Sports and Spinal Physio LTD
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The 3 Biggest Causes of Pain

Posted by on Jan 21, 2020 in Pain | 0 comments

Back in December 2019 Scott Cook and I decided to record a video on the subject of pain and sensitivity for our patients to view,  what was originally meant to be a 10 minute talk ended up being a 30 minute discussion that was divided into three shorter 10 minute videos. We tried to get inside the patients head and talk in a way that hopefully non-medical people will understand. When someone is in pain there are lots of unseen or an acknowledged reasons for the pain to present itself in the way it does and in many cases to persist for the length of time. In our short physiotherapy sessions it is often difficult to get these points across, so recording them on video allows us to share them with our patients and for the patients to view these videos in their own time on their own terms. In these information videos we aim to explain how contributing factors can increase pain levels, prevent pain from resolving and lead to chronic long term pain. We will discuss the physical, mental and lifestyle/social influences that need to be addressed if a person is to move away from pain. While we cannot provide a full list of solutions to everyone’s contributing factors we will aim to provide some self help ideas that you can take away and immediately use to help you on your road In this first part we discuss the physical contributing factors to pain such as bio-mechanics, movement, strength, flexibility and tissue loading.   In the second part we discuss the psychological contributing factors to pain such as anxiety, stress and sleep. The final part is all about fear as a psychological contributing factor to pain and we address lifestyle and social factors that can play a part too. We hope you enjoy the videos and can find something the resonates with you or someone you know. Feel free to share these with others too!   Dan Smith BSc (Hons) Phys...

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The 3 biggest mistakes people make when treating shoulder pain

Posted by on Oct 22, 2019 in Shoulder, Sports Injury, Uncategorized | 0 comments

We have seen so many sore shoulders this month we have started calling it shoulder month! We see lots of people who have experienced failed treatment or shoulder surgery. However when we delve deeper it turns out that the treatment and rehabilitation provided just hasn’t been good enough, or that the person has simply given up too early as they they thought it just would not get better. Shoulder problems are tricky to fix and people often dive into surgery too soon (mainly because they have given up on the normal rehabilitation and healing process). However with the right approach and a great deal of patience shoulders are very fixable…The most common shoulder problem we see is Shoulder Impingement closely followed by (and often as a result of) is Capsulitis (“frozen shoulder”).  Dan has created 2 short videos on the subject matter which are listed below. If you or someone you know has a shoulder issue we would be more than happy to take a look / chat on the phone to see if we can help (just reply to this and we will get in touch!).   Mean while here are two videos for you to watch.    ...

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FIFA World Cup Fever

Posted by on Jun 22, 2018 in Uncategorized | 0 comments

Physiotherapy, Massage Therapy, Podiatry, Sports Injury Prevention, Pilates, Healthy Backs   From the die-hard football supporters, to enthusiastic players and children in the park, it’s unlikely that you’ll manage to escape the hype that comes with the FIFA World Cup. Even if you’re not an all year-round supporter/ player you’ll probably find yourself drawn into watching a few matches during the football event of the year. Football has the power to bring the nation together. Like the Olympic games, it is a human experience that can bring many nationalities and cultures together with no other commonality than the joy of sport. Football is an international language. FIFA suggests 270 million people play soccer which equates to 4% of the world’s population. But if you take into account the casual kick arounds in the parks, or on the dusty patches of Africa’s huge continent, or in town squares pretty much anywhere in the world, the number is likely to dwarf that figure. EVERYONE from grass roots to multimillionaire players can kick a ball around for free, which makes it a powerful force for change across the globe. Below are a few facts and figures for injuries that you may hear of during this month’s World Cup. Apart from concussions, nearly 83% of injuries occur to the lower limb, most commonly the ankle in men and the knee in women Tackling causes nearly a quarter of all injuries 40% of all the injuries on a pitch are experienced by Midfielders making them most at risk Muscle strains to the thigh – most frequently the hamstring muscle are in the top three injuries Muscle injuries are often associated with a burst of acceleration/sprinting, sudden stopping, lunging, sliding (over stretching the muscle) or a high kick. Whereas ankle and knee injuries, where ligaments are strained, occur with cutting, twisting, jumping, changing direction and contact/tackling 1 in 5 players will experience a groin injury in a season which makes groin pain a common complaint and may be due to poor kicking technique as well as weakness in the core and pelvis And 40% of those groin injuries will cause a player to have to take more than 28 days off from play There are six printable/downloadable advice sheets on the most common football injuries mentioned above. They provide information of how to both prevent and how they may be treated with professional advice. You can download the leaflets here In most cases there is a weakness present including muscle imbalance or control issues. In fact your physical fitness is the single most important factor in preventing football injuries. Neuromuscular training for the knee can reduce the incidence of series knee injuries by 3.5 times A 3 x a week pre-season proprioceptive training programme resulted in a 7 x decrease in ACL injury and an 87% reduction in the risk of suffering an ankle sprain And a strength training programme can reduce the incidence of injuries by nearly half (47%) compared to soccer players who did no additional strength training. If you want to understand more about any of these aspects then contact us directly. A good training programme should incorporate strength and neuromuscular training, and can go a very long way to helping you reduce the risk of injury. If you’ve suffered from a...

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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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