters (OS) is a condition that is extremely common in adolescents at the time of a growth spurt. Ages vary, but generally speaking, boys may suffer between the ages of 13 and 15, whilst girls may be in the 10-12 category. It is usually associated with repeated forced knee extension, or high impact activity in sports such as football, basketball, or running.

Named after two physicians, Dr. Robert Osgood and Dr. Carl Schlatter, a typical case of OS will reveal itself as a bump, or lump just below the kneecap – people sometimes liken it to a second knee (see image below).

The primary symptom of Osgood Schlatters is typically pain at the tibial tuberosity (the bony bit at the top of the shin bone). This tibial tuberosity may become swollen or inflamed, resulting in this aforementioned lump/bump. Tenderness and pain is worse during and after exercise. The athlete is likely to experience pain when contracting the thigh muscles or performing knee bending activities. There may be subsequent muscle tightness around the joint.

OS is a self-limiting condition that generally settles with the bony fusion of the tibial tubercle (Ref 1), which may thicken long-term.

Because of its self-limiting nature, education is key in its management as symptoms may persist for up to 2 years. Other management strategies include activity modification. The key word here is modification, as there is “no evidence that rest accelerates the healing process” (Ref 1). Pain should be the main guide with regards to level of activity. As the quadriceps appear to be key contributors to the condition, soft tissue therapy alongside a graded programme of stretching and strengthening can be helpful. Some people find the P.O.L.I.C.E approach helpful.

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

REFERENCES

  1. Clinical Sports Medicine, Brukner and Khan, p.897

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.

Perthes’ Disease

I always feel very privileged that people entrust me with their most prized possessions – namely the health of their children! I work with a huge number of children and adolescents, and so I thought I would write a few blogs on a few conditions that are unique to that age group. I will look at hip, knee and heel pain.

First up, hip pain, and more precisely – Perthes’ Disease.

Perthes disease is a childhood disorder which affects the head of the femur – the thigh bone. In Perthes disease the blood supply to the growth plate of the bone at the end of the femur (called the epiphysis) becomes inadequate and as a result the bone softens and breaks down (a process in adulthood called avascular necrosis). The condition typically occurs in children who are between 4 and 12 years old, and it is up to five times more common in boys than in girls. Approx. 1 in 9,000/10,000 children are affected, so it is rare. It usually only affects one hip, but both hips are affected in about 1 in 7 children with Perthes’.

The cause is not entirely clear. It is not due to acute injury, or a vascular problem, and a child with Perthes’ disease is ordinarily fit and well. Some research suggests it that there may be a genetic link, but this is far from conclusive.

Perthes; can be easily misdiagnosed due to rarity and ranging symptoms. One of the earliest signs is a change in your child’s gait – how they walks and/or run, often most apparent during sporting activity. Your child may develop a limp, have limited range of motion, or develop an asymmetrical running style. Other common symptoms to be aware of include:

  • Pain in the hip or groin
  • Pain in the knee (Perthes’ is NOT a knee condition)
  • Pain that worsens with activity and is relieved with rest.
  • Muscle wasting in the thigh of the affected leg.
  • Shortening of the affected leg.
  • Painful muscle spasms

Depending upon the length of time your child has been suffering, and on your child’s activity level, symptoms may come and go over a period of weeks or even months. The long-term prognosis for children with Perthes is good in most cases, although it has been linked with arthritis in later life.

As always, if in doubt, get it checked out.

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.

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

GUEST BLOG: Nutritional Based Medicine, by Bec Connolly

This is a great thought-provoking Guest Blog, by Bec Connolly: Boxer, Personal Trainer, Nutritional Coach, Runner, writer & Mother of Four with a passion for sport, good food & positive people. 

Full details of Bec’s services can be found at http://www.allornothingfitness.co.uk/

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Nutritional based medicine….time to listen yet??!

Right, so been writing a lot on nutrition lately and have been having a number of interesting discussions on the subject in relation to both medicine-Prevention, treatment and cure, and general wellbeing. So thought i would add a blog in (i know so many people are asking for video blogs-i tried and failed ha! Guess im just an old-fashioned girl really).

Now this is a subject mater im fiercely passionate about and i believe, if we whole heartedly awaken our people to fully comprehend the impact of proper nutrition and its place in medicine, no one would or even could consciously go back into the dark.

Now when i talk about ‘Our Doctors’ and ‘hospitals ‘etc in this piece, i am in no way being detrimental to the effort or the service and the work they do. With what im sure, are 100% good intentions. Also when i talk of combining Eastern influences with our Western treatments i am not in any way implying our hospitals are not second to none. I truly think that the medicine we do well in this country , that is sought after the world over, is ’emergency medicine’ . Our ‘life saving interventions’ are simply the best. They are the most forward thinking, advanced and impressive the globe has to offer. What im saying is, let’s do this, lets free up our hospitals to provide emergency treatment and start tackling disease (largest killers in this country are Heart disease and cancers) on the home front. GPs are not even trained in nutrition, as a sole subject unit, in the 6 years they study! WTH??! This truly shocks me, when a diet rich in an assortment of vitamins and minerals, not only keeps you mentally and physically performing at an optimal level but prevents a large number of common illnesses and complaints that GPS are inundated with daily. It makes no sense to me why a government would spend millions of tax pounds on a campaign (we have all seen the posters ‘anti biotic won’t work on a cold’) to deter people booking appointments wanting a ‘quick fix’ medicine for a common cold virus, but the same government wont spend significantly less handing out Vitamin C. Why deal with the problem when you could mostly prevent it?

I think i will start by talking about food with families, as our children, the next generation, are the ones we need to get this sorted for really. Plus im a firm believer that education really does start at home and you do need to lead by example.

Thats not to say, before you roll your eyes at me with frustration… that i don’t ‘get it’, i do! Im as guilty as the next mum at popping a pack of 22p biscuits in my toddlers hand to get him to stop kicking off, bored at the supermarket….. or just for ten mins peace while i do the ironing! My kids have begged for A Macdonald’s milkshake and won! I’ve got in from work, tired out, nothing fresh in and put smily faces and spaghetti in front of them. I get it! I’m not saying its 100% 100% of the time, its moderation, BUT proper moderation, like a 95% 5% split. You, if your anything like me, need a guilty pleasure every now and then-christ, a few of you would have seen what a slice of carrot cake can reduce me to hahahahaha (inhaled in seconds flat) and a vody and coke barely settles in the glass hahahah !Its all about ‘real’ moderation.

Also its portion sizes, an average child needs only 35 kcal to each pound of ‘ideal’ body weight, that means that no child under 7 is ever likely to be going to need more than a 1000kcal a day. Anybody that’s ever been on a weight loss diet will know that a 1000kcal isn’t all that much. So basically stop stuffing them up!!

A child “learns” to like food, if you keep giving a healthy balanced diet, your child will, with no alternatives, eat a healthy balanced diet. It’s that simple.

Teach your children about where food is from, go vegetarian if you think you can (vegetarians a no brainer for me, i cant get my head round why anyone would want to eat a dead thing, much less kill something to feed yourself when it’s not necessary to survival. Live by ‘first do no harm’…but from talking to friends i do understand that some people just will not give up meat or fish. And with the exception of the excuse ‘what difference will i make, they will still all be killed?’ this being the only reason that i just can not abide.) (Pathetic reason to eat something, if everyone thought like this no change would or could ever happen, one quiet voice is always better than no voice-but that’s a whole other blog!) I do understand some wish to get their protein mainly from animals so, make it lean white meats. Serve your families fresh fruit and vegetables ( now im not saying, as i will get to later, that our veg is up to much, but the calorie content, saturated fat content, sugar content etc is natures perfect balance) so load um up! Get the oats, the acai berries, the spirilium, the nuts… all the power foods into them-we are the generation lucky enough to have the research done for us already , now lets apply it.

Whilst i agree that its close to impossible in modern-day Britain to get every nutrient needed for optimal functioning, i do think that this calorie controlled, low fat (still incorporating good fats), wholegrain, low sugar, no white/refined carbohydrate, vegetarian diet is the best thing you can do for both yours and your children’s health.

Basically it’s getting rid of processed foods, its simplifying your food! If it comes straight from the ground its better for you! It’s not difficult or expensive (though im totally with you on the ridiculous comparison prices of vegetables and wholegrain food, make’s me so angry-but once you portion correctly i think most people find generally their bill goes down). A simple, cheap but brilliant breakfast will always be porridge-filling, boosts metabolism and is slow release energy, make it with water to avoid adding unnecessary calories and if you must sweeten it, chuck in a handful of raisins-job done, family fed! Don’t be afraid to challenge your children’s schools either. A lot of people prefer to send in a lunch box now anyway, which is great as you have total nutritional control. The schools all have a ‘healthy schools’ policies to adhere to now, which is a great step in the right direction, parents are asked not to put crisps or chocolate bars etc. in boxes….great, but what else is going in?! I’ve seen boxes packed to the brim with white sandwiches, yogurt, plastic cheese strings, cheese dippers, go ahead bars, jelly, strawberry mouse, mini bits of meat with biscuits and cheese, cocktail sausages, sausage rolls, pork pies! Stop and think! This meal needs to be around 300 kcal of their allowance! They really do not need any high sugar foods or heavily processed things that are going to make them lethargic or crash at some point, especially in school time (make the connection between food and good behaviour here too please, the more schools and parents recognize this, the less trouble and behavioural problems our children and young people will face). Don’t let others almost ‘pressure’ you-i know this happens because it’s happened to me! The teachers and other parents making snide comments and remarks about lunch box content. My children on a typical day take in water, yep that’s right, shocking parent, water…ha…a large whole meal peanut butter sandwich and one piece or a portion of fruit salad and one portion of either raw veg sticks or a yogurt. That’s it, that’s all they need, they get a glass of milk and piece of fruit at break time too. that lunch box has approx. 300-350 kcals in it . It’s that easy. Get them used to eating correct portion sizes now, they will thank you for it later i promise you.

Anyway that follows on nicely to the next topic i wanted to discuss, as i said earlier, i don’t think much of the nutritional content of a lot of our foods now anyway. We are the benefactors of the third generation of super markets and massive commercial availability of foods. Great, cheaper, convenient and vast variety. What’s the cost of this though? The pay off is simply that our food is nutritionally raped before we get to it. Unless you are buying (truly) organic or growing your own food, it’s very likely, that because all of our soil has been worked and used so much, had fertilizers and other chemicals pumped into it for so many many years now, it lacks all the vital minerals , (there’s literally no magnesium left to be found in British soil now let alone the other 100’s needed) to grow well-balanced produce so the produce is substandard nutritionally. So then, by the time it’s harvested, treated, packed, sat in the store for 5 days, taken home by us, cooked (sapping any goodness it might have had left out…) we are left with a vastly inferior food product.

However, this doesn’t have to be ‘throw in the towel time’ ! We are the generation lucky enough to be able to benefit from modern science and all the research done, as we can find vitamin supplements readily available to us. Now this is where i have countless debates with my co-workers and such like, as some people are vehemently against this.

The belief is firmly that you should be able to get everything you need from a balanced diet, well i have just explained my reasons why i don’t thing this is happening anymore.

Also its about breaking down the misconceptions that are placed in people’s minds that these are ‘tablets’ or ‘drugs’ or something, they absolutely are not. I’m all for a natural diet (and against taking prescription drugs at all costs obviously ) but if i can swallow, in one mouthful, enough iron, vitamin A,B,C and D for my day before i even eat, then brilliant! If i had a penny for every joke that i get in the mornings at work “you’ll start rattling soon Bec” etc etc id be rich! Yep, i shoot wheatgrass and vitamins like they are sambucca and i make sure i get above and beyond my fair share of B3′ and 12’s to aid my vegetarian diet. But like with anything there is a side to be weary of, do your research, RDA are not always right for one (shocking, the government being wrong eh?! ;)…;), certain things you can get cause negative side effects by having too much of ….but things like Vitamin C, you really cant get too much of a good thing! 100mg a day RDA WTH?? I make sure i get a minimum of 1000mg daily at least. This is where media stories and propaganda shuffles through hazy memories, have you not heard that too much can damage your liver some where before, or was it Kidneys?? Yep, you probably did read that somewhere but it’s absolutely unfounded and in fact completely discredited by the research since carried out. …..

So you think you have decided to get on to the optimal health train, want to wake up feeling refreshed and rested, mind and memory sharp from all those rich Omega oils your feeding your body, hair and nails glossy from the biotin, cells regenerating and energy from all the B vitamins and extra Iron?? Then you get faced with the next major hurdle in this battle to overcome. This too, like the prescription drug empire, is a multi billion pound business and with that comes all the hard sell pitfalls to avoid. It’s not as easy as walking into Tescos and buying your generic multivitamin! Sadly, if you actually look at the quantities in these, they might be at the “government recommended” mg pitch, but nowhere near what you would need to actually feel different and boost your body. There are however some great, reputable internet sites and sports nutritionist are the best folk to speak to here for some great recommendations.

So this sounds like i got a bit side tract from my original topic of its place in Medicine. But i thought id put a bit of background in first. The thing that i oppose so strongly in our medical system is its heavy reliance on pharmaceutical companies and drugs . Firstly i don’t trust multi billion pound corporations that happen to have control over what information is added….. and conveniently, edited out of our medical journals!

Money really does and always will talk loudly in the minds of the corrupt or the money needy (our government!!).

The truth, however, if shouted loudly by anyone fierce enough to oppose what is happening, will always, in my eyes, be not only the more worthy but the leading voice into the next movement. With death, obesity and disease rates so high and medication side effect reports becoming more concerning and at times horrifying, can we afford to be the generation that doesn’t stand up?? Is this the last chance we have to fight and to speak out for our children’s generation not to live in a world where coronary heart disease, diabetes and 1 in 2 people developing a cancer of some variety is the norm??!! Lets stand up and make our words heard then!!

pharmaceutical companies have screwed us over for a profit …..and as a country we have let them!

We, in western medicine and culture like to have a drug that does just one thing, to coin a famous phrase “a pill for every ill”.

It seems too unlikely or too difficult to comprehend when someone says a certain food or herb or nettle ect will treat several ailments etc !! We need to start giving medical weight to these things though. If you look to the East and their statistics on disease, its absolutely nothing like ours-food really does matter! However these drugs companies are powerful and their money keeps them in our governments pockets. They are not going to relinquish any ruling over our medical practices any time soon -and please don’t think im saying all drugs are bad, like i said earlier our ’emergency medicine” is second to none the world over. Drugs are part of that success story, but long-term medication, no, absolutely not, not how our bodies were designed. There has to be and is another way.

There are people campaigning tirelessly across the globe that are being silenced as we speak. Its called the ‘forgotten research” It’s basically the stuff left out of our medical journals because it doesn’t make money. With risk of sounding like a conspiracy theorist, even cancer has become a billion pound industry for America and Britain. There are doctors that have had to move their families into Mexico just to practice their Medical techniques-that have had success rates far higher than we are used to in the treatment of cancer..because its illegal to practice these (un costly) things in western medicine! The founder of alcoholics anonymous, also used niacin in his recovery program and wanted to include vitamin therapy into his program but the medical board would only allow it to go ahead as a completely ‘spiritual’ group. How controlling?!!! Money!!

The research has been done, we are not in the dark. We have just been silenced and manipulated into believing we are getting the best when in fact we are playing in to a business strategy. 38 degrees and many others have done blinding work going head to head with Abbie v drug company (to get transparent date-these people were hiding side effects (legally!!!) with no concern for the devastating life effects on people…just concerned with selling more ) It’s a start but only a start.

Lets be the generation that stands up and shouts, no! 1 in 4 are the stats now…..that’s 1 of my kids! Impossible………don’t keep quiet, don’t meekly except what’s available to you! enquire, be curious, ask questions….demand answers. Do it for the next generation, a brighter legacy.

Wrist Pain

Ok, stop sniggering, boys.

The wrist is a complex joint made up of eight small bones arranged in two rows between the long bones in your forearm (ulna [little finger side] and radius [thumb side]) and the bones in your hand. Tough, fibrous bands of ligaments join your wrist bones to each other, and to your forearm bones, and to the hand bones. Tendons attach the muscles to bones. All told, its a pretty complex area.

Wrist injuries occur frequently both in sport, and occupationally. Occupationally, they are often deemed overuse, or repetitive strain type conditions. This can be any activity that involves repetitive wrist motion which can cause inflammation of the tissues around joints – so anything from using a desk mouse all day, using your thumb all day on your phone, or using a screw-driver for long hours.

In sport, they often occur due to a fall on the outstretched hand, and are more common in children than adults. In sportspeople, the most common acute injuries are fractures of the distal radius or scaphoid, or damage to an intercarpal ligament. A scaphoid fracture involves the bone on the thumb side of the wrist. This type of fracture may not show up on X-rays immediately following the injury, and can easily be missed.

It is essential to determine the mechanism of the injury causing wrist pain, and examination should include observations, active and passive movement tests, palpation, and special tests.

Other causes of wrist pain include;

Osteoarthritis is a type of arthritis which occurs when the cartilage that cushions the ends of your bones, allowing smooth articulation, deteriorates over time. Osteoarthritis in the wrist is actually fairly uncommon and usually occurs only in people who have injured that wrist in the past.

Rheumatoid arthritis is a condition in which the body’s immune system attacks its own tissues by mistake and is more common in the wrist. If one wrist is affected, the other one usually is, too. Pain associated with rheumatoid arthritis is usually described as throbbing or aching, and it is often worse in the mornings or after a period of inactivity.

Carpal tunnel syndrome develops when there’s increased pressure on the median nerve as it passes through the carpal tunnel, which is the passageway in the palm side of your wrist, between ulna and radius. The main symptoms of carpal tunnel syndrome are tingling, pins and needles, numbness and pain in one or both hands. The symptoms tend to have a gradual onset, and can be worse at night or first thing in the morning.

Ganglion cysts are fluid-filled lumps that usually develops near a joint or tendon. The cyst can range from the size of a pea to the size of a golf ball, and are common wrist complaints – mostly on the top of the wrist. Ganglions are harmless, but can sometimes be very painful!

De Quervain’s Tenosynovitis is a painful condition affecting the sheath around the tendons on the thumb side of your wrist. Symptoms include pain when you turn your wrist, grasp anything or make a fist, and grip strength will be compromised. A plumbers worst nightmare.

Wrist injuries are common in A&E Departments, and often easily and quickly ruled out from being broken. But what then?

As always, if in doubt, get it checked out.

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.

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

Evidence-Based Practice

If you have ever visited my clinic, or attended one of my Workshops, you will have heard me talk of “what the evidence says”, and “evidence based practices” until the words become almost meaningless, and so I thought I would take a few minutes to describe what exactly I mean by that, and why I feel it is such an important part of what I do.

I came across a clinic recently offering a ‘Scientific Knowledge and Experience’ based approach, swiftly followed by advertisements of treatments with evidence that is at best inconsistent, and at worst non-existent. I saw another clinic advertising;

….which – and I cant sugar-coat this I’m afraid – is complete drivel.

For a treatment to be offered, I fully believe that the therapist offering said treatment must be able to stipulate exactly why this treatment will move your rehabilitation forwards. There are of course limitations to most treatment modalities, but to offer the service, the research must show benefit to the client, or else we get into the realms of an ethical debate; can a service be offered if the research does not support its use?

It would be incredibly easy to do so, as often a therapist is seen as the authority in the room, and the client can feel pained, desperate and even vulnerable, so will take whatever advice or treatment is offered.

I believe good therapists choose the harder route; good therapists refuse to stick to the oft repeated party lines of the unchallenged past  – such as bending over is bad for your back, when “…research suggests that back pain is twice as common in the developed world compared to less developed nations..” ….(Ref 1)

….or the new in vogue conditions…

The honest therapist has to work harder, because they can’t rely on age old myths of poor posture being to blame for everything; or a “weak” core causing pain; or advising stretching to everybody, for every ailment.

An honest therapist makes their own job harder, so that you can improve quicker.

A less honest therapist can hide behind regression to the mean because – hey, sometimes, things get better no matter what you do, so lets utilise placebo and discuss a 10 week treatment plan…

Cupping (Ref 2) and acupuncture (Ref 3, 4, 5, 6) are great examples of treatment modalities that are growing in availability at roughly the same rate as the indifferent or negative research coming out regarding their efficacy. They are obviously popular, but if the (paying) public were offered the treatment with the research, would they still be? I genuinely don’t know.

Foam Rolling and Kinesiology tape are a little more interesting as the research goes both ways, but, again, is it ok to recommend a treatment with such divisive results?

There is a battle between giving people what they want – as there is, again, obviously a demand for such treatments – and giving treatments which peer-reviewed scientific study suggests will move them forward. Of course the research is more important to me, on my side of the couch, but should we not, as therapists, be the ones communicating the evidence to the other side of the couch, to allow collaborative decision making?

We therapists and health professionals spend fortunes on courses learning new skills, but what is the reasoning behind theses skills? Just because the course was expensive, we should be able to acknowledge that not all is as it seems, regardless of how uncomfortable it is to do so, should we not?

Even if you don’t always want to know why, or even how a treatment modality works, surely you would want to know if it works?

I would be very interested to hear your thoughts; feel free to email Dan@DC-InjuryClinic.co.uk.

REFERENCES

  1. The epidemiology of Lower Back Pain in the rest of the world, Violonn E, 1997
  2. http://www.imr-journal.com/article/S2213-4220(15)00359-5/abstract
  3. https://www.painscience.com/biblio/acupuncture-treatment-for-pain-review.html
  4. https://www.painscience.com/biblio/best-acupuncture-evidence-shows-only-trivial-effects-on-pain.html
  5. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005319/abstract;jsessionid=BEF08C0098B706BF5374B983683DF8C4.d04t02
  6. https://www.painscience.com/bibliography.php?ee16

 

Warm-ups

In my recent blog about Posture I mentioned the most common things that we blame for injury; core stability, over-training, not stretching enough, the wrong shoes. One other recurring theme that people come back to is “not warming up properly”. So let us look at what warming up is, if it is as important as we think, why it is important, and how to do it effectively.

What is a warm-up?

Warm-ups are essentially the preparation for physical exertion, carried out by exercising or practising gently beforehand, generally including a combination of cardiovascular exercises, stretching and strength drills. This should gently prepare the body for exercises by gradually increasing the heart rate and circulation; the warm-up is also an opportunity for an individual to prepare themselves mentally, and for a team to work together prior to the start of the game. Warm-ups can also be used to practice skills and team drills. Moreover, one of the aspects of a warm-up is “simply to stir cellular content so the sarcoplasm [part of muscle fibre] becomes liquefied” (Ref 1)

Is it important, and why?

While the influence of warm-up on injury prevention is fairly inconclusive, there is certainly research that suggests that there are no negative effects to (a sport relevant) warm-up, and the psychological impact can be huge – getting your ‘Game Face’ on, as it were.

FIFA released their own recommendation for a football specific warm-up, and research there did suggest that the “…program reduced overall risk and severity of lower extremity injury ”  (Ref 2). The British Journal of Sports Medicine also found that the FIFA 11+’ effect was “substantial injury prevention…… reducing football injuries by 39%” (Ref 3).

Similarly, looking at the sport of rugby, research published in the British Journal of Sports Medicine :-

“… found overall injuries fell by 72% when players completed the newly devised exercise session at least three times a week, either just before a match or before training. Concussion injuries were also reduced by 59%” (Ref 4)

  • As an aside, for anyone who follows/plays rugby or football, you will have noticed that teams will go through a specific warm-up on the pitch, before disappearing for 15-20 minutes back into the changing rooms, only to reappear and start playing. I have always questioned this model and personally feel that a far better approach would be to start the warm-up 15-20 minutes later and gradually build the warm-up intensity up to the beginning of the match – and so starting at full speed. There doesn’t seem to be any reason for the current model other than those most dangerous of words; we’ve always done it that way. I believe that it would only take one team to take a different approach and we would see everyone following suit. I’d be interested in opinions from team coaches.

How to warm-up

To start with, I think we should acknowledge that old cliché of no one size fitting all. This goes for both person, and sport/activity. No one warm-up will suit everybody and every sport, and so we have to keep things relevant, and sport specific. Would a rugby player and a gymnast benefit from the same routine? We need to understand the demands of your chosen activity to fully understand the requirements of your warm-up.

For runners  that I work with, everything is dynamic – there is no static stretching. Research consistently tells us that “…the Static Stretching of the lower limbs and hip muscles had a NEGATIVE effect on explosive performances for up to 24 hours post-stretching …. Conversely, the Dynamic Stretching of the same muscle groups are highly recommended 24 hours before performing” (Ref 4) and that “static stretching for 30 seconds neither improves nor reduces muscular performance and that dynamic stretching enhances muscular performance” (Ref 5). Running – like most sport- is a dynamic activity, reliant on elastic recoil of muscles. Stretching them, and potentially dampening that ability to recoil, prior to setting off makes no sense. The dynamic movements should work through the range of motion required for the activity, and so slow running is a great warm-up for fast running, and many runners will use mile/km 1 as theirs.

No no no no no. No.

Gymnasts, dancers, divers, however – activities that rely on increased flexibility – may well benefit from static stretching as part of a structured warm-up. Horses for courses. Know your sport; understand the requirements; reverse engineer your warm-up.

Fine

So warming up is a good idea, but the key thing is always, always, always specificity of task. The best warm-ups – in my humble opinion – are the ones that most closely replicate the upcoming task, at a much lower intensity than required for said task.

How does your running club/rugby club/football team warm-up? Does it fit the research? If not, maybe get them to have a read of this blog; I’d be interested in opinions.

REFERENCES

  1. Basics of Strength & Conditioning, NSCA, p.15
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867089/
  3. http://bjsm.bmj.com/content/bjsports/51/7/562.full.pdf
  4. https://www.theguardian.com/sport/2017/may/17/rugby-union-research-exercise-plan-injuries
  5. https://www.ncbi.nlm.nih.gov/pubmed/23615481
  6. https://www.ncbi.nlm.nih.gov/pubmed/16095425

As part of my Strength & Conditioning for Runners Workshops, I provide my one-stop warm-up for runners. To find out more, please see here

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.

Cramp & Stitch

Everybody knows what a stitch is, right? And everybody knows what it feels like to get cramp? Strangely though, we actually don’t know too much about what these two phenomenon’s are, or what causes them…

Lets look at what we do know;

STITCH

Side stitches are a very common problem among runners. They are mostly felt in the side, and make it difficult to breathe when exercising as it feels like someone is stabbing you in your side! Occasionally, they will be accompanied by pain at the tip of the shoulder on the same side. But as I have said, the actual cause of a stitch is still uncertain.

There are various ideas and opinions, all of which have some evidence to support them…and some to dispel them. Traditionally, it was thought that a lack of blood flow to the diaphragm can cause irritation and pain. However, studies have shown this not to be the case (Ref 1).

Another explanation for cause of stitch is irritation of the ligaments and soft tissues which connect all of the various muscles, bones, and organs inside the abdomen. The theory goes, impact during activity pulls the organs in your abdomen downwards, tugging on the ligaments in the upper abdomen and eventually creating irritation. This would make sense of why eating a meal too close to exercising seems to correlate with a stitch. However, this doesn’t stand up to research either! (Ref 2).

So how can you avoid getting a stitch? Studies have established that eating a large meal or drinking concentrated, sugary fluids like fruit juice close to the time of the exercise will increase your risk of developing a stitch, and they certainly seem to correlate with when you eat. If you are a chronic sufferer of the dreaded stitch, try keeping a food diary before exercise.

Diaphragmatic Breathing exercises may help to strengthen your breathing, as the diaphragm is a muscle (albeit involuntary), and how hard you are exerting yourself certainly seems to correlate with  getting a stitch; you may also want to consider incorporating some S&C for your hip flexors and extensors, ensuring a good, strong upright position of the trunk.

CRAMP

Cramping is a common and usually harmless condition where muscles suddenly involuntarily contract, or shorten, and become tight. Harmless they may be, but they are (often) extremely painful. Most common in the legs, any runner will know the feeling well!

Similar to a stitch, the research into the cause of cramping is largely inconclusive. There are again, however, a couple of things at play.

Most often blamed is dehydration, or an electrolyte imbalance. However this seems to stem from marketing (of sports drinks) more than scientific research. Research has actually found no relation of any kind between an athlete’s electrolyte levels and their risk of cramping (Ref 3).

Exercise induced cramps seem to stem from neural mechanisms, which are designed to inhibit muscle contraction, being depressed and the chemical and electrical synapses that fire the muscle fibers being enhanced. The result is an intense, sustained involuntary muscle contraction – cramp!

How do we avoid this cramping? Hydration is important; our muscles are around 80% water, and a 2% drop in hydration level can result in a 10-20% decrease in performance. A 5% drop can lead to a 30%+ decline. Committed athletes will weigh themselves pre- and post-workout, and measure the weight loss. For every Kg lost in weight, we would ideally be replacing that with between 1 and 1.5 litres of fluids. There are companies that will measure your electrolyte loss too, but as discussed, the science is sketchy at best.

You would have to consider exactly which muscle groups are cramping, and look to what the output expectations of that muscle group are, compared to its capabilities. Involuntary contraction of a muscle (Muscle A) can often be traced to a different muscle group (Muscle B) not being strong enough to cope, and so sending workload to a muscle (Muscle A) with an ever lower capability. Ergo, strengthen Muscle B, and ease the workload of Muscle A, resulting in lower chance of cramping.

Taking a holistic approach, other things to consider are diet – are you eating enough vegetables, greens, fruit etc? There is some research (again, fairly inconclusive…) into potassium deficiency being at play with cramps, so dietary potassium could help.

There is also some discussion on magnesium deficiency. The theory here is that as magnesium plays a role in neuromuscular transmission and muscle contraction, deficiency may predispose to muscle cramps

With both Stitch and Cramp, it will take a little trial and error on an individual level to find the exact cause (if there is a singular cause) – let me know how you get on!

REFERENCES

  1. Morton, D.; Callister, R., Spirometry measurements during an episode of exercise-related transient abdominal pain. International Journal of Sports Physiology and Performance 2006
  2. Morton, D.; Aragón-vargas, L.; Callister, R., Effect of ingested fluid composition on exercise-related transient abdominal pain. International Journal of Sport Nutrition and Exercise Metabolism 2004
  3. Brouns F, Beckers E, Wagenmakers AJ, Saris WH. Ammonia accumulation during highly intensive long-lasting cycling: individual observations. Int J Sports Med. 1990

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.

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

Recurrent “Stiff Shoulders/Neck”; the same old Trap

Shoulder and neck pain is one of the most common complaints I come across in clinic. Often, there is no acute “injury”, as such, rather it is reported as a long, gradual onset to the point where people will feel as though their shoulders are creeping further and further upwards, towards their ears, often at times of stress or tiredness. I often hear them explaining how they can feel or see – or that they have been told previously – that these muscles are knotted or tight, and they will explain how it needs to be released, loosened or stretched.

But the structures test very differently to these descriptions. Most painful upper traps/shoulders I see are weak and long, not tight and short. The sensation of tightness or stiffness felt is because they are constantly being overloaded in a position of stress, and the muscles simply do not have the capability to endure. As we looked at in my blog about posture, muscles are designed to move, and being placed in this position of length for prolonged periods of time can, and often will, lead to a level of discomfort. How long do you sit at a desk, arms in front of you, lengthening these structures? How long do you sit in a car in the same position? And this is where I see a lot of treatment falling down, focussing too much on lengthening a muscle that is already long.

Anatomically, the Trapezius muscle is a large diamond-shaped muscle, described as lower-, mid-, and upper- portions, that is found down the side of your neck and top of your shoulders. Its the most superficial muscle of the upper back and runs from the base of your skull, along to the tips of your shoulders, and down to the middle of your back, as seen in the image below. So far so good.

The complication comes from the commonly held belief of the actions of the 3 parts of the trapezius muscles. It was commonly though that the lower-, mid- and upper-traps all had isolated functions, but we now know that to not be the case. For example, we know that the actions of the trapezius muscle is insufficient to rotate or elevate the Scapula (shoulder blade) alone, instead it is its combined action with the Serratus Anterior that does this job. The action of the Serratus Anterior pulling the shoulder blade outward around the back, at about 30° of arm elevation, is ultimately when the upper trapezius muscle assist in its upward rotation and elevation.

So what does this mean? First and foremost it means that anyone in the gym doing “shrugs”, are not really hitting the upper traps, if you are not incorporating that 30° of arm elevation. There is a muscle underneath the upper-traps called the Levator Scapula, which – brilliantly – does exactly what is says on the tin; elevates the scapula (shoulder blade) – the shrug movement. So what are we strengthening exactly?

The majority of the Upper Trapezius muscle fibres attach to the end of the collarbone; when they contract they rotate the collarbone inward. This causes compression of the sternoclavicular  (collarbone-sternum) joint, and allows forces and loads from the arm and shoulder to be transferred away from the neck – a pretty amazing system to protect the neck, and a system we would like to be strong and robust.

As mentioned, most painful upper traps/shoulders I see are weak and long, not tight and short. Soft tissue therapy, massage, joint mobilisation, and taping can be a hugely effective, if somewhat transient, component of treatment for your recurring shoulder issues – hence the monthly visit to your massage therapist. But the key word in all of this is “recurrent”. Why is it coming back? Why isn’t it being “fixed”? What can you do??

There is a way to build a sustainable treatment plan, achieving long term benefit, whilst empowering you to self manage. To find out how, 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 shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.

 

 

 

GUEST BLOG; What Sport did for my Child, by Debbie Gunning

Really pleased to have GB Runner Debbie Gunning’s great blog about what sport has done for her and her children – it’s a great read!

When I became a Mother, I wanted my Children to reach their potential, aim high and learn to be proud of their achievements whether in academic studies or on the Sporting field.

As a former International Athlete I wanted to get the balance right – my pet hate was and still is pushy parents, so I let my two boys go in the direction they were passionate about. Eldest Son breezed through School, although always worked hard, Sport – he chose Swimming, not the best in his Club but his work ethic soon paid off getting to a District Standard before opting to try his hand at Track and Field, gaining County Standard in his 1st year and hoping for more improvements now settled at Uni and increasing his training.

Then along came my youngest Jack, 6 and half years after my 1st born. Life was a bit tough from the moment he tried to take his 1st breath. He struggled with basic things, like trying to pedal a bike, walking up and down the stairs, catching a ball, As a parent you know they develop differently so there was no concern, his older brother was and and still is his Idol, so he tried swimming, coordination was a problem, football he had some success, making best improver for 2 years.

Then the bullying started, last year at Primary School, was a tough year, didn’t fit in struggled in every aspect. Left Primary School as a outsider with few friends. My little boy’s smile which would light up any room was rapidly disappearing. I was concerned as he entered Secondary School.

Then he was asked to have a go at running around Lawn woods with Swindon Harriers, he loved it, he came back said he wanted to do a bit more. Bryan his Coach, put him with a Group of slightly older Girls and a friendship developed that will never be broken. The Group was renamed ‘Spice Girls plus one,’ Jack was named Spice Boy. Each week he improved, getting fitter and getting more confident, joining in more sessions , he was included and accepted. I saw a trust in Bryan, that he never had with an adult outside the Family.

Running was becoming his saviour. Track Season soon came and he smashed through the targets both his Coach and myself had set him, and when he won a league Match, an 800m race, all his Club Mates cheered him on down the home straight. The smile that day shone through on a Cold Grey And Wet Day in Newport. On a Friday afternoon in October I received a call from him , he had won his Cross Country Race at School – no big deal , loads of Kids do that, but this was a Child who had been bullied, had no self esteem, and has also been diagnosed with Dyspraxia just 12 months earlier. Going on to make it through the Swindon Schools, to run in his County Schools, reserve for his County Team for South West and English Schools , but wherever running takes him his life has turned around. He is dreaming big, believing in himself, confident and happy teenager.

So when other Parents ask me why I drive around him to training or spend all Sunday at a race, stand waiting for him to finish his sessions in the freezing cold:-

It’s not about where he finishes, or how fast he has run

Sports gives him confidence.

Sports gives him the inclusion he lacks at School.

Sport gives him the interaction with Adults and Other Children.

It teaches him to follow his dreams.

It teaches is ok to fail – just get back up and try again.

It lets him be himself.

It teaches him self discipline

It teaches the importance of a Healthy Life,

It teaches him to be the best HE can be.

And the Smile… That is absolutely priceless.

About Debbie: I didn’t start running until I was 20, joined a gym, ran a half marathon, I realised I wasn’t too bad. Joined Swindon Athletic Club, trained hard, gave up a full time job and worked part-time to achieve my ambition of earning a GB vest…managed 12 – including European Championships in 1996. Very much a rollercoaster ride, lots of failing and picking myself back up again. Became a mum and within 6 months was back running well – but didn’t make it to Commonwealth Games, went onto the roads and won the Bath And Fleet Half Marathon. Trained as a PT, had another child, started working as a full time PT in DW Sports, training everyday people to reach their goals, whether it be weight loss, sub 30min 5k, but hopefully inspire people no matter what life throws at you – be the best you can be, and just be you…

Also fitted in 5 marathons – London 2017 looks to be on the cards!