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Back pain is the most common area of pain I treat in the clinic. Everybody at some point will have an episode of back pain and for those unlucky few ongoing recurrent problems.
The approach to back pain has changed a lot and challenges many widespread beliefs about the condition. Here is what I have found out throughout my 10yrs of experience.
1. Back pain is common and normal.
Most back pain is due to strains and sprains and usually resolves within 6 weeks. Only a very small percentage go on to develop long standing disabling problems and many of these may improve with the right help.
2. Scans are rarely needed. You would think that a picture of the spine would explain why you are in pain but it is not that simple. The scans will often show up things that are poorly linked with pain. Many people who have no pain are shown to have bulging discs, degenerated discs, arthritic changes etc. If you are told you have these problems it can lead to further distress and avoidance of activity.
3. Back pain is not caused by something being out of place. Many people may feel better after manipulations/mobilisations but this is mainly down to short term reduction of pain, muscle tone/tension and fear. As therapists we use these techniques to help get you moving better not to realign you.
4. Bed rest is not helpful. This can create stiffness, muscle de-conditioning and fear. Stiffness itself is painful and treatment and exercises will be painful to get movement back again.
5. Increased back pain does not mean more damage.
6. Surgery is rarely needed. Many people who have back surgery still have pain after because they have not taken a multi factoral approach to getting better. No one treatment will work on its own.
7. There is no perfect sitting posture. It is about moving and altering posture instead of maintaining posture that is important. The body will never like being stuck in one position for any length of time.
8. Lifting and bending are safe. Yes it may cause a strain in the back but should never be avoided as it is good strength work for the back and body. And yes there are bad techniques that can lead to injury, just remember you have a pair of legs to help you. Don’t lift silly amounts of weight, be smart. The length of the activity also has an influence break it up into smaller manageable amounts.
9. Avoiding painful activities is not the way forward. Fear of pain can heighten your senses of back pain and increase stress on the back due to an altered movement pattern.
10. Poor sleep, stress, low mood and worry all influence the back.
11. Exercise is good and safe and persistent back pain CAN get better with it.
Long standing back pain has to have a whole body and psychological approach. Manual therapy can help but exercise is very important as well. So is general health, looking after you weight, healthy diet, good sleeping pattern and knowing how to cope with stress. Everyone is different so what works for one person will not work for the next.
Today I got to meet and give a well deserved treatment to a very inspirational guy, Ben Smith.
He has set himself an incredible challenge of running 401 marathons in 401 days, today was number 174. Scarborough Athletics club helped to set the route and many of the runners kept Ben company along the route.
After some well deserved time off, and over indulgence this Christmas, it’s time to look forward to a new year, and a healthier you!
As we all know exercise is extremely good for your health and well-being. Not only does it improve your muscle tone, and general fitness, it also increases your energy levels and helps stabilise your sleep pattern. Physical activity can boost self-esteem and mood, as well as reducing your risk of stress and depression (especially during these miserable, damp months).
In 2016, make time to take care of you!
To help you get started, here is a list of our top 10 tips
1. Make exercise fun and enjoyable – Find an activity that you enjoy doing, this increases the likelihood that you will stick at it. You do not need to spend hours on a treadmill or sweating in a gym to get fit, if that’s not your thing. There is a whole host of sports/activities out there, why not try a different one each month and find out what you do like.
2. Find an exercise buddy– Having a friend to exercise with helps and is good for keeping you on track. Make a regular plan to exercise together and you will less likely fob it off due to being tired, etc. than if you were exercising alone.
3. Don’t overdo it – It may be tempting, while you have the fitness buzz, to go from 0 to 60 straight away. Resist this urge and ease yourself in gently to begin with. Doing too much too soon, can lead to injuries or burnout, resulting with you discontinuing with exercise altogether. For your first few sessions, it is better to think, I could have done more rather than over doing it and not been able to move for the next 4 days. Gradually increase your effort and volume as you find where your fitness level is. This may mean in a gym class you leave slightly early to begin with or if they say pick up some weights don’t, start with bodyweight.
4. Try something new – If you’re already exercising regularly but is seems to become a bit of a chore, set yourself a challenge to try something new. This is a good way to ensure you don’t get bored, and often you’ll find that embarking on a new activity uses different parts of your body that you aren’t used to, increasing your overall mobility.
5. Set goals – Setting realistic, attainable goals is key to maintaining a healthy lifestyle. It can be a short term goal, such as swimming two lengths of the pool without stopping, or a long term goal such as training for a marathon. Scarborough Athletics Club has a walk-to-run group with the final goal running in the local 5k park run.
6. Eat a well balanced diet– Studies have shown around 80% of any fitness goal depends on your diet. This applies whether you are trying to lose weight, or train for an event. Food is fuel for your body and it is important that you put the right things in it, to maximise results.
7. Water – Keep hydrated! Aim for at least 1.5 litres a day. Water washes out salts, toxins and helps the body to recover from exercise.
8. Sleep – When you relax, the body is able to repair itself post exercise. Sleeping, also relaxes your mind, and enables you to be more focused when awake. Go to bed a little earlier and see if it helps.
9. Preventative Sports Therapy – Regular visits to an expert therapist will enable you to achieve the most out of your life and avoid unnecessary aches and pains. Pro-Am Health Scheme gives you an affordable solution to investing in your health and well being. Sign up today
10. Keep trying, don’t give up – If you have a bad experience at a gym or your sick of getting injured then remember the first 4 points above. You never know you may find a activity where you become a volunteer or coach and inspire many more people to stay active.
The same time each year I start to see more runners booking into the clinic with multiple niggles. Why? its marathon season. Training load and the capacity to handle that load is the key to many of these injuries seen amongst runner.
Tissue load is dependent on your training volume (how much), intensity (how hard), frequency (how often) and type. Your other activities like work and hobbies and anything in life that loads tissues all forms part of your overall load.
Loading tissues through exercise is healthy and promotes strength gains, improvements in fitness, and tissue healing. Problems occur when tissue load increases too quickly.
Tip1: Changes in training need to be gradual
Tip 2: Mix 80% slow and easy intensity with 20 % high intensity speed work
Tip 3: Mileage should be increased by 10% increments but also think about the intensity, it is usually best to drop intensity whilst building mileage.
Tip 4: Every 3-4 weeks should have a drop in intensity or volume to allow recovery
Your muscles, tendons and ligaments take time to adapt to load so do not be tempted to run high mileage just because your lungs let you and it feels good, it will not last.
Also when injury does occur the load capacity becomes less so your usual mileage may become too much and you need to reduce your training and build it back gradually with the aid of some strength exercises. Don’t try to jump straight back into your usual mileage, it will not work.
Also consider sleep, stress and health issues as contributing factors to your injury.
Great news over the weekend when one of our clients competed in the world masters mountain running championships held in North Wales UK. Sue Haslam competed in the over 60’s over a testing 8.76km course and finished in 2nd place and was part of the GB womens team who finished 1st. Well Done Sue!
Our newletter will be out soon ‘Snap, Crackle and Pop’ explaining: why do our joint smake noises? You can sign up to our monthly newsletter by filing the form out at the bottom of this page.
1: Stay mobile
Optimal spine health means having mobility in all directions with good control. One area that can put pressure on the lower back and neck is stiffness in the mid back (thoracic spine). If your thorax has limited rotation, more load and stress can be transferred to other parts of the body. You can check this by sitting in a chair, feet firmly grounded, hands clasped and tucked into your sternum, turn to your right and then left. You should be able to turn equally to the right and left and be able to see behind you easily. Here is a video showing thoracic whips if you find you have limited mobility mobility here, perform 4 sets of 5 reps both sides, if one side is more limited perform 2 extra sets on that side. https://youtu.be/NFWAoXwjlCQ
2: Vary positions at work
Sitting at a computer and desk all day puts increased pressure on your spine. After 30 minutes of sitting make sure you get up and walk around or do some exercises for 30 seconds to keep the flow of blood and fluids to the spine. You will start to notice many work places are looking into workstations that are for standing but again after 30 minutes you still need to move about. Make sure workstation is setup properly for you to encourage optimal posture.
3: Keep the core in good condition
Optimal strength and control of core muscles is very important for spine health, especially if you do suffer from repetitive bouts of back and neck pain. Regular exercise that includes strength training is highly recommended. Pilates is a great exercise that helps you understand how to use your core muscles and how to control movements through the spine.
4: Monthly Sports Massage
Having a regular sports massage for maintenance of well being is highly recommended to get rid of tightness and stiffness that may interfere with spine health. Sometimes our bodies will adapt to the postures and movements we do in life, this can lead to compensations which can lead to injury. If one area of the body is stiff, that limited range of movement will have to be compensated for at the next joint. This may not cause a problem to start with but over months, years it can develop into a chronic problem. Pro-Am’s Health Scheme can help prevent many injuries.
Previously Pro-Am has explained the difference between a Physiotherapist and a Sports Therapist. I did this because for some reason Physiotherapy is seen as a more recognised profession because of its use within the NHS but in private practice there are many more choices available.
This article is about the difference between Osteopaths, Chiropractors and Sports Therapists.
This is actually quite hard to explain as many of our skills and practices overlap. I was going to give a definition for all 3 but they all sounded the same.
All 3 professions can assess, treat and rehabilitate musculoskeletal injuries. All 3 use manual therapy to manipulate soft tissues and joints. And all 3 use exercise to help treat and rehabilitate clients. What makes it so confusing is we all use different methods and terms to assess, treat and rehabilitate, its like we are each in our own tribe with our own languages but in reality we have the same knowledge and end goal: Getting people pain free and healthy.
What are the differences?
You will find the manual therapies used will be slightly different. It can be said that all 3 are classed as complementary medicine but Osteopaths follow a more holistic approach, Chiropractors say they are ‘evidence based’ and Sports Therapists share both approaches.
Osteopaths and Sports Therapists take a full body approach, Chiropractors are seen to be more specialised in the spine but can treat any joint or muscle.
Out of all of them Sports Therapists are much more specialised in their degree training towards musculoskeletal and sports but what makes a sports injury, a sports injury? Many of the injuries sports people get, so do non sporting people. A Sports Therapists most common injuries seen in the clinic will be general neck and back pain from people who have non sporting backgrounds. A lot of the techniques learnt can help many with chronic pain conditions like fibromyalgia and arthritis.
Osteopaths and Chiropractors have a choice to specialise in many other areas and treat a wider variety of other health problems like vertigo, tinnitus, asthma, IBS ect. They can also specialise in working with athletes. Osteopaths and Chiropractors are a protected profession by the health council so all are guaranteed to have completed a degree, sadly Sports Therapy is still battling for this recognition and until then please check that the Sports Therapist you see has the letters BSc after their name and are registered with The Society of Sports Therapists.
You will find many Osteopaths or Chiropractors will also train in Sports Therapy or Physio and vice versa. Sadly you do get some arrogant therapists who will say ‘Osteopaths are the best’ or ‘Chiropractors can only deal with your injury’.
‘No one profession is better than the other, they have different approaches towards the same outcome’
For each therapist no matter what profession, it’s all about building a good solid reputation and offering a great service to help people in pain, improve their life and enable them to get back into what ever activity they enjoy.
My advice, ask around, word of mouth is all 3 professions main way of advertising, recommendations are everything to us. What ever injury or illness, seek out a professional who specialises in that area. If you are still not sure then find a local therapist in your area and give them a ring and ask, we are all here to help and give advice. This may be you booking an appointment there and then or it may be information of another therapist who is best suited to your needs. If your not happy with one therapist DO NOT let it put you off, its like anything in life we are all different and respond to things and personalities in different ways.
When it comes to assessing hamstring strains you will find it no longer looks at grades 1-3, now you will find you are put into 1 of 2 groups.
Type 1 – This injury occurs at high speed, for example when running. Pain and disability are high in the very early stages but the length of recovery quite short. You will find you can start to jog quite early on in rehabilitation. It is usually found to be the outer hamstring (long head of biceps femoris)
Type 2 – This injury is related to over stretching the hamstring like doing a high kick or sliding tackle. The injury may not be very disabling or painful and for this reason has a high risk of re injury. This injury takes longer to recover from than a type 1. It is usually found to be the inner hamstring (semimembranosus).
Both injuries take a slightly different rehabilitation approach. You also have to take into account the site of pain, the closer it is to your ischial tuberosity (known as the sitting bone) the longer it will take to heal.
Although it is hard to give a time frame for injury recovery as everyone is different, we can start to give more information about recovery in relation to the mechanism of injury and site of injury. One study found on average it took 23 days to recover from a type 1 and 43 days to recover from a type 2. The study also looked at specific rehabilitation programs and this will be discussed in our next newsletter sent out at the end of May.
At the weekend I finally got round to completing my part 2 Myofascial Release with John Annan (PhysioUK course). It was jam packed full of practical techniques aimed at the pelvis, front of the neck and temporomandibular joint (jaw). All of which will help me treat many lower back and neck problems.
I will write up a summary of the course and go into explaining the temporomandibular joint more in our April Newsletter.
Our March newsletter will be out soon explaining the risk factors of Achilles tendinopathy for runners.