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.

By S COLE 22 Nov, 2016
What is a static stretch?

A static stretch is used to stretch your muscles when you are at rest, and it will gradually lengthen your muscle to an elongated position from which it is then held.

So are they good or bad?

It seems static stretching has become a controversial topic, with many people reading they are harmful or should not be performed, so in this article will will try and break this down.

Should I static stretch before competition?
The answer to this is no, recent research suggests static stretching prior to working out could be detrimental. It is believed it can:
- Reduce muscle strength
- Reduce muscle power output
- Reduce explosive muscle power output
The recommendation would be to carry out a dynamic stretch routine, which is sports specific. This will increase circulation, increase temperature in the muscles, increasing elasticity and therefore flexibility. If you require more advice on this please let us know, or seek help from an appropriate professional.

However their still can be benefits to static stretching!!!
Static stretches are not ‘evil’, but like any part of your health & fitness plan their is a time and a place.
- Static stretching can improve flexibility
- Static stretching can improve joint ROM
- Static stretching may aid in helping to relive muscle muscle soreness (debated within the literature)
- It is an easy way to stretch that we can give to patients.
When do we give them here at the Muscles, Joints & Bones Clinic?
- Increase flexibility (we will come back to this, as this is important!!)
- Maintain flexibility
- Muscular imbalance - '

Good posture' is a word which frustrates both patients and practitioners alike. What is good posture, our view is aiming to provide a balanced tension across all joints by the muscles which cross it, which minimises stress on the musculo-skeletal system and ensures strength is kept. (However not just specific stretching is giving but also isometric contractions, fascial chain stretches & much more, but for that is for another article).

Flexibility good or bad?
To begin one thing I must stress is FLEXIBILITY & STRENGTHENING SHOULD GO HAND IN HAND. If performed correctly it can help guard against muscular imbalance a cause or predisposing factor to a host of sporting injuries we treat.
Too much flexibility is bad, this occurs when your stretch has reached the maximum length of the muscle and begin to stretch ligaments and tendons - YOU DO NOT WANT THIS. This predisposes to tearing plus increases joint instability and therefore risk of injury.

Also unbalanced flexibility is also VERY BAD, and in fact it is my belief one very flexible muscle compared with the others, is worse than all of your muscles to be inflexible.

Should I increase my flexibility and will it help prevent me from Injury?
It all depends, every sport exercise or activity requires a level of flexibility, having an increase above that is unlikely to prevent against injury. Evidence is suggesting that static stretching does not prevent injury or improve performance. However not having the required level of flexibility to complete the chosen exercise will increase you chances of injury.
Again having a balance is vital, for example although having a shortened (contracted) hip flexor muscle may not impact your marathon running due to a reduced range of motion required. It can inhibit the gluteal muscles when it is tight, increasing demand on the lower back muscles predisposing to lower back pain.

Hopefully this explains why my mind set towards static stretching goes far beyond just sporting benefits. But also if we are interested in reducing tension in the hip flexor, we must look globally at other muscle as well, as no longer should the body be treated in isolated muscular units but rather as a system (again this is for another article).

Stretching Post Exercise should I do it?
Post exercise: During exercise, a muscle which overloads or fatigues usually occurs at a reduced range of motion, plus waste products and lactic acid are built up in exhaustive exercise. Also the muscles connective tissue is damaged and heals within 1/2 days but will do so at a shorter length so static stretching post workout (particularly weight training) can help:

- Restore 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)
When should I static stretch, how long for and how often?
- Each stretch should be held for 30 seconds, not greater benefit in holding for longer
- They can be done daily, but aim for 3 /4 times per week as a routine (all depends on why you are doing them)
- Stretching muscles post exercise.

Please share your comments below, this is a controversial topic and would love to hear your thoughts on it.
By S COLE 02 Nov, 2016

To be specific I am referring to the hip abductor muscles, the gluteus medius and minimus. These two muscles are vital stabilising muscles when you walk and run, they provide a stabilising effect during the ‘stance phase’ of your gait cycle. So if weakness is present the pelvis drops on the opposite side to your stance leg when walking or running, leading to:

 

1.    You torso thrusts laterally to ensure the centre of gravity remains over the stance leg (your standing leg) – this is a compensatory effect, increases unequal loading to the pelvis, lower back and your lower back muscular support. Predisposing you to lower back problems.

2.    Due to weakness in the hip abductor muscles, another muscle has to compensate, this is the tensor fascia lata or the TFL. Leading to tightness and stiffness with the upper lateral part of your hip, and potential for ITB Syndrome. YES…… the dreaded IT Band, every runner seems to complain about.

3.    Excessive hip adduction occurs due the weakness in the hip adductors (gluteus medius and minimus). The resulting excessive hip adduction and internal rotation places the patella femoral joint (knee cap) in a mechanically poor position, predisposing to anterior knee pain or patella femoral pain syndrome or ‘runners knee’.

 

But how do I strengthen the gluteus medius and minimus????

 

The two ways we recommend here at the MJB Clinic, are two exercises, ‘clamshells and walk outs’.

 

Clamshells

-      Lie on your side, with both knees bent to 45 degrees..

-      Place the top foot on the bottom foot.

-      Engage your core by pulling your belly button in, this helps to stabilise the spine and the pelvis.

-      Whilst keeping your feet touching, raise your upper knee as high as you can, without moving your hips or pelvis of the lower leg off the floor.

-      Complete 20 reps.

-      Then wrap a ‘theraband’ around your legs, complete 2 x more sets of 20 reps. (Complete both sides if required).

 

 

Crab walk with the theraband.

-      Tie a therband around your calfs.

-      Develop a slight squat position, with your hands on your hips.

-      Keep tension in the band at all times.

-      Slowly keep stepping to one side.

 

Another ‘TOP TIP” – Tie a theraband around your knee when you are squatting, leg press, etc… As this requires you to isometrically control the hip from adducting.

 

Book a consultation today at the MJB Clinic.


By S COLE 04 Oct, 2016
Many of our patients suffer with headaches, as do the population. There are a variety of causes to your headaches, & getting the CORRECT diagnosis is very important.

Headaches cause unwanted pain, and on occasions blurred vision, dizziness, nausea and even vomiting.

Treatment from an osteopath may help. Gentle massage to the tight muscles and manipulation to loosen the joints of the neck, thorax and back can relieve the build-up of muscular tension that may lead to headaches. Osteopaths can also advise on exercise and lifestyle changes and offer guidance on simple changes to your posture when at work or driving which may help.

Below is a list of common types of headaches, with the cause ranging from posture, to lifestyle triggers such as diet or stress.


Cervicogenic Headaches - (headaches caused by the neck):

Commonly caused by excessive amounts of stress to the neck and cervical spine. These headaches are believed to be caused by C1-C3 cervical joints, with C2-C3 the most common source. Although posterior cervical muscles and the sub-occipital group as a potential cause. A headache commonly treated effectively by osteopaths here at the Muscles, Joints & Bones Clinic.

Signs & Symptoms to be aware of:

1.Pain which starts in the neck, spreading to the temple or shoulder or arm, which all usually occurs on one side.
2.The pain is made worse by neck movements.

Migraine:

A severe headache which can have a severe impact on someone quality of life. Migraines are slightly more common in females, with around 18% of the females and 6% of males suffer from headaches every year.

Signs & symptoms to be aware of:

1. Throbbing headache which becomes worse with movement or sporting activity
2. Headache which lasts for between 4-72 hours
3. Pain is usually moderate to severe
4. The headache usually occurs on one side of the head or neck (commonly on your temple or around the eye).

Other symptoms:
1. Nausea, Vomiting
2. Photophobia (sensitive to light)
3. Phonophobia (sensitive to sound)

Migraines can also be accompanied by visual or sensory symptoms, known as AURA. Often aura occurs before the head pain, but may also occur during or after.

Symptoms include:
1. Temporary loss of vision
2. Dizziness
3. Photophobia (sensitive to light)

Cluster headaches:

This is severe consistent headaches causing one sided pain in the head. These headaches are more common in men than women & typically develop between the ages of 20-40, but can start at any age.

Cluster headaches are characterised by bouts (clusters) of headaches for duration of 6-12 weeks every year or every two years.

Sings & symptoms to be aware of:
1. Attacks occur at night
2. Pain occurs in or around your eye or temple & can spread to other areas on the same side of the head.
3. Pain can be boring.
4. Attacks can last between 15-180 minutes, occurring every day to 8 times a day when a bout occurs.
5. Eye can become red & waters
6. The nose runs or is blocked on that side.
7. Ptosis is present (droopy eyelid)


Tension Headaches
A very common type of headache, which is classified into:

Episodic: Headaches occurs on fewer than 15 days each month
Chronic: Occurs on more than 15 days each month (presents like an episodic headache).

This headache is more common in young adults and females, & is mild to moderate in severity. It occurs on both sides, sometimes described as a tightness or tight band around the neck.


By S COLE 21 Sep, 2016
Ice

When you sprain (ligament), strain (muscular) or bruise an area, bleeding is apparent in the underlying tissue, which may lead to swelling along with pain. Ice should be the preferred modality initially for the first 24-48 hours, as this helps reduce the bodies response to injury, i.e:
· Reduce bleeding in the tissues.
· Reduce inflammation – Not prevent, this is important as you require inflammation for the healing process. Which is why YOU SHOULD NOT TAKE IBRUPROFEN for the first 72 hours post injury as this has detrimental effects to the healing process.
· Reduce muscle pain and spasm and via limiting the effects of inflammation.

These effects all help to prevent the area from becoming stiff by reducing excess tissue fluid that gathers as a result of injury and inflammation. However, this is where it gets tricky, you only wish to ice if you want to calm down inflammation as the body is creating more inflammation than what is needed. Which is why ice should be used in the short term, i.e. the first 24-48 hours, as inflammation is essential for the healing process.

Ice can also be used later on in the rehabilitation process, which aims to restore normal function. Often ice should be use initially after rehabilitation exercises have been performed, whilst some research advocates the use of ice before rehabilitation exercises as well.

How long should I apply the Ice for?
In an ideal scenario the ice should be applied within 5 minutes post injury. With the ice being applied for 15-30 minutes (depending on how deep the structures involved are, consult your therapist). Do not apply for any longer than this as the effects become detrimental and the body reacts by beginning to increase blood flow to the area, which is what ice therapy at the initial stage is trying to avoid.
How long should ice be applied for? Ideally, ice should be applied within 5-10 minutes of injury for 20 to 30 minutes. This can be repeated every 2 to 3 hours or so whilst you are awake for the next 24 to 48 hours.
After the first 48 hours, when bleeding should have stopped, the aim of treatment changes from restricting bleeding and managing inflammation to getting the tissues remobilised with exercise and stretching.

When not to use ice?
If you ice painful muscles, be careful: it might get worse! Ice can aggravate sensations of muscle pain and stiffness, which are often present in low back and neck pain. Trigger points (painfully sensitive spots) can be surprisingly intense and easily mistaken for “iceable” injury and inflammation. But if you ice trigger points, they may burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain.

Heat

Do not use heat on a new injury, the area is often already inflamed and this may make the problem worse.
One minor exception to this is new-onset low back strains. A lot of the pain in this case is caused by muscle spasm rather than tissue damage, so heat is often more helpful than ice. Although be cautious and we recommend consulting your practitioner before deciding to use heat rather than ice for your lower back pain.

When an injury is older than 72 hours, heat can be used. Heat causes the blood vessels to open wide (dilate). This brings more blood into the area, carrying oxygen nutrients, and properties to stimulate healing of damaged tissues. It has a direct soothing effect and helps to relieve pain and spasm. It can also ease stiffness by making the tissues more supple.
When using heat, it is typically applied to the painful area for 15 to 20 minutes three to four times per day.

When should I use heat?
Heat is primarily for muscular pain, & chronic pain and stiffness:
- Acute soreness from over-exertion: the pain you get after the first ski trip of the season.
- Stiffness and pain in specific areas related to osteoarthritis, muscle “knots” or trigger points, and most kinds of cramping/spasm (menstrual, neuropathic, or even just stiffness from postural strain).

Ice & Heat, is this good?
Contrast therapy can be used which is alternating between hot and cold therapy (10 minutes’ ice, 10 minutes’ heat). This is believed to be useful in altering the physiological response of pain, by reducing the pain pathway involved within an injury. It is believed to not have any great impact on healing but can be useful at controlling pain rather than taking medication.

Summary:

· Ice initial soft tissue injury for 24-48 hours’ post, no heat and no anti-inflammatory medication.
· You need inflammation for healing so do not over ice.
· Heat can be introduced no sooner than 72 hours post injury.
· Heat should be used for trigger points, muscle spasm or osteoarthritic pain as long as inflammation is not present.
· Ice can make muscular pain worse, commonly occurring in the lower back and neck.
· A mixture of ice and heat seems to have little healing benefits, but can be a good alternative to medication for pain relief.
By S COLE 21 Sep, 2016
Types of Achilles Injury

There are two main types of Achilles injury:

1. Achilles tendon strain – 1st degree or 2nd degree, or Achilles tendon rupture – 3rd degree.
When a stretch between 8-10% more occurs at the tendon the cross links between collagen fibres begin to break and the weakest parts of the tendon begin to rupture. The inflammation which follows can cause; achilles bursitis, tenosynovitis or tendonitis / tendinosis.
2. Achilles tendinosis / tendinitis – Chronic micro tears to the achilles causes by excessive activity, this is a common condition and is the cause of around 11% of all running injuries.
This blog will focus on achilles tendinosis, we recommend you book in to see a member of our sports injury clinic team to ensure an accurate diagnosis and treatment approach can be adopted.

Causes of achilles tendinosis
Overuse – we all know athletes like to train hard, but know your body and when to stop. Preventative sports massage can help manage your body during periods of highly intensive training (see the blog ‘sports massage, sue for injury prevention not injury treatment for more information’).
Overpronation (causes an oblique angle of traction) – This refers to the orientation of your foot, if unsure if you are and would benefit from orthotics please seek a professional opinion.
Hard surfaces – Depending on where you live there can be little else other than tarmac, bear this is mind when you are running extensively to train for an event.
Increase tone + contracture of gastrocnemius and soleus muscles (calf) compared against a weaker achilles.
Cold temperature with an inadequate warm up.

Signs and Symptoms
• Chronic
• Pain on tendon during exercise
• Creaking/crepitus upon movement
• Pain and stiffness in the morning
• Pain when walking upstairs

Treatment
• Limit causative activity to begin
• Deep friction and specific soft tissue mobilisation techniques directly on the achilles tendon
• Sports massage onto the calf muscles (gastrocnemius, soleus)
• Orthotics – If advised to, be careful buying directly off the shelf this can cause more harm than good if not correct for your feet.
• Osteopathic mobilisation and manipulation to ensure optimal foot mechanics for movement.
• Kinesiology taping – speak to your MJB Clinic practitioner for more information.
• Eccentric Contractions - see exercises.

Exercises:
1. Eccentric Loading with gastrocnemius stretch (calf)
• 5 x 20s Gastrocnemius stretch (A)
• Raise onto tiptoes with 2 feet x 30 (B)
• Lower slowly with one foot x 30 - Increase speed and weight with time (C)
• Repeat with knee straight and knee bent – (D)
• 5 x 20s Gastrocnemius stretch
• Ice Achilles
• Repeat 2 x per day

Please see images below. 

Building up to performing 100 reps a days, which the above plan achieves. Speak to your practitioner for a start point, do not perform without their advice.
Increasing weight is an important component, with 60kg advised per 12stone. However, THIS MUST NOT BE PERFORMED WITHOUT THE ADVICE OF YOUR PRACTTITONER.

By S COLE 21 Sep, 2016
What is sports massage?

Soft Tissue Massage is the management, manipulation and rehabilitation of soft tissues of the body including muscles, tendons and ligaments. Sports massage is not just relevant to sports people, but to anybody wishing to guard against, or recover from a soft tissue injury.

What does sports massage do?

  • The techniques used by the MJB Clinic's sports massage therapists aims to:
  • Improve circulation and lymphatic flow
  • Assist in the removal of metabolic waste
  • Sedate or stimulate nerve endings
  • Increase or decrease muscle tone
  • Increase or decrease muscle length
  • Remodel scar tissue when required
  • Assist in mental preparation for sporting participation
  • (In accordance with the association for soft tissue therapists)
What are the benefits?

You do not need to be an athlete to benefit from sports massage, it can be beneficial to relieve your day to day aches and pains, repetitive strain injuries, sprains, tension, fatigue, that everyone experiences at some point in their life,  whilst sports massage can be brilliant when used for preventive treatment and injury recovery. Perhaps this is when it works most efficiently, by having regular appointments relieving muscular tension or tightness, can be an excellent preventive tool to stop muscle strains or tears (rupture) occurring, which leave you unable to participate in the sport you love.

Lets make it Sports Specific
Athletes, of any level, can benefit from sports massage at various points through their training:
  • Training 
  • Before the event 
  • During the event 
  • After completing the event

Whilst it can be great throughout the training programme for both:
  • Injury prevention
  • Injury recovery
Is it safe?
All patients are screened to see if they are suitable for sports massage treatment and to provide each individual with the appropriate massage techniques, and advise on alternative action if required. Which is why we advise all patients new to the MJB Clinic for sports massage, to book a 45minute appointment initially to ensure there is time for treatment after the screening process.
By S COLE 21 Sep, 2016
Sitting at a desk all day? Keep getting mid back pain, shoulder pain or neck pain? Then perhaps your desk based posture is causing your pain.
When sitting at a desk we all know this optimal position is not adhered to throughout the day, and before we know it, we are hunched over, with our eyes getting closer and closer to the screen. Consequently we make our journey home from work and we complain to a neighbour, friend or partner that we have neck pain, back pain or even shoulder pain. But why does this happen?

Upper X syndrome
 
Upper cross syndrome is a term used to describe a set of signs and symptoms which occur when we suffer from a muscular imbalance, often caused from a desk based posture.
As seen in the image below it describes tightness of the upper trapezius, suboccipital muscles and levator scapula on the back (dorsal side), crossing with tightness of the pectoralis major and minor on the front. Along with weakness of the deep cervical flexors, which crosses with weakness of the middle and lower trapezius. Leading to rounder shoulder (protracted), a forward head posture (anterior head posture), increased cervical lordosis (increased stress onto joints and discs within the neck)
​​
But how does this cause pain?
Joint Pain:
To begin, this pattern leads to joint dysfunction, at the atlanto-occipital joint (base of the skull where it joins to the neck), C4-5 level of the neck (cervical spine), cervicothoracic joint (where the neck joins the back), T4-5 level of the mid-back (thoracic spine) and the shoulder joint (GH joint). Although this is far from an exact science, these areas have been documented to undergo stress and dysfunction due to the upper X posture,  often caused by the desk based posture we adopt.
Muscle Pain:
Whilst the tight muscles are contracting, and as previously highlighted in our blog on trigger points, when a muscle is contracting it uses energy, causing the nutrients and oxygen necessary for work to be depleted (used up), causing muscle spasms, tightness (and pain).

How does all this cause shoulder pain?
As part of the posture adopted, particularly the rounded shoulder (protracted shoulders) and the subsequent rotation (or abduction) and winging of the scapula, leads to decreased stability of the shoulder joint (GH joint) due to the glenoid fossa becoming more vertical due to weakness of the serratus anterior muscle, a stabilising muscle for the scapula thoracic joint.

This loss of stability requires the levator scapula and upper trapezius to increase activation to maintain glenohumeral centration, causing increased contraction which uses energy, causing the nutrients and oxygen necessary for work to be depleted (used up), causing muscle spasms, tightness (and pain).

How osteopathy can help.
-Advice on your ergonomic set up.
-Reduce tone and increase flexibility in the muscles identified as ‘tight’. This can be achieved by soft tissue techniques and muscle energy techniques to name a couple.
-Reduce joint dysfunction at the area of the spine via manipulation and or mobilisation.
-Increase GH stability by providing serratus anterior activation exercises.
-Provide exercises to strengthen the weakened muscles,  particularly the rhomboids.

By S COLE 15 Sep, 2016
What are trigger points?

Trigger Points are specific hyperactive and hypersensitive spots in your body’s soft tissue that refer symptoms to another area from that region.

The term "trigger point" is a term used to describe a clinical finding which has the following characteristics:

  1. Pain, a specific point within muscle or fascia which is painful, but is not caused by local trauma (acute), inflammation, degeneration, neoplasm or infection.
  2. It can be palpated as a tight band within the muscle, which can produce a twitch response when the trigger point is stimulated.
  3. Pressure onto the trigger point causes the patients pain, with radiation from the pain site in a distribution specific to the muscle in which the trigger point is in.
  4. The pain produced on pressure of the trigger is disproportionate to the pressure applied.
  5. The pain cannot be explained by findings on neurological examination.

Trigger points only form in muscles, causing a local contraction forming in a small number of muscle fibres, usually within a larger muscle. The local contraction formed can cause increased load on the associated tendons and ligaments associated with that muscle, leading to pain deep within a joint where there are no muscles.

How do trigger points cause pain?

When muscle fibres contract, they use energy, and in the case of trigger points, constant local contractions form. Because they are working 24/7, the trigger points (associated muscle) never get a rest. Leading to all the nutrients and oxygen necessary for work to be depleted (used up), causing muscle spasms (and pain). As a result of the constant activity by the muscle (trigger points specifically) there is an accumulation of fatigue toxins such as lactic acid, which can lead to nerve irritation (more pain). It is this build-up of toxins in the muscle, caused by the trigger point, which makes a muscle feel tight—a slippery elongated bundle.

Trigger Points must be deactivated using Neuromuscular Techniques (osteopathy) to reduce the local and referred pain.

Trigger point patterns within the lower back and the buttocks

Piriformis

The piriformis muscle, is a muscle we have looked at before in a previous blog ‘Scitaic Pain – What causes it?’ 
As previously stated it can be a cause of sciatic pain and symptoms (inclusive of loss of strength and function), due to its close proximity to the sciatic nerve. Trigger points in the piriformis can cause referred pain from the SI joint across the buttock and hip, and down the back of the thigh almost to the knee (see image).
​​



 
It is important the overlying gluteus maximus is treated along with the piriformis, although this muscle causes mostly buttock pain.

Quadratus Lumborum

This muscle is located within the lower back (lumbar region of the spine), trigger points within this muscle can refer pain into the buttocks, referring from the SI joint to the upper part of the back of the leg (posterior thigh). It can also be a source of hip pain, causing referred pain into the hip joint and above the hip joint (iliac crest region), and occasionally groin, anterior thigh region and abdomen
​​


The iliolumbar ligament is located close to the spine within the same proximity to the QL muscle and it has the same referral patterns and should also be considered.

Gluteus medius & minimus
​​



 The gluteus minimus muscle is located in the side of your hip above the hip joint, trigger points within this muscle can exactly mimic sciatica symptoms. One set refers into the lower buttock and down the back of the thigh to the calf. The other set refers to the side of the buttock and down the lateral side of the thigh, knee and lower leg to the ankle.

The muscle gluteus medius, gives a more local referral pattern although can cause SI type symptoms (see image).

N.B. There are a wide array of trigger point patterns which exists within muscles all around the body, please contact us via our contact page if your are interested to see if other trigger point patterns may be the source of your pain.

Potential Causes of trigger points

  1. Acute or chronic muscle overload
  2. Activation by other trigger points
  3.  Accident trauma (such as a car accident which stresses many muscles and causes instant trigger points
  4. Psychological distress (via systemic inflammation)
  5. Direct trauma to the region

Treatment

Osteopathy can help first determine if the cause of your pain is due to a trigger point. If so, neuromuscular techniques can be applied directly to the specific trigger point, whilst as with all osteopathic treatment a holistic approach will be adopted to assess all relevant areas of your body to help prevent this reoccurring.


By S COLE 15 Sep, 2016
So you have got elbow pain, and you have been diagnosed with tennis elbow. Yet you query this diagnosis, as you have not been playing tennis, in fact you have not held a tennis racket since you were 12. So what is tennis elbow?

What is tennis elbow?

Tennis elbow, also known as lateral epicondylitis, is defined as pain over the lateral aspect of the elbow. Which can also cause referred pain down the dorsal forearm. Also note, a similar presentation can occur on the medial side (inner) of the elbow, and is referred to as medial epicondylitis or golfers elbow.

What is epicondylitis?

Epicondylitis is a form of tendonitis, which in this case is inflammation of the tendons of the forearm muscles to the lateral (outer) portion of the elbow, known as the epicondyle. Acute inflammation of the tendons occur due to overuse, damaging the tendons, due to repeating similar strenuous activities over and over again, usually involving wrist and hand action.
However in recent studies, it has been highlighted no inflammation occurs during this condition but in fact, micro rupturing to the tendon caused by tendon degeneration is present. This causes tendon tissue to be replaced by collagen fibres in a disordered arrangement. So in fact this condition should be referred to a as a tendinosis (degeneration of the tendon), rather than tendinitis (inflammation of the tendon)

Who gets it, and is it common?

Lateral epicondylitis is the most commonly diagnosed elbow condition, with as much as 3% of the general population affected. Over 60% of all cases being predisposed by workplace activities which involve repetitive or high loading wrist and hand actions, therefore it is a common condition in labourers.

However although we have stated it is caused by overuse or repetitive wrist and hand action. Recent research has demonstrated trauma to the lateral elbow, via a direct contact and forceful extension of the elbow have both been documented to be the cause in as much as 50% of lateral epicondylitis cases.

Signs and Symptoms

The signs and symptoms to look out for are?

  1. Lateral elbow pain (outer elbow)
  2. Tenderness to touch on the lateral side of the elbow
  3. Pain is present from wrist movements, notably wrist extension and gripping / lifting movements
  4. Morning stiffness may be present
  5. Pain on activities which use the muscles primarily involved (extensor carpi radials brevis), such as picking up and using the kettle.
  6. Weakness holding heavy items in the hand, such as a handbag (they are much heavier than you think)
  7. Pain can radiate (spread) from the lateral side of the elbow down the forearm.

A similar set of sign and symptoms will occur with golfers elbow (medial epicondylitis), but will be present on the medial side of the elbow (inner).

Can I prevent getting tennis elbow?

To begin the most important point to remember is, ‘if you are suffering pain on the lateral aspect of your elbow during specific activities, decrease or stop these activities, and seek medical advice’.
However good physical fitness can help prevent against tennis elbow, notably having good strength to the forearm muscles (pronate teres, pronator quadratus & supinator in particular), and upper arm muscles (biceps, triceps and deltoid muscles). All of which increases stability to the elbow joint.

Yet it is important particularly with tennis, the correct equipment and technique is being used, as it can increase loads on the elbow if not, predisposing to tennis elbow. If you are unsure if this is the case with yourself, book in for a lesson with a tennis coach and they will be able to advise you further.  

Osteopathy can it help?

Osteopathy can be beneficial for tennis and golfers elbow, treatment will involve soft tissue techniques on the insertion point of the tendons at the lateral epicondyle, along with METs, and fascial release techniques through the upper extremity. Coupled with mobilisation techniques of the elbow joint, particularly the radial head. All of which aims to reduce the pain, this provides stage one of the treatment.
The next stage aims at improving strength of the associated muscles, and muscles highlighted earlier, to provide greater stability to the elbow, and look to prevent the condition reoccurring. This provides stage two of the treatment approach.
It is important self-treatment complements, the work done at the MJB Clinic, we will advise on the use of a epicondylitis band, which is a tight clasp placed just below the site where the micro-torn fibres insert onto the lateral epicondyle. This creates a false insertion, helping the tendons at the elbow being placed under less load and force, aiding their recovery whilst you continue to work. Whilst ice can be relieving post exertion, and is advised.

By S COLE 15 Sep, 2016
Every year working days are missed due to sickness, of which more than 10% are caused by a diagnosis of lower back pain. One cause of lower back pain is sciatica, which is generally a cause of more severe lower back pain, and is associated with preventing a higher number of patients returning to work, compared with other causes of lower back pain.

What is Sciatica?

Sciatica is described by the NHS as the compression and or irritation of the sciatic nerve. The sciatic nerve originates in the lower back, with contributions occurring from L4-S3, so any irritation, compression or inflammation occurring in these levels of the lower back, can causes sciatic type symptoms.

In 90% of cases, sciatica is described as back of the leg pain which travels below the knee. With the most prevalent cause believed to be due to a herniated disc with nerve root compression, but is this true?

Within the spine there are discs, which are made up of connective tissue (annulus fibres) and a jelly like material which contains a lot of water called the nucleus pulposus. When you cause a herniation to the disc, the connective tissue is torn to the stage where a portion of nucleus pulposus moves out of the disc, and compresses the nerves exiting the spinal canal, which travel down the leg, in this case, the sciatica nerve. The compression which occurs, along with secondary inflammation as a result of tearing the connective tissue within the disc, affects the nerve roots, which can cause radiating pain, muscular weakness, sensory disturbances, and depressed tendon reflexes. Some patients also experience bladder, bowel, and genital dysfunction.

Disc Injuries Explained

There are stages to a traumatic disc injury which are as follows:
Disc Prolapse: The outer fibres of the connective tissue (annulus fibres) within the disc are torn but no nucleus pulposus has left the disc.
Extrusion: (Also known as herniation): Outer fibres of the connective tissue (annulus fibres) are torn and some of the nucleus pulposus has moved out of the disc space.
Sequestration: Outer fibres of the connective tissue (annulus fibres) are torn and larger quantities of nucleus pulposus has left the disc space with some attaching onto the exiting nerves.
How long does sciatica last and who does it affect?

The condition can vary from short-lasting single episodes to a remitting or permanent course over months or years. This all depends on the cause of your sciatica, remember sciatica is caused by the compression of the nerve, so in more severe disc injuries (extrusion / sequestration) recovery will be longer. However if sciatica is caused by inflammation around the exiting nerves, the episode may be short lasting, or singular. There are lots of other causes of inflammation around the spine, which will be discussed later in this post, however this highlights the importance to seek medical advice when you experience back pain and or sciatica type symptoms to ensure you give yourself the best opportunity for recovery.
It is estimated sciatica affects between 2-5% of the population, with the working population most at risk, between the ages of 21-45.

Other Causes of Sciatica

Facet Joints : Facets Joints (Zygapophyseal Joints), are the joints within your spine which enable your spine to move, on a local level and the entire spine. If dysfunction or restriction in movement occurs at these joints, inflammation can occur, causing compression and or irritation to the spinal nerves leaving the Vertebral Column, therefore potentially causing sciatic type symptoms. As mentioned previously, this is likely to cause a singular or short lasting episode.

Sacroiliac Joint Restriction/Dysfunction: The sacroiliac joint is located at the base of the lower back (spine) connecting the spine to the sacrum. If restriction or dysfunction is present, it can cause a referral pain down the back of the thigh and the buttock, although very rarely it causes pain below the knee, but research has showed it can occur.

A muscular cause to your sciatica.

Piriformis Syndrome: The piriformis is a muscle located within your buttocks, after exiting the spine the sciatica nerve runs very close to this muscle as it passes through the buttocks and into the back of the leg. Yet in between 2-15% of the population, the sciatica nerve runs through the piriformis muscle.
However trauma, increased tension and or contracture to the piriformis muscle can irritate the sciatic nerve. It is believed around 5% of all sciatic pain is caused by the piriformis muscle.

Hamstring Strain / Tear: The hamstring are three separate muscles located on the back of the thigh (Biceps Femoris, Semitendinosus and Semimembranosus). They are innervated (nerve supply) by the sciatica nerve, so injury may cause inflammation leading to nerve sciatica nerve irritation.

Trigger Points: A trigger point is band of contracted / tight tissue which is:
Hypersensitive to touch, i.e. small pressure will give disproportionate pain
Contracted band of tissue
Pressure gives a referral pain away from the trigger point
Consequently the piriformis muscle, gluteal muscle group, and the Hamstrings can all develop trigger points which can cause a sciatic type pain.

What Next?

As you have read, there are a number of causes of sciatic pain, a comprehensive osteopathic examination can help to help identify the cause of your sciatic pain. If deemed appropriate a specific treatment approach will be developed and carried out, targeting the identified structure causing your sciatic pain. Whilst taking a holistic approach by assessing and treating other tissues which may be affected by sciatica nerve pain. Promoting a return to health and reducing the risk of the sciatica pain reoccurring.
Other treatment routes include a surgical discectomy, with the evidence suggesting it leads to a short term relief, but no real benefit in long term pain and or disability, and is only relevant if the cause of your sciatica pain is due to a disc injury.
However this is not case for everyone, and this may be suitable treatment approach for yourself, and may be advised by your G.P. and or osteopath. Although all your options should be explained to you on your initial consultation with an osteopath.
By S COLE 15 Sep, 2016
(This case report highlights how osteopathic treatment, and particularly my mindset may benefit a professional football player, team and medical department)

The report examines a:
23 year old right midfielder / winger who constantly injures his right hamstring
He is right footed
He has injured his hamstring 3 times in the last 18months.
At no point was each isolated hamstring strain considered greater than a grade 2 strain.

The professional footballer in question plays for a professional team, which has an elite medical team. Although re-rupturing myofibers post injury is the most common cause of hamstring strains, this risk would be minimised with the professional medical team in place, providing optimum treatment through the repair and remodeling phase post injury. Yet why does this young player keep reinjuring the same hamstring, an injury which is beginning to affect his future as a professional footballer? Below briefly outlines my views on what could be the cause of
re-injury.

Restriction of the Sacroiliac Joint (SIJ)
Perhaps he is biomechanically flawed, notably with poor lumbar pelvic rhythm. If a restriction in movement is present at the SIJ, a reduction in posterior innominate rotation occurs within the innominate, coupled with nutation of the sacrum during hip flexion. All of which prevents anterior movement of the ischial tuberosity, attachment site of the three hamstring muscles, increasing tension during the eccentric phase of contraction, predisposing to hamstring strain. Whilst it has been proven increased SIJ mobilisation improved both hamstring flexibility and strength.

Reduced range of motion within the Lumbar Spine
A reduction (restriction) in lumbar spinal movement can cause increased stimulation of mechanoreceptors within the lumbar spine. Causing a change in multifidus activation and subsequent stiffening and stabilisation of the lumbar spine via a change in reflex response. This lowers coordinated activity of multifidus leading to compensation via biceps femoris which contracts earlier to stabilise the thoracolumbar fascia, increasing the chance of hamstring injury.

Previous Lower Back Pain
Although it is unclear whether the footballer involved with this case report has suffered, or is suffering from lower back pain, it should be asked when treating hamstring strains. As chronic lower back pain, has shown to inhibit gluteus maximus activity during hip extension, increasing demands upon the hamstring and preventing its role as a transducer during hip extension, predisposing to hamstring injury.

Increased Contracture of Hip Flexors
Inflexible hip flexors is common in young athletes, and consequently increased contracture to the hip flexors notably rectus femoris can place increase loads on the hamstring group. Furthermore it is difficult to isolate one cause of a restricted SIJ, however commonly tight surrounding musculature is often present, notably the hip flexors.  

Conclusion
Although there are many causes to a reoccurring hamstring strain this case report explored briefly areas which could be considered. Areas not related to the hamstring itself, although in a study conducted in 2004 nearly half of all MRI examining hamstring strain showed no sign of tissue damage. Perhaps highlighting the importance of why they should be considered. Something I believe Osteopathic treatment can aid in diagnosing and providing suitable treatment for.



Desk Assessment, what are they? Why should I have one?

  • By S COLE
  • 23 Nov, 2016

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

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


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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