Golfers Elbow

21 Jun
I have hit that stage in life where my friends and I have started to drift away from team sports, but are still in need of that competitive aspect of their lives. Some have taken to running, or triathlons, but by far the majority have picked up a set of clubs and have found themselves on a golf course. Now, the other 3 members of my infrequent 4 Ball will happily testify that I rank up there with the very worst golfers you will ever see. Thats not to say I dont enjoy an occasional round, but my grip is what one friend described as an ‘afront to the game’. High praise indeed. The standard right handed golf grip is left hand over right but, for whatever reason, I play right hand over left – essentially a left handed grip for a right handed swing. It sounds ugly (it is), but eat my 2 pars on the Ryder Cup Course!!
 
I digress.
 
As the above has made clear, I am far from a golf expert, so I will not spend too much time discussing the finer intracacies of where your middle finger is gripping the club, or whether you should be able to see 2 or 3 knuckles, I am merely going to break down what happens when people start feeling symptoms of what is commonly known as Golfers Elbow (GE). Medial Epicondylitis, to give GE its proper terminology, could be considered the little brother of Tennis Elbow (lateral epicondylitis), and is much more rare that Tennis Elbow. So how to differentiate? As is often the  case with anatomy, the answer is in the name.
 
Medial = midline, referring to the body
Epicondyle = a rounded boney prominence (imagine a cartoon bone. The epicondyle would be the bum shape at the end!)
 itis = inflammation
 
So essentially, inflammation of the inside edge of the elbow.

General area of pain

 
 
 
 
 
 
 
 
 
 
 
 
 
 
So what happens?
GE is at its root, an over use injury. Many muscles attach through tendons to the Epicondyle, and due to the hugely repetitive nature of swinging a golf club, these muscles pull and strain which can lead to inflammation and/or damage to the tendons, causing huge pain in the inner elbow area. The damage to the tendons is classified as Tendinitis (inflammation of the tendon), or Tendinosis (degrading of the tendon), and a qualified therapist will be able to differentiate. Symptoms? Pain! The inner edge of the elbow area will be painful, and the pain may increase on movement. Movement of the wrist – for example gripping – may exacerbate the pain. There may be some visible swelling, and in some cases loss of strength in the affected arm and wrist. The inflammation of the muscles and tendons can also compress the ulnar nerve leading to numbness further down the hand and toward the fingers.
 
Self Help
The first thing to do with any inflammation injury is to get rid of that swelling, so we need to get some ice on the painful area as soon as symptoms appear. Never place the ice directly on the skin, instead wrap your ice pack in a tea towel. Do this for 10 minute periods 3-5 times for a couple of days. Anti-inflammatory drugs can also be taken, or alternatively an anti-inflammatory gel can be used (for example, Voltarol). A simple stretch that you can do at home to start with is to turn your palm away from your body, and lay the palm down onto a flat surface (see picture).
 
 
 
 
 
 
 
 
 
 
 
Treatment
As with a lot of injuries, treatment is 2 fold; primarily we need to stop the pain. To do this we need to look at exactly which of the soft tissues in the forearm are the guilty suspects. Using various active release techniques, we can start to loosen any excessively tight areas, and ease the load of overworked muscles (see www.dc-injuryclinic.co.uk/sport for more information)  Secondly, we need to correct any potential  biomechanical issue creating a problem, which can often include a strengthening programme. This correction period can be aided by the use of Kinesio Tape (see www.dc-injuryclinic.co.uk/ktape for more information).
In extreme cases, a GP may administer a cortisone injection to reduce the swelling, but this can usually be avoided when treated early.
 
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work. For more information please visit www.dc-injuryclinic.co.uk
 
 
 

A pain in the Psoas

20 Apr
The one downside this job has is seeing the huge amounts of pain people walk – or more often, hobble – into my clinic in. As much as a lot of injury treatments can be somewhat at the ‘uncomfortable’ end of the pain scale, we “Therapists” honestly (genuinely!) dont enjoy other peoples pain, and so I always try to get people with lower back pain (LBP) in as soon as possible, as I know how debilitating it can be. There are, as always, a huge range of possible causes of LBP, which I will look at individually over the coming months. In this blog I am going to concentrate on one group of muscles that pop up over and over again; the hip flexors.
 
 
What are the hip flexors?
Numerous muscles flex the hip (bring your knee up from the hip), but the two that are most commonly referred to as ‘the’ hip flexors are the group made up of the Psoas and the Iliacus – called the Illiopsoas. These are two deep muscles which attach at the top of the inside edge of the thigh bone; the Psoas ends at the Lumbar Verterbrae (lower back); the Iliacus ends on the Iliac crest.
Alongside their role in flexing the hip (walking, running), they are also a major player in lower back stabilty, enabling good standing posture.
 
 
 
 
 
 
 
What happens?
Current lifestyles mean a lot of us spend long parts of the day sat down, be that at the desk at work, driving, or sat watching t.v. This means that the hip sits at 90 degrees – or flexed – for long periods. The iliopsoas is built up of slow twitch muscle fibres, and when sat dormant in this contracted (or shortened) state they can begin to accept it as the ‘norm’. It is not only sedentary lifestyle that can have negative effects on this group of muscles though, and because of its huge work load when walking, running etc it can be suseptible to overuse. Eventually the tight psoas will begin to pull on the spinal attachments, potentially tilting your pelvis, and ultimately causing pain. In some cases lordotic curvature of the lumbar region will occur – also known as ‘duck butt’!
 
A shortened Psoas on one side will pull the spine to that side, potentially leading to  scoliosis (bending) of the spine, and a noticeable imbalance.
 
A tight Psoas can also inhibit the Glutes firing and performing normally. This is  called Reciprocal Inhibition (the Psoas and the Glutes are opposing muscles).
 
 
 
Symptoms
To go back to the start of this blog,  the primary sign of an iliopsoas injury, or issue,  is pain in the lumbar spine area. It can be painful and difficult to stand up after long periods of hip flexion (after driving, seated at a desk,  or even sleeping in a ‘fetal’ position), or sitiing up from a led down position.
In some cases pain through the groin region will also be present.
 
If when laying flat on your back you can fit your hand under your lower back – you may have iliopsoas tension.
 
Treatment
To get these muscles working to their full effect, we need to utilise them in their full range of movement. To enable this requires stretching of the muscle, both statically and dynamically, and through skilled massage techniques. Because of the deep location of these muscles, a highly trained Therapist will relax the superficial muscles to enable palpation of the Psoas, and in some cases, the iliacus. I have found that techniques such as Soft Tissue Release can be highly effective and in some cases, result in instant relief (see http://www.dc-injuryclinic.co.uk/sport.html for more information on how Sports Massage can help).
 
Self Help

A simple test of hip flexor tension is to lie on your back, and hug your knees to your chest. Let one leg go, and gently lower it straight. If your leg ‘hangs’ in the air and doesnt lie flat on the ground – you may have hip flexor tension. An easy stretch to start correcting the problem is in the lunge position as shown in the below picture.

 
 
 
 
 
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

 
 

Runners Knee: Part 2

22 Nov

And so – finally – the other common cause of what we call ‘runners knee’. As is often the way with most injuries and their name, it’s probably fair to say that a high number of sufferers of Iliotibial Band Syndrome (I.T.B.S) are not what they would consider active runners. In fact, a high number of people who lead quite inactive lifestyles can complain of this due to the body becoming less supple, and it’s very common in people new to exercise for the same reason. So; 

What is it?

A quick bit of basic anatomy first; The Iliotibial band (I.T.B) runs from your glute muscle (your butt!), along the outside of your thigh to the top of the smaller shin bone, just below and to the outside of the kneecap (patella). Its job is in stabilising the knee, and assisting straightening the knee. As the knee bends and extends, the I.T.B can rub against the bone near the knee and cause pain. 

How does it occur?

There are a number of factors that can bring on the symptoms of I.T.B.S. Generally (and this is merely my own finding) I feel that a major factor is strength and activity at the origin of the I.T.B – namely, the Glute muscles. A huge number of patients that I see – be that housewives, weekend warrior athletes or International athletes – spend a vast majority of their day sat on their backsides, meaning that the gluteal group of muscles become lazy, short, and weak. This can have a huge effect on the bio-mechanics of the lower body, and as the glute feeds into the I.T.B, this band of fibrous tissue becomes extremely tense, taking a load that it shouldn’t need to and causing pain at the knee. For me, Runners Knee is often a secondary symptom or a referred pain.

Other causes range greatly; at the other end of the leg, overpronation (inward rolling) of the ankle can create stress; running on cambered surfaces or heavy uphill running sessions; trigger points within the I.T.B; and of course, that least favourite word of anyone in training – overuse. 

Symptoms?

Pain on the outside of the knee and a tightness in the iliotibial band, or more generally felt in the outside of the thigh. Pain normally aggravated by running, particularly downhill. Pain when pressing in at the side of the knee. Weakness is sometimes felt when moving the hip away from the body, and you may even be aware of tender points in the gluteal area. 

Treatment?

There are mixed opinions on the treatment of I.T.B.S. Some Therapists – and indeed sufferers of I.T.B.S – advocate a technique called ‘stripping’ of the iliotibial band (huge amounts of pressure placed upon the ‘tight’ I.T.B – often with an elbow or forearm – and then dragged up the leg). I’m not a huge fan of this for a few of reasons; 1) The I.T.B is not a muscle and so doesn’t have the same properties as a muscle. I’m yet to read convincing evidence that ‘stripping’ is necessary. 2) I believe that it’s very rare for an I.T.B to be the sole cause of the pain. And 3) It hurts like hell. And while I’m 100% of the opinion that a little bit of pain for long term gain is fine, causing pain for pains sake is not what I’m looking for. I prefer local deep pressure, friction and myofascial release techniques combined with rehabilitive work on the cause- be that glute tension or overpronation of the ankle etc.

If the injury is at an acute, or even chronic stage, then Kinesio Tape® can be used to mechanically correct the I.T.B (http://www.dc-injuryclinic.co.uk/indexabout.htm) while other manual therapy treatments take place. This can sometimes enable sufferers to continue training. 

Self help?

Icing the tender area post activity will always aid in the reduction of inflammation, and I have found great benefit in heating the tender area (using a wheat bag or hot water bottle) and then stretching the I.T Band ( see photo). Some people find great benefit in using a Foam Roller on the problematic I.T Band – but bear in mind that it can be uncomfortable (to put it very politely!) in the acute or chronic stage – be strong!

With the bottom leg, place the ankle on the top knee and push toward the floor, lengthening the thigh and the I.T.B (the red lines)

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work
 

For more information please visit www.dc-injuryclinic.co.uk

Runners Knee: Part 1

9 Oct

It seems we live in an age where everything has to have an easily digestible name. While it could be argued that certain red top newspapers take ‘dumbing down’ a little too far, I think it is fair game when it comes to Sports Injuries. For example, have you ever heard of Lateral Epicondylitis? Probably not, but you more than likely have heard of its pseudonym, Tennis Elbow. And so it’s no surprise that Runners Knee is another example of this. However, sufferers of Runners Knee – similar to sufferers of Shin Splints (see previous blogs!) – can report a wide variety of symptoms, and so I will look at it in two separate blogs on 2 fairly specific conditions; 

Part 1 – Patellofemoral Pain Syndrome (P.P.S)

and 

Part 2 – Illiotibial Band Friction Syndrome (I.T.B.S) 

From here on in I will refer to the above two injury types by initials only – for sake of your reading sanity and my typing finger! To start with though, a couple of pictures to locate and recognise the soft tissues that are key players in these injuries;

A) Vastus Lateralis. B) Vastus Medialis

 

P.P.S

What is it?

Irritation of the cartilage that helps the kneecap work efficiently, and helps create knee stability. Characterised by pain around the knee cap – primarily on the inside edge –  and sometimes a feeling of pain underneath the knee cap.

 How does it occur?

Running is great for strengthening the outside muscle of your thigh (vastus lateralis) but can neglect the muscle working the inside of your thigh – the vastus medialis (sometimes called the ‘teardrop’ muscle – see picture). The vastus medialis is responsible for the last bit of straightening that your leg goes through at the knee joint, and as running rarely involves fully straightening the leg, the vastus medialis rarely sees any action. This imbalance means that the kneecap (patella) does not ‘glide’ sufficiently across the joint, and if the patella is out of alignment eventually pain will occur. Muscle imbalances and tightness in the calf muscles and hamstrings can also contribute as these can result in the foot and ankle rolling inwards and causing strain on the inside of the knee, meaning ‘pronators’ are very susceptible to these symptoms.

Symptoms?

Pain can go unnoticed during exercise, but post run, as the inflammation sets in, pain will emanate from the underside of the patella. Other common complaints include pain under the knee cap upon going down stairs, running down hill, leg extensions at the gym, or sitting down for a prolonged time with the knees bent, for example at a work desk. Due to hip alignment – and thus thigh bone angle – it is more common in women, but can occur in men.  

Treatment?

At its most basic level, this is an injury caused by an imbalance between the outside and inside of the thigh. To correct this, we need to consider a couple of options. Kinesio Taping can correct the tracking of the knee cap and help in retraining the body to initiate the vastus medialis muscle (see www.dc-injuryclinic.co.uk/indexabout for more information on K-Tape, or see previous blog entry).  Deep tissue massage will aid the ineffective vastus medialis muscle and help it to begin working. The opposing vastas lateralis muscle would benefit from some attention due to being overworked. Because running is very one directional, muscles that bring the leg out to the side and rotate the leg outwards at the hip are often very weak, and so most people suffering with P.P.S will benefit from prescribed strengthening work in and around the hips and glutes too. 

Self help?

A very simple exercise to carry out at home is to get a rolled up towel and place it under your knee with your leg out straight in front of you. Then, push the knee down into the towel, and really focus on tensing the vastas  medialis muscle (see picture) to start re-training the muscle into – essentially – doing its job!

Squeeze the knee into the towel – focussing on the Vastus Medialis muscle.
 
 
 
 
 
 
 
 
 
Part 2 to follow! 
 
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.
 
 
 

Kinesio Tape

6 Sep

In his book “Every Second Counts”, Lance Armstrong says it was “…a special hot-pink athletic tape that came from Japan and seemed to have special powers…” Current ATP world number 1 Novak Djokavic, US Open Champion Rory Mcilroy, and Wales football international Gareth Bale all swear by it. 

So, ever wondered what that crazy coloured tape that seems to have suddenly appeared everywhere is, or more importantly, what it actually does? Having recently completed the Official Kinesio Taping course in London – gaining another baffling combination of letters to place after my name in the process –  I will here try and condense hours and hours of classroom learning into a digestible blog! 

To fully understand K-Tapes potential, however, we will need a certain amount of back story; In the early 1970’s, a chiropractor in Japan, Dr Kenzo Kase, started thinking of a way in which he could ensure that once his patients left his treatment room, his manual work wasn’t undone. He started developing a tape that would act as a ‘prescription’ between appointments – essentially a tool to maintain the benefits of the treatment, and encourage the body’s healing. Fast forward nearly 40 years, and the strips of pink, black and blue tape paint Wimbledon, The Tour de France, The Premier League, The Six Nations, International Athletics, and still it is estimated that 85% of Kinesio Tape applications are on non-athletes. It has been found to be beneficial on conditions from prolapsed discs to cerebral palsy to muscle strains.  How?  Well, here comes the science bit.

Kinesio Tape works by being placed on stretched soft tissue. This causes convolutions on the skin, which have 2 major benefits;

1) Making more space underneath the skin for the waste products (lactic acid, interstitial fluid etc) to drain, and

2) Moving the tissue away from nerve receptors, which interrupt the nervous system relaying pain messages to the brain. 

To put that in even more simple terms – less swelling, and less pain

These 2 factors, when partnered with manual therapy treatments, combine to stimulate the body’s natural healing and repair responses. The tapes qualities mimic those of the skin in stretch and weight, meaning the body becomes unaware of its appearance. It is also water-proof, and porous, and is designed to last up to 5 days (with some looking after, I would add) which means that although it is a slightly more expensive option than traditional tapes, it actually works out more cost effective. 

Kinesio Tape works in a vastly different way to ‘traditional’ taping techniques. Anyone who has played sport to any level will have seen the traditional McConnell type taping – mummifying the ankle, for example. That type of taping aims to limit range of movement – to avoid taking an injured joint beyond its often limited range of motion. Kinesio works to encourage homeostasis, or to return to the body’s state of normality. Put another way, it is a corrective tape. Dr Kase himself  say that “Kinesio-taping is a rehabilitative, therapeutic modality based on the body’s own natural healing process”, and can be successfully used for mechanical, fascial, spacial, functional, and circulatory/lymphatic correction, as well as ligament and tendon correction.

I’ll admit it’s very easy to be cynical about a strip of bright coloured thread – it’s never going to be everyone’s idea of looking cool, or tough – though if the New Zealand All Blacks can carry it off….

My personal opinion is that as it can be used to aid or hamper a muscle (depending on treatment), K Tape relies heavily on the application – and certainly a good working knowledge of anatomy. Sports injury treatment is a results business, and Kinesio Tape – when applied correctly – gets results.  What else matters?

Taping to reduce swelling

 

 

 

 

 

 

 

K-Tape for "Shin Splints"

 

 

 

 

 

 

 

 For more information on Kinesio Taping, visit www.dc-injuryclinic.co.uk/indexabout.htm

For more information on whether Kinesio Tape can benefit you, email dan@dc-injuryclinic.co.uk

www.dc-injuryclinic.co.uk

Shin Splints

10 Aug

I’ve made the decision to start this blog with a condition that has been fundamental in my progression from perma-injured semi-professional footballer, to running www.DC-InjuryClinic.co.uk  Anyone who has had the misfortune of being a team mate of mine over the years – generally involving chasing my ‘hollywood’ 40 yard passes out of play – will know of my on-going battle against, and whinging about, shin pain, so I can now look at what is generally called “Shin Splints” from both sides of the treatment table. I say “generally called”, as Shin Splints is very much an umbrella term for lower leg pain, and so the location of the pain, the cause of the pain and therefore the treatment of the condition can all vary massively. In this blog, I am going to take a brief look at 4 types, and as we enter the start of the season – whether that be marathon, football, rugby –  hopefully there will be some usefull info hidden within:
 

Periostitis: Bones are encased in a blood and nutrient rich membrane called a Periosteum, and  ‘..itis’ is inflammation, so basically the clingfilm like wrap around the bone is becoming inflamed and thus putting pressure on the bone. This is mainly considered an over use injury, and generally the pain occurs at the inside lower half of the shin. In many cases it is very painful at the start of exercise, but pain eases as exercise continues, only to return afterwards. Lumps or bumps may be felt when feeling along the inside of the shin bone. This is the type I was ‘diagnosed’ with, becoming so problematic that I had an operation on both legs to drain the excess blood within the membrane, which proved unsuccessful. I then went through numerous steroid injections (cortisone) afterwards – again, unsuccessfully. Anti inflammatories can help short-term, but in my experience, the best form of treatment for this is deep manipulation of the surrounding soft tissues. This is the only form of treatment that enabled me to run, trek, and return to playing football.
 
Stress Fractures: I’m my opinion, this is the closest thing to true Shin Splints (although I think most authorities would choose Periostitis) as this is where hair-line cracks appear in the bigger of the two lower leg bones – the tibia –  most commonly in the lower third. Again, the main causes of this is over use. It can also be caused by a sudden change of surface, for example, changing from grass running to road running. Symptoms to be aware of include, naturally,  pain (can center around the lower third of the shin bone) when exercising, and particularly, pain on touch. Rest is the most common – and dreaded – recommendation for Stress Fractures.
 
Compartment Syndrome: This is essentially where the separate compartments of the lower leg (below the knee) grow to such an extent that layers of soft tissue that encase it (fascia, skin) cannot grow at the same rate and so the nerve endings, blood vessels and even bone that is underneath starts being crushed. This can result in depleted blood flow and oxygen to fuel the muscle, and this could eventually lead to the muscle dying. Compartment syndrome can start fairly suddenly, and key signs include pain even when at rest, a tightness of the area, numbness, paleness and the area may feel cold and hard to touch.
 
Muscle Problems: Arguably the most common and most mis-diagnosed. I think we all have a tendency to ‘fear the worst’, certainly if we are deep in a training regime for a marathon; the up coming season; an imminent event. But often these pains are merely the soft tissues (Muscle, Tendon, Ligament) being damaged, sometimes at a microscopic level. Everyone who spends any amount of time on their feet will at some stage feel aches and pains between the knee and the ankle. Consider a typical runner will be putting those joints under 2-4 times their own body weight (depending on your source) PER STEP, and you can imagine the stress that our soft tissue are put under. It’s incredible that we can walk at all after a run, and its easy to see why elite sportsmen and women are turning to therapists to aid in their recovery and keep the body working at its maximum. (see http://www.dc-injuryclinic.co.uk/indexwhy.htm for more benefits)
 
Self Treatment:
Shin pain is a common complaint amongst runners and footballers, and you will often hear people complain of having shin splints. But as you can see, there is no one answer to the treatment as everyone’s “shin splints” could be very different. One common factor in the cause, however, is the high impact training; for example running on roads or hard grass (the glorious pre season training regime!). A simple solution would be to say ‘stop the high impact training’, but as I was never happy with that advice myself, I loathe to give it to you. The R.I.C.E procedure (Rest, Ice, Compress, Elevate) WILL undoubtedly help, whilst undertaking some low impact cross training (swimming, for example), until the pain has subsided enough to restart your primary training. Shin compression sleeves are becoming more visible on runners/triathletes in particular, although I haven’t used them myself so can not comment – any reviews of compression wear welcomed!
 
How I Can Help
As you can see, diagnosing and treating the cause of shin pain can be a tricky business. In most cases intelligent stretching, manipulation and strengthening will hasten your return to action. As a trained therapist I can isolate the problem and therefore begin specific rehabilitation. This could mean breaking down scar tissue that will otherwise lay dormant yet problematic, re-allign muscle fibres that have ‘knotted’, or gain extra range of movement in muscles that are shortened in a self protective manner, all of which are causes of the above symptoms. Temporary supportive and pain relieving taping can also be hugely beneficial, and Kinesio Tape is a very useful tool in combating pain and inflammation (see www.dc-injuryclinic.co.uk/indexabout.htm for advantages of Kinesio Taping, available at my clinic).
 
Below are some strengthening and stretching exercises that are lower leg specific, and aim to improve range of movement and muscle elasticity.
 

Exercise 1 - Position 1

Exercise 1 - Position 2

 
 Exercise 1 – Ensure a slow, controlled movement as you lower back to position 1.
 

Stretching the front of the shin - Front view

 

Stretching the front of the shin - Side view

 

Exercise 2 - Working on ankle strength and movement

 
Exercise 2 – Rotating the ankle against resistance. This is great with a theraband (as shown), but can also be carried out using a towel hooked around the foot.
 
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.
 
 
 

Welcome!

2 Aug

Welcome to the inaugural DC Injury Clinic Blog! Here, I will be updating with short, digestible articles relating to any aspect of injury management and body mechanics. I will aim to give you – the loyal reader!- a brief and understandable breakdown of the anatomy of the injury; self-help tips on how to avoid, or start fixing that injury; and some stretches and strengthening exercises to further aid in your recovery. I also hope to throw in the odd interview with some of my higher profile colleagues and clients – if I can persuade them!

There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.

Any particular injury questions you may have are more than welcome, simply email them in to dan@dc-injuryclinic.co.uk, or post them on Twitter @DC_InjuryClinic, or on Facebook Group ‘DC Injury Clinic’.