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!

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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.

Injuries, neck pain

Pain in the neck? Exercises for neck pain

Neck pain is a common problem and can often radiate out to the shoulders and arms or cause headaches.

Please try the exercises below to help with any neck pain. Also remember to take painkillers if needed and stay active as neck pain is rarely serious.

Thanks again to www.rehabmypatient.com for providing us with the exercises.

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

Neck rotation:

neck rotation

Rotate your neck slowly to the left by looking over your left shoulder. Take your neck to a comfortable end of range. Repeat to the right. Make sure you keep your shoulder and back relaxed. This is an excellent exercise to improve rotation and mobility in your neck.

Repeat 4-6 times | Hold for 2-3 | Perform both sides

Video: http://youtu.be/UbHEH6t_OJQ

Neck side flexion mobilisation:

neck side flexion mobilisation

Ensuring your nose is pointing forwards, bend your neck as if you were taking your left ear towards your left shoulder. Now repeat to the right. Keep the movement gentle and rhythmical. This exercise will help improve mobility to your neck.

Repeat 4-6 times | Hold for 2-3 | Perform both sides

Video: http://youtu.be/MpUIDH-atys

Neck retraction:

neck retraction

Pull your head back as far as comfortable and down slightly. You will feel some gentle tension at the front and back of your neck. This exercise will help your neck and upper back posture.

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

Video: http://youtu.be/VYcifC6BFgc

Pendulum:

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.

Repeat 2-3 x 10 each direction times | Hold for 2-3 | Perform both sides

Video: http://youtu.be/YYvl59eU78M

Standing/sitting retraction:

standing or sitting retraction

Standing or sitting, with good posture, pull your arms backwards while squeezing your shoulder blades together. Hold the contraction and then relax, or simply hold the contraction for a longer period of time. You will feel a muscular contraction around and between your shoulder blades.

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

Video: http://youtu.be/JYyw8Uewdms

Shoulder shrugs up:

shoulder shrugs up

Shrug your shoulders upwards, towards the ceiling, to increase strength in your upper shoulder muscles (upper trapezius).

Video: http://youtu.be/YT6qn6HVQyE

Shoulder shrugs back:

shoulder shrugs back

Shrug your shoulders backwards, squeezing your shoulder blades together. You will feel a muscular contraction around and between your shoulder blades (rhomboid and shoulder blade muscles).

Video: http://youtu.be/1MmXbrOeJ9c

Bruegger’s posture sitting:

bruegger's posture sitting

Sit on the edge of a chair, and open your legs and allow them to relax outwards. Keep your body and spine tall, lift the crown of your head towards the ceiling, and arch your lower back slightly. Turn your arms outwards so your palms are facing forwards, and draw your shoulder blades down and towards the midline. Make a gentle double chin with your head at the same time. Breathe deeply throughout. You will feel a stretch across your chest and front, as well as muscles working in your back, all helping to improve your posture.

Video: http://youtu.be/_uQ_-JeWTgU

If your neck pain is not improving and you would like some advice or treatment then find out how we can help by calling 01236 425661, email admin@jmcphysiocures.co.uk, contact us via Social media or visit our website on www.jmcphysiocures.co.uk 

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Injuries

How to treat tennis elbow

Tennis elbow, or lateral epicondylitis, is a common elbow overuse problem that is likely to affect around 40 percent of the population at some point in our lives.  And certainly from my clinical experience, I don’t think I’ve ever treated a tennis player for this type of problem; it’s usually the office worker or manual worker who is lifting and gripping a lot.

The injury is mainly due to an overuse of the wrist extensor muscles since the condition is actually an extensor tendinopathy: it affects the tendons that extend the wrist joint and attach to the outside of your elbow, known as the common extensor origin.  There are a few tendons that can be involved, the most notable being the extensor carpi radialis brevis and extensor carpi radialis longus.  Most literature states that the constant overuse of these tendons results in repetitive microtrauma to the extensor tendons, which in turn causes local inflammation and pain.  This overload can occur from racquet sports, typing at the computer, gardening, or any tasks that involve repetitive wrist extension.

tenis elow iv

 

Risk factors for tennis elbow:

  • Manual occupation or office worker
  • Aged between 30-50 years old
  • Taking part in a lot of racquet sports but with poor technique

Symptoms

Pain associated with tennis elbow will be concentrated on the outside of the elbow and can radiate into the forearm and wrist.  Due to the pain and weakness it may be difficult to:

  • Shake hands on grip hold of an object
  • Turn a doorknob or handle
  • Hold a cup of tea or lift a kettle
  • Pain to touch the outside of the elbow or to bump against the area

How do we treat tennis elbow?

Firstly, I should mention that 80-90% of people with tennis elbow make a full recovery within one to two years and physiotherapy is recommended as the first line of conservative management.

Physiotherapy can assess your elbow and upper limb to find the cause, provide activity modification advice, prescribe appropriate rehabilitation exercises and manual therapy to provide pain relief. Your physiotherapist can also assist in giving advice regarding your work set up or sporting equipment.  While no one treatment modality is proven to be effective entirely on its own, a combination of both mobilisation and exercise may reduce pain and improve function.

If you want some helpful advice or treatment for any persistent tennis elbow 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.