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MJB Clinic - Blog

By S COLE 23 Nov, 2016

As much as 50% if not more of patients that visit the MJB Clinic each week suffer from pain which to some extent can be attributed to their desk posture. It really is becoming one of the leading causes of musculoskeletal pain in the UK. Whilst musculoskeletal pain is the most common form of ill health In the UK, causing small and big businesses to loose millions of pounds due to their employees being off sick with a bad back, neck, or shoulder.

 The service the MJB Clinic provides is broken down into a number of key areas, inclusive off:

 Education:

1.    Workstation setup: We can offer a presentation outlining the correct workstation setup and how this can be set up. Plus we can provide checklists for each employee to use to ensure their workstation remains set up correctly.

2.    Workstation posture: The MJB Clinic will provide advice on workstation posture, and exercises that can be performed at the desk or within the workplace to help prevent injury.


Individual workstation assessments will focus upon:

·    Display screen position.

·    Keyboard position.

·    Chair height and position.

·    Mouse – type and correct use.


Company resource:

·    Provide desk assessments by legally compliant and both qualified osteopaths and qualified (DSE/VSE) workstation assessors.

·    According to the Health and Safety Executive, employers have an obligation to assess the whole workstation including equipment, furniture, and the work environment; this is where the MJB Clinic can help.

·    Can provide in house treatment for you employees or at one of our two clinics in either Putney or Godalming.

 

So why not act, and ensure the desk of your employees is set up in the correct manner?

 

Our aim is simple:

·    Prevent injury.

·    Fix cause of any injury already sustained due to poor workstation set up.

·    Treat any injury that has already occurred.

 

The benefits of working with the MJB Clinic are:

·    Reduction in absent staff due musculoskeletal pain.

·    Increased employee productivity.

·    Increased company reputation – taking care of your employees.

 

Furthermore sign up to our FREE Corporate scheme and get 15% off all services offered by the MJB Clinic for both your company and your employees.

 

For more information email: information@mjbclinic.com


By S COLE 22 Nov, 2016
Our ethos here at the MJB Clinic

At the MJB Clinic, our approach is based around three key points:

1. RECOVER QUICKLY, RETURN STRONGER: Our ethos is to get you pain free and recovered from your pain or injury as quickly as we can. But to also have your body stronger and better equipped to prevent re-injury.

2. PATIENT CENTRED: No two treatment approaches are the same, there is NO set protocols used. Each patient has a unique treatment & rehabilitation plan. To ensure your recovery is quick and your risk of re-injury is reduced.

3. WE ONLY PROVIDE TREATMENT WHEN NECESSARY: We will NEVER have you return for treatments unless we believe they are necessary.
By S COLE 22 Nov, 2016


What is medial tibial stress syndrome (MTSS)?

MTSS is caused by your soleus muscle in your calf (lies underneath gastrocnemius). This muscle has attachments to to inner side of the tibia. Once the soleus is overloaded (overstrained), the muscle pulls at the attachment on the medial side of the tibia, causing inflammation & pain, known as periostitis of the medial tibia.

As you have discovered from previous blogs, the body reacts to pain, in this case by putting scar tissue down along the attachment site of the soles muscle on the tibia. However scar tissue is brittle and inflexible, which means increased tightness and ultimately pain.

Meaning this cycle will continue until you:
Stop the activity (not possible for a lot of our patients)
Modify the activity (again not possible for a lot of our patients, e.g. marathon runners)
Get treatment

As we always say at the Muscles, Joints & Bones Clinic, ‘PREVENTION IS BETTER THAN CURE’. So what causes MTSS?
-Starting a new activity or overtraining
-Running on hard surfaces
-Over pronation (foot mechanics)
-Tight soleus muscle (calf)
-Leg length discrepancy

Signs & Symptoms:
-Pain on the inside of the shin, gradually builds when running
-Pain is sharp, located on the lower to medial portion of the inside of your shin, usually around 5cm in length (localised)
-Pain is better for rest and usually resolves within 15 minutes post activity
-Pain on planter flexion can occur
-Lumps and swelling can be felt on the inside of the tibia.

Treatment:
  • Asess foot mechanics during running & running shoes (aim to avoid excessive pronation)
  • Decrease training volume (with the aim to build up in a controlled manner, aim for 10-15% increase in mileage each week)
  • Treatment to reduce tone in the soles muscle (within calf) + whole posterior fascial chain if required
  • Build an exercise plan into your training plan, the soleus muscle may need strengthening, due to inactivity for a length of time causing reduced flexibility.
Wait….. But my shin pain is on the outside (lateral) of my shin, so what is this?
The most common cause of lateral shin pain is often referred to as ‘lateral exertion compartment syndrome’

What is ‘lateral exertion compartment syndrome’
This is an increase in pressure in the anterior compartment of the leg. Ultimately the space between the tibia and fibula with a layer of fascia over the top. The muscles in this compartment are the tibialis anterior, and the extensor muscles of all the toes, ultimately the muscles which play a big role in lifting your foot up.
When you run, these muscles are involved if lifting the foot up and lowering the foot back down during running. To do this they must contract, which requires increased blood supply, which in turn increases the size of the muscle. However if this increase in size is too much it causes increased pressure and pain, in more severe cases this can effect the muscles ability to work, potentially causing a foot slap when you run, due to a reduced ability to lower your foot back to the ground in a controlled manner. Whilst pressure continues to increase sensory output can also be reduced, loosing feeling in-between the first tow toes (skin sensory loss).

Cause:
Cause is again very similar to MTSS, the main cause is usually due to overactivity.

Signs and Symptoms:
Although S\S are similar, there is marked differences:
-Pain is on the outside of the shin
-Pain is achy and deep in feeling
-Sensation of increased pressure
-Pain builds as you run
-Can cause a slapping foot as you run, and loss of sensation between the fist two toes.
-Pain will not resolve as quickly as MTSS post activity, usually lasts longer than 15 minutes
-Pain is made worse by running town a decline.

Treatment:
-Asess foot mechanics during running & running shoes
-Decrease training volume (with the aim to build up in a controlled manner, aim for 10-15% increase in mileage each week)
-Treatment, soft tissue techniques to tibialis anterior, calfs, extensor muscle group & fascia.
-Build an exercise plan into your training plan.

However is must be noted, the above signs and symptoms can also be caused by other causes of shin pain which are more severe & can occur if the above are left untreated:
- Stress fracture (due to overuse)
- Compartment syndrome - Medical emergency due to pressure cuts off blood supply / nerve supply to the lower leg and foot. Although symptoms are similar to lateral exertion compartment syndrome, the pain is more extreme, numbness is present, as is a lack of muscle control. But importantly these S/S increase with time & do not decrease in intensity.
Consequently is is very important you have a health care professional look at your shin pain, so an accurate diagnosis can be formed and an a relevant treatment approach is carried out.

Book an appointment now at www.mjbclinic.com and let us help your shin pain today.
By S COLE 22 Nov, 2016
Follow on from part 1, this blog discusses stages 2 and 3 of your rehab program which will take you to full recovery

Stage 2: This can start from day 3 in minor ankle injuries, to up to a week plus with more severe injuries.

• RICE should still be continued at this stage, 5 times per der day, (no more) as inflammation is aimed to be controlled.
• We advise on more severe ankle injuries, to not perform any exercise which will aggravate your ankle.
• If your ankle is able, within pain free limits begin ankle mobility exercises, initially just dorsiflexion and planterflexion, performing 4 or 5 times per day (10-20 reps). These exercises will complement mobility treatment techniques performed by your practitioner, along with gentle massage techniques to relax the surrounding muscles and help reduce swelling (kinesiology taping may be used at this point). Friction techniques may be performed at this point to break down excessive scar tissue, always seek a professional to do this (will begin after the acute phase)
• Strengthening exercises can be introduced at this point, using a resistance band, or performing isometric resistance movements. These will consist of planterflexion, dorsiflexion, inversion and eversion (if this causes pain you should stop)
• Proprioception exercises are essential and will begin within this phase:
o Stand on one leg – eyes open
o Stand on one leg – eyes closed
o Stand on a towel folded up – eyes open
o Stand on a towel folded up - eyes closed (can add towels to increase difficulty)
(progress when you can perform each for 20 seconds)

I know this may seem complicated but your practitioner will give you an exercise sheet outlining what you are required to do in detail.

Why do proprioception exercises:
First of all let’s start with what proprioception is, proprioception is our bodies ability to determine what position our body is in. Consequently, proprioception is very closely linked to balance.
But how does this affect the ankle? Within the ankle ligaments, surrounding tendons and muscles are lots of receptors (not just in the ankle in fact, but the whole body). These receptors constantly provide feedback to our nervous system about the muscles (stretch) and the joints, information such as pressure and position of the joint (& much more, this is a very simple description). Once these receptors have sent feedback to the brain, the brain reacts making subtle change or gross changes to the bodies position. So if you have poor proprioceptive feedback in your ankle, then when your ankle begins to invert (roll), the body will not correct this position, protecting your ankle, so re-injury occurs.
Why does my proprioceptive feedback reduce post injury? When injury occurs, these receptors are damaged, reducing or totally impairing the feedback mechanism back to the brain. Which means your ankle is more likely to get reinjured, as the body will not correct your body position.

Stage 3 – This can begin anywhere from between 1 week post injury, up to 3 or 4 weeks post injury. How your rehabilitation has progressed in stages 1 and 2 will dictate. We always recommend seeking professional advice before progressing.
• As previously stated, yes to heal the ligament stress needs to be applied to it, but if this is occurring too early or too strongly it can have detrimental effects to your healing. So as stress is increased in this stage, it must be carefully monitored if swelling occurs or pain occurs slow down or revert back to the previous stage exercises.
• Continue with RICE as and when required
• Mobility should be improving, coupled with the massage and mobilisation treatment you are receiving, add inversion and eversion active movements if you are not already performing them.
• Increase strengthening exercises – (your therapist will assist you with this)
• Increase proprioception exercises – (your therapist will assist you with this)

Functional rehabilitation exercises:
At this stage we begin to put the ankle under more stress, and usually this can be made sports specific.
However a generic template would consist of:

• Hopping over small ladders or in and out of hoops
• Progress to jogging
• Progress to sprints
• Progress to running whilst changing direction (here can be made sports specific, e.g. in football running with the ball whilst changing direction around poles).

Time frame for ankle injuries:
• Grade 1: 2-4 weeks
• Grade 2: 4-8 weeks
• Grade 3: 8-12 weeks

This is a rough estimate and every ankle injury is different, we always advice seeking advice from a health professional when you suffer a lateral ankle sprain or any injury.
By S COLE 22 Nov, 2016
Part 1 identifies the anatomy, signs and symptoms and potential complications to look out for.

A lateral ankle sprain is a common sports injury, which unfortunately for many is often reinjured. A lateral ankle sprain is more common than a medial ankle sprain, which is when excessive inversion occurs (roll your ankle).

How do lateral ankle sprains occur?
The mechanism is usually when the ankle is rolled and the foot / sole faces towards the inside of your body, this is known as an ‘inversion movement’. As many of you reading this article will know, it can occur through no contact at all, or can occur due to contact.

Anatomy:
There are 3 grades associated with a lateral ankle sprain:

Grade I: is characterized by stretching of the anterior talofibular and calcaneofibular ligaments.
Grade II sprain: the anterior talofibular ligament tears partially, and the calcaneofibular ligament stretches.
Grade III sprain: is characterized by rupture of the anterior talofibular and calcaneofibular ligaments, with partial tearing of the posterior talofibular and tibiofibular ligaments.
(courtesy of Mattacola & Dyer, 2002).

The anterior talofibular ligament is most commonly injured with a lateral ankle sprain.

Signs & Symptoms:

• Pain – outside of ankle where injured ligaments are
• Swelling & Bruising – may develop immediately or over the next 24 hours or not at all (in milder cases) If bruising occurs take a photo, it helps highlight the potential extent of the injury.
• Pain – inside of the ankle can also occur due to the medial malleolus and the talus being pressed together (contusion). Or because the soft tissue structures (muscular and ligamentous are being pinched between the bone.

Complications to keep an eye out for:
• Fracture & Avulsion fracture (ligament attachment to the bones pulls a fragment of the bone with it)
• Ankle Dislocation
If you are concerned your ankle pain is extremely bruised and the pain and swelling is not improvement, with pain on the bone. Speak to a health care professional who will advise you, and may recommend your ankle has an x-ray.

What should be my initial response to my ankle injury?
Stage 1: Inflammatory phase
This should occur for a minimum for the first 0-72 hours, but can last longer on more severe ankle injuries (so do not leave this phase too early, seek professional advice if you are unsure)
• Ice for 15 minutes every hour for the first day, moving to 5 times per der day thereafter. (RICE) – Ice is used to manage inflammation not prevent it, inflammation is required for the healing process. Also avoid anti-inflammatories for the first 72 hours as this can effect the healing process.
• Rest from sport
• Full weight bearing should be introduced when pain allows but not before (depending on the severity dictates how long this will take)
• Until full weight bearing can be achieved avoid excessive weight bearing (usually grade 2/3 sprains), and importantly wear an ankle support which prevent lateral movement of the ankle, i.e. inversion.
N.B. yes to heal the ligament stress needs to be applied, but if this is occurring too early or too strongly it can have detrimental effects to your healing.

Ice can be beneficial to control inflammation through all phases of healing, so if inflammation builds after performing exercises, ice is recommended. However please REMEMBER no longer than 15 minutes, as we stated in our blog ‘ice or heat’ if you ice an area too long it becomes detrimental as increased blood occurs due to the bodies response to cold. Whilst excessive icing can also lead to nerve injury, so be sure to avoid.

Stage 2 & 3 of the rehabilitation approach will be addressed in part 2.
This is only an outline, and each patient who has suffered with a lateral ankle sprain is assessed individually. We encourage you to seek medical attention if you have suffered with a lateral ankle ligament sprain
By S COLE 22 Nov, 2016
Often our patients will use the foam roller in between their sports massages. But it is clear foam rolling is becoming more and more popular, it is rare you walk into a gym without seeing someone foam rolling. But what is it? How does it work?

Foam rolling has a similar principle to a sports massage, yet you are using you own body weight to apply pressure to relive areas of tension (& discomfort) within your muscles & fascia. With the aim to increase recovery time post exercise & increase your overall flexibility.

How does it work?
There are a number of theories surrounding how foam rolling has a benefit, which can lead to pain relief, help improve joint motion, improve sporting performance and help with postural improvements. These are:

1. Has an effect on the fascia - Fascia is a connective tissue, which aids in muscle movement during contractions & transmitting the movement from muscle to skeletal movement. Foam rolling can help ‘unstick’ the fascia from other connective tissue structures & loosen the fascia allowing the muscles to which it connects to, function better.

2. Assisting in changing muscle tone and length - The idea being foam rolling can be a good self administered sports massage (as having sports massage 2-3 times per week is expensive) - by long, sweeping movements (similar to being used by your massage therapist) to increase / decrease muscle tone or length.

3. Trigger points - Trigger points are referred to as hypersensitive spots within soft tissue structures causing increased tension or inflammation (for more on trigger points read the blog ‘Trigger Points are potentially the cause of your pain, but what are they?’). These trigger points can be treated with pressure from a foam roller, to help ease the symptoms.

4. Break down scar tissue - Vital this occurs with a specialist (osteopath, sports injury clinic etc..), as non-treated scar tissue heals in an irregular formation. But mobilised scar tissue will heal in a parallel formation, increasing flexibility, mobility without pain. Soft tissue treatment will not remove scar tissue, however it will help restore the muscle to normal function. However how effective foam rolling can be for this is debatable due to it lacking precision and specificity.

Which foam roller should I use?
High density Foam Roller : Maybe a good place to start for beginners & maintenance.
EVA Foam Roller: More robust than the high density foam roller & slightly harder.
Ridge Roller: Solid structure covered in EVA foam with little ridges to aid in the form roller performing the function of a sports massage. Often recommended by personal trainers & fitness professionals as the foam roller to buy.
Rumble Roller: Scary looking foam roller, with areas of raised platforms. Not recommended for beginners!!

Lacross Ball, Tennis ball etc…: Yes not a foam roller, but often we recommend them to our patients when we want them to target specific muscles or areas within a muscle (usually in the buttock), to complement the treatment being carried out.

Before using a foam roller, seek advice from health care professional.

By S COLE 22 Nov, 2016
Repetitive Strain injury or RSI is a term used to describe pain felt in muscles, tendons and even nerves. RSI is a general term to encompass pain caused by excessive repetitive movements.

Repetitive strain injuries commonly affect:
* Forearm (Overuse / tendonitis or tenosynovitis)
* Wrist & Hand (Carpal Tunnel Syndrome)
* Elbow (Lateral & Medical Epicondylitis or Tennis or Golfers elbow)
* Neck
* Shoulder

Your MJB Clinic practitioner will be able to give your diagnosis to you depending on where the pain is & the symptoms you present with.

Signs & symptoms to look out for:
* Pain
* Tenderness or stiffness
* Pins & needles, tingling or numbness
* Cramping
* Pain which goes away when an activity is stopped, but reoccur when that activity is returned to.

If you believe you may be suffering with RSI, seek treatment before the pain becomes chronic. As this will increase the recovery time & increases the difficulty for a full resolution of you pain

Common causes of RSI:
* Restive movement
* Prolonger physical pressure
* Incorrect posture / resulting in awkward movements
* Inappropriate work equipment
* Ergonomic set up incorrect

All areas your MJB Clinic practitioner can provide advice on to help seek a resolution.

By S COLE 22 Nov, 2016
As we mentioned in a previous blog ‘Static Stretching, good or bad?’ static stretching post exercise can be great for:

- Restoring muscle to full range of motion
- Whilst not impacting on muscle growth.
- Can help reduce post exercise soreness (not agreed upon unanimously in the literature)

So the below stretches are a must for runners & any of you athletes who spend time running in your sport. Yes I am looking at you the ‘5-aside players’ who I never see stretch full stop!

N.B. Hold all stretches for 30 seconds. Videos and images availbale for MJB Clinic patients.

Hamstring Stretch

* • Stand with heel propped on low table, knee straight.
* • Gently and slowly lean forward at waist.
* • Rotate the foot inwards (hold for 30 seconds), then hold with the foot straight (hold for 30 seconds) & finally outwards (hold for 30 seconds).
* • Repeat with the other leg.

Top tip: Keep the knee straight & the greater the table height the greater the stretch.

Quadriceps Stretch

* • Stand on one leg (can use table or chair for balance)
* • Bend knee of leg involved.
* • Pull leg towards buttock.
* • Hold & repeat.

Top tip: Keep thigh straight in line with the body, do not bend the hip.

Hip Flexor Stretch

* • Half kneel (lunge position).
* • Lean forward keeping the hips & the back straight.
* • Hold & repeat

Top Tip: Progress by placing step up platforms or a foam roller under the back leg to increase the stretch.

Gluteal Stretch

* • Lie on back, right knee bent, right ankle across left leg
* • Place right hand on hip to keep the pelvis on the floor
* • Left hand gently pull right knee inwards, until a stretch is felt into the right buttock.
* • Repeat on the leg.

Top tip: Keep both shoulders on the floor.

Groin Stretch

* • Sit with knees bent, soles of feet together.
* • Slowly let you knees drop to the floor.
* • Grasp ankles with your hands & slowly lean forwards from the hips.

Top Tip: Try to keep elbows on the inside of your knees.

Calf Stretch 1

• Stand, one leg in front of the other
* • Face wall, hands on wall for support.
* • Slowly bend both knees, with both heels on the floor until a stretch is felt.
* • Repeat with other leg.

Calf Stretch 2

* • Stand facing the wall, with both hands on the wall.
* • Step forward with uninvolved leg, leaning hips towards the wall.
* • Keep rear leg straight with heel on floor.

By S COLE 22 Nov, 2016
Patella femoral pain is the most common type of knee injury runners suffer with, along with cyclists and many other people who are active. So what is it? How does it cause pain? What are the signs and symptoms? Can it be treated? This blog will answer all these questions for you, so you are better informed about this type of knee pain.

What is patellafemoral pain syndrome?

It is pain which affects the patella, under, or slightly to the side of the patella (kneecap) and can also affect the surrounding area, although the centre site for the pain is at the kneecap. ‘The term 'patella femoral pain syndrome’ is a generic term related to anterior knee pain, with there being many potential causes.

What causes it?
The theory related to this condition vary greatly within the literature, however research has mainly focused around the patella position on the femur and the forces which can affect this, of which include:

- Unbalance in the muscular system, notably causing increased internal rotation of the femur (gluteus medius is important).
- Excessive knee valgus (refers to the angle of you knee), increasing the pull on the lateral side of your knee.
- Contacture of the quadriceps muscle group, leading to an excessive pull on the patella femoral joint surface.
- Over pronation, increasing tibial rotation, whilst poor footwear can contribute to this.
- Neuromuscular control - Although muscle bulk is eveident the VMO may contract after the quadriceps, predisposing to the pain.
Yet is has also been highlighted excessive activity (loading) or frequency in training contribute to the knee pain & associated symptoms.

I am not a runner, but I have been told I have ‘runner knee’.
Patellafemoral pain is very prevalent in runners, however there are many conditions which can cause knee pain in runner such as ITB syndrome. Furthermore you do not have to be a runner to get this pain, cyclists, and office workers are common patients, along with people who complain of anterior knee pain when at the theatre or at the movies or on a train. So don’t worry, the term ‘runners knee’ is a slang term almost, and it certainly does not define this condition!!!

Signs & Symptoms:
- Anterior knee pain under or around (front of your knee), pain can change in location & variation occasionally.
- Pain is worse for going up an incline or decline, sitting & activity.
- Pain is likely to be a gradual build up, unlikely to have been a sudden sharp pain
- Pain is worse during activity, or after the activity has been completed and occasionally the next day.
- Cracking / clicking sound may be evident when bending the knee.
- Wasting in the quadriceps may be evident if it is an old injury.
- Tightness in the muscles surrounding the knee (medial tissues compared with lateral tissues)

Treatment:
To begin your practitioner must first understand the cause, before formulating a treatment approach.
The most common approach adopted is to, reduce pain (ice - read article on our blog), strengthen and rebalance the muscular system & applying kinesiology tape the knee to control patella position.

VMO - common muscle targeted to strengthen, whilst stretching and reducing tone in the vastus lateralis
Gluteus medius - again commonly targeted to avoid increased internal femur rotation.

For anymore information related to knee pain you can get in contact with the clinic via emailing information@mjbclinic.com.


By S COLE 22 Nov, 2016
The two main knee conditions which ‘runners’ suffer with are:

- IT Band Syndrome
- Patellafemoral pain (maltracking)

Part one of this blog will focus on IT Band syndrome

What is the IT band?

The iliotibial band (ITB) is a tendon & fascial band which originates iliac crest and is also attached to the gluteal muscles (particularly gluteus maximus) & your tensor fascia latae or TFL muscle. It then extends down the outside of your leg and attaches to your tibia.

What is ITB syndrome?

It refers to when you have lateral knee pain, as the ilitiotibal band moves back and forth across the lateral femoral epicondyle (a bony formation of the femur). This movement occurs during flexion and extension of the knee, hence why is common in runners, cyclists and athletes.

Signs & Symptoms

Main site of pain is the outside of your knee, although pain can occur around other areas of the knee.
Tender to touch on the lateral epicondlye of the femur
Pain is worse for going down a decline (downstairs), whilst it is usually not affected by ascending (upstairs)
Pain gradually started over the course of a few hours or a day (not a sudden onset of pain)
Pain can be worse if sitting down for long periods

Potential causes:

- Tight IT Band, caused by tightness in the gluteus maximus & TFL muscle (potentially latissimus dorsi muscle)
- Over pronation or poor foot mechanics
- Increase in training
- Weak gluteus medius muscle (hip muscles)

Treatment:

-Improving flexibility (focus work on the TFL & gluteus maxmius
-Strengthening the gluteus medius (if required)
-Assessing foot mechanics
-Gradual return to fitness , drop by 50% after treatment, followed by an increase 10% each week thereafter.

Should I foam roll my IT band?

NOOOOOO the IT band is a thick and very strong, and foam rolling will have little effect, + it just hurts! However foam rolling the gluteals and the TFL could be beneficially as these muscles are bio-mechanically relevant.

This is a brief summary of ITB syndrome, for more information or to seek help book an appointment at the Muscles, Joints & Bones Clinic.

More Posts

MJB Clinic - Blog

By S COLE 23 Nov, 2016

As much as 50% if not more of patients that visit the MJB Clinic each week suffer from pain which to some extent can be attributed to their desk posture. It really is becoming one of the leading causes of musculoskeletal pain in the UK. Whilst musculoskeletal pain is the most common form of ill health In the UK, causing small and big businesses to loose millions of pounds due to their employees being off sick with a bad back, neck, or shoulder.

 The service the MJB Clinic provides is broken down into a number of key areas, inclusive off:

 Education:

1.    Workstation setup: We can offer a presentation outlining the correct workstation setup and how this can be set up. Plus we can provide checklists for each employee to use to ensure their workstation remains set up correctly.

2.    Workstation posture: The MJB Clinic will provide advice on workstation posture, and exercises that can be performed at the desk or within the workplace to help prevent injury.


Individual workstation assessments will focus upon:

·    Display screen position.

·    Keyboard position.

·    Chair height and position.

·    Mouse – type and correct use.


Company resource:

·    Provide desk assessments by legally compliant and both qualified osteopaths and qualified (DSE/VSE) workstation assessors.

·    According to the Health and Safety Executive, employers have an obligation to assess the whole workstation including equipment, furniture, and the work environment; this is where the MJB Clinic can help.

·    Can provide in house treatment for you employees or at one of our two clinics in either Putney or Godalming.

 

So why not act, and ensure the desk of your employees is set up in the correct manner?

 

Our aim is simple:

·    Prevent injury.

·    Fix cause of any injury already sustained due to poor workstation set up.

·    Treat any injury that has already occurred.

 

The benefits of working with the MJB Clinic are:

·    Reduction in absent staff due musculoskeletal pain.

·    Increased employee productivity.

·    Increased company reputation – taking care of your employees.

 

Furthermore sign up to our FREE Corporate scheme and get 15% off all services offered by the MJB Clinic for both your company and your employees.

 

For more information email: information@mjbclinic.com


By S COLE 22 Nov, 2016
Our ethos here at the MJB Clinic

At the MJB Clinic, our approach is based around three key points:

1. RECOVER QUICKLY, RETURN STRONGER: Our ethos is to get you pain free and recovered from your pain or injury as quickly as we can. But to also have your body stronger and better equipped to prevent re-injury.

2. PATIENT CENTRED: No two treatment approaches are the same, there is NO set protocols used. Each patient has a unique treatment & rehabilitation plan. To ensure your recovery is quick and your risk of re-injury is reduced.

3. WE ONLY PROVIDE TREATMENT WHEN NECESSARY: We will NEVER have you return for treatments unless we believe they are necessary.
By S COLE 22 Nov, 2016


What is medial tibial stress syndrome (MTSS)?

MTSS is caused by your soleus muscle in your calf (lies underneath gastrocnemius). This muscle has attachments to to inner side of the tibia. Once the soleus is overloaded (overstrained), the muscle pulls at the attachment on the medial side of the tibia, causing inflammation & pain, known as periostitis of the medial tibia.

As you have discovered from previous blogs, the body reacts to pain, in this case by putting scar tissue down along the attachment site of the soles muscle on the tibia. However scar tissue is brittle and inflexible, which means increased tightness and ultimately pain.

Meaning this cycle will continue until you:
Stop the activity (not possible for a lot of our patients)
Modify the activity (again not possible for a lot of our patients, e.g. marathon runners)
Get treatment

As we always say at the Muscles, Joints & Bones Clinic, ‘PREVENTION IS BETTER THAN CURE’. So what causes MTSS?
-Starting a new activity or overtraining
-Running on hard surfaces
-Over pronation (foot mechanics)
-Tight soleus muscle (calf)
-Leg length discrepancy

Signs & Symptoms:
-Pain on the inside of the shin, gradually builds when running
-Pain is sharp, located on the lower to medial portion of the inside of your shin, usually around 5cm in length (localised)
-Pain is better for rest and usually resolves within 15 minutes post activity
-Pain on planter flexion can occur
-Lumps and swelling can be felt on the inside of the tibia.

Treatment:
  • Asess foot mechanics during running & running shoes (aim to avoid excessive pronation)
  • Decrease training volume (with the aim to build up in a controlled manner, aim for 10-15% increase in mileage each week)
  • Treatment to reduce tone in the soles muscle (within calf) + whole posterior fascial chain if required
  • Build an exercise plan into your training plan, the soleus muscle may need strengthening, due to inactivity for a length of time causing reduced flexibility.
Wait….. But my shin pain is on the outside (lateral) of my shin, so what is this?
The most common cause of lateral shin pain is often referred to as ‘lateral exertion compartment syndrome’

What is ‘lateral exertion compartment syndrome’
This is an increase in pressure in the anterior compartment of the leg. Ultimately the space between the tibia and fibula with a layer of fascia over the top. The muscles in this compartment are the tibialis anterior, and the extensor muscles of all the toes, ultimately the muscles which play a big role in lifting your foot up.
When you run, these muscles are involved if lifting the foot up and lowering the foot back down during running. To do this they must contract, which requires increased blood supply, which in turn increases the size of the muscle. However if this increase in size is too much it causes increased pressure and pain, in more severe cases this can effect the muscles ability to work, potentially causing a foot slap when you run, due to a reduced ability to lower your foot back to the ground in a controlled manner. Whilst pressure continues to increase sensory output can also be reduced, loosing feeling in-between the first tow toes (skin sensory loss).

Cause:
Cause is again very similar to MTSS, the main cause is usually due to overactivity.

Signs and Symptoms:
Although S\S are similar, there is marked differences:
-Pain is on the outside of the shin
-Pain is achy and deep in feeling
-Sensation of increased pressure
-Pain builds as you run
-Can cause a slapping foot as you run, and loss of sensation between the fist two toes.
-Pain will not resolve as quickly as MTSS post activity, usually lasts longer than 15 minutes
-Pain is made worse by running town a decline.

Treatment:
-Asess foot mechanics during running & running shoes
-Decrease training volume (with the aim to build up in a controlled manner, aim for 10-15% increase in mileage each week)
-Treatment, soft tissue techniques to tibialis anterior, calfs, extensor muscle group & fascia.
-Build an exercise plan into your training plan.

However is must be noted, the above signs and symptoms can also be caused by other causes of shin pain which are more severe & can occur if the above are left untreated:
- Stress fracture (due to overuse)
- Compartment syndrome - Medical emergency due to pressure cuts off blood supply / nerve supply to the lower leg and foot. Although symptoms are similar to lateral exertion compartment syndrome, the pain is more extreme, numbness is present, as is a lack of muscle control. But importantly these S/S increase with time & do not decrease in intensity.
Consequently is is very important you have a health care professional look at your shin pain, so an accurate diagnosis can be formed and an a relevant treatment approach is carried out.

Book an appointment now at www.mjbclinic.com and let us help your shin pain today.
By S COLE 22 Nov, 2016
Follow on from part 1, this blog discusses stages 2 and 3 of your rehab program which will take you to full recovery

Stage 2: This can start from day 3 in minor ankle injuries, to up to a week plus with more severe injuries.

• RICE should still be continued at this stage, 5 times per der day, (no more) as inflammation is aimed to be controlled.
• We advise on more severe ankle injuries, to not perform any exercise which will aggravate your ankle.
• If your ankle is able, within pain free limits begin ankle mobility exercises, initially just dorsiflexion and planterflexion, performing 4 or 5 times per day (10-20 reps). These exercises will complement mobility treatment techniques performed by your practitioner, along with gentle massage techniques to relax the surrounding muscles and help reduce swelling (kinesiology taping may be used at this point). Friction techniques may be performed at this point to break down excessive scar tissue, always seek a professional to do this (will begin after the acute phase)
• Strengthening exercises can be introduced at this point, using a resistance band, or performing isometric resistance movements. These will consist of planterflexion, dorsiflexion, inversion and eversion (if this causes pain you should stop)
• Proprioception exercises are essential and will begin within this phase:
o Stand on one leg – eyes open
o Stand on one leg – eyes closed
o Stand on a towel folded up – eyes open
o Stand on a towel folded up - eyes closed (can add towels to increase difficulty)
(progress when you can perform each for 20 seconds)

I know this may seem complicated but your practitioner will give you an exercise sheet outlining what you are required to do in detail.

Why do proprioception exercises:
First of all let’s start with what proprioception is, proprioception is our bodies ability to determine what position our body is in. Consequently, proprioception is very closely linked to balance.
But how does this affect the ankle? Within the ankle ligaments, surrounding tendons and muscles are lots of receptors (not just in the ankle in fact, but the whole body). These receptors constantly provide feedback to our nervous system about the muscles (stretch) and the joints, information such as pressure and position of the joint (& much more, this is a very simple description). Once these receptors have sent feedback to the brain, the brain reacts making subtle change or gross changes to the bodies position. So if you have poor proprioceptive feedback in your ankle, then when your ankle begins to invert (roll), the body will not correct this position, protecting your ankle, so re-injury occurs.
Why does my proprioceptive feedback reduce post injury? When injury occurs, these receptors are damaged, reducing or totally impairing the feedback mechanism back to the brain. Which means your ankle is more likely to get reinjured, as the body will not correct your body position.

Stage 3 – This can begin anywhere from between 1 week post injury, up to 3 or 4 weeks post injury. How your rehabilitation has progressed in stages 1 and 2 will dictate. We always recommend seeking professional advice before progressing.
• As previously stated, yes to heal the ligament stress needs to be applied to it, but if this is occurring too early or too strongly it can have detrimental effects to your healing. So as stress is increased in this stage, it must be carefully monitored if swelling occurs or pain occurs slow down or revert back to the previous stage exercises.
• Continue with RICE as and when required
• Mobility should be improving, coupled with the massage and mobilisation treatment you are receiving, add inversion and eversion active movements if you are not already performing them.
• Increase strengthening exercises – (your therapist will assist you with this)
• Increase proprioception exercises – (your therapist will assist you with this)

Functional rehabilitation exercises:
At this stage we begin to put the ankle under more stress, and usually this can be made sports specific.
However a generic template would consist of:

• Hopping over small ladders or in and out of hoops
• Progress to jogging
• Progress to sprints
• Progress to running whilst changing direction (here can be made sports specific, e.g. in football running with the ball whilst changing direction around poles).

Time frame for ankle injuries:
• Grade 1: 2-4 weeks
• Grade 2: 4-8 weeks
• Grade 3: 8-12 weeks

This is a rough estimate and every ankle injury is different, we always advice seeking advice from a health professional when you suffer a lateral ankle sprain or any injury.
By S COLE 22 Nov, 2016
Part 1 identifies the anatomy, signs and symptoms and potential complications to look out for.

A lateral ankle sprain is a common sports injury, which unfortunately for many is often reinjured. A lateral ankle sprain is more common than a medial ankle sprain, which is when excessive inversion occurs (roll your ankle).

How do lateral ankle sprains occur?
The mechanism is usually when the ankle is rolled and the foot / sole faces towards the inside of your body, this is known as an ‘inversion movement’. As many of you reading this article will know, it can occur through no contact at all, or can occur due to contact.

Anatomy:
There are 3 grades associated with a lateral ankle sprain:

Grade I: is characterized by stretching of the anterior talofibular and calcaneofibular ligaments.
Grade II sprain: the anterior talofibular ligament tears partially, and the calcaneofibular ligament stretches.
Grade III sprain: is characterized by rupture of the anterior talofibular and calcaneofibular ligaments, with partial tearing of the posterior talofibular and tibiofibular ligaments.
(courtesy of Mattacola & Dyer, 2002).

The anterior talofibular ligament is most commonly injured with a lateral ankle sprain.

Signs & Symptoms:

• Pain – outside of ankle where injured ligaments are
• Swelling & Bruising – may develop immediately or over the next 24 hours or not at all (in milder cases) If bruising occurs take a photo, it helps highlight the potential extent of the injury.
• Pain – inside of the ankle can also occur due to the medial malleolus and the talus being pressed together (contusion). Or because the soft tissue structures (muscular and ligamentous are being pinched between the bone.

Complications to keep an eye out for:
• Fracture & Avulsion fracture (ligament attachment to the bones pulls a fragment of the bone with it)
• Ankle Dislocation
If you are concerned your ankle pain is extremely bruised and the pain and swelling is not improvement, with pain on the bone. Speak to a health care professional who will advise you, and may recommend your ankle has an x-ray.

What should be my initial response to my ankle injury?
Stage 1: Inflammatory phase
This should occur for a minimum for the first 0-72 hours, but can last longer on more severe ankle injuries (so do not leave this phase too early, seek professional advice if you are unsure)
• Ice for 15 minutes every hour for the first day, moving to 5 times per der day thereafter. (RICE) – Ice is used to manage inflammation not prevent it, inflammation is required for the healing process. Also avoid anti-inflammatories for the first 72 hours as this can effect the healing process.
• Rest from sport
• Full weight bearing should be introduced when pain allows but not before (depending on the severity dictates how long this will take)
• Until full weight bearing can be achieved avoid excessive weight bearing (usually grade 2/3 sprains), and importantly wear an ankle support which prevent lateral movement of the ankle, i.e. inversion.
N.B. yes to heal the ligament stress needs to be applied, but if this is occurring too early or too strongly it can have detrimental effects to your healing.

Ice can be beneficial to control inflammation through all phases of healing, so if inflammation builds after performing exercises, ice is recommended. However please REMEMBER no longer than 15 minutes, as we stated in our blog ‘ice or heat’ if you ice an area too long it becomes detrimental as increased blood occurs due to the bodies response to cold. Whilst excessive icing can also lead to nerve injury, so be sure to avoid.

Stage 2 & 3 of the rehabilitation approach will be addressed in part 2.
This is only an outline, and each patient who has suffered with a lateral ankle sprain is assessed individually. We encourage you to seek medical attention if you have suffered with a lateral ankle ligament sprain
By S COLE 22 Nov, 2016
Often our patients will use the foam roller in between their sports massages. But it is clear foam rolling is becoming more and more popular, it is rare you walk into a gym without seeing someone foam rolling. But what is it? How does it work?

Foam rolling has a similar principle to a sports massage, yet you are using you own body weight to apply pressure to relive areas of tension (& discomfort) within your muscles & fascia. With the aim to increase recovery time post exercise & increase your overall flexibility.

How does it work?
There are a number of theories surrounding how foam rolling has a benefit, which can lead to pain relief, help improve joint motion, improve sporting performance and help with postural improvements. These are:

1. Has an effect on the fascia - Fascia is a connective tissue, which aids in muscle movement during contractions & transmitting the movement from muscle to skeletal movement. Foam rolling can help ‘unstick’ the fascia from other connective tissue structures & loosen the fascia allowing the muscles to which it connects to, function better.

2. Assisting in changing muscle tone and length - The idea being foam rolling can be a good self administered sports massage (as having sports massage 2-3 times per week is expensive) - by long, sweeping movements (similar to being used by your massage therapist) to increase / decrease muscle tone or length.

3. Trigger points - Trigger points are referred to as hypersensitive spots within soft tissue structures causing increased tension or inflammation (for more on trigger points read the blog ‘Trigger Points are potentially the cause of your pain, but what are they?’). These trigger points can be treated with pressure from a foam roller, to help ease the symptoms.

4. Break down scar tissue - Vital this occurs with a specialist (osteopath, sports injury clinic etc..), as non-treated scar tissue heals in an irregular formation. But mobilised scar tissue will heal in a parallel formation, increasing flexibility, mobility without pain. Soft tissue treatment will not remove scar tissue, however it will help restore the muscle to normal function. However how effective foam rolling can be for this is debatable due to it lacking precision and specificity.

Which foam roller should I use?
High density Foam Roller : Maybe a good place to start for beginners & maintenance.
EVA Foam Roller: More robust than the high density foam roller & slightly harder.
Ridge Roller: Solid structure covered in EVA foam with little ridges to aid in the form roller performing the function of a sports massage. Often recommended by personal trainers & fitness professionals as the foam roller to buy.
Rumble Roller: Scary looking foam roller, with areas of raised platforms. Not recommended for beginners!!

Lacross Ball, Tennis ball etc…: Yes not a foam roller, but often we recommend them to our patients when we want them to target specific muscles or areas within a muscle (usually in the buttock), to complement the treatment being carried out.

Before using a foam roller, seek advice from health care professional.

By S COLE 22 Nov, 2016
Repetitive Strain injury or RSI is a term used to describe pain felt in muscles, tendons and even nerves. RSI is a general term to encompass pain caused by excessive repetitive movements.

Repetitive strain injuries commonly affect:
* Forearm (Overuse / tendonitis or tenosynovitis)
* Wrist & Hand (Carpal Tunnel Syndrome)
* Elbow (Lateral & Medical Epicondylitis or Tennis or Golfers elbow)
* Neck
* Shoulder

Your MJB Clinic practitioner will be able to give your diagnosis to you depending on where the pain is & the symptoms you present with.

Signs & symptoms to look out for:
* Pain
* Tenderness or stiffness
* Pins & needles, tingling or numbness
* Cramping
* Pain which goes away when an activity is stopped, but reoccur when that activity is returned to.

If you believe you may be suffering with RSI, seek treatment before the pain becomes chronic. As this will increase the recovery time & increases the difficulty for a full resolution of you pain

Common causes of RSI:
* Restive movement
* Prolonger physical pressure
* Incorrect posture / resulting in awkward movements
* Inappropriate work equipment
* Ergonomic set up incorrect

All areas your MJB Clinic practitioner can provide advice on to help seek a resolution.

By S COLE 22 Nov, 2016
As we mentioned in a previous blog ‘Static Stretching, good or bad?’ static stretching post exercise can be great for:

- Restoring muscle to full range of motion
- Whilst not impacting on muscle growth.
- Can help reduce post exercise soreness (not agreed upon unanimously in the literature)

So the below stretches are a must for runners & any of you athletes who spend time running in your sport. Yes I am looking at you the ‘5-aside players’ who I never see stretch full stop!

N.B. Hold all stretches for 30 seconds. Videos and images availbale for MJB Clinic patients.

Hamstring Stretch

* • Stand with heel propped on low table, knee straight.
* • Gently and slowly lean forward at waist.
* • Rotate the foot inwards (hold for 30 seconds), then hold with the foot straight (hold for 30 seconds) & finally outwards (hold for 30 seconds).
* • Repeat with the other leg.

Top tip: Keep the knee straight & the greater the table height the greater the stretch.

Quadriceps Stretch

* • Stand on one leg (can use table or chair for balance)
* • Bend knee of leg involved.
* • Pull leg towards buttock.
* • Hold & repeat.

Top tip: Keep thigh straight in line with the body, do not bend the hip.

Hip Flexor Stretch

* • Half kneel (lunge position).
* • Lean forward keeping the hips & the back straight.
* • Hold & repeat

Top Tip: Progress by placing step up platforms or a foam roller under the back leg to increase the stretch.

Gluteal Stretch

* • Lie on back, right knee bent, right ankle across left leg
* • Place right hand on hip to keep the pelvis on the floor
* • Left hand gently pull right knee inwards, until a stretch is felt into the right buttock.
* • Repeat on the leg.

Top tip: Keep both shoulders on the floor.

Groin Stretch

* • Sit with knees bent, soles of feet together.
* • Slowly let you knees drop to the floor.
* • Grasp ankles with your hands & slowly lean forwards from the hips.

Top Tip: Try to keep elbows on the inside of your knees.

Calf Stretch 1

• Stand, one leg in front of the other
* • Face wall, hands on wall for support.
* • Slowly bend both knees, with both heels on the floor until a stretch is felt.
* • Repeat with other leg.

Calf Stretch 2

* • Stand facing the wall, with both hands on the wall.
* • Step forward with uninvolved leg, leaning hips towards the wall.
* • Keep rear leg straight with heel on floor.

By S COLE 22 Nov, 2016
Patella femoral pain is the most common type of knee injury runners suffer with, along with cyclists and many other people who are active. So what is it? How does it cause pain? What are the signs and symptoms? Can it be treated? This blog will answer all these questions for you, so you are better informed about this type of knee pain.

What is patellafemoral pain syndrome?

It is pain which affects the patella, under, or slightly to the side of the patella (kneecap) and can also affect the surrounding area, although the centre site for the pain is at the kneecap. ‘The term 'patella femoral pain syndrome’ is a generic term related to anterior knee pain, with there being many potential causes.

What causes it?
The theory related to this condition vary greatly within the literature, however research has mainly focused around the patella position on the femur and the forces which can affect this, of which include:

- Unbalance in the muscular system, notably causing increased internal rotation of the femur (gluteus medius is important).
- Excessive knee valgus (refers to the angle of you knee), increasing the pull on the lateral side of your knee.
- Contacture of the quadriceps muscle group, leading to an excessive pull on the patella femoral joint surface.
- Over pronation, increasing tibial rotation, whilst poor footwear can contribute to this.
- Neuromuscular control - Although muscle bulk is eveident the VMO may contract after the quadriceps, predisposing to the pain.
Yet is has also been highlighted excessive activity (loading) or frequency in training contribute to the knee pain & associated symptoms.

I am not a runner, but I have been told I have ‘runner knee’.
Patellafemoral pain is very prevalent in runners, however there are many conditions which can cause knee pain in runner such as ITB syndrome. Furthermore you do not have to be a runner to get this pain, cyclists, and office workers are common patients, along with people who complain of anterior knee pain when at the theatre or at the movies or on a train. So don’t worry, the term ‘runners knee’ is a slang term almost, and it certainly does not define this condition!!!

Signs & Symptoms:
- Anterior knee pain under or around (front of your knee), pain can change in location & variation occasionally.
- Pain is worse for going up an incline or decline, sitting & activity.
- Pain is likely to be a gradual build up, unlikely to have been a sudden sharp pain
- Pain is worse during activity, or after the activity has been completed and occasionally the next day.
- Cracking / clicking sound may be evident when bending the knee.
- Wasting in the quadriceps may be evident if it is an old injury.
- Tightness in the muscles surrounding the knee (medial tissues compared with lateral tissues)

Treatment:
To begin your practitioner must first understand the cause, before formulating a treatment approach.
The most common approach adopted is to, reduce pain (ice - read article on our blog), strengthen and rebalance the muscular system & applying kinesiology tape the knee to control patella position.

VMO - common muscle targeted to strengthen, whilst stretching and reducing tone in the vastus lateralis
Gluteus medius - again commonly targeted to avoid increased internal femur rotation.

For anymore information related to knee pain you can get in contact with the clinic via emailing information@mjbclinic.com.


By S COLE 22 Nov, 2016
The two main knee conditions which ‘runners’ suffer with are:

- IT Band Syndrome
- Patellafemoral pain (maltracking)

Part one of this blog will focus on IT Band syndrome

What is the IT band?

The iliotibial band (ITB) is a tendon & fascial band which originates iliac crest and is also attached to the gluteal muscles (particularly gluteus maximus) & your tensor fascia latae or TFL muscle. It then extends down the outside of your leg and attaches to your tibia.

What is ITB syndrome?

It refers to when you have lateral knee pain, as the ilitiotibal band moves back and forth across the lateral femoral epicondyle (a bony formation of the femur). This movement occurs during flexion and extension of the knee, hence why is common in runners, cyclists and athletes.

Signs & Symptoms

Main site of pain is the outside of your knee, although pain can occur around other areas of the knee.
Tender to touch on the lateral epicondlye of the femur
Pain is worse for going down a decline (downstairs), whilst it is usually not affected by ascending (upstairs)
Pain gradually started over the course of a few hours or a day (not a sudden onset of pain)
Pain can be worse if sitting down for long periods

Potential causes:

- Tight IT Band, caused by tightness in the gluteus maximus & TFL muscle (potentially latissimus dorsi muscle)
- Over pronation or poor foot mechanics
- Increase in training
- Weak gluteus medius muscle (hip muscles)

Treatment:

-Improving flexibility (focus work on the TFL & gluteus maxmius
-Strengthening the gluteus medius (if required)
-Assessing foot mechanics
-Gradual return to fitness , drop by 50% after treatment, followed by an increase 10% each week thereafter.

Should I foam roll my IT band?

NOOOOOO the IT band is a thick and very strong, and foam rolling will have little effect, + it just hurts! However foam rolling the gluteals and the TFL could be beneficially as these muscles are bio-mechanically relevant.

This is a brief summary of ITB syndrome, for more information or to seek help book an appointment at the Muscles, Joints & Bones Clinic.

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