Category Archives: Uncategorized

Sportive Bike Riding

Based here in Swindon, on the edge of the Cotswolds, we are blessed locally with numerous annual Sportives, over a wide range of distances and terrains – from road to cyclo-cross. Sportives are great ways to ride new roads without having to spend hours route-planning (or risking getting lost, inadvertently turning your 20 miler into a 40 miler!), and they are great fun for those looking to ride in a big group – and of course there’s also the huge sense of achievement at the end!

Depending on your goals, there are a few ways to make your long hours on your bike more comfortable. Incorporating other forms of training (cross-training) will be beneficial to your cycling, but naturally you will want to spend the majority of training in the saddle. There are plenty of good, generic strength and conditioning for cyclists articles to be found, such as this one on the TrainingPeaks website. Ideally, knowing your current strengths and weaknesses can isolate a more specific approach.

Phil Burt, Lead Physiotherapist for Great Britain Cycling Team advocates sports massage as part of the training protocol saying “A regular, say monthly, appointment with an experienced soft tissue therapist can be useful as a body MOT and can help identify areas of tightness or concern”, which in turn can lead to a more specific approach to your training.

It is a good idea to get your bike checked over, pre-event, to ensure it is in working order and so there is less chance of you having mechanical issues on the day. Whilst there may be mechanics on course, it will effect your enjoyment of the day, so learning the very basics (such as how to use your puncture repair kit) can be beneficial. Locally, I can recommend Run&Repair for bike maintenance.

A big factor effecting your enjoyment on the bike is of course how comfortable you are on the bike; this is effected by your bike position, the clothing you are wearing and your cycling history. I advocate a 3-step integrated process, devised to harmonise Man and Machine.

STEP 1 – Musculoskeletal Screening: Identify common musculoskeletal and biomechanical deficits and imbalances highly prevalent in cyclists.

STEP 2 – Rehabilitation and/or S&C Plan: Address aforementioned musculoskeletal and biomechanical deficits, with tailored, bespoke exercises and stretches.

STEP 3 – Discipline Specific Bike-fit: Incorporating the aforementioned musculoskeletal and biomechanical deficits, discipline specific adjustments of the bike take place, designed to maximise your position within the ‘3 Pillars’;

For many years, bike fitting has been the domain of the bike mechanic, but research suggests time and time again that it is in fact the clinicians perspective which can be most valuable. For full details of what I offer – see here.

The keys to successful training are like in any other sport;

  •  try to increase the amount you are doing gradually.
  • The sooner you start your training and more time you have to train, the greater the progression you will make before your event.
  • Try and incorporate some group rides into your training, as riding in a group is a good skill to learn before an event with people around you.

Let me know how you get on!

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

Placebo & Nocebo

Placebo. We’ve all heard of it, but what is it exactly?

A placebo is a substance or treatment with no active therapeutic effect. The Placebo Effect is a phenomenon in which the recipient perceives an improvement in their condition due to personal expectations, rather than the treatment itself. So lessening pain through no intervention. Placebo effects are absolutely fascinating, with some placebos seemingly more effective than others; large pills seem to work better than small pills, colour pills work better than white pills, an injection is more powerful than a pill, and fake surgery gives a stronger placebo effect than injection (Ref 1)! Whilst fake surgery seems a crazy idea, the Finish Meniscal Legion Study Group’s trial published in The New England Journal of Medicine, found a sham meniscal (cartilage) surgery to be equally effective as the actual procedure. Think about that.

The use of placebo is also an interesting ethical topic for any therapist, which I wrote a little more about here.

And what of Placebo’s lesser know twin – Nocebo. The Nocebo Effect is when a negative expectation causes a treatment or therapeutic intervention to have a more negative effect than it otherwise would. It is the perception that will have a negative influence on the result, not the treatment itself. So creating more pain, through no intervention….The words we use can be incredibly nocebic; a simple diagnosis can sometimes have that effect if it is not communicated correctly. We all know someone that ‘cant’ do exercise because of the negative effect that it will have, having been told so by a health professional, and the healthcare profession is full of potentially nocebic words; “rupture” and “impingement” for example. Another classic example of this a therapist saying “…oooh, this is gonna take a least 10 treatments…”, reinforcing the persons perception that they are “in a bad way”.

This in turn leads to catastrophizing – we know from studies that we can “… successfully manipulate pain catastrophizing in positive and negative directions in both chronic pain patients and healthy volunteers and … show that these manipulations significantly influence pain levels”. So just by our words and body-language, we can alter other peoples pain state.

A classic case of catastrophizing that many a runner will be familiar with is ‘Maranoia’, where every sneeze or ache turns into a career-ending condition days before an event…

So be aware of the tricks our own brain can play on us – in both positive and negative directions, and don’t be afraid to question your health professional to clarify exactly what the treatment is setting out to achieve.

REFERENCES

Reference 1. https://books.google.co.uk/books?id=NfCDR_Yl7f0C&lpg=PA21&ots=K0nNndldOB&dq=large+pills+capsules+placebos&pg=PA21&redir_esc=y#v=onepage&q=large%20pills%20capsules%20placebos&f=false

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

The Foot/Pedal Interface

Humans are asymmetrical beings. Yet bikes & pedal systems are designed symmetrically which can create biomechanical challenges for the lower extremities of a cyclist. In this blog we will look at the most crucial, and often misunderstood, connection point on the bike: the foot/pedal interface.

On Physics Of Cycling, it is said that “At the start of the ride, the cyclist initially has chemical energy stored in his/her body as a result of the cyclist’s food intakes. This chemical energy in the cyclist is then converted to kinetic energy on the bike pedal due to the cyclist applying a downward force upon the bike pedal. As a result, the kinetic energy upon the bike pedal is transferred to the cogwheel on the bicycle’s backside via the bike chains attached to the pedal. The cogwheel begins to output motor energy onto the back bike wheel, which enables the bicycle back wheel to move in a clockwise direction.” In other words, every watt of power generated in the key cycling muscles, is transferred in to forward motion of the bike via the foot/pedal interface.

One of the most important and overlooked aspects in bike fittings is the tilt and angle of the forefoot. Studies show that 96% of all cyclists are misaligned in their connection to the bike, decreasing comfort and efficiency.  Of these cyclists, most have what is known as a Forefoot Varus (the inside of the foot tilts upward) – for runners who may have had a “gait analysis“, they will be familiar with terms such as ‘pronation’. This causes a misalignment as soon as you clip into a pedal because the pedal is flat, and solid carbon fibre. This misalignment can also lead to pain and/or numbness in the feet, with reports suggesting up to 54% of cyclists suffer from such (ref 1).

A specific tilt adjustment where the cleat/shoe meet can resolve the most common painful or numb areas of the feet. Cleat Wedges, or In-The-Shoe Wedges, are stackable to fine-tune your unique forefoot tilt, which can be measured by a professional. They are specially designed to fill the gap between the natural angle of your foot and the flat, hard pedal. This allows your foot to maintain its natural position – not change it.

This can also have dramatic effects further up the chain, as, whereas with running the foot is a slave to the hip, in cycling, the knee becomes a slave to the foot. If your foot is forcing itself flat in the solid shoe, the knee will follow. Have your cycling friends ever commented on your knees deviating in toward the frame on your rides together? Do you suffer from knee pain in the low impact sport that is bike riding?

And its not all about wedging the foot; the fore-aft (front-back) position of the cleat, the width of the spindle, the medial-lateral (left-right) position and the rotation (or float) of the cleat will all have dramatic effects on where both the foot and the knee will travel in each single revolution – of thousands at a time.

If you are suffering from foot or knee issues on the bike, or would like to know more about increasing your efficiency, more information can be found here.

REFERENCES

  1. Journal of Science and Cycling 2012; 1(2): 28-34

Leg Length Discrepancies…

Leg length discrepancy (LLD) is a measurement that is taken by many rehabilitation professionals when patients present with various conditions. Its something that a lot of people locally to myself present with as a previous diagnosis, their symptoms ranging from plantar fasciitis to headaches. However, I think its fair to critically appraise the research, and ask ourselves if these inequalities are truly associated with all these symptoms and, if so, how much of a discrepancy must exist before we see problems?

Firstly, here are a couple of classifications of LLDs

Anatomical or true leg-length discrepancies (which I think of as “mechanical” difference) are when there are actual measurable skeletal differences in the shape and length of the leg bones, such as the femur, tibia and fibula. These can only truly be confirmed by scanning.

Functional or apparent leg length discrepancies are where there are no bony differences and the legs are technically the same length, instead its other conditions such as spinal scoliosis, pelvic asymmetries or muscular imbalances that create the appearance of one leg to act longer or shorter than the other.

There are numerous ways to measure leg length; and unfortunately, they are all pretty unreliable if the LLD is less than 1cm. (Ref 1). And according to the review study below (Ref 2), which examined studies on LLD over a 25 year period, LLD was found to exist in 90% of the population. In fact, on average most of us have a LLD of 5.2 mm (0.5cm) and suffer no negative consequences.

Reading on, seven studies in the review compared asymptomatic (no pain) individuals with people who had symptoms somewhere in the kinetic chain (knee, hip, and low back) and found that there was no statistically significant difference in leg length (5.1 mm versus 5.2 mm). These results suggest that average LLD is not correlated with painful lower limb issues, the most proximal position to the any fitted orthotic, for example….

Which leads us onto orthoses; again, I come across a huge number of people who have been fitted orthotics, for a wide range of symptoms, and have had them in their shoes for a number of years. Orthotics, also called orthoses, are devices that are worn to “correct” foot and ankle problems without surgery. Most people think of shoe inserts or “arch supports” when they hear the word orthotics, but they can include devices such as foot pads, shoe inserts, ankle braces and similar items. They should – in my humble opinion – only ever be fitted by a trained podiatrist. I am a huge fan of the work of Ian Griffiths, Sports Podiatrist who says “Orthoses are rarely, or seldom, going to be a life sentence….Orthoses change the load in our tissues; rather than thinking of Orthoses as an external crutch, or brace, which they are not; as something which realigns the skeleton, which they don’t…they are another way of managing load…When that tissue is built up to have the appropriate and the requisite strength, conditioning, endurance capacity; that Orthoses is now redundant and should be removed(Ref 3)

So, when might a LLD matter? Well, it appears that a LLD of >20 mm (2cm) may be associated with the development of knee osteoarthritis and/or low back pain. A LLD <20 mm can usually be compensated for by passive structural changes.

So, are your legs the same length? Probably not.
Is that the cause of your pains? Probably not

As always, when in doubt, seek out a trained therapist. 

REFRENCES

  1. Interexaminer reliability of supine leg checks for discriminating leg-length inequality. https://www.ncbi.nlm.nih.gov/pubmed/21621725
  2. Knutson GA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Chiropr Osteopat. 2005.”
  3. https://youtu.be/FmohVPOODac

“My Joints Ache More In The Cold!”

Often heard, but is this true? Many people can correlate their pain getting worse with the weather being cold, but why is this, and is there any causal reasoning for it? Can we actually “feel it in our bones”?

This study concluded that “data supports the belief held by many osteoarthritic patients that changing weather patterns influence their pain severity.”. Again, this talks about the belief that weather effects pain, more than a robust reasoning.

The most common reasoning is to do with Barometric Pressure. Barometric pressure is the weight of the atmosphere surrounding us. If we imagine the tissues surrounding the joints to be like a balloon, high barometric pressure that pushes against the body from the outside will stop the tissues from expanding. If however, barometric pressure drops – before bad weather sets in, for example – this lower air pressure pushes less against the body, allowing the tissues to expand – and these expanded tissues can put pressure on the joint and nervous system, causing pain! This is similar to our legs swelling on a long-haul flight, again associated with the drop in pressure.

This is all very hypothetical, and research is very much in the “we don’t know” area – however consistent grandmas knee seems to be!

Cloudy With A Chance Of Pain is the world’s first smartphone-based study to investigate the association between weather and chronic pain. Data collection for the site began in January 2016 and ended in April 2017. They are now analysing more than five million pieces of symptom data submitted over 15 months alongside comprehensive weather data from across the UK. It will be interesting to see their results, due in Spring 2018!

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

 

Are you Ski Fit?

During the winter months, a weekly occurrence in clinic will be someone booking an appointment either due to a last-minute injury, or more often a last-minute concern, before heading off on their winter ski/snowboard holiday.

As is the way with a lot of endurance based sports, a lot of ski-injuries can be traced back to the onset of fatigue. We tire – we lose focus (or ‘form’). Specific training can help reduce your chance of getting injuries whilst away, but they can also be used pre-emptively, to try and ensure that you enjoy your time away by limiting the aches and niggles that can sometimes plague winter breaks.

Of course, it makes sense to concentrate on improving our aerobic capacity before we leave, which means getting out of breath a few times a week. This is particularly important for skiing due to most resorts – naturally – being at altitude where air is thinner. It would generally be recommend that you give yourself a good 8-12 weeks pre holiday to get yourself ski-fit, but even if you fall within that window, it is still recommended that you utilise your time wisely.

If we want to avoid as best as possible those burning thighs on that long red run home and tired aching muscles the next day, we need to work on our leg strength – specifically our quadriceps (thighs), the gluteal muscles (backside) and calves. Core muscles shouldn’t be neglected either, but I find these to be best worked as compound exercises rather than in isolation. Stance – or balance – is important whether you are skiing or boarding, which is why I, generally speaking, like single leg work.

Below are a few exercises that may be useful if you are heading to the slopes soon; they all focus on strength, core, balance and posture, all key when trying to avoid injury when skiing or snowboarding.

For more information, or specific advice pre-ski, 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.

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

Some (inconvenient) Truths About Backs

Back pain can be debilitating, limiting and above all scary. However, this doesn’t mean that we should become completely reliant on our chosen healthcare professional…

Some facts:

– 80% of the population will suffer back pain at some point. 85% of these cases will not have any specific cause. (Ref 1)
– Your back is extremely STRONG and ROBUST, and is designed to cope with bending and lifting.
– Segments of you back DO NOT go in and out of place and DO NOT need realigning over a long running, costly series of treatments.
Core (in)Stability IS NOT a reliable predictor (or cause) of back pain. (Ref 2)
– Scans are rarely needed, and are only PART of the bigger picture. Discs age, they can bulge, they sometimes herniate, but they never slip. Research shows time and time again that the % of “abnormal” findings on Lumbar Spine (lower back) in MRI & CT images in PAIN FREE subjects in 30-40 year olds shows 40% had Disc Bulge. Pain is NOT THE SAME as damage. (Ref 3)
– Nearly all of us have worn joints – it is a NATURAL caressing of time. Worn joints do not correlate with painful joints.
– Pain relies on CONTEXT; social, psychological, biomechanical. Fear and apprehension can be as harmful as the physical condition. Nocebic, fear-mongering, harmful language by therapists can contribute to this.

However –

– None of these mean that your recovery can not be AIDED, and sped up. But none of them point towards treatments lasting months, or longer. Often long-term treatment plans go hand in hand with harmful, nocebic words, either intentionally or unintentionally.
– Treatment alone, without patient input and education, can cause over-reliance on the therapist, and lack of SELF-MANAGEMENT.

The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. Their advice for Non-specific low back pain and sciatica management” includes (Ref 4);

Do;

  • Consider a group exercise programme for people with a specific episode or flare-up of non-specific low back pain with or without sciatica. Take people’s specific needs, preferences and capabilities into account when choosing the type of exercise.
  • Consider manipulation, mobilisation or soft tissue techniques (for example, massage) for managing non-specific low back pain with or without sciatica, but only as part of multi-modal treatment packages.
  • Consider a combined physical and psychological programme (preferably in a group context, that takes into account a person’s specific needs and capabilities) for people with persistent non-specific low back pain

As importantly, the recommended do not’s include; belts or corsets, foot orthotics, traction, acupuncture, ultrasound, routinely offered opioids, or spinal injections for managing non-specific low back pain and sciatica.

So try not to panic when your back “goes” – it will “come back”, and you shouldn’t be left bankrupt because of it. As always, if you are in doubt, seek professional advice.

DOWNLOAD MY FREE E-BOOK, A 34 PAGE GUIDE TO WHAT PAIN IS, HOW IT WORKS, AND WHAT YOU CAN DO ABOUT IT!

RIGHT CLICK ON THIS LINK, AND SAVE TO READ AT YOUR LEISURE –  Why, Pain

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

REFERENCES

  1. Deyo & Weinstein, 2001
  2. http://www.ncbi.nlm.nih.gov/pubmed/18187614
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/
  4. https://www.nice.org.uk/guidance/ng59/documents/short-version-of-draft-guideline

Things I Learnt From Disney Songs

My wife and I have two young daughters. So I know my Disney films. And you don’t drive from A to B in your car with two young daughters without listening to Disney songs. Doesn’t matter if you’re in the car for less time than it takes to find the “right” one. Also doesn’t matter if said daughters know the name of the “right” song; to them, a lyric will often suffice. And if you don’t know the lyric that they mean… 😮

So yeah, I also know my Disney songs. Here are some things they have taught me;

“You’ll learn things you never knew you never knew” Colours of the Wind, Pocahontas

Early in my journey (how X-Factor) to retrain as an injury treating chap, I “knew” everything. I signed up for courses, I studied hard, I dedicated hours learning the recommended texts, and I passed the tests. But soon after my first qualification, out in the real world, trying to positively effect peoples lives, seeing the results (good and bad) I began questioning. Why is what I have been taught the way? Is what I’ve been taught the way? So I read more. I worked harder. I placed myself in uncomfortable discussion and situation. I ensured I found myself in rooms with people infinitely smarter than myself. I started questioning everything. I learnt things I didn’t know I didn’t know. And now, I see this as the single most important part of my progress; critical thinking. And today, I “know” – for sure – less and less. But I see this as a good thing. It taught me of the perils of confirmation bias; of seeing what you always see, because that’s what you always see. If you only converse with people that see the world exactly as you see it, or work with people that you have trained yourself, then your window of vision narrows. In my previous career, I always found it hard to work with people who struggled to admit “I didn’t know that”, as if it were some kind of weakness. Being challenged is a good thing, it has to be, and I encourage this in my clinic. Ask me why this is your treatment. Ask me what these exercises will do for you. Ask me why I think how I think.

Nothing grows in a comfort zone.

Pocahontas knew.

“Finding you can change, Learning you were wrong”, Beauty and the Beast, Beauty and the Beast

In similar vein, a hugely important process I went through was that admission of not knowing everything, and actually, admitting to myself that some of what I thought I knew was wrong. No one knows everything. How could they? I look back at those initial treatments I carried out and some make me cringe. Not because they were bad treatments necessarily, but because they were the wrong treatment, for the right person. Because what I thought was right, I now don’t. And I can hold my hands up to that. Everything in life is a lesson; good, bad, indifferent. Now, no-one likes being told, or finding out, they are wrong, and the transition was hard. I wanted to believe that the skills I had been taught were beneficial, that they were helping people, and this is one of my bugbears with my profession today. People pay huge amounts of money to do courses, so naturally do not want to know that what is taught may not be exactly evidence based. But that certificate does not give us carte blanche to do as we please; we still have an ethical responsibility to follow the evidence, to stay current with the evidence, and to be able to justify what we do. These things outweigh the cost of a course.

The weight of evidence, and my own clinical experiences, showed me that I simply couldn’t justify some of the things I had been taught. Don’t get me wrong, they are still taught on courses up and down the country, and they will still be carried out in clinics everywhere. I just chose a different path, I guess.

No-one learns from getting it right all the time…

“Birds don’t just fly. They fall down and get up; Nobody learns without getting it wrong” Try Everything, Zootropia

…what a link! Ok, this is one for the Disney completists, but it is the current favourite in the Clayton car, and so definitely counts. A message we could all learn from. Its ok to be wrong. Its ok to make new mistakes, as long as we try to limit making the same mistakes. I am often told that my clinical approach is different from many have experienced elsewhere, as I put a lot of emphasis on self-management, empowerment and education. This comes at a risk, because we know that a lot of information given out on clinic can be misunderstood or in some cases, instantly forgotten. So I always tell people its ok to make mistakes, to try slightly different things, but to stay focussed, and positive, on the outcome. Recovery is never a linear road, and there are often bumps along the way. As long as we get back up when we ‘fall’, this is ok. And this is also true of my profession; I recently read an article that suggested that the average career span in my profession is less than 1 year. You read that correct. LESS than ONE year! Now, I have my own opinions on why exactly this might be – opinions which are long and varied and probably not popular – but one thing I think we all need, in all walks of life, is perseverance. Of course I am very proud of my clinic now, but it wasn’t a case of qualifying on Sunday and being fully booked on Monday. I started with one, non-paying, client. I thought about giving up more times than I (and my incredibly supportive wife) can remember. As Richard Branson says, “it take years to become an overnight success”.

I love my girls singing this one on the way to school. Strong lyrics.

“The call isn’t out there at all; its inside me”, I Am Moana (Song of the Ancestors), Moana

Recently Bath Half Marathon was in the headlines for all the wrong reasons. The organisers had ordered circa 12,000 medals, but 12,700+ finished, meaning a lot of unhappy runners wanting their well deserved bling. And it got me thinking; would I have been upset? Why do I run? I’m certainly not a competitive runner, so its not the winning. I’m not particularly unhealthy, so its not health related. I enjoy running on my own, so its not the social aspect. And I’m not a medal collector, so its not the medal. I should say, all of the above reasons are great reasons. But, for me, its an intrinsic drive to push myself. I come from a 25 year competitive sport background, and it becomes who you are.I want to run a little further. A little harder. A little faster, even (I know, we’re not allowed to admit this last one…). Its like an internal alarm clock that nudges me if I haven’t been running for a few days.

And its the same professionally. Why do I lie on bed reading about medical conditions that I may see in clinic once a year (once in a lifetime, some of them)? Why don’t I put up every certificate I have? Do I even tell people what I have recently qualified in? I have a theory that we all suffer a little bit of Imposter Syndrome – an intrinsic need to always prove oneself, and improve oneself? I’ll always want to be better at what I do. The day I don’t, is the day I’ll shut up shop and hang up my running trainers.

“Hakuna Matata”, Hakuna Matata, The Lion King

“It means no worries, for the rest of your days”. I literally didn’t know that.

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

 

 

Tennis Elbow

Following on from my blog on Golfers Elbow, Tennis Elbow (TE) is another common cause of elbow pain affecting the opposite, outer side of the elbow, and the official term for this one is Lateral Epicondylitis. So;

Lateral = Farther from the midline, referring to the body

Epicondyle = a rounded bony prominence

itis = inflammation

TE may cause pain to radiate down the forearm, and in some cases, cause pins and needles in the hands and fingers. Similar to Golfers Elbow, Tennis Elbow does not just afflict the tennis players it is associated with. It in fact affects about 3% of the population and I see it most often as an occupational condition, with sufferers often manual workers, but also in gym-goers and weight lifters. It is equally common in men and women, peaking between the ages of 30 and 50.

Ordinarily, TW usually begins as inflammation of the tendons of the forearm as they attach to the humerus (upper arm) bone, just above the elbow joint. This inflammation is usually caused by  gripping activities such as hammering, screw-driving, drilling, weight lifting, digging in the garden, driving and – naturally – racquet sports. In advanced conditions, simple activities such as gripping a door handle or opening a jar can be excruciating.

NB: It is important to remember that pain in the elbow region can be a referred problem from the neck or shoulders, and these should be examined in order to eliminate them before a diagnosis of Tennis Elbow is made.

The first thing to do with any acute injury is the P.O.L.I.C.E procedure, to enable some level of pain management. As with GE,  we need to assess exactly which of the soft tissues are the guilty suspects; to loosen any excessively tight areas, and ease the load of overworked muscles which may mean (short-term) amendment of offending activity. There may also be a need to correct any potential  biomechanical issue creating a problem, which will often include a graded and relevant strengthening programme. As TE is a tendinous condition, an isometric (static) programme is usually an initial approach (Ref 1), followed by a specific eccentric (lengthening) programme (Ref 2).

REFERENCES

Ref 1 https://www.ncbi.nlm.nih.gov/pubmed/25262525

Ref 2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971639/

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

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