Hove Physio are the experts! - Proximal Hamstring Tendinopathy

Here at Hove Physio we pride ourselves on being experts in the field of tendon injuries and rehabilitation. We work tirelessly to keep ourselves at the forefront of the latest evidence based research findings. This enables us to give our patients the best possible advice at each stage of recovery and to optimise their rehab throughout.

Our patients are in the lucky position to have access to one of the UK's leading physiotherapists in Tendinopathy. Tom Goom aka 'The Running Physio' lectures across the UK and internationally, sharing his vast knowledge with other physiotherapists and health professionals. Tom has recently published a research article on Proximal Hamstring Tendinopathy. He worked closely with other world leaders in the area of tendon rehab to bring us a comprehensive rehab protocol for this challenging injury.

Tom has also written for Runner's World, Running Fitness, Cycling Weekly and a host of online sports websites. Along side Tom's work in research we get to see him apply his knowledge daily in clinic. He was recently asked to provide a specialist consulting service with the current world 10,000m and 5,000m world record holder Kenenisa Bekele. Tom sees a variety of sports men and women of all levels from novice runners to elite athletes who compete internationally.

As Clinical Lead at Hove Physio Tom shares his knowledge with the rest of team during our regular CPD sessions in order to provide the best possible service and help each patient recover as quickly as possible.

If you have a tendon injury and you would like our expert advice to help you recover then please get in touch today on 01273 667826 or email admin@hovephysio.com.

Hove Physio are the bees knees at taping!

Kinesiology tape and sports tape is a thin, stretchy, elastic cotton strip with an acrylic adhesive and it is almost identical to human skin in both thickness and elasticity. In this article we discus the methods used in taping. There is a vast array of taping methods available today, of which many can be used for problems with different anatomical locations. The exact application of each technique may be different depending on the reasoning process of the person who applied the tape. Because of the scant scientific evidence on this area and because each individual is different, there is no truly 'correct' method of applying tape, as each patient has a different problem.

If the tape is being applied by a chartered Physiotherapist then a thorough examination of the problem would have been undertaken, with the clinician then applying the tape with the aim of limiting unwanted movement at a joint or offloading specific anatomical structures where a weakness has been identified. Because there are a huge number of structures that could require support there is no single definitive taping technique. Therefore working with a Physiotherapist who can accurately diagnose and identify structures that might be a potential source of pain is key. Appropriate taping techniques can only be applied with this knowledge.

Literature describes taping in the treatment and prevention of several musculoskeletal conditions such as ankle sprains, patellofemoral pain, wrist sprains and shoulder injuries. Research methods include randomised controlled trials, retrospective and prospective cohort studies, biomechanical lab base studies and correlational epidemiological studies. The scientific evidence for the effectiveness of taping for these problems is mixed, but the clinical use of taping techniques is widespread. The ankle is the most commonly taped joint in football.

The type of taping technique and the choice of material used is largely based on the athletes preference, with this decision largely based on custom, superstition and comfort (both physical and mental). Ankle tape is also appropriate following acute ankle sprain. As well as immobilisation, a compression bandage can help to limit swelling. In the recent study by Barton et al 2105 BJSM physiotherapists advocated taping as a major component of the management of anterior knee pain. It was found that a combination of taping, manual therapy, appropriate exercise prescription, gait analysis had the most improved results for patients with anterior knee pain.

Here at the Physio Rooms we follow all methods of taping and where necessary are advocates of its usage. If you have any questions on taping or are experiencing a pain which could be alleviated by taping then please dont hesitate to contact us on 01273 667826 and we would be happy to share our knowledge.

Has an Anterior Cruciate Ligament injury brought you to your knees? - a very common knee injury discussed

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The anterior cruciate ligament (ACL) is a strong ligament which runs diagonally through the middle of the knee. It prevents the femur (thigh bone) from sliding out in front of the tibia (shin bone) and gives rotational stability to the knee.

The ACL is one of the most common knee injuries that occur in sport. Most ACL injuries occur during non-contact running, jumping, and landing tasks with inadequate neuromuscular control of the lower limb. That is when you slow down very quickly, change direction rapidly, or land incorrectly from a jump. This is commonly due to decreased knee flexion (knee bend), increased knee valgus (knee collapsing in), and internal rotation at the hip during landing and cutting movements. It can also happen through direct contact or collisions such as a football tackle.

Horsley (2015) outlines the risk factors that influence the alignment through the lower limb:

Weak muscles: gluteals, quadriceps, foot supinators

Over recruitment: hamstrings, hip adductors, trunk flexors

Decreased proprioception (joint position sense)

Reduced dorsiflexion of the ankle

Reduced tibial internal rotation

Usually you will know if you have injured your ACL as you may hear a ‘popping’ sensation in the knee. You may also feel the knee ‘give way.’ There is often severe pain and inability to continue with sporting activity, the patient is often unable to weight bear. Swelling begins quite quickly within a few hours as the ACL has an abundant blood supply.

There are different severities of ACL tear ranging from a grade one tear (the ligament is mildly damaged but is still able to keep the knee joint stable) to a grade three tear (the ligament has been snapped in two and the knee joint is unstable).

Treatment for an ACL tear will depend on the severity of the damage to the ligament and the patient’s individual needs. For example the young athlete involved in agility sports will most likely require surgery to return safely to sports, versus the less active individual that could be managed with non-surgical intervention.

Surgical treatment involves removing the ACL and replacing it with a graft (often a section from the patella tendon or hamstring) which is then screwed in from the femur to the tibia to replicate a new ligament. Rehabilitation from surgery is vital for return to sports and daily activity. A physical therapy programme will focus on regaining knee strength, movement, and stability. It usually takes 6 months to a year to make a full recovery from ACL reconstruction; however this is very dependent on the individual and how closely you follow the programme and advice from your therapist.

If you are suffering with knee pain or want to know more about the treatment for ACL injuries please get in touch with one of our highly trained Physiotherapists or contact us on 01273 667826 at one of our clinics.

The fustration of sport injuries - A tennis case study with Keelan Oakley

It is the peak of the tennis season, the French Open finals have been played and Wimbledon is round the corner - now is the perfect time to highlight some of the work we do with some of Sussex's top ranked tennis players. With that in mind we asked long time college and ITF professional tennis player Keelan Oakley to share his experiences working with Hove Physio team. Keelan is an ITF professional tennis player, with a career high ranking of 997. He currently tours the ITF circuit playing challenger events across Germany, Egypt, Cyprus, Great Britain and many other international venues. Keelan is coached by Barry Fulcher (@BF_Tentrade) out of Preston Lawn Tennis Club who has recently achieved number 1 ranking in men's over 35 tennis. Keelan also works closely with Brendan Hayes (@theconditioning) and has a long term working relationship with the Hove Physio team, namely clinical lead Tom Goom.

In Keelan's own words...

"Throughout the 2102 season I struggled with low back pain. This pain gradually got worse with symptoms spreading to my left leg. By the end of the year I was having difficulty walking. After a MRI it was discovered that I had severe intervertebral disc damage that would require surgery. In Feb 2013 I had back surgery on a disc bulge L4/L5, the surgeon predicted it would be a few months or so at least before I would be back on court even to do the absolute basics of hitting for a light hour with minimum movement.

At that time I was having physio twice a week and we managed to halve the recovery time and I was back on court in about 4/5 weeks. This was great as I was able to prepare well for a summer of competing and I reached a career high ranking of 997 ATP in the next 6 months.

Unfortunately I had another flare up at a tournament in Cyprus. It didn't require surgery but I was out for another 9 months. During the 9 months I had physio once a week and could do some really limited stuff on court and bits in the gym. Tom had the idea of getting my 'team' together (physio Tom, Fitness trainer Brendan, coach Barry) so we could all discuss the best way of getting me back on court as soon as possible.

This really helped speed up my recovery as everybody was working towards the same goals, we covered everything from what Tom and Brendan would be doing with me (a lot of hamstring work!!) and a detailed breaking down of my footwork and technique to find a way to prevent a complete blow out whilst in competition. This involved extensive video analysis of my technique. Going back to basics with footwork drills and agility. We built strength and control through gym sessions.

On court we worked endlessly to build new movement patterns, it really felt like I was learning to play tennis all over again which in essence is what we were trying to achieve to prevent further break downs. We would (and still do) meet every 2/3 months to keep on top of my programme and see if there are any ways we can improve it and so far so good! A few exercises from Tom and a massage once a week, enjoying IP sessions a lot more than rehab!!"

If you are suffering with a sports injury and getting frustrated missing out on the activity you love, then Hove Physio are here to help. For any advice or to book an appointment please contact us at one of our clinics.

How's your posture? Dont' suffer in silence with neck pain

Our lifestyles have changed dramatically in the past thirty to forty years. We are spending more and more time sitting down at computers or mobile devices, watching television and driving and this means we are seeing neck pain becoming increasingly more common. Neck pain has now joined lower back pain as one of the two most common pain locations in the body. Acute neck pain (pain that manifests abruptly) generally has little to do with this change in our society, but can be caused by sudden jerky movements of the head and neck, or by trauma injuries from sporting accidents and falls.

Whiplash occurs when the head is suddenly moved backwards and forwards, causing the muscles and ligaments of the neck to strain and in some cases tear. Whiplash is commonly experienced in rear-end car collisions and can produce pain and aching to the neck and back, referred pain to the shoulders and often headaches.

Simple neck pain implies pain that arises due to relatively minor problems with the muscles, ligaments joints and nervous systems of the neck. Simple neck pain can come on after a minor injury or sprain but in many cases no injury can be identified. It can arise after something as simple as sleeping badly in bed at night. This type of pain comes about because the sprained tissue becomes irritated and sometimes inflamed which causes pain signals to be sent to the spinal cord.

However, most neck pain that is not caused by whiplash or trauma and has a postural component as part of the underlying problem. Sitting in front of a computer for long periods with static seating frequently leads to muscular, joint and neural pain in the neck, back and shoulders.

It is estimated that 45% of the working population is affected by neck pain. Therefore it is very important to understand the different aspects of poor posture that contribute to this type of pain in order to prevent and manage it.

A common cause of postural neck pain is the forward head and shoulder posture. This occurs when the neck slants forward, placing the head in front of the shoulders (this can be observed while working at a computer, laptop, ipad, iphone etc.) This position places undue stress on the vertebrae of the lower neck. The muscles of the upper back are also continually overworked to counter-balance the pull of gravity on the forward head. Forward shoulders and a rounded upper back with increased extension of the cervical spine often accompanies this position. This leads to very tight pectoral muscles and causes a lot of tension between the shoulders as well as contributing to the neck pain.

Physiotherapy assessment and treatments such as manual therapies, massage and stretching can help ease symptoms. Postural re-education is key. A patient specific exercise program to help mobilise and strengthen the back, neck and shoulders in order to pull the shoulders back into a neutral position, can alleviate some of this tension and pain. Stretching before and at intervals during the working day can also do wonders for tight, tired muscles.

Another way to minimise the risk of developing postural neck pain, or to manage it if you already suffer from it, is to adjust your workspace around you so that you can work comfortably.

Desk

• Most desks have a fixed height; therefore it is important to ensure you have an adjustable height chair so that your arms can operate the keyboard comfortably

Chair

• Always sit as far back as possible in the seat so that your lower back is well supported

• The back of the chair should be high to support the middle back

• Your chair height should let you type with your forearms placed horizontally on the keyboard

• Try to keep your feet flat on the ground, if your feet dangle off the ground when you’re sitting fully back in the chair, using a foot rest is a good idea

Keyboard

• Pull up close to your keyboard

• Position it directly in front of your body

• Wrist rests can help maintain a neutral wrist position when you are taking a break from typing but are not recommended for use during typing as typing in this position may cause carpal syndrome in the wrist

If you are suffering with neck, shoulder or upper back pain please get in touch with one of our highly trained Physiotherapists or contact us on 01273 667826 at one of our clinics.

Pilates - the secret weapon to success at the RBS 6 Nations Rugby Championship

As we are well into the excitement of the RBS 6 nations, you can see the gruelling nature of the sport and how these athletes need to do more than just strength and conditioning to stay injury free and match fit. Georgie our Pilates Teacher talks about her experiences with the sport. "I’ve been working with Harlequins Rugby team for the last 18 months doing one to one Pilates on the reformer with the players. The reformer is a versatile piece of Pilates equipment that has springs which you add for resistance. It is used to strengthen the core, work the body uniformly, and increase flexibility and mobility.

There are many professional rugby clubs that have also jumped on the band waggon of Pilates and have it as an integral part of the players fitness program. At Harlequins we have key players that are on my list for a session each week; those that are slightly older and really benefit from the mobility side of the session, key players that are in the starting 15 that the coaches want match fit week on week out, and those that have long term injuries that really benefit from the low impact and specific rehab strengthening exercises.

Pilates offers a completely different element to the rugby players overall program. It gets the players away from the high level, high impact muscle activation used at the gym or in their fitness session, and gets them tapping into a new side of training their bodies working more holistically, and at a lower level to reintroduce neuromuscular training patterns and activating weakened areas from injury back to where they should be. As you tend to feel so good after coming away from a session on the reformer you can imagine how popular Pilates has become at the club."

So for those of you out there unsure or nervous to give it a go the Pilates Reformer is a truly versatile piece of equipment for any age and gender and after a few sessions you’ll be hooked! As if you need convincing here is a few words from Danny Care who plays for England and is the Captain of Harlequins Rugby Team:

"Georgie has been vital for me in ensuring I am fit and ready to go for every training session and more importantly every match. I often turn up to training sore with a tight back but with Georgie's help and guidance through Pilates she ensures I am in great shape to train. She is incredibly professional and a joy to work with."

To find out more about Pilates please contact Georgie our Pilates Teacher. Alternatively for any help or advice or to book an appointment please contact us at one of our clinics.

Have I got Sciatica? - this complicated diagnosis in detail

Sometimes back pain causes pain in the legs which doctors often refer to as ‘Sciatica’ because the sciatic nerve, which runs down the back of the leg, is most commonly involved. Pain can actually be felt in the buttock, back of the thigh, calf or into the foot. There is nothing wrong with the leg itself, but the pain is caused from an injury on the spine irritating the nerve. These symptoms are often described as referred pain. You may also experience numbness or pins and needles in the legs and feet. Do I have Sciatica?

Your physiotherapist can perform certain clinical tests to give an indication as to whether symptoms in your leg are coming from your back (referred pain) and whether the is nerve root irritation (radiculopathy /radicular pain) which along with your clinical history might also point to a more specific problem. If your physiotherapist thinks there is a specific structural problem they may refer to your doctor accordingly, but this is very rare.

Why am I getting pain?

Sciatica 1

Your back is made up of 24 bones known as vertebra sitting one on top of the other. Where each vertebra meets another 3 joints are formed that include: 2 bony (facet) joints at the back and a soft inter-vertebral joint formed by the discs at the front of the spine. The discs act as shock absorbers and the facet joints control movement of the spine. At each joint there are also ligaments and muscles that attach to the vertebrae to control and assist the movement of the spine.

Sciatica 2

Sciatica 3

What can help?

Physiotherapy!

A physiotherapy assessment can identify reasons why your pain is persisting and ease your pain. Your physiotherapist may choose to perform massage, spinal mobilisation or manipulationand show you some pain relieving exercises. Whether you have stiffness, weakness or instability, these exercises and treatments will help you return to your normal activities sooner. You may also gain a better understanding of what causes your pain and how to prevent the frequency of future episodes and manage them independently, if they do occur. If you find symptoms are persisting and you are not returning to normal activities, to reduce pain and improve your function your physiotherapist may develop more specific conditioning exercises for you based on your presentation.

Medication

Over-the-counter pain medication like paracetamol and ibuprofen are very effective for initial pain symptoms. Don’t wait until you have severe pain before you take pain medication. If the pain is limiting your ability to move and exercise it could also affect the time it takes for you to recover. If you have any other medical conditions you should always consult your doctor before taking any pain medication.

Exercise

Your physiotherapist can also guide you on the most effective way to ease stiffness and pain. Exercise is important as your pain eases for improving muscular control, strength and stamina, general fitness, flexibility and improving your mood. If pain persists, the lack of normal movement can cause muscle to become idle and make it more likely that you could reinjure your back again in the future. So it’s important that you don’t rest for too long and you do as many of your normal activities as possible. If you are in so much pain that you need prolonged bed rest try to make sure that you gently move your back as pain will allow.

Do I need to see the doctor?

If you are in severe pain or prolonged pain that doesn’t resolve after 4-6 weeks then you may need to see a doctor. Also if you notice weakness of the muscles in your leg, especially if you can’t pull your foot up towards you, you should see a doctor. You should also seek medical advice immediately if you lose control of your bladder or bowel function or you have numbness or pins and needles in both legs.

(Sources are available on request)

If you are suffering from any of these symptoms or you think you might have Sciatica please get in touch with Guy one of our senior, highly trained Physiotherapists or contact us on 01273 667826 at one of our clinics.

Combat fitness is more than just boxing - learn how Underground Gym do it

We are proud to have our Portslade Clinic inside Underground Gym, a performance led gym. They have very unique facilities and offer combat classes which are showing an increase in their popularity worldwide. Read on to see what they have to offer: "We are proud to say that Underground Gym is not only Brighton's largest Strength and Functional Gym but also the home for some of the South Coast’s finest combat instructors who will make you feel welcome from the moment you walk onto the mats. At Underground Gym we cater for all levels of ability. In the first session you will be shown correct techniques and how to progress further within your chosen class. If you find training by yourself a chore, a Combat class could be for you. Research shows that people who train in a class environment actually reach their goals quicker than regular Gym users. We put this down to making fitness fun, and at the Underground Gym we have a real mix of members who all help push each other in every session.

Come and learn a new skill, meet friends, have fun, and burn a truckload of calories in Brighton's premier fitness facility."

Meet the Instructors and their classes:

John Hathaway – MMA

Taught by UFC fighter John ‘The Hitman’ Hathaway. John breaks down what has given him a 6-1 record in the UFC and a 17-2 record overall – Johns focuses on Wrestling, Submissions and Ground & Pound.

Jack Magee - Submission Grappling

This class is taught by BJJ Black Belt Jack Magee who combines the exercises and drills used by professional fighters and blends them into a fun session that will give you great confidence in ground fighting.

Danny Zaharan - K1 - Kickboxing

Danny’s class involves low kicks, knees, and involves a strong Muay Thai Boxing influence. This is great class for anyone who wants learn the art of stand up fighting.

We are very pleased to be joining in with Underground Gym's charity open day on 20 and 21 February 2016, we will be available for Free Physiotherapy Drop Ins on the Saturday.  These short sessions are free of charge and a great opportunity to discuss any aches or pains that you are experiencing. We will then be able to advise what would work best for you; maybe some hands on treatment, or an exercise prescription to get you out of your current injury. If you've had a niggle that you have been trying to ignore here is a chance to get it looked at!  So if you are interested in checking out Underground Gym pop along on the open day and enter your name into our prize draw where you could win yourselves a free sports massage with one of the team!

Training tips for Marathon & Half Marathon runners – including our injury prevention cheat sheet

Our top tips for marathon and half marathon training:

1. Avoid training error – 80% of all running injuries are caused by training error.  At The Physio Rooms we encounter this on a daily basis. Some simple guidelines to follow are: make sure increases in training volume are GRADUAL.  A 10% increase in total mileage per week is best. Mix intensities – 80% low intensity running to 20% high intensity hill work or sprints. Your long slow runs must be slow, the plan with these runs is to build endurance, it’s about time on your feet not the speed at which you run. Implement a step up step back training program. This involves increasing mileage for three weeks and decreasing on the fourth week. Plan each run, they should have a different objective to ensure variety in your weekly training schedule.

2. Strengthen and conditioning – a recent study has shown that implementing a basic strengthen and condition program decreased injures in runners up to 50%. Strengthening the body’s muscles and tendons enables us to cope with the stress and loads of endurance running better. At The Physio Rooms we have also noticed that our athletes who follow our strengthen and condition programs see big improvements in overall performance with many achieving personal bests in their events.

3. Running shoes and equipment – some recent trends have suggested that using a minimal shoe and running on the forefoot works best. As a general population almost 98% of us naturally heal strike. At The Physio Rooms we have seen a big increase in the number of injuries presenting in clinic due to a sudden change in running style. The most important piece of a advice to follow when buying new running shoes is that new shoes should feel comfortable to run in. Try and spend some time running in them before you buy. Most shops have treadmills these days. We recommend Nick Rivett for all your running equipment needs.

4. Nutrition – science suggests that you should fuel your muscles and liver before your train or run the big event. Try fuelling your body with approximately 250/300 calories about 1-1.5 hours before you run. Eating too close to a run can cause cramp and not eating enough could lead to a lack of energy. A basic rule of thumb for longer runs is that we need about 100 calories after the first hour and approximately 100 calories every 45 minutes after that.

5. Hydration – pre run try to drink about 500ml of water 2 hours before and then just before approximately 150ml. During the event try and drink about 200ml every 20 minutes. It’s important to remember here that the stomach can only empty 800-1000ml of fluid every hour and running on a very full stomach can be very unpleasant.

Download our handy injury prevention cheat sheet here:

PDF version

JPG version

For any help or advice or to book an appointment please contact us at one of our clinics.

With the Australian Open Tennis Championships starting on 18 January we look at cross training during the 'off season'...

The Australian Open is fast approaching and whilst we’ve been relaxing and eating mince pies, the tennis professionals have been hard at work. The period at the end of the year is known as the off season or pre-season on the tennis pro’s calendar. This time allows the players some rest from the tennis court to recharge both physically and mentally, before getting back into training in order to be in the best shape possible for the long competition season ahead.

During the off season it is common for players to ‘cross-train’ and train in other sports to maintain and improve their fitness. Popular sports for cross-training include swimming, cycling, running and boxing, as well as continuing their strength work in the gym.

Cross-training will continue to improve important aspects of the players’ fitness such as muscular endurance, strength, agility and speed but without the repetitive movements of being on a tennis court. The off season also allows players to work on weaknesses or small details that can make a huge difference to their game.

This pre-season, the women’s world number 22, Victoria Azarenka has been focusing on correcting her footwork and agility after a long standing foot injury. These small changes may make a big difference to her speed and change of direction around the court in the approaching season.

So, as a recreational or club player how can this benefit your game? This article recognises that tennis professionals use other sports as a means of maintaining and improving their fitness which will carry over onto the tennis court. Tennis is very repetitive and adding other training such as some specific strength work in the gym can make a big difference to performance on court as well as reducing the risk of injury.

To find out more about the benefits of cross training and how this can help you on the court, please contact Kate one of our Physiotherapists.

Alternatively for any help or advice or to book an appointment please contact us at one of our clinics.

Don't forget your conditioning Marathon runners - Pilates will help; a case study using the Reformer

So you’ve signed up for a marathon; sourced a program, bought new trainers, are thinking of training soon but have you thought of your conditioning? Pilates may not be the obvious choice for runners when planning their cross training but here’s why it should be: Running is a highly repetitive movement and if there are imbalances in the body it often leads to injuries as the mileage starts to increase. For efficiency and speed, runners need to eliminate any unnecessary sideways or up and down movements. Their bodies need to be able to smoothly rotate with each stride which requires balance and mobility as well as trunk and pelvic stability. All too often many runners suffer tight hamstrings, quads and IT bands and can pick up knee, hip and lower back injuries. These muscle imbalances then create strains and tension throughout the body. Which if not looked after properly can result in having to take time off from running to strengthen the areas of weakness.

"Pilates develops the body uniformly, corrects wrong postures, restores physical vitality, invigorates the mind and elevates the spirit." - Joseph H. Pilates.

Pilates works on pelvic stability to help any unwanted collapse of the hip and improve short foot contact times on the ground. The breathing helps to teach more effective breath patterns essential for maintaining good a running pace. It is also a great source of strength training particularly on the reformer where you can do squats and lunges with resistance.

A Marathon/Reformer Case Study with Georgie our Pilates Teacher & Physiotherapist

In April 2014 Georgie completed the Brighton marathon in 3:58. Previously she would have been in the gym lifting heavy weights as part of her program, but she decided to ditch the gym and instead spend time on the Reformer and use Pilates for her cross training.

Overall how has Pilates helped and been included in your training? Pilates has been fantastic throughout my training, I have used sessions both for strength and flexibility. After the long Sunday runs it was great to jump on the studio equipment and get my body stretched out in ways I couldn’t do myself. I’ve also used the apparatus as a strength and conditioning session, creating a mini circuit with squats, lunges, upper body, and core.

Do you think Pilates has helped you limit your injury risk? Massively so! What Pilates brings to you more than anything else is body awareness. Through my Pilates practice I soon noticed where my weaknesses were and then worked hard to correct them. It meant that when a niggle came up in my knee, foot, back etc, I could focus on strengthening that area and maintain good movement to keep me on track and avoid injury.

Has Pilates helped with recovery after your training sessions? Yes hugely so. It has been invaluable knowing how to properly stretch out the body. I had kept quite a strict routine of coming home, having ice bath, and doing some gently stretches and mobility.

"You can tell the power of Pilates and its brilliance as the next day I am walking normally and not hobbling about in pain!"

To find out more about how Pilates and the Reformer can help your Marathon training and running programme please contact Georgie our Pilates Teacher.

Alternatively for any help or advice or to book an appointment please contact us at one of our clinics.

Low Back Pain - the facts

Low back pain (LBP) has a high incidence rate and will effect 20% of the adult population each year. Over 40% of people will at some stage in their lives suffer with LBP. Pain will commonly occur from the bottom of the rib cage down to the top of the buttock and gluteal region. Pain can also frequently radiate into the lower limbs. There can be several structures that can cause pain including: muscles, nerves, discs, joints, and other connective tissues.

A key issue in the treatment of low back pain is identifying the cause of the individual’s pain and implementing an appropriate management strategy. Whether it is tissue over load due to inappropriately sustained postures or acute injury due to muscle imbalance or poor lifting technique a guided treatment plan should help reduce pain and begin the road to recovery.

Here at The Physio Rooms one of our team of physiotherapists can help you with manual therapies to easy your pain and exercise prescription to help you achieve a full recovery with a ongoing management plan. Contact our Brighton Clinic to book an appointment.

The top three most common Tennis injuries

Tennis is a sport which places high demand on the body and requires players to perform technical, repetitive, high-speed movements over a prolonged period of time. The fast and repetitive movements can lead to overuse, muscle weakness and tightness and other incidents such as falls, which can all result in injury. Research would suggest that there are approximately 54 injuries for every 1000 matches played which is about half the number of injuries when compared with football. The three most common tennis injuries are:

1. Ankle Sprains

2. Shoulder pain

3. Muscle strains

Ankle Sprains

The majority of ankle sprains are caused by ‘rolling’ the ankle inwards as a result of quick movement over a short distance, with changes in direction on the tennis court. This results in the ligaments over the outside of the ankle (lateral) to overstretch or tear. Only 5-10% of ankle sprains occur to the ligaments on the inside of the ankle, as these ligaments are stronger and provide more stability than the lateral ones. Symptoms include pain over the ankle, swelling and bruising. Early rehabilitation for ankle sprains should include ankle movements, strengthening and proprioception exercises. More advanced exercises to improve the stability of the lateral ankle ligaments include single leg stand and lunges on a wobble board/cushion and lateral bounds.

Shoulder Pain

Shoulder pain in tennis players is often due to the repetitive strain placed on the joint during shots, particularly the serve. Injury to the shoulder may be due to muscle imbalance, weakness and tightness. Some common causes of shoulder pain include rotator cuff injuries, shoulder bursitis and impingement. The rotator cuff is a group of four muscles that surround the shoulder and provide it with strength and stability. These muscles are key in all of the tennis strokes, so it is important that athletes strengthen and stretch the muscles to prevent injury. The repetitive movements of tennis strokes can also cause a fluid-filled sac called a bursa to become irritated and inflamed, another cause of shoulder pain. Impingement is also a common cause of shoulder pain and is due to a pinching or aggravation of a tendon and/or bursa usually when lifting or rotating the arm, particularly during serving and high forehands.  Shoulder pain can be prevented by strengthening and stretching all the rotator cuff muscles. Exercises include external rotation, internal rotation, shoulder abduction and hand behind back with resistance band. These exercises can be easily performed with a resistance band and it is common to see professional tennis players using these exercises during their warm up on court.

Muscle Strains

Muscle strains in tennis are often injuries to the calfs, hamstrings and abdominals as a result of muscle tightness or weakness. Calf and hamstring strains usually occur after quick explosive movements around the court, whereas abdominal strains are frequently on the non-dominant side from stretching up during the serve. Muscle strains can be prevented by doing an adequate warm up and cool down, wearing appropriate clothing and gradually building up training. Some exercises to strengthen the hamstrings and calf muscle groups include squat jumps, scissor jumps, linear and lateral bounds. Isometric abdominal contractions and crunches will work to strengthen the abdominal muscles.

If you have any of the conditions above or want to avoid injury in the future why not contact us - Admin@hovephysio.com to see one our highly qualified physiotherapists for some treatment and advice.

Tennis Elbow - surprisingly not just for Tennis pros!

Tennis elbow, otherwise medically known as lateral epicondylalgia is a painful, chronic condition associated with symptoms on the lateral side of the elbow. While commonly associated with playing tennis less the 5% of sufferers do in fact play tennis. This injury is often work-related, any activity involving wrist extension, pronation or supination during manual labour, housework and hobbies are considered as important causal factors. Tennis elbow is a relatively common condition that can affect people who preform repetitive movements of the upper body such as painters, carpenters, musicians and computer and I.T. workers. Overuse of the muscles and tendons of the forearm and elbow together with repetitive gripping or manual tasks can put excess strain on the elbow tendons.

Tennis elbow sufferers will often report weakness in their grip strength or difficulty carrying objects in their hand, especially with the elbow extended. They commonly experience pain and localised tenderness over the lateral elbow.

Tennis players Approximately 40% of people who play tennis on a regular basis have reported a current or previous incidence of elbow pain. Tennis elbow is more common in individuals over 40 with 40% of players describing their symptoms as severe or debilitating.

Risk factors The risk factors for tennis players include:

1. A sudden increase in amount of playing time
2. Playing on consecutive days
3. Change in grip size
4. Change in racquet size/weight
5. Lack of appropriate strength and condition program

The risk factors for office workers include:

1. Poor positioning of keypad/desk/chair
2. Repetitive use of mouse
3. Prolonged periods of typing
4. Poor posture

Treatment

As with any injury or pain it is very important to first get a professional diagnosis. Once a tennis elbow injury has been identified a comprehensive treatment plan can help reduce recovery time. Manual therapies, exercise prescription and advice regarding posture and technique can all be helpful.

If you have elbow pain or would like any advice please feel free to contact us at our Brighton Clinic.

Gait Analysis and Running Assessments

Are you among the 66% of runners who regularly runs with niggles and pain? Are you new to running and eager to make sure that you are doing the right thing? Are you floundering trying to achieve that new personal best? Which ever one of these categories you fall into one sure fire way to help you archive your running goals in the most efficient and injury free way is to seek the advice of one of our running Physio experts. Gait analysis is a systematic procedure of analysing locomotion in humans. Gait analysis is used to assess, plan and treat individuals who have difficulty with walking or running. During your appointment we provide a detailed biomechanics assessment, we also carry out video gait analysis looking at various  factors and parameters such as stride length, stride width, cadence etc.. Following this we can provide further assessment and design a specific program including strength and conditioning to help you achieve your goals.

So whether you a trying to run with injury, trying to achieve a personal best or you are new to the world of running why not come to our Brighton clinic and meet one of our running injury physiotherapists who are all run coach qualified and experts in all areas of running.

Managing Neck Pain

Our lifestyles have changed dramatically in the past thirty to forty years. As we see ourselves spending more and more time sitting down at computers and televisions, we are also seeing neck pain becoming increasingly common throughout the world. Neck pain has now joined back pain as the two most common pain locations in the body.

Acute neck pain (pain that manifests abruptly) generally has little to do with this change in our society, but can be caused by sudden jerky movements of the head and neck, or by trauma injuries from sporting accidents and falls.

Whiplash occurs when the head is suddenly moved backwards and forwards, causing the muscles and ligaments of the neck to strain and in some cases tear. Whiplash is commonly experienced in rear-end car collisions and can produce pain and aching to the neck and back, referred pain to the shoulders, and often headaches.

Simple neck pain implies pain that arises due to relatively minor problems with the muscles, ligaments and joints of the neck. Simple neck pain can come on after a minor injury or sprain but in many cases no injury can be identified. It can arise after something as simple as sleeping badly in bed at night. This type of pain comes about because the sprained tissue becomes inflamed and causes pain signals to be sent to the spinal cord.

However, most neck pain that is not caused by whiplash or trauma has a postural component as part of the underlying problem. Sitting in front of a computer with bad seating and posture frequently leads to muscular pain in the neck, back and shoulders.

It is estimated that 45% of the working population is affected by neck pain. Therefore it is very important to understand the different aspects of poor posture that contribute to this type of pain in order to prevent and manage it.

A common cause of postural neck pain is the Forward Head and Shoulder posture. This occurs when the neck slants forward, placing the head in front of the shoulders. (This can be observed while working at a computer, laptop, ipad, iphone, T.V., driving for example.) This position places undue stress on the vertebrae of the lower neck. The muscles of the upper back are also continually overworked to counter-balance the pull of gravity on the forward head.

Forward shoulders and a rounded upper back with increased extension of the cervical spine often accompany this position is also commonly seen. This leads to very tight pectoral muscles and causes a lot of tension between the shoulders as well as contributing to the neck pain. Physiotherapy assessment to and treatments such as manual therapies, massage and stretching can help ease symptoms. Postural reeducation is key. A patient specific exercise program to help mobilize and strengthening the back, neck and shoulders in order to pull the shoulders back into a neutral position can alleviate some of this tension and pain. Stretching before and at intervals during the working day can also do wonders for tight, tired muscles.

Another way to minimise the risk of developing postural neck pain, or to manage it if you already suffer from it, is to adjust your workspace around you so that you can work comfortably.

Desk

• Most desks have a fixed height; therefore it is important to ensure you have an adjustable height chair so that your arms can operate the keyboard comfortably

Chair

• Always sit as far back as possible in the seat so that your lower back is well supported
• The back of the chair should be high to support the middle back
• Your chair height should let you type with your forearms placed horizontally on the keyboard
• Try to keep your feet flat on the ground, if your feet dangle off the ground when you’re sitting fully back in the chair, using a foot rest is a good idea

Keyboard

• Pull up close to your keyboard
• Position it directly in front of your body
• Wrist rests can help maintain a neutral wrist position when you are taking a break from typing but are not recommended for use during typing as typing in this position may cause carpal syndrome in the wrist

If you are suffering with neck, shoulder or upper back pain why not contact our Brighton physiotherapy clinic today. One of highly trained physiotherapist will be more than happy to guide you on the road to recovery.

The Five Most Common Football Injuries

With the 20th Fifa world Cup kicking off in Brazil during June, intensity levels are increasing for football players who have been working hard throughout the year. Sporting injuries however, come with the territory of the game. Football has recently become the world’s most popular sport with over 240 million registered players and even more recreational players. There are a few injury types that make up the bulk of injuries in football. Not surprisingly, 50-80% of these injuries concern the legs and feet of the players.

1. Hamstring Strain

An injury to the hamstring muscles or tendons occurs when fibres tear due to the muscles being stretched beyond their limits. A tear in the muscles is referred to as a strain and can be classified depending on severity as a first, a second, or a third degree strain. A hamstring strain usually occurs during running or high velocity movements. To prevent a tear in hamstring muscles gluteal and eccentric hamstring strengthening exercises are recommended along with adequate warm up before activity. A warm up, prior to matches and training is thought to decrease muscle injuries because as body temperature increases, muscles become more extensible and can withstand longer lengths of stretching. A specific and adequate strength and condition program has been shown to reduced this type of injury by 50%.

2. Sprained Ankle

Ankle sprains in football usually follow a typical pattern. The sole of the foot rolls under, damaging the ligaments of the outer ankle. Ankle injuries account for 40-45% of leg injuries. To prevent ankle injuries proprioceptive and balance exercises (both double and single leg) are advised. Local muscle strengthening to the ankle joint also decreases the risk of ankle sprain. When recovering from injury taping and bracing the ankle can help to reduce the risk of ankle sprains. Taping provides support for the ankles and improves stability.

3. Anterior Cruciate Ligament Injury

The anterior Cruciate ligament (ACL) is the main ligament involved in stabilising the knee. It helps prevent the tibia sliding out in front of the femur. Partial tears of the ACL are rare; most ACL injuries are complete or near complete tears. The ACL can be injured in several different ways in football, most notably by landing from a jump onto a bent knee then twisting, or landing on a knee that is over extended. Direct contact on the knee from opponents can also cause damage to the ACL. Research found that player to player contact is the leading cause of injuries in football. Treatment for an ACL tear will vary depending on the patients individual needs. For example, a football player involved in agility sports will most likely require surgery to safely return to sports. Proprioceptive and balance exercises and quadriceps and hamstring strengthening exercises are thought to be very effective in prevention of ACL injuries, as well as during rehabilitation.

4. Knee Cartilage Tear

In the knee, there are areas of cartilage tissue, which act like shock absorbers in the joint –theses are called menisci. There are two menisci within each knee joint that are made from tough fibrocartilage. The classical injury is for a footballer to twist the knee whilst the foot is still on the ground. For example, whilst dribbling round a defender. How serious the injury is depends on how much of the meniscus is torn and the exact site of the tear.

Having strong quadriceps and hamstring muscles that can deal with the strain on the knee may be helpful in preventing knee cartilage tears. Small cartilage tears may settle with physiotherapy treatment, but more significant cartilage tears may require surgery.

5. Hernia

Hernia and groin problems are common in sports such as football where the pelvic region undergoes large stresses during kicking, sprinting and turning. The two most common conditions that affect footballers are an inguinal hernia and Gilmore’s groin. After matches and training players with hernias will experience stiffness and pain in the groin are. In the early stages of a hernia, activity can be continued but the problem usually gets progressively worse. To reduce the risk of developing a hernia core strength and core stability are essential. This improved muscular strength and stability can help to counteract the large forces that are applied to the lower abdomen and pelvis.

If you are suffer with any of the above injuries why not contact our Brighton Clinic's team of highly trained physiotherapists for an appointment and get back on the road to recovery.

Tom visits new runners at Brighton and Hove Women's Running Club

On Thursday the 22 May we were invited along to Brighton and Hove Women's Running Club (BHWRC) to discuss injury prevention when starting out as a new runner. Tom also went for a run with the Club then helped out with stretches and advised any injured runners. After, he provided a brief talk on injury prevention and answered a handful of runner's questions.

Please see below for a copy of the handout that was provided during the session:

Running Injury Handout

BHWRC is a friendly club with great support for new athletes, we highly recommend them for runners of all levels.

Running Sisters 3

www.brightonandhoverunningsisters.org.uk