Self Help Tips for Desk Related Pain

We find a lot of people reporting to into the clinic with upper limb or neck pain that they attribute to spending the majority of their day sat working at a desk or laptop.  In our clinic we see increases in this during other periods that are associated with increased desk time e.g. exam revision times, end of year deadlines.

 

Signs of work related musculoskeletal pain:

1. Pain that only occurs when at work e.g. after sitting at for long periods, working at a laptop or computer,
2. Pain that settles during holiday periods or change in routine
3. Pain that increases with an increase in work volume e.g. deadlines, exam periods

 

How can you minimise the occurrence of desk related pain?

Whilst your desk set up and posture are important in minimising pain, the reality is that if you sit in any position for a long period of time- no matter what your posture is like, or how high the monitor is, you are going to develop discomfort and potentially pain.  That is not to say that optimal desk, monitor and keyboard set up isn’t important- they are a good starting point for optimising your work station for when you are sat at the desk. However the key is a regular change in position. Ideally a change in position every 20-30mins is beneficial in minimising the development of pain. Ideas to facilitate this are:

• central printers away from your desk
• drink breaks
• standing and walking whilst making phone calls
• going and liaising with colleagues rather than emailing
• desks with variable desk heights (standing desks)

 

One key driver in minimising desk related pain is the exercising away from work. Research shows that the more active you are away from work the more able you are to tolerate being sat for longer periods. So exercising outside of work is really important. Building this into your day e.g. at lunch times can also facilitate a break from the desk. This can be as simple as a walk at lunchtime or a short exercise class.

 

So remember the key is movement, move often, exercise regularly and you will help minimise your chances of developing desk related pain.

Needles for less pain?

Today I wanted to highlight one of the treatment modalities we use at Physiokinetic.

Acupuncture. The process of pushing needles into the body to create a specific response.

Or more aptly described by the Acupuncture Association of Chartered Physiotherapists as, “one of the many skills used within physiotherapy as an integrated approach to the management of pain and inflammation and as a means of stimulating the body’s own healing chemicals in order to aid recovery and enhance rehabilitation”.

The effects of acupuncture can be divided into three areas.

1. Local tissue (skin, muscle) response
2. Segmental analgesia (effects on the spinal cord)
3. Supraspinal analgesia (effects on the brain)

How we would describe this to you as a patient would be as a combination of the above three mechanisms.

When you put a needle into the skin, the skin and muscle you are going through is affected. The body will release chemicals in response to something that shouldn’t be there, these chemicals are described as being part of our normal inflammatory response and will have an impact on the nerves and other cells around that area. This can lead to pain relief and a change of sensation in a painful area.

There is also a dull sensation that occurs with acupuncture, traditional theories would call this ‘Dai qi’. This is thought of as stimulation of nerve fibres that can impact the way our spinal cord is sending information to the brain. Once again modifying the painful sensations we may be feeling from a problem.

Finally there is a central response, a response from our brain. This is where emotion and experience has an impact. The initial two affects as described will be listened to by the brain, which will interpret the sensations based on previous memories and experience of this kind of sensation. This has a neurological and chemical affect in the different parts of the brain, which will then in turn change the way the brain feels that area, affecting your pain.

We have two physiotherapists that practice acupuncture as part of a combination of treatment approaches. If it is something you are particularly interested in please get in touch and ask us any questions you may have!

For further reading see https://www.aacp.org.uk/page/14/what-is-acupuncture

 

 

 

Running niggles…how to self manage…

With the London Marathon just days away and summer just around the corner, I thought I would discuss some common running niggles that can occur when you either start increasing your mileage or start running for the first time.

 

Achilles pain

The achilles tendon connects your calf to your heel bone. This like many other tendons often gets aggravated when you increase mileage too quickly or suddenly introduce a new activity. If you do start to experience pain over your achilles tendon it doesn’t necessarily mean you need to back off training completely but you should probably reduce some of your activity to allow symptoms to settle. A rule of thumb is if your pain stays below a 4/10 then you can continue with the activity. However if your pain starts to increase day to day or during activity then you need to consider reducing the amount you are doing. Alongside this most people with these symptoms require some additional strengthening for the lower limb. This may be calf strengthening or actually higher up the kinetic chain – e.g. hamstrings or gluts.

 

High Hamstring Pain

This is another load related injury involving the hamstring tendon. Common symptoms include pain on sitting, high speed running and hill running. Common mistakes with managing this are to stretch the hamstrings- this often maintains the symptoms and can make the symptoms worse. Basic management is to avoid high speed running and hills and to not stretch the hamstring. The best treatment for this is to undertake a hamstring loading program and you probably need some guidance from a physio as these conditions can be difficult to manage.

 

Knee pain- on the outside

The usual culprit for this is the Iliotibial band that connects one of the hip flexor muscles to the knee. Often people develop pain on the insertion of this band at the knee due to a particular movement pattern that causes the knee to fall inwards. Correcting this movement pattern will reduce symptoms. Strategies to correct this often include glut strengthening exercises and functional movement training e.g. single leg squat, hopping, step ups. Running gait analysis can sometimes be beneficial to identify any issues in this area.  

 

Knee pain- front

Pain in this area can have many causes but with runners it is often due to a combination of reduced muscle strength (usually calf, hamstring, gluts) and a similar movement pattern that we see with other knee pain that causes the knee to fall in. Addressing muscle strength deficits and correcting this movement pattern can have a big impact on reducing the symptoms.

 

On the whole most running injuries are a result of overload. Simple strategies of increasing mileage slowly and including plenty of recovery and strength work within your running programme can help mitigate a lot of issues. However if you do run into problems and need some guidance on managing symptoms and running load then it would be advisable to book in with a physiotherapist for a comprehensive assessment and rehab plan.

 As ever have a good Friday and Weekend!

 

Becki

 

 

Easter Break, Time for Learning, What’s Normal?

With a lot of our student athletes competing abroad or going home to train, we have had a little more breathing space over the last couple of weeks!  (slightly)

We chose this period to complete a trio of educational seminars delivered to our high performance team at the University of Birmingham. Included in this team are strength and conditioning coaches, nutritionists, performance lifestyle consultants, sports psychologists and sports physiologists.

The three areas discussed were the Sporting shoulder, the hip and groin and the foot and ankle. We delivered presentations based around the up to date approach to assessing and treating these areas and further discussed how we can integrate with the performance team to ensure a speedy recovery from injuries. A persistent questions in all seminars was ‘what is normal?’, ‘what should I expect to see?’

So, what is normal? To define this you have to have extensive knowledge in a specific area, and a lot of people to help you complete research! ‘Normal’ is actually a unusable term in our area of physiotherapy. I prefer ‘optimal’. As each activity or sport has its own adaptations that make that particular joint or muscle work optimally, and so, redefining what is ‘normal’. To know this about a sport, research is done on the most successful athletes in those sports. You can then create a picture of the physical characteristics of the best performers in that sport, and you can be sure there will be a lot of similarities!

For example, in the shoulder, if you perform a sport that requires you to use a single arm overhead, (tennis, water polo, cricket) it is preferential for you to have different levels of strength across your two arms and this will create (not so subtle) postural changes. If you try and apply those same changes to a swimmer, you will find a lot of ‘non-optimal’ readings and observations.

Just look at this video of an athlete throwing a ball and watch how far his right shoulder rotates backwards, quite incredible! (you will be redirected to youtube.com to watch it)

 

So next time you are comparing yourself to what you think is ‘normal’, remember, you are a product of years of going about your business in a certain manner, we all develop differently!

 

Have a good few weeks!

 

Continued good luck to all our Commonwealth (ex)patients, you are doing us proud!

 

The art of tapering…….

So we are fully into marathon season so with many races on the horizon for the running community I thought I would discuss the value and art of tapering for race day.

Tapering before a marathon should ideally begin around 2-3 weeks out for most runners.

So what does tapering mean? What does it achieve?

Tapering is the opportunity for your body to get some recovery and rest from all the mileage you have accumulated throughout your training. Evidence would suggest that a 2-3 week taper allows muscle glycogen (energy stores), enzymes, antioxidants, and hormones to return to optimal ranges. It is also an opportunity for muscle damage that has occurred during high volume training to repair and this improves muscle strength. Immune function also improves meaning you are less likely to get ill leading into the race.

 

However a common mistake during this period can be to over taper! Here is some guidance on how to manage you load during this period….

Weekly Mileage

A reduction to 80% of your weekly mileage in the first week, 70% second week and 50% in the final week should be sufficient to provide the necessary physiological adaptations required without leaving you feeling sluggish on race day. So if your weekly mileage is 50 miles then your taper mileage for week would be 40miles per week.

Long Run Volume

Whilst you don’t want to eliminate long runs you should reduce the volume, most coaches would recommend reducing this by 20% week 1 and 50% in week 2.

Intensity

You should also make sure you maintain some intensity to your sessions. Training at race pace is still beneficial during this period. One higher intensity session per week will be sufficient in week 1, a moderate intensity session at 60% volume of your normal hard day. In the final week this session can be in the form of mini session e.g. 6-8 x 2mins at race pace with 2mins recovery.

The day before the race it useful to get out a do a light run. This has the benefit of stimulating the nervous system and provides some psychological comfort by alleviating nerves. An easy 3 miles would be appropriate.

Whilst this blog has provided some insight into the reasons behind tapering and given some examples of how to manage tapering load, it isn’t a one size fits all model. You will need to find a tapering model that suits you and best prepares you both psychologically and physiologically for the race. It takes time to develop a routine and be comfortable with a tapering regime, so the more you do the more you will find what works for you!

As always…. Have a great weekend from the Physiokinetic team!

Cheers Becki

Slouching for healthy shoulders and good posture!

At Physiokinetic we see a lot of shoulder injuries.

They are most prevalent in people that complete activity in the overhead position.

Quite often this is also the main symptom that people will seek physiotherapy,

“I get pain when I reach up to dry my hair”

“My shoulder hurts when I reach upwards to turn the light on”

“I can hit a forehand but as soon as I try to serve I get shoulder pain”

Quite often these symptoms will come with a diagnoses of “shoulder impingement”.

This is an accurate description of the symptoms. However it is just that, a symptom of a problem, not a diagnoses.  The diagnoses is derived from what is causing the shoulder to pinch. This is due to multiple factors.

The most significant factor and improvement people can make in the early stages of injury is to relax and allow yourself to slouch! The misleading information that creates the need to relax comes from the ideal that sitting up straight and pulling the shoulders back is a good idea while you move the shoulder.

This causes more problems and can quite often worsen the symptoms of impingement. 

This is as a result of accidentally fixing the shoulder blades in once place.

The shoulder moves! To create space and to give you a stable platform for the arm to work, the shoulder blade needs to move forwards and rotate upwards. Any lack of this movement and the shoulder will function sub optimally.

To promote this movement I use the cue to relax and as the arms raise up overhead, expand the back between the shoulder blades. The exact opposite to pulling them back! You can try this now, simply try and hold your shoulder blades together and raise your arms, then do the same while relaxed and letting your shoulder blades move. Which is easier?

When you have the feeling of this you can then train to maintain the muscular balance around the shoulder to keep this rotation occurring efficiently.

 

Have a good week!

 

Dan

A Royal Affair

So we’ve had an interesting week here at Physiokinetic!

We started the week with a Royal visit on Monday. The Princess Royal met Physiokinetic staff and some scholar athletes when she attended the site to officially open the Sport & Fitness Club.

Having discussed with the Queen’s daughter to some of the services we offer, I thought it would be a good opportunity to remind everyone of the diversity of skills we have to offer.

Physiokinetic we provide physiotherapy services to over 20 different sports at the University of Birmingham. Additionally, we are the regional provider of physiotherapy to the Talented Athlete Scholarship Scheme (TASS) which provides support to talented athletes aged 16 and over in over 30 sports.

Alongside this we also work in collaboration with Birmingham Children’s Hospital to provide physiotherapy assessment and rehabilitation services to children in the region. Our input supports children at a range of levels from accessing school PE, grass roots football and international para-skiing.

At Physiokinetic we understand the mindsets of patients and athletes of all levels. We understand the time sensitive nature of injuries and the needs of patients. As such we have developed a Sports Medicine Clinic that runs fortnightly on site to provide assessment for all our University Scholars, TASS athletes and patients. The service is headed up by Dr Kim Gregory. Dr Kim Gregory is the Chief Medical Officer for GB Para-Olympic Team at the Winter Olympics this year.

For those patients that don’t require sports medicine review we have worked hard to develop strong links with Orthopaedic Specialists in the area and have excellent knowledge of local services should patients need onward referral.  This is through both NHS and Private pathways and as such we can support all patients with their needs.

 

I hope this has provided some insight into the range of expertise and services we have here at Physiokinetic!

 

Have a great weekend

 

Bex

Short vs Long

When we see a client in our practice, we go through a series of important decisions. But one remains the most difficult, when do you focus on a short term ‘fix’ and then, when do you think about the long term?

Once we have a comprehensive history of the problem we will examine the area and develop a reasoned diagnoses. Straight away we then have to make a decision, do we concentrate on the injured area and continue to formulate a plan based on this, or do we continue to assess and find the reasons behind the injury and focus on the long term? Here lies the dilemma.

The main factors that will influence this decision are actually found out during our history taking and further signalled by our diagnoses. The most straight forward example to describe this is an acute muscle injury vs a gradual onset of knee pain.

For an acute muscle injury, it is most likely that initially we will focus on the injured tissue and be singularly focussed on managing that area, looking for quick, short improvements. These injuries are normally traumatic and come on suddenly and the explanation of the injury will reflect this. It would not make sense (and quite often you are unable) to start looking around the body for reasons why that muscular tissue has been injured. You wouldn’t put a footballer on a treadmill to look at running style the day after they have sustained a tear of their hamstring! Instead we identify the hamstring injury, get an accurate idea of the degree of injury, remove the factors that may worsen the injury (this may be running, or in extreme cases even walking) and immediately start to get that athlete moving in different ways. Quickly you would see improvements and then it logically makes sense to progress to looking at the long term and for reasons as to why they may have injured the hamstring area.

Conversely in the second example, a runner with a gradual onset of knee pain, it is logical not to get internally focussed on the injured area only. Instantly when talking to the runner we would see there was no clear reason why the injury occurred. We will most likely ask much more in depth questions as to the runners training history, their load management (see previous blogs) and look at the whole body to see why the knee is getting over loaded. This case would be appropriate to look at running style as there is likely to be a certain volume of running that the runner could do without pain. We then formulate a diagnoses and as before remove the problematic variables. Then we formulate the plan, involving rehabilitation for any of the issues we may have found with a focus on the long term improvement from the offset.

Obviously there are exceptions to these basic rules, but those exceptions still follow the same trends as above. You get an accurate diagnoses, remove the influences that could make the injury worse and then start the rehab process involving as much of the long term factors that you have identified as you can. It is more a question of when you look at the long term, not if!

So next time you are unfortunate enough to sustain an injury, think about the above to help you understand where your rehab focus needs to be!

If you have any questions please get in touch over on our facebook page!

 

 

 

Snowboarding Injuries: Are they preventable?

On the eve of the Winter Olympics reports that Katie Ormerod has suffered a double injury blow that will rule her out of the event has come as a massive disappointment for her and the British Team. Ormerod reports that she suffered a fractured wrist two days before the official opening ceremony, then in training the following day she suffered a severe calcaneus fracture.

We saw last week with Joe Breedon that injuries are part and parcel of being an extreme sport athlete. But how preventable are these traumatic injuries?

I thought today I would discuss how to prevent common snowboarding injuries. Whilst skiing injuries often involve the knees, snowboarding injuries by contrast tend to involve the upper extremities and head. When snowboarders fall they land on their hands, back, head and in free-style events a significant force will go through the board and feet. The most typical snowboarding injury is a wrist fracture. Other common injuries include the shoulder, neck and concussions

Unlike many sporting injuries that are related to overuse, ski and snowboard injuries are normally related to an acute traumatic event and as can be more difficult prevent. However, there a few things you can do to help minimise the risk of these injuries when you are on the slopes:

 

1.     Invest in some wrist guards- there is evidence that has demonstrated that these will reduce the risk. The guards should be flexible and longer rather than shorter with the splint palm side only.

 

2.     Wear a Helmet- evidence has shown that whilst wearing a helmet won’t eradicate your chances of getting a head injury, they can reduce the severity of head injuries.

 

 

3.     Learn how to fall. Avoid falling on out-stretched arms. See this video

 

4.     Do not over reach- stay on slopes and routes that are not too challenging and allow you to develop your skill level safely

 

Hopefully this has re-enforced some safety tips and ideas for all of you hitting the slopes this season.

Have a great weekend and enjoy the Winter Olympics!

 

Becki

Readiness to train: When to push on and when to hold back…

Happy Friday all!

We’ve had another busy week here at Physiokinetic. Having had a few patient’s come and see me after developing some overuse injuries I thought it would be useful to give you some tips on monitoring your training load.

When you’ve decided to undertake a training plan and commit to those hours running, in the gym, on the bike or on the pitch; missing sessions or not training hard every session can be a really difficult task. However; training too hard continually, without appropriate rest periods or down time can lead to injury and illness. Whilst we can never truly predict injury or illness there are subtle signs that can indicate when our likelihood of getting injured or ill is higher. We can use these to steer our training.

The first tool we have is the ability to monitor training and competition load. In professional sporting environments Sport Science Staff have the ability to monitor load through GPS tracking and Heart rate data. This data gives an insight into the external load placed on the body (e.g. GPS data, gym load) and the internal response (heart rate data). So how can we track this information without the use of GPS units? There is actually a relatively simple alternative that will allow you to track your load over time. It is an estimate, but it does give you a useful insight into how your training load fluctuates and may guard you against increasing your training too quickly.

Rating a session using a RPE score (rate of perceived exertion) you can estimate the load of a session by scoring it on a scale of 0-10 (1-very light à 10-very very hard).  By multiplying this number by the duration of the session we get an arbitrary figure which represents that training session. For example, a bike session that lasts 60mins at an RPE of 6 would give a TRIMP (training impulse) of 360. Using this method to rate your training sessions will allow you to ensure ‘easy’ sessions are actually easy and hard sessions are hard!

The second tool we can use is recovery monitoring. This essentially assess your readiness to train. We can use simple questions to monitor how we are responding to training and whether we need to modify our plans. Rating your levels of fatigue, motivation and sleep quality can allow you to quantify whether your risk of injury or illness may be higher.

The following questions are a useful start to monitoring your readiness to train:

Rate them on a scale 1-5 (1 poor- 5 Excellent)

How many hours sleep have you had?

How would you rate the quality of your sleep?

How rested are you?

How motivated are you to train?

 

If you just starting out on monitoring your training and responses, then it will take a few weeks in order for you to assess what is normal for you.

Hopefully you’ve found this useful and given you some tools to start to monitor your own training and readiness to train!

 

Have a great weekend!

Becki