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

Advertisements
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

 

SONY DSC

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

SONY DSC

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

SONY DSC

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

SONY DSC

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

SONY DSC

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.

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!

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.

pexels-photo-401896

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

 

Injuries

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

“Marginal gains” is the term made famous by the success of Team GB’s Olympic cycling team in winning multiple gold medals and by Team Sky winning the Tour de France.

They look for marginal gains by examining how they could gain 1% improvements through simple to achieve methods and have these 1% gains accumulate to make larger changes. They used a number of strategies for this including:

  • Providing each athlete with their own pillow and having a personal sleep strategy
  • Painting the floor of the mechanic area white to pick up on any dust particles which may get into the bikes
  • Analysing performance times to personalise training regimes as different people peak in the morning or afternoon. (This was linked to the sleep strategy to ensure peak performance)
  • Looking at the aerodynamics of the bikes
  • Improving infection control measures to reduce colds/infections
  • Improving diet

I personally much prefer Kevin Bridges’ marginal gains approach of losing weight: “switch from eating McCoys crisps to Quavers or have fried rather than deep-fried food”

Read more: How to treat tennis elbow

How does this apply to non-olympians?

The basic concept of marginal gains is to look for imperfections in your training/work/sport and improve them. Essentially a micro-managing of all aspects of your life. I can certainly think of a few things that I need to improve on without getting a microscope out (please feel free not to email me any suggestions!)

Where this can be useful from a physiotherapy perspective is in longer-term rehab. We regularly deal with conditions which require regular exercises over a prolonged period of time to allow a full recovery. For example, this could be after a  cruciate ligament injury to return to football; following joint replacement surgery to be able to walk around the shops or with shoulder rotator cuff injuries just to be able to put your jacket on.

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

Practical use of marginal gains can be just creating the time each day to work on your rehab by cutting something else out. It also applies to making sure you are physically ready to work on your exercises by finding out whether first thing in the morning or after work is a better option for you.

Diet and Sleep are key to recovery from injury and also to improving performance. We work alongside Ambition Nutrition who can advise on this more effectively than we can.

Marginal Gains for performance

At JMC Physiocures we can also offer advice on marginal gains for sports performance. This can be in the form of massage to reduce DOMS, advice on an injury prevention programme or a specific strengthening issue to help with technique. We also provide Pilates classes and work with personal trainers like Michael McCartney to help focus training on your goals.

Overall the idea of marginal gains is as simple and complicated as identifying the things you could do better and then making them better. If you are anything like me then I am sure you have a to-do-list or if you are like William then you will have 3472 post-it notes so all we have to do is pick one thing off the list at a time and make it better!

Injuries

Balancing act: ankle injuries

A common complaint we hear from people is that they have “weak ankles” or in the sporting world it will be referred to sarcastically as “you’ve got chocolate ankles”.

It inevitably starts with someone going over on their ankle and sustaining a typical inversion injury to their lateral ankle ligaments.  Ankles are the most commonly injured body part – each year approximately 8 million people sprain an ankle.  Millions of those will then go on to sprain that same ankle, or their other ankle, in the future.  The recurrence rate for ankle sprains is at least 30% and depending on what numbers you use, it may be as high as 80%.

Read more: Pain in the neck? Exercises for neck pain

However, I believe and it is widely regarded within the physio world, that many of those second (and often third and fourth) sprains could be avoided with an easy course of treatment and rehab.

Patricia Flavel (AUS) finish line Athletics 2000 Sydney PG
© Sport the library/Tom Putt Sydney 2000 Paralympic Games Athletics – Patricia Flavel (AUS) at finish line

What is balance?

Balance is the ability to maintain your centre of gravity (vertical line from centre of mass) within your base of support with minimal postural sway.

A healthy balance system allows us to see clearly while moving, identifying our orientation with respect to gravity, determining direction and speed of movement, and the ability to make automatic postural adjustments to maintain posture and stability in various conditions and activities.

Maintaining balance requires coordination of input from multiple sensory systems that send information to our brain about our body’s position.

balance

How to improve my balance?

In essence, the key to improving your balance is simple: sand on one leg, try not to wobble, hold for a minute and repeat.

Balance training is supremely low-tech but several studies have shown that the treatment, simple as it is, can be quite beneficial. All you need is simply a little space, a table or wall nearby to steady yourself if needed and a pillow.  You need to firstly ensure that you can comfortably weight bear on the joint before starting balance training.

Read more: Five tips to help manage back pain

Begin by testing the limits of your equilibrium, with the aim being to stand safely and unaided for 1 minute, the pillow can then be used to introduce an unstable surface and make the exercise a little more challenging.  Once you can achieve this you have a good starting base to progress your rehab to the level of recovery that is required for each individual.  This can then be progressed to single leg standing whilst throwing/catching a ball or for the higher-level athlete it may consist of single leg hopping over a box whilst pivoting through 90 degrees.  Either way as their balance improves you will find that their pain subsides and their confidence returns, thus allowing them to return to the gym or football, or more importantly for others, being able to wear their heels again!

So please don’t keep living with those “weak ankles” that are stopping you from your sports, or just impacting your Saturday night out with friends.

If you want some helpful advice or treatment for any persistent injury then come and see one of our experienced members of staff at JMC Physiocures, 01236 425 661 or 07808 552 520.

Check out more of our blogs here.