How to keep your shoulders Healthy?

How to keep your shoulders healthy?


Tommy Conway - Head physiotherapist TC Physiotherapy


Over 50 and struggling with shoulder pain? Worried that you might have Frozen shoulder? Struggling to lift a kettle or reach for something in the press?


Today I am going to give you a simple solution to help your shoulders but first I am going to explain why you should do my 2 simple exercises everyday.


As most of us spend time typing on our phones and laptops, our arms are never lifted above head throughout our waking / working day. This results in a lack of over head movement and that's the important part if you spend little time with your arms over head they won't want to move overhead. Your body is very simple the more you do something the better it gets at it and also if you don't use it you lose it.

The lack of movement overhead causes a tightness in the muscles at the back of the shoulder blade called the posterior cuff. This tightness will then lead to weakness in the main muscles of the shoulder, the deltoids. In time a combination of both can cause frozen shoulder, impingement and tendonitis of the shoulder.

So what can we do? We can loosen the posterior cuff and then strengthen the deltoid muscles. Here is the first two shoulder stretches you should do everyday.

1: Door and lat stretch 20 seconds x 5 both sides

2: elephant pose (Pilates) 1 minute x 5

If you are unable to get into either of the above positions without pain then you should see a physiotherapist and get hands on treatment to help rectify the issue. If you have any questions about your shoulder pain don’t be afraid to message us on Instagram @tcphysiotherapy @onepilates or send me a mail info@tcphysiotherapy.com and I will get back to you.


Are you feeling what you are meant to be feeling?

Tommy Conway - Physiotherapist 

So after having a third knee surgery in February, it was about time I sorted my lower limbs out and decided to dedicate the next few months to fix all my ailments. It has been an interesting injury and wasn't easy to get better but was very rewarding in what I am learning from it. This brings me onto the heading of the Blog “ Are you feeling what you are meant to feel?”.

After traveling to Nebraska in December to complete the PRC exam, one point kept sticking in my head “can your clients feel what you want them to feel?”. So you give them single leg deadlift, single leg squat and all they feel is the calf. Well they are a hamstring and quad exercise and your client is just getting the calf, so they are not feeling what they are meant to feel, hmmm what’s going on?. This was also the case with me post operation as I was doing lunges walking forward my left (unaffected and 3 cm bigger in quad bulk) was burning whilst my right (operated leg) was asleep and felt I could lunge forever on it. Over the next two days I would have left leg DOMS but no right leg DOMS. I have seen this more and more with knee injuries and post-surgery, the operated leg does not fatigue when it should if anything it's feeling stronger.

So what’s going on?

Mostly after surgeries, the issue within the joint is resolved but the pattern or position that the joint was in pre-op is not resolved and we have to figure that out first. So where to start? Let's start with stance.

Stance: Underrated

Stance is the most underrated exercise that we use. It really is one of the most important things when rehabbing clients. When treating a young GAA player post patella tendon (Right knee) rupture who has significant atrophy of the Quadriceps and VMO in particular. His surgeon was obsessed with getting that VMO back and he had spent months doing knee extensions but it didn’t grow. When asked the question “ what do you feel when doing the knee extensions?” he replied “ the tendon”. So we spent an hour going through an assessment and then exercises for the VMO and quad but it was all tendon, I through the kitchen sink at it but no good. I had failed but decided to give it another go next week and work on it together. When he was leaving and his mother was paying he was standing at the desk and put his left foot in front of his right, he had about 15 degrees right knee bend two hands on the reception desk and I was watching from my room (with two doors open its a clean view to reception) and there it was winking at me the VMO - he was in right stance and that's what I missed. We should always get stance first because it's the first thing you lose.  

Breaking down stance:

What to look for in stance and all exercises

Which way is the

1: Sternum: Thorax is 50% bodyweight you need to own that first

2: Zipper: It will tell you which way your pelvis is going

3: Shoulder height - it will dictate how well you can hip hike.

 

  • Stance reposition 1: 

 

  • Stance reposition 2: Use a book as it will allow for a hip hike

 

NOTE: These positions are where I feel the muscles recruiting more and also fit the mold of PRI patterns. What alters these patterns is a pathology.

The Lunge:

Let's break down the lunge for instance - Right foot forward lunge with left leg trailing, whats going on at the quads?. Right quad is concentric shortening whilst the left leg is eccentrically lengthening and loading. If you lunge with the right leg and feel left quad you need to figure out how to get that left quad to let go or you will never load the right side properly. This is so important for field sports athletes as this position mirrors running mechanics and change of direction. For example, if when playing the left quad that has being been holding you up during your 3 - 9-month rehab is taken away (slips, stuck in the ground) you have a right quad trying to slow down a knee that does not know how to without help from its left quad friend.

Right quad loading Lunge position:

  • Right lunge with right side rotation of t spine = left rotation of pelvis

  • Zipper to left rib cage to the right

 

 

Right Lunge with rotation and counterweight

  • Counterweight will mean sternum turns right

  • Zipper left

  • Left shoulder lower

 

Right Lunge with counterweight + right intercostal lengthening 

  • counterweight will mean sternum turns right

  • Zipper left

  • Left shoulder lower + right intercostal stretch

 

 

The wall Squat:

A staple of most knee rehab programmes and I use to loathe it but I have recently started using it again. The reason I use to loathe it is because I couldn't get people to “feel what they were meant to feel”. So here is some simple fixes of the wall squat.


Left quad wall squat

  • Zipper left using foam roller

  • Sternum right

Left quad wall squat + Loaded

  • Zipper left

  • Sternum right

  • Left shoulder lower

Left quad wall squat on book + loaded

 

  • Zipper left

  • Sternum right

  • Left shoulder lower

  • Left hip hike



Thanks for reading and next week I am breaking down fixes for a single leg deadlift and glute bridge

 

Tommy

Tennis Elbow - Pain when you grip?

Piercing Elbow Pain? - Tennis Elbow!

Orla O' Regan & Andrew O' Neill. 

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Are you feeling pain on the outer side of your elbow? shooting pain while gripping and touching that area can be quite sore? Do you use your computer on a daily basis? Does your job include repetitive use of your hands? Are you a painter? Carpenter? Butcher, or are you working on a computer a lot?
 

You may have lateral epicondylitis or more commonly known as tennis elbow. Tennis elbow is associated with playing tennis, but only 5% of cases originate from the activity. Tennis elbow is associated with inflammation and tiny micro-ruptures of the tendon attached to the elbow caused by repetitive overuse and stress. If you are someone who uses a computer on a daily basis or someone who uses their hands repetitively in your job or even during activities of daily living you may suffer from tennis elbow. These people have a higher chance of suffering from the tendinopathy because repetitive overuse leads to small tears in the muscles/tendon from work/habits. The majority of the muscles in the forearm on the outside of your arm insert into the outer area of your elbow. The muscles around this area are called the extensor muscles and do just that, extend the wrist. You use these muscles to hold your mobile phone, to pick up a cup of tea or twisting your arm to turn a door handle. Over a couple of months, you may find it difficult to lift or have a painful grip. There is another version called “Golfer’s Elbow” which is on the inner area of your forearm or the opposite side. 

These are the most common causes of tennis elbow but other factors are at play. In our clinic, we always look to see how well the wrist, the elbow and the shoulder interact with each other. As the elbow is the joint between the wrist and shoulder and a lot of forces are passed through this joint and the muscles attached to it. This joint is similar to the knee joint which takes a lot of ground reaction forces when we walk or run. Similar forces apply in the elbow when we are lifting, gripping and throwing so it is imperative that there are no other issues on the wrist and shoulder. Unfortunately there usually is with people who suffer from this type of pain. So treating the area of pain at the elbow will not suffice. It will reduce the pain for a period of time but if there is a mechanical deficiency around the shoulder or the wrist the pain will return. 

Within the clinic, tennis elbow is a common problem and can be treated very quickly through specialised treatment options that are suited to each patient and the success rate of getting patients out of pain is very high. For further information on tennis elbow or golfer's elbow please see our website: tcphysiotherapy.com and check us out on all social media platforms.

 

Hamstring Injuries - What Can Cause Them

Andrew O'Neill - Chartered Physiotherapist 

Are you constantly ‘pulling’ your hamstrings ? do they constantly feel tight? Hamstring injuries are probably the most common sports-related injuries we see in the clinic especially in GAA players and runners. So why is this? Several reasons are playing, sometimes the issue is not the hamstring muscle or tissue itself, it’s what’s happening around it.

The hip capsule and knee capsule.

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Its important people can first of all fully flex the knee and hip, To simplify - the ability to bring heel to bum lying on your front and bring knee to chest lying on your back. An inability to do this may mean you may have some knee capsule tightness and quad length issues (if quad muscles cannot lengthen, hamstrings cannot shorten)  or hip capsule tightness. Generally, people you have this on their hip will feel a pinch in their groin when they go to do this movement. If you cannot do both of these movements properly your hamstring cannot function effectively when you are running and as the leg swings forward and backward.

How the hamstrings and calf muscle work together.

 

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When our feet hit ground a lot of forces go through the leg and up through the the body. It is important that we can control these effectively. This obviously starts with the foot and ankle but one of the most important junctions to absorb these forces is the posterior knee or back of the knee. At this point the calf muscles and hamstring muscles have to interact together. We find in most people who have recurrent hamstring injuries that these muscles do not work well together and they are quite weak here also. So, what tends to happen is the the calf does a lot more work than the hamstring and an imbalance forms where the hamstring doesn’t activate properly and basically it cannot create enough of tension required to contract the muscles in a few different ways that need to run, jump, slow, twist and turn.

 

The position of the pelvis.

We often see in clinic that people have really long hamstrings. They can lie on their back keeping the leg straight and raise it to 90 degrees and beyond. This is not good. This generally means they have LONG hamstrings. So why do they say they still feel tight though they can lengthen them so far? This is important so stick with me !

 

The reason people still feel they have tight hamstrings even though they are long is because the hamstring muscles are in a constantly lengthened position. Think of an elastic band - if you stretch it, it is not loose is it ? If you flick the band when it stretched there is tension on it, you hamstring is the very same but your brain cannot distinguish if this tension is in a lengthen position or in a shortened position - it will just feel tension ! So unfortunately people feel this tension and presume they are tight and then they stretch them even further creating a vicious circle ! Next, let’s think of what’s happening when your running with long hamstrings. Well remember if they are in a constant lengthened and toned state, so they cannot full contract fully or act like a spring. Hence they only work through a short range of motion and then become tired and give up, causing pain or worse, a tear. To adjust this we need to posteriorly tilt our pelvis and try not to run is such an extend position especially when we are tired and caught for air ! We can do this by working on our diaphragm and rib cage. We have several exercises online to show you how to do this.

 

Pic demonstrates anterior pelvic tilt - note lengthened hamstrings on right hand side

 

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So as you can see hamstring issues, isn’t down to tight hamstrings it’s multifactorial issue. For more information visit our website and facebook and instagram pages, or do not hesitate to contact us.  

 

Poor Sleep = Pain ?

Andrew O'Neill - Chartered Physiotherapist 

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Recent studies on poor sleep quality and/ or lack of sleep has shown to increase injuries in athletic populations. Why is this the case? Well, there are a number of reasons. Firstly, fatigue affects reaction time. A tired athlete is slower to react to a potential hit on the field. Secondly, fatigue affects the body’s immune system, making players more susceptible to illness. Thirdly, shorter sleep periods don’t provide the body with enough with sufficient time to regenerate muscle cells and repair from training and playing. Over time, injuries sustained in games, health issues and the inability to fully recover can wear on an athlete and contribute to more time spent on the sidelines or with the physio!

In a world where we constantly seek out new recovery tools and treatments to enhance performance, we often neglect the most obvious one, sleep. We simply cannot live without it! “If you told an athlete you had a treatment that would reduce the chemicals associated with stress, that would naturally increase human growth hormone, that enhances recovery rate, that improves performance, they would all do it. Sleep does all of those things.” - Casey Smith, Head Athletic Trainer, Dallas Mavericks.

Cheri Mah, a researcher at Stanford University, conducted a sleep extension study with the university’s men’s basketball team. After he got the player to maintain their normal sleep schedule for 4 weeks to establish a baseline, players from the team went through a 7-week sleep extension period. Over this time, the players obtained as much night-time sleep as possible, aiming for 10 hours. The results were staggering:

“Measures of athletic performance specific to basketball were recorded after every practice including a timed sprint and shooting accuracy. Subjects demonstrated a faster-timed sprint following sleep extension. Shooting accuracy improved, with free throw percentage increasing by 9% and 3-point field goal percentage increasing by 9.2%. Improvements in specific measures of basketball performance after sleep extension indicate that optimal sleep is likely beneficial in reaching peak athletic performance. ”

Closer to home, Michelle biggins (a physiotherapist that I had the pleasure of working for in Galway) conducted a study where she got 69 elite male GAA athletes to answer a set of validated questionnaires related to sleep, general health, stress, and mood. "Questions were asked around time taken to fall asleep, sleep quality and duration, sleep disturbances and daytime dysfunction. We then compared the general health and wellbeing of the poor sleepers and the good sleepers."

"We found that 47.8pc of these elite GAA athletes were poor sleepers. Athletes who were poor sleepers had significantly lower general health, increased stress and lower mood."

Michelle pointed out that athletes need about 8-10 hours of sleep per night, to facilitate recovery from tough training sessions.

So, we can see sleep should be one of the most important tools in our armor not just to reduce injury risk but to actually increase performance. If you would like to read any of the research papers on sleep and it’s importance on athletic performance please do not hesitate to contact TC physiotherapy and we will gladly provide you with them. Also all this week on out Instagram and facebook page we will be discussing the topic and show you some tips and tricks on how to improve your sleep.

Orla's Blog - Week 3 & 4 - Final year Physiotherapy student -

As last week hampered the clinic's schedule, TC was closed and I decided to hold off on this week's blog and just add it to week 4. 

2/3/18 -Blog 3-  Arthritis

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The past few days the weather has been the topic of conversation. The country
had gone from a yellow to a red warning in a matter of hours. Everyone is
delighted to see rain back in Ireland now. Concerning the weather, some wonder
whether the joint pain is linked to the colder climate. Research studies showed a
mixed result. Last week the general anatomy of the knee was discussed.
For the people who have limited information about arthritis, this blog will briefly
discuss the cause, symptoms, and treatment. There is two subtype of arthritis 1)
Rheumatoid Arthritis 2) Osteoarthritis. Rheumatoid Arthritis develops in
patients around 20/30 years old while Osteoarthritis is usually above 40 years
old. There isn’t one direct cause of osteoarthritis, but professionals believe it is
a combination of factors. The most common reason is wear and tear with aging,
high load on the joints such as being overweight, environmental and genetic
factors. Symptoms of osteoarthritis are stiffness, pain, swelling and muscle
weakness.

Physiotherapy is very helpful to Osteoarthritis and Rheumatoid Arthritis
sufferers. Physiotherapy is key to the treatment and the management of patients
with arthritis. Concentrating on reducing pain and stiffness to help you have a
regular daily life by increasing movement in the joints. The treatment and
management are done through a tailored treatment programme. Techniques are
provided within the clinic to allow you to be independent and to reduce
pain/stiffness. For elderly, it is the utmost importance to keep warm in this
Christmas-like weather and to keep moving every hour while staying safe.
Throughout the week the quotes are:

Tommy regarding: “Your goal throughout your life, is to maintain the basic movements that you have being given as a child."
From Andrew: “Don’t let a little injury become a major problem –Get it checked!”
From Natalie: "Slow, controlled movements are the most important part of pilates"
From Amy: “Pilates doesn’t have an age limit”

 

9/3/18 -Blog 4- Back Pain

When you’re lifting your baby do you have pain in your back? When you are
working at in the office, do you feel pain in your back? Low back pain is quite
common, and it is usually recurrent but rarely serious.

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The first instinct is to avoid the movement(s) that induces the pain, people may
become stressed about preventing that specific movement. When you avoid a
certain movement for a long period the supporting muscles can be overused
while the main muscle can shift into a state of dormancy, or else the opposite
side of the body will be overcompensating. Stress, fear and worry can hinder
your progress to normality. When this overcompensating occurs, muscle
guarding takes place. Muscle guarding is when a supporting muscle is in an
active state to protect the muscle or structure that has been damaged.

Think of it as a fight response or your muscle is on guard to help out all the time when it should
not be. It is a protective mechanism that can be driven by fear or worry and the
supporting muscles become the main activators.

The body mechanism is to defend itself from potential/perceived threats however without actual threats it will lead to a potential problem.

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In the past, bed rest was recommended for low back pain. Recently evidence-
based research showed that low back pain sufferers who remain active have a
better long-term outlook for reduced pain and improvement for the normal daily
living. With this in mind, find a balance of rest and staying active to improve
movement, don't wait for the pain to be gone entirely before moving again. For
the first week rest but introduce exercises provided by a physiotherapist to
ensure a full recovery. If it has been awhile since exercising your muscles that
were asleep are activated again, some feel the effects of DOMS, which is
different. DOMS is known as Delayed Onset of Muscle Soreness, which is stiffness
and pain that occurs after exercise.

When muscle guarding occurs is can be released by the help and support from
physiotherapists. So if in doubt, check it out!

Throughout the week the quotes are:
Tommy regarding: “The most important thing is what position you are in, not which muscles are strong or weak. It's easy to make a muscle weak, just put it in a bad position."
From Andrew: “Pain is an output of the brain it’s a worrying sign but doesn’t
always mean damage”
From Natalie: "Exhaling is essential to gain full abdominal control"
From Amy:  "Pilates is for everyBODY!"

Fall-Related Injuries and What To Do When They Happen

Andrew O'Neill - Chartered Physiotherapist

I spent a year in Limerick in an orthopedic hospital. We use to call December and January silly season due to the unbelievable spike in fractures, sprains, and all round fall-related injuries. What caused the spike? Well, the weather was partly to blame, mainly due to frosty or icy footpaths and generally people simply slipping. Of course, christmas shenanigans on Christmas nights of were also, unfortunately, a major part of the increase of people that came through the hospital doors. Similar scenes will have occurred last week and this week due to the heavy snow!  

I felt it might be a good time to discuss what to do if you feel you have fallen, landed awkwardly or twisted an ankle for example! This article will also serve as a guideline to those who injure a joint playing sport also. The types of injuries I am discussing are what we call acute injuries and will focus on joint injuries. An acute sports injury is one in which there is a specific mechanism of injury (hit by the ball, plant, and twist, collision with an opponent) and an immediate onset of symptoms including swelling, pain, bleeding and possible deformity. The same can be said for fall-related injuries.

A number injuries can be considered acute including:

• Sprains (injury to ligaments)

• Strains (injury to muscles)

• Contusions (bruises)

• Subluxation (partial dislocation that reduces itself)

• Dislocation

• Fractures

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Ankle Sprain

If you or somebody you know were to suffer an injury like these it is important to know when to get to the A&E department or when you can do something about it yourself with what we like to call the P.R.I.C.E principle. This stands for:

  • Protection

  • Rest

  • Ice

  • Compression

  • Elevation

Firstly, if you see any deformity in the joint you or another person has injured - go to an A&E department. If you cannot put any weight on the ground - go to an A&E department. If you have extreme swelling and pain - go to an A&E department. If it’s a thing that you didn’t initially go to an A&E department and the pain has not reduced somewhat and has persisted 24-48 hrs later - go to an A&E department.

I have had plenty of joint injuries playing a sport such as an ankle and wrist sprains. Not all of these have required me to get an x-ray. So try and be smart about it. Am I in a situation similar to above in the last paragraph or do I feel using something like the P.R.I.C.E principle may help me reduce the pain symptoms. It’s quite simple to use. PROTECTION - clean the injury and protect it, if it there are any cuts or bruises. REST -  time can be a great healer, don’t keep moving around with the joint sore, give yourself a rest. ICE - the only way to reduce swelling and in turn reduce pain apply 5-10 min at a time. COMPRESSION - Also very important to reduce swelling and will give the joint a sense of protection. ELEVATION - this will allow the swelling to dissipate into the bloodstream further reducing pain.

Once pain and swelling have reduced, you will probably find the joint will be stiff. This is the when you need to get it assessed by a physiotherapist. Too often we see people come into clinic months after the initial injury in chronic pain, something that could have been avoided if the were to get the correct type of hands-on treatment and exercise therapy.

Orla's Blog Week 2

Blog 2: The Knee Joint

Orla, Student Physiotherapist.

The second blog will focus on the general anatomy, possible problems, and a case study of the knee joint, based on an educational perspective for people who have general interest or students studying physiotherapy.

 

The knee joint that is also known as the Tibiofemoral joint. Above the knee, there is the femur and below is the tibia. Lateral to the tibia is the fibula, which supports the tibia. The patella (commonly known as the kneecap) is connected to the tibia by the patellar ligament. Beneath the patella is the Infrapatellar fat pad. At the end of each bone (Femur and Tibia), there is a rubbery surface that acts as a shock absorber and allows movement this material is called the Articular Cartilage. The meniscus is known as the cartilage of the knee, help spread the weight of the body.

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There small “ropes” around the knee that are called ligaments. The ACL (Anterior cruciate ligament) and the PCL (Posterior cruciate ligament) are within the joint. The ACL stops forward motion of the tibia, and the PCL stops backward movement of the tibia.  The MCL (Medial collateral ligament) (inner side of the knee) connects the femur to the Tibia, which resists valgus force. The LCL (Lateral collateral ligament) (outer side of the knee) resists varus force.

Healthy, functional muscles are essential for everyday activities. At the front of the leg, there are the muscles that allow you to straighten your knee.

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Four quadriceps muscles are:

➢    Rectus Femoris

➢    Vastus Medialis

➢    Vastus Lateralis

➢    Vastus Intermedialis

The muscles behind your thigh are called the Hamstring muscles.

 

The group consists of:

➢    Bicep Femoris

➢    Semitendinosus

➢    Semimembranosus

 

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If you place your hand on the side of your thigh, you can find the Iliotibial band. The muscles located on the inner thigh are known as the adductors. The Tricep Surea is the medical term for calve muscles. These muscles will be discussed in a future blog.

Nerves:

The most essential nerves around the knees are the tibial nerve and the common peroneal nerve, which supply sensation and muscle control. The majority know of the Sciatica nerve, the Sciatica nerve splits (at the back, above the knee) into the tibial nerve and the common peroneal nerve.

Blood Supply:

Keeping it simple and to the point, the popliteal artery (has come from the femoral artery) and the popliteal vein are the most significant blood supply to the leg and foot.


Common/ Potential problems:

➢    ACL Injury

➢    PCL Injury

➢    MCL Sprain

➢    LCL Sprain

➢    Meniscus Tear

➢    Patella dislocation

➢    Fat Pad Syndrome

➢    Patellofemoral Pain Syndrome (Runner’s Knee)

➢    Osgood Schlatter’s

➢    Knee Osteoarthritis

➢    Tendinopathy

➢    Popliteus Tendinitis

➢    ITB syndrome

➢    Muscle Strain

➢    DOMS (Delayed Onset Muscle Soreness)

➢    Hamstring Strain


Case Study: Post Meniscus (Cartilage) Surgery

During the surgery: the lateral meniscus was “cleaned up and smoothed out”, and medial was not touched during the operation. The patient presented with pain medially and posterior to the knee, some pain located at the pes ansinerus site, pinch felt and locking sensation when extending the leg. On palpation, the popliteus is tense and hamstrings tense and short. For clinical reasoning we want to know why the popliteus is locking. Looking back at the anatomy of the knee can you understand why?

The insertion of two of the hamstring muscles in detail, they insert to the proximal tibia, pes anserinus (Semitendinosus) and posterior medial condyle of the tibia (Semimembranosus), from extensive research they also slightly insert to the medial part of the meniscus/cartilage. Bearing this in mind, the hamstrings are short and tense, the cartilage on one side of the meniscus was cleaned, and the opposite was not touched. The hamstrings may be pulling the cartilage, which may be leading to a pinch.


Quick Quiz:

Which hamstring muscle inserts to the lateral condyle of the Tibia and the head of the Fibula?

Which hamstring is most medial in terms of location?


Throughout the week the tips are:

Tommy regarding: “The most important aspect of any rehab including knee, back and neck problems is to make sure you can stand on each leg properly”

From Andrew: “Neck muscles become tight when the upper rib cage is elevated because neck muscles are attached to rib cage.”

From Natalie: “Exhaling all your air out and you will feel abs twice as much”

From Amy: “Breathing is the first act of life and the last”

 

How Breathing Pattern Disorders Cause Injuries and Pain

Andrew O' Neill Chartered Physiotherapist @ TC Physiotherapy

What are breathing pattern disorders?

Before I answer that question we have to understand what good functional movement is. It can be described as the following - the ability to produce and maintain an adequate balance of mobility and stability while integrating fundamental movement patterns with accuracy and efficiency within the body.

Why is this important?

If we can’t move efficiently we will more than likely have pain somewhere in the body or the in-efficiency itself may eventually lead to an injury. To be efficient in movement, even in general walking or running you have to be able to shift the body from one side to the other effectively. Many, many people can’t do this. In essence, they are ‘stuck’ in one side, mostly on the right leg i.e. most people will place more weight and force on their right side. Many people think this is because most people are right legged or right handed. But, it actually comes down to the diaphragm which is stronger on the right side and in a poor position. Without going into too much detail we compensate for this by shifting to that side from pelvis down and rotate our rib cage and thoracic spine to the left. Unfortunately, we can shift too much into these compensatory patterns and reduce our movement efficiency which may lead to injury and pain. Also, it's important to remember we are not perfectly symmetrical like textbooks and anatomy pictures show us!

(more accurate representation of what the diaphragm looks like)

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So we are getting a picture here why the diaphragm is important. When it works efficiently and is in a good position these overcompensatory patterns are not an issue.

Let’s get back to breathing pattern disorders ! what are these? They are really just when a diaphragm does not work properly - remember it is a muscle, it has to be able to lengthen and contract like every other muscle. We see in our clinic that many people’s diaphragms are weak, hence they are not breathing properly. Most will breathe through their mouth and are what we call apex or upper chest breathing. This means the rib cage becomes elevated which in turn leads to an increase in the arch in the lumbar spine and an anterior pelvic tilt. (see below)

 

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This leads to a multitude of issues. Have, you ever had low back pain, tight calves, achilles pain, plantar fasciitis, knee pain, neck or shoulder pain? All these issues could be down to poor breathing patterns.

 

How do we fix it?

Well, there are few things we need to do, Firstly, we need to be able to lengthen and strengthen the diaphragm. Like I said it is a muscle. We can train it just like any other muscle. Specific breathing exercises in specific positions and even using a balloon can do this (see pic below). We a need to reduce our respiratory rate (the amount of breaths we take per minute) breathing should be long and slow, not short and shallow, this reduces neuromuscular tension and relaxes the nervous system while also reducing the need for upper neck and shoulder muscles from working too hard. Nose breathing will slow down respiratory rate while also using your diaphragm more effectively. Also just ‘strengthening’ your core will not ‘fix’ your back. The most effective trunk stabilizer you have is actually your diaphragm, strengthen this.


 

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Orla's Blog - Week 1

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Note: I have never been able to touch my toes and my challenge to the TC team is to get me to touch my toes in 8 weeks. 

From the beginning of the week, Tommy and the staff were very welcoming for a physiotherapist student to join them. Tommy, Andrew (chartered physiotherapists) and Ed (Athletic Therapist), work in TC Physiotherapy. Natalie, Lead OnePilates instructor, and Amy, the reformer pilates instructor walked me through TC Physiotherapy and the One Pilates premises. 

The minority may not know the importance of physiotherapy and why it is a critical aspect to improve problems which may restrict a person in everyday life. The ultimate goal of physiotherapy is to identify and promote, develop and maintain a person quality of life, improving functional ability by prevention and treatment. Reformer Pilates is the use of a machine with resistance and assistance. The equipment can cater for different levels of resistance. It is built specifically to fit different body types and fitness levels. It’s vital for developing and maintaining strong core, hamstrings, and glutes (muscles essential in maintaining good, correct posture and reducing injuries), the OnePilates concentrates on the right pelvic position and promoting the best breathing techniques. Physiotherapy and Reformer Pilates combined supports the optimal rehabilitation for patients starting their treatment or maintaining their progress.

For the first blog, the main areas that will be concentrated on are the two treatment tools that are available in TC Physiotherapy clinic. Exercise is always the main focus of any treatment, but for extra support with the exercises, the Graston technique and the Myofascial trigger point Dry Needling are an option. 

There were many cases that the clinic treats such as: 

Low back pain, 

Frozen shoulder, 

MCL (Medial Collateral Ligament) sprain, 

ACL (Anterior Cruciate Ligament) post-surgery rehabilitation, 

Knee pain, 

Neck pain, 

Posture, 

A/C dislocation, 

Fibromyalgia,

Sciatica, 

Tendinitis including tennis elbow and Achilles tendinopathy. 

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Graston technique is based on cross friction massage. The technique breaks down fascial restrictions and scar tissue adhesions. It is usually used for patients who have suffered from tendinopathies such as tennis elbow, golfers elbow, rotator cuff tendinosis and Achilles tendinitis. The reason for using the Graston technique has been shown in research and in practice to improve recovery; it breaks down malformed fibers by using the cross friction massage and reducing the need for anti-inflammatory medication and most importantly reduced pain.

Another technique used within TC Physiotherapy is Myofascial trigger point dry needling, also known as Dry Needling. The technique uses a tiny “dry” needle, one without medication or injection, inserted through the skin into areas of the muscle. Simply put when the needle hit the ‘taut’ band of muscle or ‘knot’ it releases it. When it releases there is an increase in blood flow through the muscle, with that comes an increase in oxygen flowing through the muscle. All this combines to relax the muscle in question and allow it to move more efficiently and pain-free. This is different to acupuncture. Acupuncture is based on Chinese medicine, and the needles are only placed on top of the skin.

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Throughout the week the tips are: 

Tommy regarding back pain: “If there is back pain, always concentrate on triceps, obliques, hamstrings and abdominals.” 

From Andrew regarding running: “The diaphragm is the most important muscle in the body.”

From Ed regarding Massage "Regular massage treatment is very important for clients with chronic pain and arthritis, it works"

From Natalie regarding the classes: “It’s a full body workout, you realise you have muscles in places you have never felt.”

From Amy regarding reformer beds: “The reformer bed is amazing, it’s adaptable for every person. Two clients who are regulars for the weekly classes had previous back surgery, which just shows how safe and effective the reformer Pilates is”

Orla, Student Physiotherapist.

 

Health & Technology

Tommy Conway

So this week I am going to give a quick rundown of three health and fitness products that I really like and use.

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First up is the -Tronsmart GLEAM wireless headphones- €39.99 (FIXMYI): I started using these headphones when we moved the clinic to Axis business park and wanted to walk to and from work. They are very comfortable and wireless so no cables (thank god for that invention), also the sound is excellent and you can take calls on the move. The key feature which I think a lot of people will like is that they glow in the dark, I like this for walking at night or early morning in the dark. The band at the back flashes or stays a constant luminous green for safety reasons. For me, every runner/ walker should have a pair as they light up the most important area when running at night, your head. They really are the best product I have bought in a while, very comfortable in your ear, I wear a wooly hat over them on the way to work you wouldn't even notice them. They can be bought at any Fixmyi store Tullamore, Mullingar, and Athlone.

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Secondly is the -Oura ring- €329 (https://original.ouraring.com/product/oura-ring/): This is a sleep tracking device that I use personally to track my sleep on a daily basis. This product is quite expensive but very accurate to sleep quality. There are three small receptors that sit on the inside of the ring that accurately gives a reading of heart rate so you can estimate when your body is going through the different sleep cycles (REM, Deep Sleep). It's the most expensive form of sleep tracker and it comes with some fatal flaws: 1: The battery only last 2 - 3 days which means you have to charge it every second day. 2: Its ugly: you are meant to wear it during the day but its very bulky and stands out from the crowd so you don't get an activity tracker with your sleep tracker. The good news is there is a new Oura ring on the way and it has a battery like for a week so I think I'll be investing.

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Third, we have the -Tronsmart element T4 portable Bluetooth speaker- €29.99 (FIXMYI): This is perfect for all outdoor activities. This product is water resistant and has a playback time of 6 hours. I think this is ideal for hiking activities which have become more prominent in Irish culture over the last few years. hiking is something that is going to grow and grow over the next few years and I feel its a brilliant activity for people to maintain basic fitness. If you a hike in a group this can be a brilliant product for background music.

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Anterior Cruciate Ligament Knee Injuries

The Dreaded, But Very Common ACL Injury

The anterior cruciate ligament (ACL) is a band of dense connective tissue which courses from the femur (larger upper bone of the leg) to the tibia (lower bone of the leg). The ACL is a key structure in the knee joint, as it resists anterior tibial translation and rotational loads. Meaning it helps prevent the knee from overly twisting (usually inwards) or the lower bone shift aggressively forward, it actually provides approximately 85% of the total restraining force of anterior translation or this forward movement.

Most of these injuries occur during sporting activities (but not always !). The most common reason it occurs is when the person's foot is planted on the ground and the knee is twisted inward but the upper body and femur is twisted in the opposite direction usually when trying to suddenly change direction. It can also occur if there is extreme hyperextension or hyperflexion of the knee or there is direct contact (usually to the outside) of the knee.

Several studies have shown female athletes have a higher incidence of ACL injuries than males because of differences in pelvic and lower leg alignment and the effects estrogen has on ligament properties. For these reasons, when it comes to rehabbing a female patient special emphasis must be placed on ensuring certain muscles around the pelvis are really strong to prevent it reoccurring. Here at TC Physiotherapy, we place a huge emphasis on hamstring strength in both male and female cohorts, Unfortunately, this is regularly overlooked when it comes to rehabbing the injury.

The Hamstrings are very important because they need to be able to extend the hip, flex the knee and rotate the femur and tibia but most importantly they stop excessive translation or too much shifting of the tibia on the femur. (see below)

If you hamstrings are long and weak (which most peoples are !) this will affect your ability to be able to fully straighten the knee, if you can’t do this you will be placing your knee under severe stress and it is  likely that the injury will re-occur and/or lead to other knee injuries when you are back playing sport.

Strength training in general for the knee is also very important as it increases stability and helps to compress the joint.  Without that stability, you have a loose, sloppy joint, that’s really going to be subject to increased wear and tear. The most important factor is you get the right rehab program for you and not to do a generic one. As the name suggests ‘cruciate’ is a ‘crucial’ ligament in the knee and yes it a serious injury but it doesn’t mean the end of your sporting career once you have gone through a proper rehab program tailored to your specific needs.


 

Dry Needling: Don't be afraid of it, IT WORKS.

Andrew O'Neill - Chartered Physiotherapist specializing in Chronic pain.

QUICK NOTE: At TC Physiotherapy we have three clinicians all trained in Dry Needling. We have all done separate training as to bring the best ideas in the industry and share them with each other. It is the most skillful form of treatment as you are dealing with a tiny needle and very little room for error, So never blame the therapy maybe blame the practitioner if not successful.

Dry needling of the upper trap muscle for neck pain and headaches.

Dry needling of the upper trap muscle for neck pain and headaches.

Why Does Dry Needling Work?

You may have heard about the rather unusual treatment Physiotherapists use to relieve all types of muscle pain from the head to the toe, called Dry Needling. A process in which needles are placed into specific muscles around the body. Sounds kind of crazy really, allowing somebody ‘poke you’ with a needle into a muscle! I assure you it is isn’t and will explain why. So the important stuff, what exactly is it?, How does it work? Is it the same as acupuncture? And most importantly, is it safe?

Too often physiotherapists are quick to jump on new ‘state of the art treatment modalities’. Unfortunately, these are used for a while on patients with varying results and then tossed aside when something better or more innovative comes along, only for the same process to occur again. Don’t get me wrong, some of these treatments such as ultrasound or laser have a place with certain patients in trying to reduce pain, unfortunately, we are not overly sure why they work for some people and not others. Some of the positive outcomes we see may just come down to the placebo effect. Dry Needling, however, is not a new ‘sexy’ and ‘innovative’ treatment, it has been around since the 1940’s. Research into the area is revealing it is very effective in treating painful muscular trigger points.

What are these muscular trigger points?

A trigger point is a taut band or ‘knot’ of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch, and touching a trigger point may cause pain to other parts of the body leading to difficulty performing everyday tasks. When a person has painful muscles and trigger points, it is sometimes called myofascial pain syndrome. We can find these trigger points all over our body depending on the type of pain and stress being experienced by a person. From experience here in our clinic, they can be especially useful in reducing neck/ shoulder pain and low back pain.

How does it work?

The technique uses a tiny “dry” needle, one without medication or injection, inserted through the skin into areas of the muscle. Simply put when the needle hit the ‘taut’ band of muscle or ‘knot’ it releases it. When it releases there is an increase in blood flow through the muscle, with that comes an increase in oxygen flowing through the muscle. All this combines to relax the muscle in question and allow it to move more efficiently and pain-free. This is totally different to acupuncture. Acupuncture is based on Chinese medicine and the needles are really only placed on top of the skin.

Is it safe?

Dry needling is a specialized treatment for muscular trigger points provided by highly trained physiotherapists who have undergone specific training in the area and who are regulated to provide the treatment. These physiotherapists must have an excellent knowledge base in human anatomy. Hence, they will only administer the treatment to specific parts of the body. So, when carried out by a physiotherapist who has undergone this specific training it is perfectly safe. Remember, this is treatment adjunct, and is usually combined with other techniques including specific exercises, to manage muscular pain. It is very effective in treating pain but not so much the root cause of your pain. Your physiotherapist can perform a thorough evaluation to help determine if you are a good candidate for this treatment as part of a program designed to reduce your pain and improve your function.

Now that you have become informed, you can see it’s not a scary treatment. It is an evidence-based therapy backed and researched by Western Medicine showing to have impressive results. Of course, you will have to remember that this treatment alone will likely not cure you, but that you may need to fix imbalances with corrective exercises. But getting “poked” maybe that thing you need to get you over that hump and get you straight on the road to recovery!

- Growing pains: KIDS -

Tommy Conway

So often in the clinic, we see young kids from the ages of 8 - 14 with "growing pains", It can be quiet painful on the kids especially if they want to play or just move around pain-free. In this article, I am going to discuss what causes these growing pains? where is the common site of these pains? and how can you help them? 

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What Causes growing pains? 

There is no clear scientific evidence that growth spurts are actually linked to pain. In my experience, I find that as your child grows certain muscle groups have a far greater ability to control a longer body and in turn, they become tighter and cause painful issues. The muscles I am referring to are the Quads, Calfs, and back muscles, these muscles will have control of major landmarks of the body, the quads will control the kneecap and the calfs with control the heel bone.This brings me to the next section.

Where is the common site of pain? 

The two most common sites of pain are below the kneecap tendon (Osgood schlatters) and also the site of the heelbone tendon (Severs disease). Osgood schlatters is characterized by pain when climbing stairs, kneeling, and running. The kneecap tendon becomes inflamed and results in a bump on the shinbone, both will be very tender to touch. Severs is pain just above the heel bone characterized by pain when getting out of the bed in the morning, running and climbing stairs. Severs can also cause an increased size of the Achilles tendon. 

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How can you help them? 

First off you have to make sure that your child's issues are actually growing pains and not just a muscle issue causing the pain. So, how do you know? Well, its very simple: IF THEY HAVE PAIN IN BOTH KNEES = GROWING PAINS. If they have pain in one knee = Muscle problem and rule out growing pains."But I read up on it and my son has growing pains in his left knee only?" my response as always did your son's left leg grew quicker than the right? As that doesn't make sense. Think about it logically you cannot have a growth spurt on one bone, one limb, but you can have greater bulk in a muscle on one side. Either way, REST is not the cure, If your child is very active these small things will relieve pain, Ice on the painful area, rest for a week or 2 but when they return to the activity it will return. So what do you do? More and more in the clinic we are seeing young kids and the results are very good, usually we can get someone out of pain with Osgood's or servers within a month and commonly the diagnosis is 3 - 6 months out from sport. How do we do this? We offload the muscles that are directly affecting the painful area and we build strength in the muscles that oppose quads, back muscles, and calfs.The great thing when dealing with kids is that do recover quicker, they are still learning new patterns of movements and they are not as rigid as adults so you can change them quite quick and get great results.

Have You Started Getting Knee Pain? And don’t know why?

Andrew O'Neill - knee specialist 

Many of you have just turned over a new leaf, you may be 2 weeks into to your new year’s resolution of getting fitter and healthier. You have started to move a lot more, be that hitting the gym, running, cycling, swimming or walking. All of a sudden your getting aches and pains in joints and muscles you never knew you ever had! Do not be disheartened help is at hand and what you are feeling is perfectly normal. You have basically given a shock to your system and it will take a bit of time to get used to the new you. However, if the pain you are feeling is persisting more than 3-4 days it’s best to get it checked out before it gets any nastier and puts a stop all your good work to date and your personal goal.

This time of year we see an influx of people into our clinic just like I have described above. These people are smart people! One of the main reasons people regress on fitness regimes is due to simple injuries, 99% of which are simple to fix! With the correct treatment of course! But the key is not to leave it go too long.

One of the most common injuries we see this time of year is knee pain, particularly on the side of the knee or the front of the knee. These always manifest when people go from zero to 100 miles an hour over a short period of time in relation to there training regime.

Are you are feeling pain on the outside of your knee or on the side of your thigh but you haven’t had a twisting injury or taken a fall to that knee you may well be experiencing IT Band pain.

Typical symptoms with ITB syndrome include pain or tightness on the outside of the knee at or just above and below the level of the knee cap which can move all the way up the outside of the leg to the hip. Symptoms are typically worse with activity and leaving your knee bent for a period of time.

The ITB is a thick fibrous band that runs from the outside of the hip, all the way down the outside of the thigh to insert just below the knee joint on the tibia. We often get this pain where the band attaches to the knee joint because the band has become tight and almost ‘pulling’ at this junction. This results in the band being a) pulled tight over the femur (big upper leg bone), and b) repeatedly dragged back and forth over the bone as it helps bend and straighten the knee.

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So, why does the band tighten in the first place? Well there are several factors at play:

 

  1. ‘The knee is stuck in the middle with nowhere to go !!’

What we mean by this is that the symptoms you experience here are most likely to be caused by  some dysfunction either around and above the hip and pelvis or down in the ankle. You must remember that your knee doesn’t just have to straighten and bend when we walk or run. The lower leg bones (fibula and tibia) have to be able to rotate on the upper leg bone (femur) and vice versa. And yes, even this needs to happen when we are running and walking in straight lines! An inability to control these forces and rotations through weak or non-functioning muscles can lead to this type of knee pain.

 

    2. Breathing and Posture

 

We regularly come across people in the clinic who have poor breathing patterns. We find many of them are mouth breathers and don’t sufficiently use their diaphragms – this can cause havoc with your posture. Most mouth breathers tend to have ribs that flare out quite a bit.

Unfortunately, this rib flare can lead to an increase of lumbar lordosis in the spine increasing the tilt of your pelvis forward (what we call anterior pelvic tilting). Anterior pelvic tilting will lead to lengthened hamstrings, weakened and lengthened glutes, and tightened quads. This will affect how you walk or run causing the Knee joint to overload and experience this type of knee pain.


What can be done to fix it?

Strengthen your hamstrings and Glutes in a posterior tilted pelvic position.

The role of the glutes is to primarily extend the femur. This is very hard if you are in an anterior pelvic tilt position. It is important to maximise the muscles that will give you the greatest control of your posture and the muscles that will propel you forward to maximum effect when running and walking. Hip thrusters are proven to be one of the most effective ways to do this. We find most people have long weak hamstrings, a 90-90 hamstring exercise that focuses on diaphragmatic breathing is a great way to strengthen hamstrings and improve your pelvic positioning. These exercises can be found on TC physiotherapy youtube page.

Finally, Get Your Posture Assessed

Although the exercises above are all highly effective to help the tissues around your knee joint, the key is to find YOUR specific root cause of the problem. Therefore we never just prescribe the same exercises for two people with the same symptoms because we are individuals and our postures are all completely different. It is generally a good idea to get a qualified clinician to assess your posture as it will speed up the process and get you out of pain faster.

New year, New me, New injury!!!

Tommy Conway 

So it's that time of the year again when we think about the damage done at Christmas and try frantically to burn it off. I am no saint, I do it every year as well but I also see a lot of people in the clinic that really want to try and make a change but end up getting injured.

Any personal trainer or gym will tell you that the most common cause of client drop off is an injury so I am going to try and give a few simple pointers on how to avoid the pitfalls. 

1: What muscles should you stretch? 

There are lots and lots of stretches but if you are coming from a sedentary lifestyle you need to concentrate on these three: 

A: Quad chair stretch: You can use a chair or a couch to get into the position (see pic below) and where you should feel it is on the front of your thigh. If you can't even get into that position I can nearly guarantee you're going to get injured and you need to see a physio. 

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B: Back stretch - Door stretch: One of my favorite stretches as it loosens out the stubborn back muscles, which will stop you from breaking down and losing focus on your goals. Pull out of a door handle and you should feel it along with your lower and middle back (see pic below).

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C: Calf stretch: Try and get into the below position and yes you should feel your calfs.

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2: Start with 3 days, but don't do three in a row:

I always tell my clients when starting exercise you should always leave at least a days gap between your sessions. So for example, do a Monday, Wednesday and Friday, this will give you a days recovery between sessions. Don't get carried away looking at other people who train 5 days a week, remember you're at the start don't kill yourself give your body time to adjust and develop.

3: Recovery = Sleep 

Try and get your 8 hours sleep, there is no recovery protein drink that replaces sleep. Don't be afraid to take  9-10 hours sleep on your first 2 - 3 weeks of exercise your body is telling you that you need recovery. One thing I see a lot of people doing which is a mistake, sleeping on average 6-8 hours a night on the weekdays and then massive lie-ins on a Saturday and Sunday, this is really tricking your body in a bad way. Key point try and stay as close to 8 hours sleep a night for 7 days a week.

4: Low impact for greater impact: 

Try and pick an activity that has the least impact on your body but remember it's your body so try and take into account your past before taking up an activity. If you have had a number of injuries or are currently in pain, take up something that will correct these problems whilst also toning and strengthening your body. 

5: Nutrition:

I am no expert and won't pretend to be. It's quite simple if you're buying food from neon-lit shops at night then stop doing that and you're already onto a winner.

To stretch or not to stretch?

Ed Scully -Soft tissue and rehabilitation specialist 

Have you a feeling of tight calves, hip flexors, hamstrings, quads, upper back when training?  I want to run but my muscles are just too “tight”.  I want to go to the gym today but I have that niggle; maybe I will wait until next week?  So, does this mean your muscles are tight and need a vigorous stretching regime?  Absolutely not!  

The feeling of tightness is actually a perception just like thirst.  I bet there will be a lot of people reading this blog thinking, “I have a tight hamstring and I have been stretching it for God knows how long, but yet it still feels tight”.  This is due to a muscle imbalance!  Your hamstring is probably too long and needs to be shortened.  Our muscles have sensory receptors that respond to pressure and change in length. That feeling of tightness may actually be your muscle saying “please help, I am hanging on for dear life!”.   The key here is if you have a feeling of tightness get it checked out by a physiotherapist or athletic rehab therapist, it could be as simple as getting a deep tissue massage, at the right time, in the right place.

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One of the fundamental concepts of strengthening a muscle is to increase the cross-sectional area of the muscle fibre.  This will make the muscle bigger, stronger and create more force. A muscle that is in a shortened or lengthened positioned will never reach optimal performance.  Movement requires the contraction of an agonist muscle and the relaxation of the antagonist.  An example is; to contract the quads (agonist), the hamstrings (antagonist) needs to relax to a certain degree to allow the movement to commence. Without the relaxation of the hamstring, walking would be impossible.

I got into rehabilitation because I had a keen interest in the gym, but was constantly hitting plateaus and getting overuse injuries.  I now know what the problem was; I was feeding a pattern of pathology by strengthening my muscles in a shortened position. Without checking their antagonist. Now, for some, who have been training for years this may seem like basic knowledge, but don’t judge me yet! Have you ever had a chronic or overuse injury? Well,  if the answer is yes, you too have had training errors.  According to Sports Medicine Australia, “Up to 70% of recreational and competitive runners sustain overuse injuries during any 12-month period”, this information was gathered in a survey in 2006.  This is an astonishing statistic; the vast majority of these injuries could have been avoided.  There are two major outliers here; muscle imbalance and training errors.

So, for anyone hitting that plateau with your lifts or trying to get that 5k time down, ask yourself Is that muscle really tight or are you making yourself pathological?   Either way, you need to be advised correctly.  Just think this year you could be faster, stronger or injured! The choice is yours.

 

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Fibromyalgia - A case study of someone I helped

Ed Scully - sport and soft tissue specialist

The Patient 

(Mary is not the client's real name and either is her age as to keep her identity private)

The patient is a 42-year-old female, I am going to call her Mary for the purpose of the article. Mary is a devoted mother of three and has worked hard as a clerical officer for over twenty years.  She had no major surgeries but has been suffering from chronic pain, sleep disruption, headaches, fatigue, and fibromyalgia for four years. This has greatly impacted her quality of life and left her feeling tired and frustrated. She has a list of prescription medicine to help her get through the day. 

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Initial Consultation (11/9/17)

To get a diagnosis of fibromyalgia is actually quite difficult as there is no specific test or protocol to follow. The condition is complex and has so many variables. However, there are general guidelines to follow and these were published by the American College of Rheumatology. The guidelines suggest that a person with a history of widespread chronic pain for over three months, as well as associated symptoms of fibromyalgia, will merit further investigation. On examination, the person will have decreased tolerance to pressure in eleven specific areas of the body. This is seen as adequate information to warrant a diagnosis of fibromyalgia. Mary's main areas of pain are as follows: Feet, knees, hips and lower back, neck pain with headaches and sometimes burning in the hands. That is a very common list with fibromyalgia clients the key thing we need to identify is which areas are causing the majority of pain - I like to call them "the trigger muscles". The initial treatment is a light flush massage that allows sufficient feedback to the clinician, of the areas of hypersensitivity causing pain and discomfort. A light Flush massage will allow the client to understand which areas relieve quicker and in turn, they then understand their individual problem area.

Follow Up (14/9/17)

Follow up is within three days; this is because most people with fibromyalgia will generally look for treatment during a fibro flare. During a flare, all symptoms of fibromyalgia will spike. It is crucial to get that follow up treatment early, as the initial treatment may aggravate symptoms if left too long! This is why the initial treatment is a light flush massage rather than a deep tissue massage. It is also important to understand that the body may not like change; change is always good whether it is positive or negative. The key is working towards that positive change. 

The treatment at this stage includes a deep tissue massage and trigger point release followed by a light flush. Trigger release therapy was especially needed for this particular case as her upper shoulder and neck region muscular tissue was carrying a lot of tension. The tension in this region can cause intensive headaches. 

 

Follow Up 2 (18/9/17)

Mary’s symptoms of pain, in general, have subsided slightly from the last session but headache’s had intensified. The most important thing for this session is to releases her neck muscles, the sub occipitals in particular. These muscles are located at the base of the skull. Pressing on these tension points will mimic the symptoms of a headache.  It can be a tricky process as these points can be quite hypersensitive due to the fibromyalgia. I gave Mary specific breathing exercise to help with her posture. Depending on the findings, other modalities can be used in the treatment of Fibromyalgia. I have also used passive and active release techniques as well as dry needling. Sometimes, it is beneficial to have other treatment options to target those stubborn tension points.

Follow Up 3 (21/9/17)

On this session, her fibro flare has subsided and sleep has improved. Mary is getting out for a walk twice a week and doing her prescribed exercise every night. A headache is still persisting but not feeling as intense. This session was a deep tissue massage to maintain the changes. With the symptoms subsiding Mary is now able for more complex exercise to help resolve her headaches and regain control.

 

Follow Up 4 (25/9/17)

Mary was in great form today, no headaches since the last session. A Little bit of stiffness in her upper back from the exercise but greatly improved. The appointment from here on out was pushed out to a week apart. Not every week has been as good as this but she has regained control of her life and is in a better place.

Management and control. 

The management is all down understanding what is going on and letting someone else solve the issues for you. With Mary, she took the step in coming to me and asking my advice on how she would improve and I was able to guide her in the right direction. The first step is to understand that it is going to be a tough three weeks to get this routine nailed down, especially if you are going through a fibro flare. The key is to get regular massages to treat those tender points, so many people give up and don't understand the importance of sticking to a plan. Get professional advice, stick to the plan, regain control.

 

 

 

 

Hip Bursitis Pain - A pain in the butt

Andrew O'Neill

One of the most common causes of hip-related pain is something called hip bursitis. People who suffer from the condition most commonly complain of the following - A dull, burning pain on the outside of the hip bone which in turn means people cannot lie on that affected side causing difficulty to sleep, they also struggle to walk up and down the stairs or cannot sit for prolonged periods of time. Many people will state it gets worse with excessive walking.

What is a Bursa and what is Bursitis?

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A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees. When a bursa becomes inflamed, the condition is known as "bursitis." There are two major bursae of the hip, the trochanteric bursa, and the ischial bursa. These are located adjacent to the edges of the femur (thighbone) and pelvic bone, respectively.

Such a condition is more likely to happen on the right hip as opposed to the left hip (although not uncommon in both). There are several reasons for this, but a lot of the time it comes down to the fact as humans we favor the right side of our bodies more than the left. Funnily enough, this is nothing to do with us being right handed or right legged. It’s all to do with the orientation of our diaphragm - the muscle that pulls air in and out of our lungs. The diaphragm is larger and stronger on the right side of our body. How is this related to my right sided hip pain ?! Well the fact that the diaphragm is larger and stronger on the right means our rib cage gets turned/ orientated to the left because we try to compensate for a weaker diaphragm by flaring the left side of our rib cage, in turn (and this is the important bit !!) our pelvis then rotates and orientates to the right which means we place a lot more weight through our right hip. Our right hip internally rotates, as a result, hence a lot of the muscles become dysfunctional on that side which can cause pain and inflammation. Have a look at somebody in a queue sometimes, I bet you will see them standing over to the right side or leaning through their right hip! This may sound complicated but in reality, it just takes an understanding of how the body moves when we breathe, walk and stand.

How do we fix it?

It’s actually quite simple, we get people to use the LEFT side of their body more! These exercises can be something as simple as standing and shift their weight into the left hip more activating left hip muscles or even making them aware of their left heel and foot with the use of a specific insole. You will find a lot of these exercises on our website and youtube page (just type in tc physiotherapy). It is also necessary to do some specific hands-on treatment as well to get you out of pain initially. To help ease it yourself at home we advise you ice the area, do some glute stretching but also and more importantly do some groin stretches. This should help with the pain but may not solve the issue fully, that takes a trained eye and a specific assessment.

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