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Lower Limb Tendon Pain – What shouldn’t you be doing?

Posted on 28th Nov 2018 by

We love a good Infographic here at goPhysio, and recently came across this great one from @YLMSportsScience10 Things NOT To Do If You Have Lower Limb Tendon Pain.

Lower Limb Tendon Pain

Tendon pain in the lower limb, aka tendinopathy, tnodionitis, tendonopathies……like achilles tendinopathy or patella tendinopathy, are one of the most common type of injuries we see at our clinic in Chandlers Ford. It’s a side effect of having a pretty active, local population who regularly take part in exercise to help keep them healthy!

Tendon pain can be pretty frustrating to have. Firstly, because it often affects those that are naturally more active or sporty, so has a huge impact on being able to do what you love to do. And secondly, it can be difficult to know what to do for the best. There’s lot’s of conflicting information out there and can be a bit of trial and error to find the right solution and have a successful recovery.

So, this infographic, which illustrates some great, evidence based principles on managing lower limb tendon issues, offers some extremely useful guidance.

  1. Do not rest completely – we prefer the term ‘relative rest’. So advise that you avoid activities that directly aggravate your pain, but keep going with others or find alternatives. It’s important to carry on ‘loading’ (so getting your tendon to work) to help your recovery.
  2. Do not rely on ‘passive’ treatments – there is overwhelming evidence that passive treatments (so something that’s just done to you, whilst you lay there happily!) alone will not help with tendon problems. They can be useful in relieving your pain in the short term, enabling you to do some more specific exercises though.
  3. Do not have injection therapy – this advice refers to having an injection as the first line of treatment. If you’ve tried a consistent, high quality, exercise based treatment plan and it hasn’t worked, then injection therapy may be indicated or Shockwave Therapy is also a good alternative to consider for certain conditions.
  4. Do not ignore your pain – just like #1, use your pain level as a guide for your activity. Pain in your tendon is your body’s way of telling you it can’t really cope and you need to listen to it!
  5. Do not stretch your tendon – when you place your tendon on stretch, the lengthening action also compresses the tendon and this has been shown to affect recovery. There are alternative exercises to stretching that are significantly more beneficial to you.
  6. Do not massage your tendon – if it’s painful, it’s irritated. Massaging directly on the tendon is likely to cause further irritation and make the pain worse.
  7. Do not be worried about images of your tendon – try not to have a picture in your mind of what your painful tendon might look like on an ultrasound or MRI scan. Visions of or words like ‘degeneration’ or ‘tears’ can make you afraid of using your tendon, when actually, gradually building up what you do and with guided, appropriate rehabilitation is the best way of recovering.
  8. Do not be worried about rupture – reassuringly, most people who rupture their tendon have not had any pain. Because you have pain, you are naturally easing off what you do (if you’re listening to your body and respecting your tendon!), so you really don’t need to worry about the risk of rupturing your tendon.
  9. Don’t take short cuts with rehabilitation – it takes time for an injured tendon to build strength and capacity (ability to cope with the demands you place upon it). There are no quick, easy fixes unfortunately! With the right rehab, outcomes are excellent. That’s exactly why we now have supervised, exercise based rehabilitation at the clinic. So you can work on a customised, specific, evidence based rehabilitation programme that will give you the best outcomes.
  10. Do not have a lack of understanding of what loads are right for your tendon – this is crucial but not an easy concept for non-Therapist to understand fully. Gradually loading your tendon to optimise recovery is fundamental. What you should be doing and when can take careful management. Sometimes the internet or ‘Bob‘ at the Running Club, or @RunningLover on Twitter aren’t fully qualified or experienced enough to help you with this. You need to call in the experts, and that’ where we come in!

What is load?

If you read anything ‘rehab’ based about tendons, you will often hear the term LOAD and may be thinking what exactly does that mean?

Load can be simplified as the demands that you place upon your body. So, if you take your achilles tendon, when you walk you are loading it, running you are loading it even more, jumping loading it even more! If you go on your tip toes, you’ll be loading it; if you’re holding a weight whilst going up and down on your tip toes, you’ll be loading it even more.

So loading can be varied by weight, duration, number of times or how long you do something for, how high impact you are working at……….there’s lot’s or variations.

What next?

If you are suffering with a tendon problem, don’t waste any more time or prolong your frustration. Seek expert advise from us at goPhysio. We are able to offer you a full package of support, with as little or as much ‘hand holding’ as you need. Give us a call on 023 8025 3317 to book your first appointment.


Top 5 Running Injuries & How to Manage Them

Posted on 29th Jan 2018 by

The top 5 running injuries. In this blog, I will share with you some insider information built up over a lifetime of clinical practice in the sports injury sector, treating 1,000’s of active patient’s with overuse, lower limb injuries.

I’d like to shed some insider light on the 5 most common running injuries and debunk some myths, helping you understand these injuries better, and give you some guidance on how to prevent and manage them if they do occur.

5 Most Common Running Injuries

The 5 most common running injuries we see here at goPhysio are:

  • Plantar Fasciitis
  • Achilles Tendonopathy
  • Calf Tears and trigger points
  • Anterior Knee Pain
  • Gluteal / Piriformis syndrome

Interestingly enough, all these injuries can originate from a similar movement dysfunction.

Starting at the foot with flattened foot arches or over-pronation, there is often a chain of biomechanics events leading up the leg to the trunk. These are nicely illustrated in this diagram. .Biomechanics chain of events

 

Plantar Fasciitis

Plantar-fasciitis is a fancy, latin word for inflammation of the plantar fascia. The plantar fascia is a thickened sheet of fascia (connective tissue) on the sole of the feet, it’s elasticity gives us a spring in our step when walking or running. The cause of plantar-fasciitis is linked to it being on an excessive stretch for prolonged periods of time, when the arches in your foot are too flat. So on push off when walking or running it’s excessively overloaded and stretched and overtime micotrauma, inflammation, pain and injury can result. Read more about plantar fasciitis here.

Achilles Tendonopathy

Flattened foot arches results in an inwards collapse of the heel bone (calcaneum) into which the achilles inserts. Thus with each step the heel bone excessively moves side to side, in a side-to-side whipping type motion of the achilles resulting in a build of force, overuse, microtrauma, inflammation, pain & injury! Read more about achilles tendon injuries here.

Calf Tears & Recurrent Myofascial Trigger Points

Again a similar mechanism to above. Over time, the calf muscles become tense and tight, they tend top hold a long term dull background contraction in an attempt to control the inward collapse of the heel bone. This increased tone is aggravated by running (we take approx 1,000 steps per km, per foot), resulting in tense, tight, overactive and painful muscles, which worsen with running and can become a long term or chronic issue. It feels especially tight after hill sessions, when the calf or achilles is also on stretch. Read more about calf tears here. 

Read more about the treatment of calf tears here.

Anterior Knee Pain

Anterior knee pain is an umbrella term, used to describe a wide range of injuries causing pain in the front of the knee. Although everyone is unique, in runner’s it is often linked to flattened foot arches and the inward collapse of the heel with it’s knock on effects felt through the whole kinetic chain (as per the diagram above). This inward heel collapse causes the shin bone (tibia) to rotate inwards and the knee will fall inwards, resulting in an asymmetrical build of of forces in structures around the front of the knee and some of the most common running knee injuries, namely; Infra-patellar tendonopathy, Patello-femoral joint map-tracking and Ilio-tibial Band friction syndrome (ITB syndrome). Read more about runners knee here.

Gluteal / Piriformis Syndrome

So, as the heel collapses inwards, we get internal rotation of the legs and hips. Subsequently, the gluteal (buttock) muscles become tense and tight in an attempt to control the inward rotation and movement of the leg and hip. This increased tone over a run (approx 1,000 steps per km, per foot), can result in tense, tight, overactive painful muscles. This often worsens with running and can become long term or chronic, which often results in referred pain travelling down the leg mimicking sciatica. Over my career I’ve even seen patients with this condition that mistakengly have been operated on, (the Surgeon thought it was a disc injury causing the sciatica) when it was merely this “Piriformis syndrome” referring into his leg.

The Solution

With all of these conditions, it’s crucial to understand that……..

the injured structure is actually the victim, the true cause is the uncontrolled movement!

Effective management of such injuries therefore needs to address the following:

From the foot upwards – Fully assessing foot position and biomechanics, looking at incorporating custom orthotics to correct the foot positioning and alignment and control excessive movement and rotation from the foot up the whole lower limb.

From the spine / “core” downwards – This is a crucial and often forgotten element, improving muscle stability and movement control throughout the body. Pilates is great for this.

Reduce inflammation – Ice and non-steroidal anti-inflammatories are an effective way to reduce inflammation in the early stages.

‘Hands-on’ Physio treatments – In the early stages, massage and acupuncture to normalise muscle tone, taping to correct alignment and ultrasound to stimulate natural healing, can all be effective ways to help ease pain and discomfort to help you quickly progress into active recovery.

Selective rest – Means to just rest from the aggravating (pain causing) activities, whilst actively participating in non-aggravating activities such as swimming or cycling to maintain movement and fitness. As we’re designed to move, movement in itself is therapeutic. We can really help guide you on this, as many people think if they have an injury they just need to completely rest.

Running Rehabilitation – Specific exercises, training advice and a return-to-running programme are all crucial to ensure a positive, long term return to running injury free.

Preventing these Injuries

We are our own normal

I want to reassure you that we are all different. We all have biomechanical differences that our bodies cope just fine with, we are our own ‘normal’. So, if you have ‘flattened arches’ but are able to run a marathon with no issues, nothing needs to change! You don’t need to address this ‘just in case’. Pain or injuries, such as those above, often arise when we are demanding too much of our body too soon, without giving it time to adapt to the demands – so in running, increasing distance or speed too quickly, changing the terrain etc. So much of the skill in preventing these injuries comes down to our training technique and running habits, combined with our body’s own ability to adapt.

However, what we often see is that a small biomechanical issue such as those explained above, combined with demanding too much of our body too soon, results in the body complaining with one of these injuries. Runners then get stuck in an injury cycle, where they can’t run without getting pain. By fully understanding and addressing the combination of biomechanical issues and training, this is the most effective way to overcome the injury and continue to enjoy a lifelong love of running!

By Paul Baker MCSP, goPhysio Clinical Director

The Injured Runner Project
We are trying to find out more about what injured runners do to get back to pain-free running, and would love to hear from you! If you’re interested in helping us out, please take a few moments to answer a couple of questions by clicking on this image. Many thanks.

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Should I run through pain?

Posted on 22nd Jan 2018 by

In my experience, I’ve found many runner’s to have a high pain threshold, which can be a help when you’re a runner. However, deciding whether to run through pain is a dark art and filled with many pitfalls!

So, in this blog, I’d like to help you avoid unnecessary injuries and share with you some insider information built up over a lifetime of clinical practice treating runners, offering you some clarity and debunking these myths related to running through pain:

Pain is weakness leaving the body!

Pain is a sensation and all sensations are pleasurable, so enjoy the pain!

No pain no gain!

So, “should I run through pain?” Well, in a nutshell it depends on what type of pain you’re experiencing. Broadly speaking there are 2 types of pain related to running and it’s crucial to be able to distinguish between the main 2 types.

1. Delayed onset of muscle soreness, also known as DOMS for short, which is a normal part of any successful exercise training programme. It’s often described as “heavy legs” and in runners is mostly felt as a broad, dull, heavy, ache in the large propulsion muscles of the leg i.e. gluteals, quadriceps or claves.

DOMS is often experienced the day after a run, when you’ve increased the mileage or done a hard hill or speed session, when you are doing day-to-day tasks that work those muscles, such as getting out of a chair or walking downstairs. It’s entirely normal and desired for the training effect.

Physiologically, one way to describe what’s happening within the muscle in DOMS is that during the harder exercise session, you get microscopic tears within the exercised muscle. The body is then in a phase where it’s laying down new muscle fibres, increasing muscle cross sectional area (getting larger) and increasing strength and endurance, hence the desired “training effect”. It normally peaks day two after the exercise session and then subsides. Read more about DOMS here.

2. Pain as a result of injury This type of pain is undesirable as any part of a training programme. Unless there is a definite memorable traumatic incident whilst out running either a slip, trip or fall (which you would be able to remember), all other running injuries can be classified as overuse injuries.

By their very nature, overuse injuries, will start gradually and mostly occur when there is a perfect storm of intrinsic and extrinsic factors.

Intrinsic (Internal) Injury Factors

These are factor internal to your body, namely:

  • A recent increase in body weight
  • Your running technique
  • Poor or altered foot & lower limb biomechanics
  • Long term muscle imbalance
  • Muscle strength & control
  • Muscle flexibility

Extrinsic (External) Injury Factors

These are factors that are external to your body and focus generally around your training parameters, namely:

  • Running volume – frequency, duration or distance
  • Running intensity and speed
  • Running terrain – hilly or flat, road or off-road
  • Inadequate warm-up
  • Running footwear

When we assess runners at goPhysio we will often find a unique mix of these factors. When combined together, they lower their body’s loading capacity or ability to cope with the demands that are being placed on their body. This results in the body complaining, often with a sharper, more niggling pain, where injury has occurred. An important part of our job as physiotherapist’s is to prioritise which factors, if addressed, will give the quickest, best outcome i.e. return to running symptom free long term.

However, if you continue to mindlessly run on this type of sharper pain without addressing the predisposing factors, it will likely worsen in severity and frequency, being felt earlier into a run and to a greater severity, eventually limiting your ability to run.

At this stage, what is usually happening physiologically, is the DOMS described above has developed into pain from injury. The micro-trauma, if left unaddressed, becomes inflammation, pain and eventually an injury.

So, if you think you’re experiencing these worsening, sharper symptoms over 2-3 runs in a week to 10 day period, stop and seek an expert physiotherapy assessment to identify, modify and remove all the predisposing factors getting you back to painfree running quickly!

Happy Running and don’t enjoy the pain!

By Paul Baker, Clinical Director of goPhysio


Running injury? When to get help and who to see!

Posted on 18th Jan 2018 by

Injuries are part and parcel of sport, exercise and running. But when is it OK to manage the injury yourself and when do you need to get help?

Firstly, our bodies are designed to heal naturally from injury over a period of a few weeks, depending on the severity of the injury and nature of the condition.

However, being sensible is the key. If we fall and suddenly we have a swollen, painful, red/bruised limb, then we should seek immediate attention in A&E or a walk in centre. If you’re unsure which to use, calling 111 to get a healthcare professional to help you with all your enquiries.

However, if you’re suffering with a less severe or ongoing overuse injury in your soft tissues (muscle, tendon, ligaments) or joints, which is taking a long time to settle i.e. lower back pain, knee pain, or a sports injury,  then seeing your G.P. or a Physiotherapist, is your best option.

Unfortunately, the reality waiting to see your GP if you’ve got an injury only serves to delay your recovery. Most will advise rest in the first instance and maybe painkillers, and ask you to come back in 6 weeks if it isn’t better (sound familiar?). Have a look at a previous blog post we wrote ‘The magic 6 weeks‘.

Eventually they may refer you to an NHS physio, and there’ll be more waiting for an appointment, which can be up to 18 weeks or more locally! That’s 6 months plus of potential pain, suffering and not doing some of the things you enjoy.

However, most private Physio’s accept direct referrals, minimising any hold ups in your treatment, giving you peace of mind and a positive action plan, without any delays. Clinically, physiotherapy is justified from day 1 of an injury – competitive and elite sports men and women will have immediate physio.

However, for the general population, the ideal time to see a physiotherapist will depend on the severity and nature of your condition and your aims and goals.

If you have a severe painful injury that stops you from running (or exercising) and you’re due to run a marathon event in 4 weeks – immediate Physio is crucial.

If an injury stops you from going to work and you’re self employed – immediate physio is highly cost effective! We see so many people that can’t work because of an injury and if they aren’t getting paid, the cost of private treatment to get them back to work quicker is actually very cost effective.

If you have minor injury that is improving steadily, you can avoid the aggravating factors and don’t mind not being so active for a while, then you could attempt to self treat your injury. However, with this comes the potential risk of re-injury when you return to the causative activities.

If your injury isn’t improving and you want to get back to a high level of activity, i.e. golf x 2 weekly or gardening, then Physio is important to help you return to your activities and prevent re-injury.

There’s an old, well known saying “time is the best healer”, but where injury is concerned, this is a myth!

Essentially, if your injury is not improving within 5-7 days, you need to see an adequately qualified and experienced physiotherapist. The longer you delay seeing someone, taking the ‘wait & see approach’, the longer it will take you to get better and the more it will cost you in pain, effort, time, money and frustration at not doing the things you enjoy.

Who to see?

We understand there’s an overwhelming choice of healthcare providers and it can be a stressful experience choosing which therapy or clinic is best for you. The lines between different therapies are merging, making your choice of therapy and clinic more complex as Chiropractor’s give exercises, Physio’s do manipulations and Personal Trainers do rehabilitation.

From your perspective we’re all the same – you just want to see someone who can get you better! A good clue when deciding which profession to see, is to consider who the professionals use to look after their bodies? In professional sports, from cycling to football, rugby to the Olympics, it’s a Chartered Physiotherapist that is trusted to sort out injuries, they’re the ones you’ll see run out onto the pitch. There’s obviously a good reason for this. Physiotherapy is also the 3rd largest health profession in the UK after Doctors and Nurses.

Physiotherapy is a proven strategy for in the first instance, easing the worries and concerns of people suffering from aches, pain and stiffness. And then helping that person move freely again, bending further, stretching easier, feeling healthier and stronger and living an active, fulfilled lifestyle into their 40’s, 50’s, 60’s, 70’s and beyond.

Here at goPhysio we will offer you an appointment within 24 hours of you getting in touch. It’s YOU that matters and for that reason our care is focused on listening to you, solving your injury problems and achieving your goals.

The sooner you take the time and effort to invest in your health and wellbeing with physiotherapy, you’ll be back doing all the things you enjoy.

If you need a solution to your running injury, don’t delay – you can book your appointment online here now.