Sports and Spinal Physio LTD
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Pronation is great!

Posted by on Oct 5, 2017 in Uncategorized | 0 comments

Physiotherapy, Massage Therapy, Podiatry, Injury Prevention, Pilates, Healthy Backs   If you have ever experienced a lower limb injury, you have flat feet or are a runner you will possibly be familiar with the term pronation. Typical statements about pronation include “I’m an over pronator and this is causing my knee pain” “My foot over-pronates so I have been told I need to wear stability trainers to fix my Achilles pain” “I wear orthoses to correct my over pronation” The term pronation essentially refers to the movement that the foot makes as its makes contact with the ground, it is also known as eversion. The foot rolls inward towards the arch with each step, flattening the foot and cushioning the shock of weight bearing. So what is over pronation? Historically this is the term used to describe a foot that rolls into this position above what is normal. The problem with this is, exactly what is normal? How much is too much and when does it quantify as being over? There is no set normal pronation value therefore how can we say that it is over what is normal! Pronation is essential to foot function and should not be considered as “bad”. Without pronation our lower limbs would be subjected to increased stress and strain through lack of cushioning and deceleration of our bodies load. So in fact pronation is actually GREAT! Why does pronation get such a bad reputation? A sudden increase in the amount of pronation will occur as a result of an increased amount of distance walked or run. A change in foot wear or an injury to the leg can also alter our pronation. Essentially prolonged, rapid or uncontrolled pronation can unfortunately lead to stress or overload of our tissues (muscles/tendon/joints) and contribute to pain and injury. As a clinician it is our job to establish that it is this mechanism that is the cause of our patient’s pain and aim to bring some “control” to the pronation. Thus changing the forces acting on the injured body part that are causing the patients pain. How can you reduce pronation forces? If pronation is contributing to pain and injury, slowing down, reducing the quantity and controlling pronation is our key aim and achieved by the following: Reducing the activity that is using pronation i.e running / walking (decreasing load/force) Adding an insole (orthotic) – the foot makes contact with the orthotic sooner than it would the floor, this reduces the pronatory force (the foot may still pronate as much but with less force which is good for the injured tissues). Wearing a shoe with a stiffer sole – if the inside of the shoe is stiffer it can act on the foot a bit like the orthotic in the above example. Combining a stiffer sole and an orthotic – as above. Improving control and strength of the inner calf muscles (tibialis posterior and anterior) through specific exercises. Essentially improving the ability of the muscles to cope with the forces that come with pronation. Addressing how the rest of the leg works – improving the control and strength of the muscles around the hip to reduce the force of inward rotation of the leg which contributes to pronation.Pronation is vitally important to how our lower limb functions...

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It wasn’t all Champagne and Strawberries at Wimbledon!

Posted by on Jul 11, 2016 in Uncategorized | 0 comments

5 most common injuries in Tennis Ankle sprain Shoulder Pain Calf strain Back problems Tennis Elbow    Ankle sprain An ankle sprain is also classified into grades 1-3. Grade 1 being a more mild injury to 3 being a complete rupture.  The sprain can be a single or multiple ligaments,  of those the most commonly injured are the outside ligaments. The way sprains occur are the ankle is sometimes twisted inwards, player would experience pain at the front of the ankle due to damage in tissues. Exercise to help avoid:  Standing on an uneven surface on one foot to help promote the stability of the ankle.                    Shoulder Pain This is common pain/ injury in tennis as the muscles in the shoulder are used heavily throughout training and the matches! Common muscle injuries are to the rotator cuff muscles and Serratus anterior which is responsible for controlling the shoulder blade . Exercise to improve: On all fours lifting up one arm and holding still for 45 seconds. This will strengthen the muscles which hold the shoulder blade in place. To make the exercise harder put hands on a pillow to make it an uneven surface.   Calf Strain The calf muscle group consists of the Gastrocnemius, Soleus and Plantaris muscles, situated at the back of the lower leg. Their function is to pull up on the heel bone and these muscles are most active during the push-off when a tennis player has to move quickly to react to an opponent’s shot. A strain occurs when the muscle is forcibly stretched beyond its limits and the muscle tissue becomes torn Exercises to improve: An easy to do at home exercise is stretching the muscle to elongate the scar tissue and progressively increasing the muscle strength. This is done by putting one foot in front of the other and ensuring the back heel is on the floor hold the stretch for 30-45 seconds. To make the exercise harder move the back foot further away from your front foot. Don’t start stretching until 10 days after your injury. Back problems Serving in tennis requires a combination of spinal hyperextension (bending back) together with rotation and side bending of the trunk. This puts a lot of stress on an area of the vertebra.  This can lead to a long term pain in the back. An exercise which may help you avoid the pain in the spine  is a modified bridge. This is learn to control flexion and rotation of the spine. Laying on back lift hips off of the floor ensuring trunk is flat, lift on foot off the floor and don’t allow hips  to rotate .  Initially this exercise will be hard to control so it is all about repetition. Hold the bridge for 10 seconds initially and increase the hold- repeat for 2-3 mins Tennis Elbow Tennis elbow is inflammation of the muscles and tendons of the forearm as they attach to the humerus (upper arm) bone. This inflammation is caused by prolonged gripping activities such as gripping tennis rachets. Depending how bad the condition is this can be improved simply by rest or with the use of anti-inflammatory medication. However it may need physiotherapy. A simple exercise to reduce pain from a tennis...

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Is IDD the best non-surgical treatment for prolapsed and herniated disc?

Posted by on Jul 22, 2015 in Spinal Pain | 0 comments

IDD observational study, outcomes for pain and disability index measures. Sharon Mumford MCSP, Dan Smith MCSP (2015) Introduction Low back pain is a significant problem in today’s society and persistent low back pain can result in many costly invasive interventions.  Intervertebral Differential Dynamics (IDD) therapy  is a non-surgical spinal decompression for back pain, neck pain and sciatica.  IDD was developed in the late 1990s to overcome the failings of traditional traction and manual therapy.  Cholewicki et al (2009) investigated the effect of traction on muscle activity and flexibility pre and post traction in healthy volunteers.  They found muscle activity to be minimal and fluid exchange in the disc provides the biomechanical effect in traction. Shealy and Borgmeyer (1997) reported it was possible to distract isolated lumbar segments by angling the distraction force and thus decompress a specific disc.  The Accu-Spina device using the IDD therapy protocol is able to focus distraction force to a specific lumbar segment and combing this with multiple primary waveforms and secondary oscillatory wave forms apply a neuromuscular component (Shealy  2009). Method The observational study has 24 subjects who had IDD treatment consisting of 20 sessions within a 6 week period.  Treatment began with a distraction force of half body weight minus 20 lbs increasing gradually to half body weight plus 20lbs.  Angle of distraction was directed to most symptomatic level if more than one lumbar level was affected. The data included intention to treat results as well as completed treatment results. Inclusion criteria Prior failed treatment from osteopathy, physiotherapy, chiropractor for low back pain due to disc or facet dysfunction Prior failed facet joint injections or failed nerve ablation for low back pain due to disc or facet dysfunction MRI scan to indicate, either herniated or prolapsed disc bulge (slipped disc), degenerative disc disease, sciatica,  foraminal stenosis with or without radicular pain. Low back pain of 1 year duration or greater   Exclusion criteria Osteoporosis (T score -2.5 to -2.8 or greater) Unresolved compression fractures on the spine Spondylolithesis Spondyloysis Open growth plates Severe canal stenosis Surgical hard ware in spine Severe scoliosis Abdominal aortic aneurysm Vertebral fusions Pacemaker Pregnancy Genetically unstable or defects of the spine.   For graphs showing the  findings click here IDD observational study jan 2015 (1) (1) Data analysis Pain score Median score before treatment was 6/10 with lower quartile 3/10 and upper quartile 8/10, mode was  8/10 Median pain score post treatment was 1/10 with lower quartile 0/10 and upper quartile 2/10, mode was 0/10 Standard deviation was ±2.85 before treatment and ±2.09 after treatment Student t-test (96% CI) p=0.0000054 (statistically significant) Oswestry disability index scores 13 patients reported a greater than 10% decrease in their ODI score. 54% of patients, including those who didn’t complete the course of treatment, had a significant decrease in ODI score 65% of patients who completed treatment had a clinically significant decrease in ODI score Discussion The results found to date are reflective of those in other studies with a reduction in pain from VAS  6 to 1 (83% reduction).  Schimmel et al (2009) report a statistically significant reduction in pain from a VAS of 61 to 32 and a statistically significant reduction in ODI in their study of 60 patients with low back pain of more than 3 months duration.  Shealy (2005) for...

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Are You Fit To Run?

Posted by on Mar 4, 2015 in Sports Injury | 0 comments

Have you taken up walking or running as part of a new years resolution? Or maybe you are competing in a marathon this year? In the lead up to the various marathons taking place this year many thousands will develop a lower injury as a consequence of extra walking or running. Walking aside, running doesn’t come naturally to most people and in our opinion only 5% of runners have the perfect “body set up” and are unlikely to suffer with injury. So what causes lower limb injury? Poor biomechanics Incorrect training Increasing distance or frequency of training too rapidly Inappropriate footwear Trauma – ankle sprains etc.. In this article we are going to look at how we can observe, analyse  and correct faulty biomechanics that contribute to the onset of injury. Biomechanics refers to how the body functions from a mechanical point of view. These still images are examples of common biomechanic faults – that is faulty movement occurring in the body during walking and running that is linked injury. The above photo shows a pronated foot during mid stance – Foot and Ankle, Achilles tendonitis, shin splints and knee problems are related to this dysfunctional position. A positive Trendelenberg sign on left hip – this can cause knee, hip and back problems – including patello-femoral pain syndrome, lumbar disc problems, bursitis, muscle and tendon injury. At the clinic we are able to video our patient’s walking or running and using the footage we can analyse the movement of the leg and foot to diagnose faulty biomechanics. How is this different from what they provide at sports shops? Sports shops are simply looking to sell you the most appropriate trainer. They are looking for 3 possible foot type and function: A flat-ish foot that foot rolls in – “you over pronate and need a stability or motion control shoe”. A high instep that does not roll in  – “you need a cushioned shoe” A “normal looking foot that does neither to great excess – “you are a neutral runner – you need a neutral shoe”. Video analysis at our clinic provides us with additional information that we use to devise treatment rehabilitation programmes. Here are some of the additional areas we might identify as being a problem: Your gluteals (hip muscles) are not working and your pelvis is dropping to one side. This predisposes you to back, hip and knee injury, is very common and is probably the biggest cause of lower limb injury. This requires specific exercises. Your calf muscles are tight or your ankle is stiff – you may need a heel raise in your shoe, to begin calf stretches or some hands on treatment. Your big toe is not bending enough – you may need this treating or something in your shoe to make up for the lack of bend. You knee is rotating inwards – normally due to a lack of hip control see point 1. Your trainers are the right type but they still don’t control your foot sufficiently –  you require additional support in the form of a foot orthotic (insole). This is prescription based – we can provide this. Bare Foot Running If you are a barefoot runner or are considering switching to this style you may be thinking that footwear and orthotics don’t apply to you… wrong!  There is a certain type of foot best...

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300 Different Types of Headache… Are There 300 Different Causes Too?

Posted by on Sep 16, 2014 in Spinal Pain | 0 comments

Over 300 types of headache have been described – but are there really 300 different causes of headache? Maybe the different forms of headache are not separate conditions simply different presentations of the same disorder. In the same way that people experience lumbar disc problems in different ways (back ache, buttock ache, tingling in feet, calf pain, groin pain etc…) maybe headache is the same. The diagram above is a small example of how the neck segments/joints can cause a variety of pains in the head . Our belief is that all headache sufferers share a common problem; a sensitized lower brain stem. The upper neck has the ability to sensitize this area leading to the amplification and in addition convergence of normal sensory information from the cranium (head) with nocioceptive information (warnings signs) from the upper neck, in turn causing the head pains experienced by migraine and headache sufferers. For further information on this subject see...

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Devastated by Back Pain

Posted by on May 13, 2014 in Spinal Pain | 0 comments

My life was devastated by back pain but now I’m playing football with my kids again…thanks to IDD Therapy Scott Bryan from Chingford thought his days as a scaffolder were numbered when the back pain he’d suffered with for years finally took its toll. “I suffered on and off with lower back pain and grinding sciatica in my leg for a few years but last year the episodes became more severe and sometimes my leg would actually go numb when I stood for too long.” Scott’s condition became progressively worse and soon the intermittent pain became constant – eventually he couldn’t sleep and the manual nature of his job as a scaffolder became impossible, forcing him to take time off work. “I was in so much pain I could hardly walk and was only sleeping for a couple of hours a night.  I needed to take painkillers every day but even with regular medication, the pain was too much for me to bear – and I’m a big strong bloke!  The most heartbreaking thing was not being able to play football with my sons – my family tried to stay positive but I know they were worried about me.” Scott’s GP suggested various manual treatments before putting him in touch with a back pain consultant who diagnosed him with a herniated disc and decided that surgery was the answer. “My doctor sent me for some osteopathy and acupuncture sessions but they didn’t help and an operation was the last thing I needed – being self-employed, I couldn’t afford the time off work for a start! I couldn’t see a future without the pain and I was feeling very despondent.  I decided to ask my old school friend and physiotherapist, Dan Smith for some advice – I didn’t realise that Dan was actually offering a non-invasive treatment specifically for disc problems and sciatica called IDD Therapy.” Intervertebral Differential Dynamics (IDD) Therapy is a non-invasive treatment involving the gentle drawing apart of specific spinal segments where discs are damaged or herniated (bulging). This relieves pain by taking pressure off targeted discs and any trapped nerves and helps to relieve muscle spasm. After a review of Scott’s recent MRI scan, Dan confirmed a large disc bulge pressing on some nerves in his spine and he decided that Scott was an ideal candidate for the IDD Therapy programme. “I felt so relieved when Dan told me I could be treated with IDD Therapy.  He explained that the damage to my disc was quite severe and would need several treatments but with every session the pain eased and I became steadily more mobile.  After the third session I was walking a lot easier and by the 15th I was able to go back to work.      I finished my treatment programme a couple of weeks ago and I’m feeling fantastic; my pain has drastically reduced and I’m able to walk, drive and sleep properly.  I still have to take care of my back and avoid heavy lifting but this is nothing compared to the debilitation I suffered before my treatment. Best of all, I’ve just had a great Easter break with my family and been able to play footie with the boys again.  It’s really not an exaggeration to say that IDD Therapy...

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Uncontrolled Movement – Pain, Injury and Treatment

Posted by on Mar 10, 2014 in Spinal Pain | 0 comments

The Concept of Relative Flexibility and Stiffness The term relative flexibility refers to the theory that during movement the body and in particular our joints and soft tissues will take the path of least resistance, that is movement will always occur at a joint or region that is more flexible than a stiffer neighbouring one (Sahrmann 2002). This can occur in tissue and joints next to each other as well as ones that are opposite.  For example the fourth lumbar vertebra (the second from last bone in your lower back) might develop increased movement during backward bending to compensate for a stiff upper back or stiff hip flexors.  Once a joint or soft tissue has increased in its range of movement to compensate for the adjacent stiffness the supporting structures (ligaments, capsule and muscle) become insufficient at resisting movement in this area. This increased range of movement (or compensation) strains the joint or muscle and causes pain and injury. Restrictions include joint stiffness, muscle or connective tissue shortening, muscle spasm, scarring and increased bone formation or osteophytes. Uncontrolled Movement Uncontrolled movement is the term used to describe a body part that a patient finds difficult to control. In the clinic we use specific tests to determine this .  Medical research has shown that pain occurs as a result of uncontrolled movement. Relative flexibility is linked to the site of uncontrolled movement i.e. the relatively flexible area is normally the site of uncontrolled movement. Treatment When planning treatment of any condition, one must address the stiff joints and muscles with mobilisation and stretching techniques. In addition the patient must be taught exercises that help to control the flexible parts/uncontrolled movement that are causing pain. A skilled approach is required to diagnose this correctly and to teach the most appropriate exercises. At Sports and Spinal Physio our Better Back Programme uses this approach to provide long lasting results for patients with back and neck pain. For video examples of various test we use to assess for uncontrolled movement please see our YouTube channel For further reading on Uncontrolled Movement theory and concepts please see Kinetic...

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Bench Press and Shoulder pain

Posted by on Jan 21, 2014 in Sports Injury | 0 comments

Are there any precautions we should be taking when bench pressing? Should we be sticking to single arm standing cable pressing for maximum scapula (shoulder blade) movement to keep our shoulders ‘safe’ or do we just continue on with the big bench presses that are common in todays gyms? Bench has long been a favourite exercise of body builders, sports people and gym goers for development of hypertrophy and strength in the pecs, triceps and anterior deltoid. This is because bench press tends to get great results due to the ability to maximally load the muscles ie weight lifted/intensity. Lying on a bench to perform chest/bench press can lead to lack of scapula retraction (backward movement) and result in increased movement at the shoulder ball and socket joint. The forward shear of the ball on the socket will stress the joint and potentially add to joint laxity. It is our opinion that this stress on the front of the joint only becomes problematic in cases where significant laxity is already present, for example in people with previous capsular injury such as dislocation and subluxation. As well as people with multi-directional instability. This excessive ball and socket movement caused by lack of scapula retraction in bench pressing more commonly causes excessive (eccentric) loading in the subscapularis tendon and subsequent tendinopathy (damage to the tendon) rather than joint stress and subsequent laxity. So if you bench press heavy enough and frequently enough – areas will be overloaded and then injured. Ensuring correct technique will help to minimise the inevitable overload. Tips for avoiding bench press related injuries. 1) Periodisation: schedule breaks from bench pressing every 6 weeks or so and substitute exercises that allow more scapula movement such as cable press and push ups. Even dumbell pressing on a swiss ball allows more scapula movement than a bench does. Also be careful to make gradual increases in intensity and volume only. 2) Roller/Towel: place a rolled up towel or 1/2 foam roller long ways along the bench. This may also allow more scapula retraction. 3) Technique: always be careful of technique ie controlled eccentric movement (lowering) without any bouncing. 4) Range: Reduce the range so that the bar is only lowered to 10cm above the chest. 5) Grip Width: vary your grip width regularly. Generally a narrower grip width reduces loading on the above mentioned structures....

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5 reasons massage is not just about pampering yourself!

Posted by on Nov 25, 2013 in Sports Injury | 0 comments

Massage helps to: 1.Relieve Pain – stiff tight muscles can lead to pain 2.Promote Better Sleep– reduce tension, improve relaxation and affect the hormones that help us drift off to sleep. 3.Relieve Mild Depression – stress increases our level of cortisol, this hormone affects our mood. Massage reduces tension and stress and has the potential to rebalance our hormone levels. 4.Reduce Post Exercise Soreness – Massage helps to flush away the build up of lactic acid and other metabolites that cause post exercise soreness. 5.Improve Circulation – Massage improves circulation and lymph drainage. In addition to these 5 benefits we use massage to loosen up the stiff bits in your body that limit your movement and cause you to compensate with with movement elsewhere. It is these compensations that cause pain. So it works great with your physio treatment too! Want to know more? Please see our massage...

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IDD Therapy – Spinal Decompression – New treatment for bulging herniated and slipped discs

Posted by on Oct 28, 2013 in Spinal Pain | 0 comments

Well it’s here! Our IDD Therapy Spinal Decompression machine arrived two weeks ago. We feel very excited to be in the position to bring this fantastic new treatment for sciatica, back and neck pain to Brentwood and the surrounding areas. We are one of only 16 clinics offering this service in the UK. IDD Therapy Intervertebral Differential Dynamics (IDD) Therapy is the successful and trusted non-surgical spinal decompression treatment for back pain, neck pain and related conditions such as sciatica. We will become the 16th clinic in the UK to offer this exciting new treatment and we are very excited! Most spinal problems are as a result of a problem at a specific level, for example L5/S1 in the lower back. IDD Therapy can target the specific level and gently distract (draw apart) the segments of the spine by up to 5-7 millimetres, taking pressure off the joints, discs and nerves. Because IDD Therapy is computer-controlled it can sense resistance in your spine (muscle spasm) and adjust the forces slowly and gently to achieve a comfortable and painless stretching of your injured area. http://www.youtube.com/watch?v=qcEEJTcy3Sg Benefits of IDD Therapy  Improved Disc Rehydration – The treatment creates a negative pressure at the targeted disc promoting the movement of water, oxygen and nutrients into the disc which are required for improved hydration and repair of the degenerative (worn) disc. Decompression of Disc – Decompressing (taking pressure off) an injured or bulging disc may reduce any pressure or irritation to nerves. This may result in a reduction or resolution of back and neck pain and sciatica. Decreased Muscle Spasm – IDD Therapy additionally promotes improved mobility in the spine through decreasing muscle spasm and the stretching of the soft tissues, this facilitates the body’s natural healing mechanisms to operate more efficiently. Increased Spinal Flexibility – Stretching of the joint and soft tissues in conjunction with a reduction of muscle spasm and pain will result in increased mobility of the spine. Reduction in disc bulge size – In some instances IDD therapy has led to a visible reduction in size of disc bulge when comparing before and after MRIs. Why choose IDD Therapy? In one study 86% of IDD Therapy participants experienced a positive response from their treatment. IDD Therapy should be considered if you have back or neck pain and have tried various other treatments without success. You should consider IDD Therapy if: Your current treatment is not working You want to stop taking painkillers You are seeking long-term pain relief You want to return to normal daily activities You are looking to avoid surgery IDD Therapy is effective for the following conditions:  Chronic back and neck pain Sciatica Referred arm pain (Radiculopathy) Trapped or irritated nerves Bulging, herniated or slipped discs Degenerative disc disease Spondylosis (arthritis of the spinal joints) Facet joint disease Our thoughts on IDD Therapy “The use of manipulation and hands on techniques combined with correction of posture, movement faults and core stability can help most people with spinal pain; however some patients need something a little extra to help them feel better. With IDD we can precisely target the spinal segments in a safe, gentle manner to help patients in a way which is not possible with our hands or with traditional mechanical treatments” Clinic Director Dan Smith...

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