Myofascial Release Part 2

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.

 

 

Plantar Fasciitis in Runners

Correctly referred to as Plantar Fasciopathy (FP) or Plantar Heel Pain due to there been an absence of inflammatory cells in this condition. This is an overuse condition of the plantar fascia at its attachment to the calcaneous (heel bone).

PF is a common condition amongst runners and can be often challenging and frustrating for both injury therapist and runner. The plantar fascia plays an important role in normal foot biomechanics, offering static support and dynamic shock absorption during the foot’s contact phases of running. The plantar fascia may be overloaded at the push off phase when the toes are dorsiflexed (pulled up towards the shin) and the calf muscles are the main contributors to propulsion

The development of PF appears to be linked with increased load on the plantar fascia. This can be due to a number of things like increased mileage, poor or worn down trainers, muscle weakness and poor motor control. However some recent research suggests we may be able to change how we run to help combat this injury?

Although we may associate PF with increasing mileage too quickly a study by Nielson et al 2013 suggests we also need to consider rapidly increased running pace. Other injuries that maybe affected by this speed change include Achilles tendinopathy and calf injuries. It was found that marathon runners were at less risk of PF compared to runners running shorter distances, suggesting PF is more easily developed at shorter distances.

This leads us to the next study which asks ‘is it possible to alter the loading on the plantar fascia?’ A study by Wellenkoiter 2014 suggests a 5% increase in cadence (steps taken) may benefit. For me this flags up a few questions, how do you increase your cadence and does this go against the above paragraph by increasing cadence, does this increase you speed? Are you sacrificing stride length to increase cadence? Is this about reducing foot contact time and how does this affect how much force you push off with, which in turn gives you your propulsion forward?

Another study by Crowell 2011 found running with a softer/quieter footfall reduced vertical loading rate which can be linked to PF. I would love to see how you would explain and get your average runner to try and land more quietly without them looking like they are prancing around.

The findings from the studies above do sound like positive solutions for runners suffering from PF but for your average runner they may be hard to practically implement. Running style and technique are very hard to change. There is also no evidence it will improve pain or function in PF.

This next study suggests a more practical and effective way to treat PF. Rathleff et al 2014 looked at high load strength training compared to a standard plantar specific stretching program in the treatment of PF. The stretch group were told to sit with the affected leg over the other and grasp the base of toes and pull them up to wards the shin for 10 seconds repeat for 10 reps and perform 3 times a day. The high load strength group performed a heel raise off a step with a towel under the toes to mimic the high load phase on the plantar fascia. Each rep would take 3 seconds going up, hold for 2 seconds in the up position and lower back down taking 3 seconds. Every other day they would perform 3 sets of 12 reps and throughout the weeks they would progressively add weight by using a back pack loaded with books (set and reps were adjusted accordingly). At 3 months the high load group were showing better results but at 6-12 months there were no differences in outcome. If you were to choose between two treatments that have similar long term effects but one will give a quicker reduction in pain, it makes sense to prescribe the one with the quickest reduction in pain.

Conclusion

Each person seen with PF needs to have their own treatment approach to suit them, if they have brought in speed work too soon, it may have been the trigger. If they have a slow cadence and/or land very heavily then getting to them to speed up their cadence and land lighter may help. Implementing a progressive loading program to strengthen the plantar fascia and structures around (calf, hips, core.) to cope with load may play a more effective approach.

Tips for runners with plantar fasciitis from the study by Rathleff et al 2014

  1. It is important to complete the exercises instructed to you by your injury therapist. It is more likely that your heel pain will decrease if you comply.
  2. You should not run before your heel pain has been pain free for 4 weeks and you can walk 10k without pain during or the morning after. (pain scale 3-4 /10 acceptable, 5 and above not acceptable)
  3. If you need to wear flat shoes (dress shoes) use heel gel inserts in both shoes.
  4. It is important to keep your exercises going even if your pain might have gone, this will decrease risk of recurrence
  5. Use the pain scale guidance. Some pain 3-4/10 is acceptable but let us know if pain suddenly gets worse after the exercises and lasts for more than 24 hours.
  6. Make sure you are performing your exercise correctly
  7. It is important to try and avoid activities which cause your heel pain to flare up. When you want to start up with these exercises again you should be careful and slowly progress. Refer to number 2 which can be used to help you understand when you are ready run again.

 

Studies referenced

Rathleff et al 2014. High load strength training improves outcome in patients with plantar fasciitis: a randomised controlled trial with 12 month follow- up. Scand J Med Sci Spor. doi 10.1111/sms12313

Nielson et al 2013. Classifying running related injuries based upon etiology, with emphasis on volume and pace. Int J Sports Phys Ther Apr; 8 (2);172.9

Wellenkotter et al 2014. The effects of running cadence manipulation on plantar loading in healthy runners. Int J Sports Med. Aug;35(9);779-84

Crowell et al 2011. Gait retraining to reduce lower extremity loading in runners. Clin Biomech (Bristol, Avon). Jan;26(1);78-83

 

 

 

Should you exercise through pain?

As a Sports Therapist this is a common question I get asked.

‘Should I exercise through pain?’

First of all if you have persistent pain whilst exercising, please get it checked out.

My response  to this question is usually ‘it depends, pain is complex’ clients are left frustrated by me leaving the answer open ended. It is important for the client to understand pain but it can take time to explain. I tend to stick to 3 short rules.

  • During your session use a pain scale 1-10 (1 no pain 10 pain as bad as it could be) do not go into or beyond 6/10.

0-2 Safe 2-5 Acceptable 5-10 high risk

  • Recovery, if you have 3/10 pain the next morning that is okay you can do your next session, if you have 3/10 pain in 1-2 days you can do your next session with caution reduce intensity or volume, if you still have pain above 3/10 3-5 days after, then you have done too much, rest, and cross train. Your next session should involve less volume or less intensity when pain has reduced to an acceptable level.
  • If you have to miss 2 weeks of exercise or pain is not reducing in fact is getting worse: rest, cross train and seek out an injury expert.

The above maybe all you want to know but here is some more in depth information:

Pain is a complex thing, I have done a lot of reading on it and here are my conclusions. It can really stop us in our tracks or it can just let us know we had a good training session. Peoples perception of pain varies greatly, what is sharp for one person may just be dull for another. Our bodies response to a pain stimulus is also not very accurate, using an example of making toast, it can not tell whether you have burnt the toast or burnt the whole house down. It just sends the signal and sometimes, over reacts. We can say pain and tissue damage are very poorly correlated. Just because you feel pain does not necessarily mean you have damaged something. An example would be a single episode of cramp.

Can you change your pain?

See if slowing down, reducing intensity, and/or changing type of exercise (high impact to low impact) eases your pain. Are there certain movements which ease your pain, performing these regularly but staying away from painful actions can off load the injury site and help it recover. Sometimes a change of footwear is needed. If trainers are getting old or have started to lose their support due to getting soaked through it can trigger many lower limb injuries. Check for technical errors or if you have implemented some changes intensity/volume/technique/equipment have these triggered the pain?

Sometimes when you can modify your pain it is good to test your limits. I have seen many clients where actual fear of injury recurrence can increase perception of pain. Test it out gradually on your next sessions, do not go straight back into the same volume or intensity, build it back up. Your injury site has to get back to a level of been able to cope with the impact, fitness and stress of your exercise. Exercise in itself can help stimulate healing. An injury specialist can help guide you, to help get you back fully into your chosen exercise.

Physiologically what signs can we see of a serious injury?

Look for swelling, redness, heat, severe pain, giving way or locking of a joint and bony tenderness. You should not exercise through pins and needles or numbness, which are your typical symptoms of referred pain from a disc/nerve been compromised. All of the above are symptoms you should not exercise through. These are symptoms to get checked out.

When should I definitely NOT exercise?

If there is any suggestion of a stress fracture, then exercise especially impact exercise (running, zumba, gymnastics ect.) should be avoided until advised it is safe to do so. You may be able to use swimming or cycling for very light exercise but only if they give the go ahead. Acute injuries or the acute stage of an injury (1-2 wks) active rest is recommended. If a tendon has become swollen and very painful (reactive) exercise will likely aggravate it further. If a tendon injury has been around for a while and you mainly get pain after or the next day but it goes away in a few days, exercise is okay. If you have been training really hard, you may have over trained and rest can be the best option for both recovery and injury. Do not push through chest pain or abdominal pain.

Try to follow the above information if you are having pain exercising and if ever in doubt get it checked out. Never put up with pain thinking it will go away, it may just get worse.

 The text above is for guidance purposes only. If you are in pain whilst exercising then seek out a specialist in this area.

Neck and Shoulders Feeling Tight?

Neck and shoulder pain? tight or painful chest? stressed at work or home? does your pain keep returning or getting worse? Breathing patterns can contribute to or even be the cause of your chronic muscular pain. Here is some information you will find helpful to start finding relief.

Breathing is intertwined with our bodies emotional responses and stress levels, how? the diaphragm’s connection to the brain. We have to breath to survive, we do not have to think about breathing it just happens but it can also be controlled.

How does breathing relate to painful shoulders? when we are stressed our brain sends an alarm signal that alerts us to danger. however this works like a fire alarm. It does not know whether you have burnt your toast or if the house is on fire. It simply sends an alarm.

Your reaction to this alarm has 3 reactions Fight, Flight or Freeze. Within the work environment you can not start a fight or run a way from it unless you want to lose your job. You just hope that the deadlines and work volume will somehow go away without devouring you? This is the freeze response and is usually accompanied with breath holding. Breath holding is a natural primitive survival instinct and is an automatic response to stress and pain.  It is something we do not usually notice ourselves doing unless we are extremely body aware.

When we freeze our breathing becomes shallow, our ribs move less and our muscles become tense. If we were in a real life threatening situation we would be playing dead. With this response repeated day after day it can lead to our muscles feeling stiff and hard, leading to chronic pain and dysfunction.

If not acknowledged and dealt with stress can cause many health problems, sore muscles are just the first step. It can lead to you feeling tired and run down, frequently getting ill and headaches. All warning signs that your body needs some kindly attention.

So what can you do?

You begin your journey by having awareness of your breath. It is advised that you do seek out a therapist to make sure you do not have any underlying mechanical reasons for your neck and shoulder pain. Breath holding maybe in response to protecting an injury site.

Muscular pain caused by work related stress is very treatable. With the assistance of a therapist you can become more aware of your breathing pattern and put ‘you’ in driving seat to combating your pain.

Here at Pro-Am we can help you to understand the mechanisms of the stress response and help improve your breathing pattern which will help keep your shoulders, ribs and chest mobilised.

 

 

 

Sciatica Causing You Problems?

Is Sciatica causing you pain? How can we help ease your sciatic pain?

What is Sciatica?

Sciatica describes a set of symptoms that can include lower back pain, pain in the glutes (buttocks), pain shooting down the leg and numbness and tingling in parts of the leg and foot. It is often just experienced down one side of the body and can interfere with activities of daily living and sleep.

What Causes Sciatica?

Sciatica is an irritation of the sciatic nerve, there are many causes and in order for treatment to be successful the right cause needs to be found. Common causes are tight muscles in the lower back or glutes, and disc or facet joint irritation .

Less common sciatic symptoms can be caused by spinal stenosis (a narrowing of the spinal canal) or a growth or infection.

What is piriformis syndrome?

Piriformis syndrome describes a case where the muscle known as the piriformis compresses the sciatic nerve due to its position deep in the glutes. This can be caused by poor posture when lifting, poor prolonged postures (office based, driving) or physical activity  overuse. If referral pain is present is usually stays above the knee sometimes into the calf but rarely, if referral pain travels into the ankle or foot is is most likely related to the disc. Sometimes piriformis syndrome can mimic a hamstring strain.

Piriformis_Sciatic

Can Sports Therapy provide effective Sciatica treatment?

In cases where muscle tightness and stiffness is causing impingement of the sciatic nerve, then yes. If your injury is caused by the disc becoming irritated or facet joint irritation without  damage, then yes. You have to remember that muscles control joint position and when tight can alter posture and create compression on the sciatic nerve. Even with a herniated disc we can advice you on exercises to help get you back to full fitness and how to prevent flare ups.

Early treatment intervention can prevent chronic muscle tightness from establishing itself. However even in cases where chronic tightness is already presenting itself sports therapy can still be an effective treatment intervention.

Often sciatica creates a pain cycle, once the nerve has been irritated by tight muscles, the body further contracts around the sensation of pain to protect itself. This exacerbates the original tightness. A Sports Therapist can manually locate, ease and soften tight muscles and provide relief of pressure and relief of pain. We educate about good movement patterns and use muscle energy techniques to change the bodies pain cycle allowing movements to become pain free.

If there are any underlying issues that created the primary irritation of the sciatic nerve sports therapy can work in support of other treatment modalities. Just inform the therapist if you already have a diagnosis of sciatica so they have the full details and can design a treatment plan to suit your needs.

How else  might we support you through your sciatica care?

We can show you how to do exercises to ease and mobilise stiff muscles and joints. At Pro-Am we believe starting with a good breathing pattern and good body awareness enhances the efficacy of the exercises given. We like to make you involved in improving on and maintaining the benefits our treatments provide.

Please note that this blog post is for information purposes only.If you think you may be suffering with sciatica please seek out an injury professional or see your doctor.

Supporting Local Events

This weekend I volunteered my sports massage skills to help runners prepare and recover from the Yorkshire Coast 10k.

2014 McCain's Yorkshire Coast 10K Road Race and Fun Run

2014 McCain Yorkshire Coast 10K Road Race and Fun Run

 

This event is hosted by my athletics club “Scarborough AC” with the help of local sponsors.  I have been a member since I was 8 years old and athletics has been a big part of my life and to be able to take part in a local event like this is a great.

The weather was glorious, perfect for some good times and great support by the public who got to bask in sunshine as they cheered all the runners on. Well done to all the competitors and volunteers who made this event a great success roll on 2015, entries open in June.

This next weekend I get to travel to Manchester for a 2 day course on Myofascial Release Part 2. This will add to skills I learnt on the level 1 I attended in 2006. My next monthly newsletter will evaluate the course.

 

 

Top Rankings

This weekend saw one of our clients race the Lock Ness Marathon.  Sue was the 15th woman overall in a field of 2,478. Not surprisingly first Over 60. Her finish time of 3 hours 21 minutes was the fastest time by a United Kingdom woman in her age group this year by 15 minutes.

 Sue also claimed the top spot in the United Kingdom Road Race Rankings for her age group at 10 kilometres earlier in the month at Tholthorpe, remaining unbeaten in her age group on the road.

Sue will pop in for a sports massage to help with recovery, when she feels any niggles or just as a treat.

What are Pro-Am’s clients up to?

As a new blog subject we are going to start to show you what some of our past and present clients are up to each week.

Here is the race result of one of our most crazy but super amazing athlete

Scarborough Athletic Club’s ultra distance specialist runner Nikki, competed in the latest Hardmoors 60 event. This race consisted of a very testing 62 mile course which started at Guisborough and finished at Filey Church via the Cleveland Way, and a total ascent of approximately 6,500 feet. Nikki finished 41st overall and the 6th woman in 14 hours 10 minutes. She has now become the very first ever woman to complete the 160 Triple Ring and any two other ultra races – 30, 55 or 60 miles.

Nikki is in her 20’s and has come from an athletic sprinting background and modern pentathlon so to go into ultra running was unexpected but she seems to have really taken to it. She will pop in for a maintenance massage when she feels her legs are getting heavy.

 

Time Flies

Its coming up to the McCains Yorkshire Coast 10k Oct 12th 2014. Entries are now closed as it has reached it’s limit of 1600 which is fantastic! I will be there providing sports massage services pre and post the event. Its a great day out with music entertainment and the fun run is still open for entry.

I will also be attending a course in October “Myofascial Release Part 2” in Manchester. It was in 2006 that I completed part 1 and use the valuable skills learnt all the time. I’ve been looking to get on this course for a long time now and look forward to advancing my skills.

 

Stay in Contact

Don’t forget you can stay connected to Pro-Am via Facebook and twitter. We have a great monthly newsletter, full of injury prevention tips and our YouTube Channel has some great videos on self treating ankle sprains and foam rolling techniques. You will find all the links to Pro-Am’s social media in the footer of our website.