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Injuries

Why do muscles cramp?

We’ve all been there, whether it’s during or after sport, sitting on the couch or during the night, nice as you like, then BOOM something cramps up! You hobble around sometimes screaming in pain from the shock of it all or are ripped from a delightful sleep and try to stretch off or grab the offending muscle until the pain subsides!

What is skeletal muscle cramp?

Definition

  • Powerful involuntary skeletal muscle contraction during or immediately after activity, with no underlying metabolic, neural or endocrine pathology.

Evidence

  • 12-year study of marathon medical issues showed only 6.1% athletes suffered with cramp, meaning only 1.2/1000 of participants.
  • Family history of cramp can predispose.
  • Men are more likely to suffer exercise cramp over women due to higher numbers of fast twitch muscle fibres.
  • Studies have shown correlations between higher exercises intensity and duration will result in increased cramp and individuals who cramp more are predisposed to more tendon and ligament injuries.

Theories / The Science Bit –

  • Thought to be due to dehydration or electrolyte imbalance.
  • Increased sweating causes the extracellular fluid compartment to contract, leading to a loss of interstitial volume.
  • Increased sweating causes reduced sodium, calcium, magnesium, chloride and potassium, this causes mechanical defects to nerve endings and increased ionic and neurotransmitter concentration and thus hyperexcitable motor nerve units and spontaneous discharge, leading to cramp.
  • All studies supporting these theories have shown no cause and effect, relating to cramps.

Ineffective Treatments –

  • Lack of evidence to support the efficacy of salt tablets and magnesium supplements.
  • Quinine reduces night and idiopathic cramps, however is now prohibited in the USA as it can reduce blood platelet levels.

Effective Treatment –

  • Re-educate agonist muscles i.e. – strengthen weak muscles around the cramping ones, for example: hamstrings generally cramp due to overloading and compensating for Glute Max weakness.
  • K-tape and compression garments cause skin convolutions and increase local blood flow.
  • Massage therapy to reduce neural excitability.
  • Pickle juice (1ml per KG body weight) = salt and acetic acid to trigger inhibitory reflex.
  • Stretching is still the most effective way to relive fatigue induced muscle cramps.

 

Source – Physiotutors

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Injuries

Six simple exercises for shoulder pain

Shoulder pain is a common problem affecting more than a third of all adults at some point. There are a number of reasons why your shoulder may become painful and most of these will improve by:

  • Staying active with gentle movements of your shoulder
  • Taking painkillers to allow you to move
  • Trying simple exercises

Isometric exercises are exercises where a muscle contracts but the joint it works on does not move. These could also be called static contractions. Isometric exercises have been shown to reduce pain for a number of conditions and are a good starting point for simple shoulder pain.

Exercises provided courtesy of rehabmypatient.com our exercise programme partner.

It is normal for these exercises to feel uncomfortable or mildly painful but do not push into severe pain.

pendulum ii

1. Pendulum

Lean over holding on to a chair or table, let your arm hang down by your side, and swing your arm gently in circles. Try to let momentum and gravity move your arm. Go anti-clockwise and clockwise. This exercise is a great way to passively mobilise a stiff shoulder.

Hold for 2-3

Video: http://youtu.be/YYvl59eU78M

 

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2. Isometric shoulder flexion wall

Stand facing a wall. Decide If you wish to use a bent arm, or a straight arm. It does not really matter which you choose. Push your arm in front of you, into the wall. This will cause a contraction of the shoulder muscles. Hold the contraction, and relax. Repeat as required.

Perform 3-5s times daily | Repeat 6-8 times | Hold for 2-3

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3. Isometric shoulder abduction wall

Stand with your side to a wall. Push your arm away from your body into the wall. This will cause a contraction of the shoulder muscles. Hold the contraction, and relax. Repeat as required.

Perform 3-5s times daily | Repeat 6-8 times | Hold for 2-3

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4. Isometric shoulder adduction wall

Stand with your side to a wall. Push your arm inwards across your chest, into the wall. You can also use the side of a door frame for this exercise. This will cause a contraction of the shoulder muscles. Hold the contraction, and relax. Repeat as required.

Perform 3-5s times daily | Repeat 6-8 times | Hold for 2-3

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5. Isometric shoulder internal rotation wall

Stand with your side to a wall or a door frame. Tuck your elbow into your body. Push your arm inwards across your chest, into the wall. Keep your elbow tucked in to your side as you perform the movement. This will cause a contraction of the shoulder muscles. Hold the contraction, and relax. Repeat as required.

Perform 3-5s times daily | Repeat 6-8 times | Hold for 2-3

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6. Isometric shoulder external rotation wall

Stand with your side to a wall or a door frame. Tuck your elbow into your body. Push your arm outwards away from your body, into the wall. Keep your elbow tucked in to your side as you perform the movement. This will cause a contraction of the shoulder muscles. Hold the contraction, and relax. Repeat as required.

Perform 3-5s times daily | Repeat 6-8 times | Hold for 2-3

If your shoulder pain is not improving and you would like an assessment or if just want advice on specific exercises then please get in touch on 01236 425661, email at admin@jmcphysiocures.co.uk or contact us on social media.

Pilates

Pilates: How do you start?

Have you always wanted to try Pilates or have you been to a class and found it too difficult to understand? These simple exercises explain how to get the basic movements of Pilates before you start more complex exercises.

If you would like to know more about Pilates, want a 1:1 session or fancy coming along to one of our Pilates classes then get in touch with Lisa on 01236 425661, email admin@jmcphysiocures.co.uk, get in touch via social media or visit our website at www.jmcphysiocures.co.uk

Exercises provided courtesy of www.rehabmypatient.com our exercise programme partner.

finding neutral pilates

Finding neutral:

Lie on your back with your feet and knees hip distance apart, with your arms by your side. Place your thumbs and index fingers together to form a diamond shape, and place it over your lower abdomen. Your fingers touch your pubic bone, and the base of your thumbs rest next to your belly button. Find neutral by tilting your pelvis and make sure your diamond is parallel to the floor.

Video: http://youtu.be/lZObWFl6XuM
centering pilates

Centering:

Lie on your back with your feet and knees hip distance apart, with your arms by your side. Place your thumbs and index fingers together to form a diamond shape, and place it over your lower abdomen. Your fingers touch your pubic bone, and the base of your thumbs rest next to your belly button. Find neutral by tilting your pelvis and make sure your diamond is parallel to the floor. Imagine a belt sitting below your belly button tightening, as you gently contract your lower abdominal muscles.

Video: http://youtu.be/r8PV_Hifo_Y

supine pilates

Supine start position:

Lie on your back, with your knees bent and the soles of your feet firmly on the floor. Place your hands on your lower abdomen, with your elbows bent resting on the floor. Allow your spine to lengthen and relax. Encourage areas of your body in contact with the mat to feel heavy and supported. Soften your thighs and hips, and widen your chest. Lengthen your neck and relax your jaw and face.

Video: http://youtu.be/kRI4V7jnGGI
rib cage placement pilates

Rib cage placement:

Lie on your back with your feet and knees hip distance apart, with your arms by your side. Soften your ribs, to make them lower to the ground and in line with your pelvis. Do not force your mid-back into the floor. Inhale as you take your arms up towards the ceiling, and exhale as you take your arms over your head, but maintaining your rib cage alignment. To return to the start position, inhale as you take your arms up towards the ceiling, and exhale as you place your arms back by your side.

Video: http://youtu.be/fz3m3VMnl2U
head and neck placement pilates

Head and neck placement:

Lie on your back with your feet and knees hip distance apart, with your arms by your side. Lengthen the crown of your head away from your tail bone to create a sense of length through the spine. Avoid poking your chin towards the ceiling.

Video: http://youtu.be/Z_BAtKHDkps
lateral pilates

Lateral breathing:

Sit down in a comfortable position, and inhale to the lower back aspect of your ribcage, so that your ribs move laterally. Make sure you are not breathing from your upper rib cage, or the abdomen.

Video: http://youtu.be/VhC6uTsHAQs
shoulder blade placement

Shoulder blade placement:

Sit in a comfortable position. Glide your shoulder blades gently down and inwards to the spine, to allow your collar bone and chest to widen. Do not squeeze your shoulder blades together.

Video: http://youtu.be/gppMUH6oWZI
pron e

Prone start position:

Lie on your stomach, and rest your forehead on the back of your hands. Your feet and knees should be parallel to your hips. Lengthen your neck and gently draw your shoulder blades towards the spine. If there is discomfort in your lower spine, place a small folded towel under your abdomen for extra support. Keep your pelvis in neutral by avoiding flattening or arching your lower back, but your lower back should feel lengthened.

Video: http://youtu.be/JvfHhMbvtfc
side lying start position pilates#

Side lying start position:

Lie on one side, with both knees bent in front of you so that your hips and knees are at right angles, and your arms in front of you together. Lengthen your top waistband to create a small space between your waste and the mat. Contract your deep abdominal muscles, and find a neutral position of your pelvis.

Video: http://youtu.be/sEuHSDttW74
four point kneeling

Four point kneeling:

Kneel on all fours on the mat. Place your hands directly underneath your shoulders, with your knees beneath your hips. Lengthen your arms, but avoid locking your elbows. Keep your abdominal muscles contracted. As you exhale, tilt your pelvis backwards allowing your lower back to round. As you inhale, lengthen your spine and tilt your pelvis forward, allowing your back to arch slightly. A neutral position is neither tucked nor arched. Do not allow your head to drop below the level of your spine.

Video: http://youtu.be/RlRrktN5iH4

Injuries

Snap, crackle and pop: why do joints crack?

There’s a couple of options here, joints crack during normal joint movement and when passively forced within their limits, what we would call a manipulation.

Firstly, normal joint cracking – this happens when soft tissues such as ligaments and tendons rub over bony prominences. If you have some joint degeneration, wear and tear/OA, the joint surfaces are no longer as smooth as they were when you were a teeny bopper and this can result in audible cracking/creaking/rice crispy like sensations, known as Crepitus. Most common in the knee joint when going up and down stairs. This can be painful if the joint is inflamed so if you’re experiencing this, it may be an idea to get checked out by a Physio to look at improving joint control.

Read more: Four simple exercises for lower back pain

Another form of cracking is cavitation, like cracking your fingers, knuckles or neck, this can happen in natural movement but is more so associated with manipulation of a stiff joint.

What is Cavitation? – A manipulation causes the joint surfaces to separate slightly, the noise you hear is the release of gaseous bubbles in the joints synovial fluid when the manipulation causes a decrease in joint pressure. Like a localised stretch at a joint!

Self-manipulation wrists, fingers, necks, backs – we’ve all done it. Feels good doesn’t it? The relief you get is often instant, however it doesn’t last long and that stiffness will build back up. It’s fine to self-manipulate, but it can become a habit, this is where it can cause problems and become less effective, such as the joint becomes too mobile and lacks control.

Read more: What is the perfect posture?

WARNING – be careful if self-manipulating your neck or back, best advice would be to get yourself assessed by a qualified Physio/Chiropractor/Osteopath, there’s a lot of nerves and blood vessels around these joints which if manipulated improperly could do more harm than good!

Clicking, clunking and PAIN associated with a trauma…STOP! If you’ve had a slip, trip, fall or sports injury and feel a popping or clicking or any joint deformity, get it assessed. This is NOT normal.

So, to recap, joints click, its normal behaviour in the absence of any trauma.

The problem occurs when the joint itself is irritated (swollen, red, hot), if this is the case get it assessed by a Physio. Sometimes joints need a manipulation if they’re particularly stiff and this is always best carried out by a qualified professional who has an understanding of the underlying anatomy and joint mechanics but will also provide you with home exercises to help you improve joint mobility and /or control.

If in doubt, get it checked!

If you have any joint cracking related queries, please contact us on admin@jmcphysiocures.co.uk where one of our Physio team will be more than happy to get back to you!

Back pain

Four simple exercises for lower back pain

 

Low back pain is the most common reason people book an appointment with us. It is rarely serious and often improves by taking over the counter painkillers, (anti-inflammatories normally, although always check with your GP before starting any new medications), staying active by adapting your normal activities rather than completely avoiding them and by exercise.

The following exercises are easy to do in the comfort of your own home, they are safe and will help get your back moving.

Exercises provided courtesy of rehabmypatient.com our exercise programme partner.

It is normal for these exercises to feel uncomfortable or mildly painful but do not push into severe pain.

Lumbar rotation

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Bend your knees, and keeping your feet flat on the floor, rotate your hips to one side creating a rotation through your lower back. Only go as far as feels comfortable, you do not need to get your knees to the floor. Return to the opposite side. This is an excellent lower back mobility exercise, especially if you have acute lower back pain or disc problems.

Perform 30s times daily | Repeat 2-3 times | Hold for 2-3 | Perform both sides

Video: http://youtu.be/UxORTXzuU9E

Read more: Marginal gains: what are they and should I use them?

Pelvic tilt lying

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Lie flat on your back, and engage your deep core muscles by drawing your belly button inwards (towards your spine slightly), while flattening your spine against the floor, then relax. Repeat as required.

Perform 30s times daily | Repeat 2-3 times | Hold for 2-3

Video: http://youtu.be/44D6Xc2Fkek

Read more: What is Pilates and how can it benefit you?

Single leg back stretch

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Lie flat on your back, and bend your knee towards your chest. Hold this position and feel a gentle stretch in your back. If you get any groin pain while doing this exercise, stop and inform your therapist. Relax, and then repeat as necessary.

Video: http://youtu.be/lka-1VKjrew

Read more: Returning to sport: how to balance injury prevention and performance

Back extension medium

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Lie on your front, and rest on your forearms. Straighten your arms to a 90 degree position as shown. Hold this position. Your back will be arched. Start gently with this exercise as it can cause some stiffness when you first begin.

Video: http://youtu.be/jwI8g1dNzbw

If you have any concerns or questions about your back pain then please get in touch on 01236 425661, email at admin@jmcphysiocures.co.uk or contact us on social media.

Injuries

Returning to sport: how to balance injury prevention and performance

Returning to sport after injury can be a daunting process. There is never a perfect time and especially after a prolonged period of time injured it can be difficult to know when you are truly ready. It is important to adapt your training regimes during a return to sport to help reduce the risk of flare-up and chronic injury before returning to your normal routine. I don’t make any claims of being an expert in this field and every person is different, but there are a few general things worth considering when returning to sport.

Injury prevention vs performance:

If you are returning to sport after a muscle/tendon/joint injury and have been attending physio, then (hopefully) you will have been gradually increasing the amount of resistance or load by exercising. Injury prevention generally focuses on slow, controlled movements possibly with low repetitions and high resistance. While this is helpful in your rehabilitation and can help you to feel strong again most sports require high speed specific movements with low resistance.

It is therefore important that when you begin to return to sport that sport-specific training forms the last part of your rehab. This could be as simple as kicking a football, having a bounce match of badminton, going to the driving range or just running. Ask your physio about any drills that you could do which will help with your injury but are also targeted at your sport.

Injury prevention plans have been shown to have some benefit particularly when tailored to individual sports such as FIFA 11+ programme for football players.

exercise

How hard is too hard?

The first stage of this is finding out what your limits are and then setting a baseline level or normal. Training sessions should be based around this and are generally advised to be at between 80-120% of normal. It is important to bear in mind when returning after an injury this is your current normal and not your pre-injury normal!

High loads or quick increases in load of 150% of normal can place you in the “danger zone” for injury and should be kept to a minimum, only used around competition times for example. Likewise exercising at too low a level such as 50% of your capability doesn’t adequately strengthen your muscles or prepare you for a normal session. Light sessions should be used for recovery sessions with a sensible balanced plan of intense work, rest and rehab work.

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How much to increase it?

Although the answer to this question would be different for every person a relatively safe rule of thumb would be to increase the amount of exercise by 10% per week. While this can make return to your previous level a laborious process and may be too slow for some people it has been shown to reduce flare-ups.

When returning to competitive sports it is also worth spending some time returning to training only before a full return. This is especially important for any team contact sports where you have to consider other people and a naturally competitive instinct which might encourage you to push harder than planned.

Make sure you are mentally and physically ready!

The psychological aspect of return to sport is often undervalued particularly if the injury happened on the field of play. Fully trusting your body to do what you will ask it can be a difficult process and Sports Psychologists are the real experts in this.

From a Physiotherapy perspective one way to help with mental readiness is to be confident in your physical ability. A rough set of targets which are specific to you are worth setting such as for a footballer to be able to:

  • Run 5-10Km
  • Sprint 20-30yards x5-10 with changes of direction
  • Hop/Jump/Land in multiple directions – (making sure that both legs are relatively equal)
  • Strike a ball full force pain-free
  • Tackle

If your targets consider, the physical demands of your sport and you know your body can meet these without any problem then hopefully you are ready to get back to normal.

 

Back pain, Injuries

What is the perfect posture?

The answer is your next posture! A number of studies undertaken to find the perfect posture reveal that how you sit or stand is miles less important than how often you change position.  No one position has been linked to increased pain or days off work

So Mrs McK my old teacher who told me that if I slumped I would end up in a wheelchair – my gut instincts were right you were talking rubbish!- I would also like to point out that now that I do a lot of ergonomic assessments I was also correct about the chair being too small for me and THAT was why I slumped!! (Not that I am one to hold a grudge for 25 years 😊)

Read more: Marginal gains: what are they and should I use them?

Common sense tells us that sitting in awkward positions for long periods of time is bad for us, but it would be healthy if we all stopped worrying about this as much.

Where this all goes wrong is when we go to work and sit in the way that the chair/desk/PC has been laid out for us rather than sit how we do watching TV at home. Most people find that sitting in a chair which provides support through our spine in a slightly reclined rather than upright angle is more comfortable. This is why we lounge into the couch when watching Dancing on Ice on a Saturday night (note to self should have lied and said while out at fancy restaurant/pub!).

When you go back to work, or even better if you are at work just now. GET UP AND GO FOR A WALK. Try having a bit of a stretch in the chair or do a hula hoop on the desk.

When you finally sit down after all of that then adjust your chair so that it is comfortable, your feet are flat on the floor, your spine is rested against the backrest and your elbow is at desk height.

Read more: What is Pilates and how can it benefit you?

Only then should you pull it into your desk, move your mouse and keyboard close to you at elbow distance, and then adjust your screen to a natural height without leaning forward or angling your head-up. That should do the trick and then finally set an alarm for 30-45 minutes so that you can get up and do it all over again!

If you need any advice on alternative equipment or how to set your workplace up effectively then please ask us about workplace/DSE assessments by contacting us on 01236 425 661, or admin@jmcphysiocures.co.uk