Author Archives: linsladept

About linsladept

I am a Canadian ex-pat living in the UK for the last 16 years. I own and work in a physiotherapy/sports injury clinic that I have had here for the last 10 years. The office is in Linslade which is part of the town of Leighton Buzzard. I provide treatment and rehabilitation to patients in the NHS, patients from insurance companies and clients of local solicitors. I treat a number of local athletes who participate in rugby,football, MMA, judo, karate, thai boxing, wrestling and other combat sports. I play rugby, bass guitar and dabble in various combat sports/arts. On occasion I have been known to write/recite poetry at the most inappropriate times ;' ). Welcome to my blog ! :' )

Sitting down to help reduce falls and fractures.

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Falls have been a big topic since people can have their lives change forever should they break a hip or dislocate a shoulder or anything similar.  Falls are the commonest cause of injury-related hospitalisation in persons aged over 65 years, accounting for about 30% of all medical emergency admissions. Women are 3x more likely to fall than men, and in the elderly, are also more likely to be osteoporotic making the chance of a fracture higher.  I find all this information concerning.

You can get advice on controlling falls that ranges from eating dietary supplements to performing balance training to wearing protective clothing to protect points where a fracture might occur.  One thing that I have noticed hasn’t been given that much attention is that often people lose the ability to sit with control at a relatively young age.  If you can’t control how you sit down then there is a bigger chance of slipping sideways off the chair or falling backwards than there would be if you sat with control.

The 1 minute squat test is a good way yo see how fit a person is but there is the assumption that the person is getting up and down correctly which might not always be the case.

1 MINUTE SQUAT TEST

Stand in front of a chair, feet shoulder-width apart and squat down to lightly touch the chair before standing again. See how many you can do in one minute. Make sure the chair is low enough so that it allows your hip bone to drop a fraction below your knee.

Superfit: More than 60
Fit: 40-60
Barely fit: 20-39
Unfit: Less than 20

Sometimes it’s better to start , without worrying about the time limit, and see if you can perform a chair squat with good form:

Chair Squats:

Stand about 2 feet in front of a chair, hinge forward at your hips, torso leaning slightly forward (45 degree angle), bend hips, knees (knee caps tracking over first and second toe) and ankles congruently, move hips back and down toward the seat pan (sit bones barely touch the edge of chair), arms crossed in front of chest, brace your core. Stand up fully (shoulders and hips level).

Now if you want to progress there are lots of variations but one that I like best is to start performing goblet squats which can be a precursor to performing back squats.

Goblet Squat 

The few coaching cues involved in the goblet squat more than suffice to get the job done:

  • Hold a weight against the chest.
  • Position your feet so your stance is a smidge outside shoulder-width, with your toes pointed slightly out. If you’re taller, you may need to widen the stance a little more.
  • Sit back and down between the knees, keeping your chest up the whole time. Make sure you’re not falling forward or rounding your back.
  • Go down as low as you can while keeping your feet flat on the floor. If your heels come up, your stance is still too narrow.
  • At the bottom, brush your elbows down the inside of your legs and push your knees out. This is what makes the goblet squat so special, so let me say that again: knees out, knees out, knees out.  This helps to engage your gluteal muscles more effectively.
  • Stand back up and stand tall at the top.

Simple enough, right? Make sure to not overthink it. Think less, squat more, and you will find yourself moving more confidently and getting stronger.

Now not everyone will want to or be able to do all these different squat variations  but each has the ability to help make your legs/thighs/hips stronger and help you to walk with more confidence and hopefully with less likelihood of feeling wobbly.  If you have an sort of medical condition please check with your health care provider before trying any of these exercises out but if you get the ok I am sure that there is some benefit waiting here for you.

Regards,

Ross

 

P.S. If you have trouble following these exercises you can certainly make an appointment with a local physical/physiotherapist, personal trainer or athletic therapist to help you work through these exercises.  If you are in the Leighton Buzzard area and want me to see you then you can book to see myself using the following link : https://form.jotformeu.com/42456841375359

 

Basics on progressing your stretches

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People  have an injury, it stops hurting and then they return to their normal activities. Ideally it would be this simple but often you are left with tightness/discomfort.  This happens partly due to the fact that tissues tighten and shorten as they heal.  There may also be sensitivity issues which affect how tight things feel when trying to get back to your ‘normal’ activity.  In the following section I am going to look at a basic simple progression on how to get back your knee flexion mobility following a resolved injury.

To start with the simplest thing to do is just repeat the movement that is tight. For example one could just repeat the tight movement and the anterior thigh muscles should loosen to a degree just from doing that same movement.  This is a basic stretch that you can see footballers doing on the side of the pitch before and after a soccer match-

If this basic stretch isn’t enough then you can progress the stretch as tolerated depending on how sensitive the knee is.  If the restriction appears to just be soft tissue tightness and not a problem within the joint, then this second stretch might allow you to progress to a pain free state.  To do this stretch you use a pillow to gap the knee joint so avoid joint compression while stretching the thigh muscles.  The joint might be painful simply because the soft tissues crossing the joint are tight. By using the pillow ,and external support, you may avoid joint pain and see whether the knee/thigh can be more comfortable once the soft tissue tightness is relieved-

Whatever you are stretching, you need to consider what factors might be in play that could be producing discomfort or restrictions.  I mentioned that sometimes as area can be tight because of external factors making the area sensitive.  Another factor that can affect tightness is whether there are any muscles involved that cross more than one joint. When a muscle crosses more than one joint then you need to adjust your stretches to make sure that both ends of the muscle are being stretched to get the soft tissues to fully relax and allow good extensibility.

In this last stretch there is an emphasis to get the rectus femoris muscle stretched. It is important to tighten the abdominal muscles to make sure the stretch isn’t being overly focused in the lumbar spine.  Be careful when doing this stretch that you don’t fall over.  You may need to do the stretch near a wall. You might also find that you can’t reach back fully so a towel or belt might be needed to allow you go get to the stretch you are capable of even if your arms won’t reach.

So a recap.  In this instance I have gone from an easy stretch, to a more difficult stretch to finally a specialised stretch to get full comfortable flexion of my thigh muscles.  As mentioned other procedures might be needed if the knee joint is affected. Sometimes you might need to use a foam roller or cross tissue massage to loosen any tightness that is in a direction unusual for the muscle being stretched.  If the joint is affected then you may need to apply pressures across the joint to allow better mobility.  Joint work is something you need to discuss with a professional before trying on your own.  Finally remember that once you regain your mobility you should be performing strength and co-ordination training to enable the limb to work normally. You might find that these last two procedures can be added into the mix earlier as tolerated and in fact may be necessary in order to regain full flexibility.

Lots to consider. I hope that this information at least gets you started in your quest to regain your function.  It is a bit artificial to separate things out but by doing so it might help to localise and identify where problems are occurring.  Please let me know if you have any suggestions or comments that might be useful in these endeavours.  Regards.

Ross

Everything you wanted to know about Sciatica.

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Sciatica!!!This common problem gets a lot of peoples’ attention!  The difficulty is that there isn’t just one problem, and often people (clinician’s and  patients) use the term to mean differing things.

You will get different advice from medical doctors, physiotherapists, acupuncturists, sports therapists, chiropractors, osteopaths and massage therapists.  Each one has their own perspective but it’s not always clear what’s the best option to take. It can be really confusing!

The trouble is that sciatica is a symptom and not really a ”diagnosis” at all.  Most of the time people refer to pain down the back of the thigh as ”sciatica” as though there was something in the leg that had actually had been damaged. This isn’t always the case.

There are 4 main things that can produce pain down the back of the leg –

First there is the ”classic sciatica” which is thought to be a compression injury to the sciatic nerve in the buttock by the piriformis muscle.

Secondly pain down the thigh can be produced by tissues in the back which may or may not involve nerve entrapment.

Nerve entrapment can be produced by a disc compression type injury, stenosis (narrowing of the holes in the back centrally or on one side due to joint degeneration, disc herniation or wear) or by a combination of these factors.

Thirdly, you can also have pain down the leg simply by having a disc being irritated, so that it causes pain to be referred along the course of the nerve sheath, without actually having any damage to the nerve at all.

Finally, you could also have pain referred, or occurring locally, in the back of the leg due to injuries to the hip joint, sacro-illiac joint or hamstring muscles.

Really it can seem like a maze trying to figure out what is wrong or what to do about the symptoms that you have.

Diagnostic imaging can show damage that may never cause symptoms.  The use of MRI and x-ray can confuse the issue, because of the inconsistency of the relationship between how much damage people have and what complaints they have.  Sometimes there is nothing to be seen on a scan or x-ray, yet people suffer greatly.

There are many opinions as to what the best tests are, but a thorough history and examination performed by an experienced clinician can go a long way towards clarifying

  • what a person is suffering from
  • what to expect
  • what sort of treatment, if any, is necessary.

There are no magical new examination methods that have been shown to work any better than this.

 

 

Basic grip exercise using newspaper

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medial and lateral tendons at epicondyles

medial and lateral tendons at epicondyles

Here is a short little video about how to help build your forearm strength using newspapers.  I mention that this is one of a number of methods that can be used to help with forearm rehabilitation.  Other methods/exercises include forearm stretches, gripping without anything in your hand, dumbell exercises and using a wrist roller.  I haven’t added the wrist roller to this first video but I will be adding a second video shortly to further expand on these training methods.

Ross

Scars? Physiotherapy can help you!

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Scars.  You have them from injuries or surgery but often no one tells you what to do about them if they bother you.  Some women find scar pain is present in scars following a c-section.  Other people find scars post mastectomy can be painful for quite a long period of time.  Most people don’t know that there are a few things that can be done to help with scar pain or that a scar can benefit from remodelling of a sort.

Why should a scar be remodeled?

1. It can help decrease pain
2. It can improve range of motion in the surrounding joint and muscle
3. It restores normal mobility and function

A scar needs to be assessed and treated as it can affect your performance in a variety of areas including work, sport or even the bedroom. Episiotomy scars, perineal tears, overly tight stitching and c-section scars can all leave a woman uncomfortable and not comfortable being intimate. Typically these sort of scars (vaginal/perineal) are treated in a specialised hospital pelvic floor treatment unit as opposed to an outpatient/sports clinic. C-section or other abdominal scars are routinely treated in an outpatient clinic.  Sportsmen may find that a scar hampers their mobility, strength and co-ordination. It is difficult to perform to your true potential when you feel restricted or if you are waiting for a stab of pain to kick in.

Treatments can be active or passive.  These include a number of the procedures commonly used in physio/physical therapy practice such as soft tissue mobilizations(manual or instrument assisted), ultrasound, acupuncture and exercises.  Additionally  silicone gel sheets/silicone ointments and mildly stretchy K-tape may be used to add additional heat/stretch or humidity to the scar for longer periods of time.

hand scar acu

gua_sha_tools.

A great amount of treatment can be carried out by patients on their own but often it takes an independent person to see all the problems that aren’t immediately evident. Unsurprisingly people often avoid putting pressure on a scar and don’t notice just how sensitive the tissues in the area are.

If you have concerns about a scar then consider speaking to your family medical doctor or your physical therapist regarding having the scar assessed. There is no reason why you should have to suffer without some help/advice considering the amount of knowledge that is available these days.

Ross

Sitting can undo the benefits of a healthy lifestyle!

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I have been warning people for years about the dangers of too much sitting. Now a number of sources have come up reasons not to sit too long that further convinced me!

Firstly, sitting is known to be one of the most compressive position on the spine and has been thought to lead to potential disc injury over time.

HIZ

 

Our discs are tough but they are not meant to be constantly loaded without a break. Some people are lucky and have a greater degree of protection due to their genetics.  Not everyone is this lucky.  Typically I tell people, especially those with a history of acute low back pain attacks, not to sit for more than 30 minutes without either getting up or changing the position they are working in. This is all common sense and is easy to understand (although I do understand that some people might have different opinions).

Secondly, the new information (not that new really) shows that there is a high correlation between the amount of time you sit and the development of certain illnesses such as diabetes, heart disease and high blood pressure  . This can certainly affect the average person but some groups are more prone to these diseases and sitting less might be one thing a person could do that would help to lower their risks. There has even been talk that people working hard to maintain their fitness, such as runners, can loose up to 8% of the benefit of their run from every hour that they are sitting. One author came up with the term ”active couch potatoes” to describe athletes who sit too much. Alex Hutchinson , on the Runner’s World web site commented

” sitting appears to have some significant bad effects that can’t be “cancelled out” by exercising. Too much sitting and not enough exercise are two different things, and they’re both worth paying attention to. ”

Finland have worked out ways to minimize the effects of sitting on children by including a 15 minute break in every hour in the class room. I believe that this was put in place to help stop children from being restless.   it has the potential to help in so many areas that it is something schools might want to consider bringing in anywhere. Businesses could learn from this example and help to reduce occupational health risks, as well as cardiovascular diseases, by encouraging regular breaks at work. Too often you hear that people work through their lunches and breaks, come to work early and stay well beyond what one might consider a reasonable working day.

Although the focus is often to try and help physical health getting up and being active has been recognised as a valuable tool in combating some mental health issues. Centres like the Mayo Clinic have strongly encouraged exercising, such as walking, as one tool to help combat complaints such as depression,

It may sound like a rant but the benefits of getting up and moving about, both physical and mental, are too important to be ignored. Some are calling sitting ”the new smoking” (Dr. James Levine, director of the Mayo Clinic-Arizona State University Obesity Solutions Initiative) because of all the associated problems that can be linked to inactivity. Perhaps instead of just saying prevention is better than cure we should be looking at ways to put good ideas into practice. As ”James Brown” once so aptly put it ”get up off of that thing”!

Age

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Age is no limit!

People age. It’s a fact of life!  But what does that mean and how should it affect what we do?  Not everyone is going to be extremely active as they get older but there are benefits to any activity and you would be surprised at what can be accomplished both in terms of health benefits and personal goals.  For example, there is a great article in the Physician and Sportsmedicine that looks specifically at differences in muscle in a 40 year old tri-athlete, a 74 year old sedentary person and a 74 year old tri-athlete.  The differences are obvious to anyone who looks! The second article has imaging pictures of each individual’s legs.

Specifically you can see in the triathlon article that the 40 year old and the 74  year old competitors have similar muscle mass.

40 year old tri-athlete

74 year old sedentary man

74 year old tri-athlete

Another good example is a man by the name of Joe Stockinger who, weighing 74 kg and being 82 years old , was lifting a combined total of over a thousand pounds (454 kg) for the 3 lifts in his powerlifting competition.

There are many more examples of individuals who have continued to participate well past the time that many would have had them retire.  All of us can benefit from their examples.. that famous old saying is still true today ”If you don’t use it, you’ll lose it!”

You don’t have to be a high level competitor to receive the benefits of exercise which can include  fat loss, improved  muscle tone, better cardio-vascular health, improved bone density and just being able to comfortably enjoy your life!!  Find something that you can love to do whether it be dancing, running, swimming, drumming or any other type of activity that feels good to you!  If you are concerned then get a physiotherapist or your medical doctor to check you over to make sure that you feel safe in increasing your activity level.  Sometimes this can provide the peace of mind you need to feel confident in getting on with being you!

See you on the pitch!! ;’  )

Ross

What can an Assessment do for you?

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People aren’t always sure of what a physiotherapist does or whether they have a complaint that might be helped by a physiotherapist. Personally I treat mainly musculoskeletal problems (sports/spinal/arthritis…) but physio’s are involved in a number of areas. When someone comes in with a problem that I feel would be treated by a physiotherapist with a different speciality I send them to the appropriate person (Pat in our office has a focus on Occupational Health as one sub-speciality). Specialities include neurological conditions, women’s health, occupational health and a number of other areas.  When we do an assessment we try to focus in on what a person’s problems might be and whether one of our physio’s can help or not.  The assessment can clarify if there is a serious problem or if a person might be able to just get on with things themselves using just some information for guidance.

If you would like to have something looked at or discuss a particular problem I am offering a free 15 minute assessment for anyone able to come to my office. If you are interested please follow this link http://form.jotformeu.com/form/41794272933361 to book your free assessment.

Looking forward to seeing you and hopefully giving you a hand!

Ross

 

Clinic newsletter

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I have a monthly newsletter that you can look at for relevant information and up to date offers. Take a peek, let me know your thoughts and please feel free to suggest topics about rehab or injuries that you would like to see discussed. Thanks

http://eepurl.com/YpEXD

Planning for Recovery

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People often say to me ”I took a month off but when I returned to playing I got injured again”!  This is frustrating for many people but it occurs partly because people make the mistake of confusing ”this no longer hurting” with their body being completely healed and back to ”normal”.  There are a couple of things to consider that might help to make planning for recovery easier:

1)  Injuries often are healed fairly quickly but the tissue that has replaced/repaired has not been subjected to normal stresses and may well be locally stiffer, more sensitive and generally weaker than it originally was.

2)  Even when strength,sensitivity and mobility have returned to normal levels you will have lost the conditioning to the affected part of your body because you haven’t been able to train properly.  Even if you healed completely you still haven’t recovered your skills/co-ordination. You can often get by without much training before returning to competition if you aren’t hurt too badly or you are only doing things at a low activity level.  You do still run a higher risk of re-injury if you don’t do some prepatory training.

3)  Ok, you now have a healed injury and your co-ordination appears to be back to normal and you are ready to go!  Well almost.  The last consideration is that with a substantial lay off you also have the chance that you have lost some of the capacity you have built up over the years from participating in whatever activity you do. This isn’t a big factor if the injury has been recent and you have gone through a conditioning program before returning to what you do.  On the other hand, if you have had a long time off ( due to injury or just inactivity) your body has lost some of it’s built up ”toughness”. This means that you might find things get sore/injured again because you have less resilience.  Part of avoiding this would be to get back on a regular graded training program  before moving on to higher levels of participation or competition.  Adults who have played a sport for years and then stopped , say to have children, and then returned a decade later find that they seem to initially get injured relatively easily to what they expected.  This is partly due to the body naturally getting weaker/stiffer when not challenged to keep up optimum strength and flexibility.

To minimize problems each of these concerns need to be reviewed.  If you need help to check things find a health care practitioner to help you go through and see that strength, range and co-ordination are back to normal and comparable from side to side.  If you aren’t sure about your conditioning then either a health care practitioner or a personal trainer might help you check your fitness (strength and conditioning) levels.

So before rushing back onto the pitch, or even back to a hard labor intensive job, consider the things listed.  With a bit of planning and training you have a good chance of recovery with minimal problems.

Ross