Avoid HARM for acute injuries (TOP TIPS)

Avoid HARM for acute injuries

After injuring yourself it can be difficult to know what to do. Do you use, ice or heat? Rest or movement? Elevation or massage? The asnwers to these questions are found in the type of injury that you have sustained.

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Acute Injuries

An acute injury is an injury with a sudden onset, usually as a result of some sort of impact or trauma, such as a fall, sprain or collision. Acute injuries are sudden and sharp, occur immediately (or within hours) and cause pain (possibly severe pain). With this form of injury, two acronyms are extremely valuable to remember: RICE and HARM.

RICE

The RICE acronym is one that should be followed as the four factors help to reduce swelling and inflammation that is likely to occur within the first stages of healing for an acute injury. RICE stands for:

  • Rest
  • Ice
  • Compression
  • Elevation

HARM

In contrast, the HARM acronym provides four factors that should be avoided with acute injuries, and stands for:

  • Heat
  • Alcohol
  • Running
  • Massage

HARM is extremely important to remember within the initial 48 hours following an acute injury because both heat and alcohol cause the blood vessels to dilate (open up) – this increases the bleeding in the injured area. Exercising the body part or massaging the area also has the same impact and can be detrimental to the healing process.

Chronic Injuries

Differing to acute injuries, chronic injuries can be subtle and may emerge slowly, with no known factor that triggered it. Chronic injuries may come and go, and may cause dull pain or soreness. Long standing low back pain is a classic example of a chronic injury, and often results from overuse and repetitive movements. However, if an acute injury is not effectively treated, it may lead to a chronic problem.

Heat therapy

Heat therapy is frequently used for chronic injuries or injuries that have no inflammation or swelling – such as nagging muscle or joint pain. Using a heat pad, or getting into a warm bath can help to increase the elasticity of joint connective tissues and stimulate blood flow, which can consequently aid pain relief. Whilst this is often a temporary solution, it can provide relief nonetheless.

Prodced by JB Physio and re-produced with permissions via twitter

Commonwealth Day #9 – Reflection 4

XX Commonwealth Games
XX Commonwealth Games

 

The 2014 commonwealth games is coming to a close within the next few days. The Glasgow platform has provided some amazing sporting outcomes and a great experience for athletes, team officials, and Clydesiders alike. As part of the medical services, working in the polyclinic has given me a taste of the multi-sport elite level competition, and whilst it is hard work, it’s certainly something I have thoroughly enjoyed.

 

The What?

I have learnt a lot from being in the polyclinic environment and working alongside some fantastic physiotherapists over the past two weeks. When an athlete is injured, they usually transferred to the polyclinic, from the field of play, to receive world-class treatment. However, what happens when the athletes doesn’t listen?

 

So What?

A netball player presented to the polyclinic with an acute ankle sprain, 2 days previously, she sprained her ankle competing. Treatment was provided to aid recovery but as part of my assessment, I enquired as to when she was competing next, the reply I received was ‘5pm today’.

As physiotherapists, we naturally want to promote activity and sports participation, but sometimes the body needs time to heal. The athlete always wants to play and the coach always wants their best players fit for action. The difficulty comes when the coach is present to hear your opinion about an injury or doesn’t choose to hear it.

I advised the netball player that should not play on her ankle in its current state, despite the fact that she had a game that afternoon, and this is why.

The ‘envelope of function’ (according to Dye, 2005): increase in activities (both frequency and intensity) leads to tissue loading outside the zone of physiological homeostasis
The ‘envelope of function’ (according to Dye, 2005): increase in activities (both frequency and intensity) leads to tissue loading outside the zone of physiological homeostasis

The tissues within the body are maintained in homeostasis through training and competing. The tissues and structures in the body are pushed into ‘supraphysiological overload zone’ when competing, which means that are optimised within the ‘Envelope of Function’. When these tissues are overloaded beyond the ‘Envelope of Function’, i.e an injury occurs, then tissues fail and break or rupture. due to injury, the envelope of function is reduced and tissue homeostasis is disrupted.

 

What this means in the context of the athlete competing, is that they have a reduced physiological ability to perform to their highest level, which would be needed at an international event like the Commonwealth Games. If the athletes does compete with a reduced ‘Envelope of Function’, then they risk further injury as the tissues get overloaded beyond the envelope sooner. The cycle of boom and bust can re-occur until the tissue is given sufficient time to heal and repair to restore tissue homeostasis.

 

Now What?

1) Communicating the importance of tissue healing to athletes is difficult but needs to be emphasised to avoid boom and bust cycle of injury.

2) Communicating the outcomes of clinical assessments to the athletes medical team should be done immediately to discuss return to competition but athletes want to play and coaches want their best players available for selection, so getting this message through can be difficult.

3) Treatment of injuries should be looked at in the short-term and long-term outcomes with the athlete at the centre of the treatment goals

 

Reference

1) Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res 2005; 436:100-110.

 

NFL Injuries 2013/14

Hello everyone, thought id share this infographic from Wall Street Journal. It shows all the injuries sustainted fornm one season during NFL.

 

Not surprisingly the knees have taken a heavy load of the injuries, and those ankles are at high risk of injury. Looks like a slight correlations between reduced injuries and increased protective armour in that area. However, there is still plenty of shoulder and concussion injuries.

 

Enjoy the viewing.

 

Thanks
Tom

Outdoor Training Time

The Warm-up Trail

In this series of blogs we are going to take a look into the world of training outdoors with Chris Watson, an expert in outdoor personal training and conditioning. Enjoy this weeks blog:

Run! Here come the boys…

Now that summer is finally upon us and the weather seems to be picking up (hopefully) it’s time to leave the treadmill behind and get outdoors and into your local park! Don’t get me wrong I love the gym but what’s the one thing many gyms don’t have? Space! Especially during those peak hours at lunchtime and after work. No more waiting for machines or banging into people at the squat rack. So what’s so good about training outside I hear you ask? Well, it’s free, you don’t need any kit and when the sun is shinning on a summers evening there’s no better place to train. So let’s get our gear on and get outside!

First you need to identify a suitable park, preferably within running distance from work or home. Use the run there as part of your warm-up. Find a good spot, something that has a handy bench and maybe a few trees nearby. Give the area the once over, gotta check for the usual suspects, glass, stones, dog muck, etc. Now you’re ready to get stuck in. The fun bit about outdoor training is using your surroundings, get creative! Sure have a plan in your head of what you want to do during your session, but you may find a tree perfect for pull-ups or an old tree stump for box jumps or a handy bench for dips. Every park offers hidden training gold.

I have various parks where I like to train as each one offers something a little different and that’s how I structure my training session or that of my clients. For example, a typical session will consist of a light jog to said park, a dynamic warm-up then usually 5/6 exercises over 3/4 sets with varying rep rates. I’d always allow a good hour. Start with a 10min run followed by a 5min warm-up to get nicely stretched. Around 25/30 mins for your session, finishing off with a light warm down run (back). Spend at least 10mins stretching at the end. Job done!

Man of Steel…

Over the next few weeks we’ll look at the different types of sessions you could plan. Whether you have an hour or just 20 mins. The exercises you could include and the effectiveness of weight-free training for burning fat. Things you can use, goals you can set and how you can bring a bit of fun to your training.

Thanks for reading and see you next week

Chris
[level 3 PT- outdoor training specialist]

cw
Chris Watson

Enquires for PT to cdwatson1972@gmail.com

Neuromuscular Control – What does it mean???

Neuromuscular Control – What Does it mean?

Neuromuscular control is certainly a complex procedure undertaken by the body but this has been made easier to understand by Vern Gambetta, a top performance coach from the U.S. Great reading and this will certainly improve that understanding of movement.

Movement is quite simple and from that wonderful simplicity comes the complexity of sports skill and performance. Twenty-five years ago in an attempt to better explain movement and how we should effectively train movement I came up with this simple diagram I call the Performance Paradigm.
NMC
It was somewhat like what Albert Szent-Gyorgi, once said, “Discovery consists in seeing what everyone else has seen and thinking what no one else has thought.” Essentially it is the stretch shortening cycle of muscle with a more global interpretation and proprioception brought into consideration. It is the basis for what some people call the Gambetta Method; to me it is common sense. I use this to evaluate movement efficiency or deficiency and then to guide training and if necessary rehab.

Essentially all movement is interplay between force reduction and force production. The quality of the movement is dictated by our proprioceptive system. We begin movement by loading the muscles – this is the force reduction phase. Basically this is the eccentric loading phase as a well as instantaneous isometric action that lends stiffness to the muscle. This is the most important component of the performance paradigm, but probably the most overlooked as well as the most misunderstood. There are several reasons for this; the most notable being that it is less measurable. Because it is more difficult to quantify we have tended to emphasize the more measurable component, force production. It is during the force reduction phase that most injuries occur. Think landing on one leg and tearing an ACL or planting to cut and spraining an ankle. It is during this phase that gravity has its greatest impact; it is literally trying to slam the body into the ground.

Once force has been reduced the subsequent result is force production. Force production is easy to see and easy to measure. Consequently it gets an inordinate amount of attention in the training process. We see it because it is the outcome. It is how high or far we jump. It is how much we lift. But just because it is easy to see and measure does not mean it should receive the inordinate emphasis, in training that it does. It must be stressed that it is the component of the performance paradigm that is highly dependent on the other phases.

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The third component of the Performance Paradigm is proprioception. Ultimately it is the glue that binds a whole functional program together is proprioception. Proprioception is the awareness of joint position and force derived from the sense receptors in the joints, ligaments, muscles, and tendons. It is that component that gives quality to the movement. “The quality of movement, in part, is dependent upon neurologic information fed back from proprioceptors within muscles and joints to the higher brain centers. The information returning to the central nervous system from the periphery includes “data” concerning tension of muscle fibers, joint angles, and position of the body being moved.” Logan and McKinney (Page 62) It is the feedback mechanism that positions the limbs to be able to achieve optimum efficiency. It is a component of movement that has been all but ignored in most traditional training programs until recently. It is highly trainable, especially if it is incorporated as part of a whole program.

It is almost too simple. Perhaps to appreciate proprioception we should look at the extreme case of a stroke victim that is able to return to normal movement patterns. Why can’t an athlete who has all their capacities enhance the quality of their movement by focusing on the same things that the stroke victim has to focus on to get back to function? The key to that is proprioception. We must strive to constantly change proprioceptive demand throughout the training program in order to enhance the quality of movement.

The performance paradigm will serve as a guide to determine how we train all components. It can also serve as a very useful guide to help us to evaluate movement from a slightly different context. It should serve as a guide to be more functional in our approach by emphasizing the timing and sequence of all three components of the paradigm. The synergistic interplay between them will produce the highest quality of movement.

It is very easy to get caught in the trap of measurable strength. How much you can lift or how many foot-pounds of force you can express on a dynamometer are meaningless numbers. Functional training does not depend on measurable strength. Quality of movement, coordination and rhythm are more important. The goal is always to apply the strength that is developed in the actual sport performance. How is the force expressed? Can you produce and reduce the force? Force production is all about acceleration, but often the key to movement efficiency and staying injury free is the ability to decelerate and stabilize in order to position the body to perform efficiently. A good functional training program will work on the interplay between force production, force reduction and stabilization. The end result is functional strength

Thanks for reading, see my next post on ACL and neuromuscular control!!!

TA Physio

prehab not rehab for sport injury prevention
prehab not rehab for sport injury prevention

Kiniesiology Taping Course

KINESIOlOGY TAPING COURSE

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This exciting one day clinical Physiotherapy course will enable participants to:

  • Develop their understanding of the role of Kinesiology taping
  • Develop expertise in the application of Kinesiology Tape for common clinical conditions
  • Become proficient at applying Kinesiology  tape effectively to a variety of regions

 

Venue: Birmingham City Hospital, Dudley Road, Birmingham, B18 7QH

Date: Saturday 16th February 2013 (9 am: 4.30pm)

 

Tutor: Melanie Betts , MSc (Manip Ther); MMACP; MCSP; HPC;

London 2012 Olympic Volunteer Physio, Private Practitioner, World Student Games (1995) and World figure skating championship (1995). Great Britain Swimming Team from 1995-1999. She  was the physiotherapist for the Great Britain Target Shooting Team 2001-2010. These roles took her to Manchester 2002 & Melbourne 2006 Commonwealth Games, and the Athens Olympic Games 2004. She is also a sought after MSc Manual Therapy/ MACP Clinical mentor.

Fee: £95 (Includes all taping materials)

Contact: Gerard Greene, MSc (Manip Ther); MMACP; MCSP; HPC; PgCertEd

Ph: 07968 011832

Email: greenegerard@hotmail.com

Facebook: HarbornePhysio

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Runners Need Gleuts of Steel

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So many peolpe are training and runing over the winter, and thats a great away to get fit or die trying. But to help keep those unwanted injuries at bay,  try these exercises. These exercises help prevent leg injury’s in so many sports and activities, not to mention keeping your posterior nice and perky.

So here they are…

1) This video is a demo of the ‘Crab Walk’

Crab Walk

This video is a demo of the ‘Waltz Walk’

The Waltz

Finally this is a demo of the ‘Pee’d your pants Walk’

The Pee’d Pants

So there we go, a great first attempt at video blogging from Adam Meakins

If you have any questions or comments I would love to here them so please leave me a comment….

.

Thanks for reading and watching

TA Physio

beach running

Hypermobility Awareness & Assessment

Hello again,

Just sat here thinking about work during my time off and what I realised is how many of my clients are hyperlax, hypermobile or have hypermobility syndrome. Shockingly, 90% of these clients are not aware of this underlying condition and have never had it diagnosed by a fellow healthcare professional.

This article is to highlight how to assess and diagnose hypermobility during clinical assessments. There is a significant need for more awareness of these conditions, for the patient to understand their body and for clinicians to factor this into their rehab.

 

What is the Hypermobility Syndrome?

Connective tissue proteins such as collagen give the body its intrinsic   toughness. When they are differently formed, the results are mainly felt   in the “moving parts” – the joints, muscles, tendons, ligaments   – which are laxer and more fragile than is the case for most people. The   result is joint laxity with hypermobility and with it comes vulnerability   to the effects of injury.

The Hypermobility Syndrome is said to exist when symptoms are produced,   a state of affairs that may affect only a minority of hypermobile people.   It is probably more correct to refer to Hypermobility Syndromes (in the   plural) as a family of related genetically-based conditions which differ   not only in the particular protein affected, but also in the degree of   difference of formation. Thus at one end of the spectrum are the diseases   with the potentially serious complications such as Marfan Syndrome or   Ehlers-Danlos Syndrome Vascular Type (formally EDS IV). At the other end   are what is now called on good evidence Benign Joint Hypermobility Syndrome   (BJHS) and Ehlers-Danlos Hypermobile Type (formerly EDS III), which may   be one and the same

 

Hypermobility or Hypermobility Symdrome?

Hypermobility and hypermobility sydrome (HMS) can be diagnosed by a set of tests called the Beighton Score, and then tested against the criteria for HMS which is called the Brighton Score:

Beighton Score:

The Beighton modification of the Carter & Wilkinson scoring system   has been used for many years as an indicator of widesparead hypermobility.   A high Beighton score by itself does not mean that an individual has HMS.   It simply means that the individual has widespread hypermobility. Diagnosis   of Hypermobility Syndrome or HMS should be made using the Brighton Criteria.

The Beighton score is calculated as follows:

Score one point if you can bend and place you hands flat on the floor without bending you knees.
Score one point for each knee that will bend backwards.
Score one point for each elbow that will bend backwards.
Score one point for each thumb that will bend backwards to touch the forearm.
Score one point for each hand when you can bend the little finger back beyond 90°.

If you are able to perform all of above manouevres then you have a maximum   score of 9 points.

Brighton Score:

An important landmark was passed in July 2000 with the publication   in the Journal of Rheumatology (2000; 27: 1777-1779) of the Brighton Diagnostic   criteria for the Benign Joint Hypermobility Syndrome (BJHS).

The actual criteria have been reproduced (as published) below.

Major Criteria

  • A Beighton score of 4/9 or greater (either currently or historically)
  • Arthralgia for longer than 3 months in 4 or more joints

Minor Criteria

  • A Beighton score of 1, 2 or 3/9 (0, 1, 2 or 3 if aged 50+)
  • Arthralgia (> 3 months) in one to three joints or back pain (>     3 months), spondylosis, spondylolysis/spondylolisthesis.
  • Dislocation/subluxation in more than one joint, or in one joint on more than one occasion.
  • Soft tissue rheumatism. > 3 lesions (e.g. epicondylitis, tenosynovitis, bursitis).
  • Marfanoid habitus (tall, slim, span/height ratio >1.03, upper: lower segment ratio less than 0.89, arachnodactyly   [positive Steinberg/wrist signs].
  • Abnormal skin: striae, hyperextensibility, thin skin, papyraceous scarring.
  • Eye signs: drooping eyelids or myopia or antimongoloid slant.
  • Varicose veins or hernia or uterine/rectal prolapse.

The BJHS is diagnosed in the presence two major criteria, or one major   and two minor criteria, or four minor criteria. Two minor criteria will   suffice where there is an unequivocally affected first-degree relative.

BJHS is excluded by presence of Marfan or Ehlers-Danlos syndromes (other   than the EDS Hypermobility type (formerly EDS III) as defined by the Ghent   1996 (8) and the Villefranche 1998 (9) criteria respectively). Criteria   Major 1 and Minor 1 are mutually exclusive as are Major 2 and Minor 2.

 

The Subjective Give Away.

During your subjective assessment you should look for comments made by clients about their flexibility.

 

Clients may report that they feel a disconnection to their movements whilst partaking in sport. They may report numerous episodes of tripping for no reason, theymay alos report a long history of ankle problems. Ankle instability is well documented in HM and HMS sufferers as they have the flexibility in the ankle ligaments for them to stretch wihtou causing damage.

 

It is also well documented that dancers have exceptional flexibility, and most commonly ballet dancers, so their past times or activiteis may include dancing.

 

Such comments as, ‘I’ve always been very flexible’, ‘I’ve sprained my ankle loads of times’, ‘I used to do a lot of dancing’ are a sign for you to investigate further.

 

Start with the Beighton Score and then consider the Brighton Score is you suspect more. Always provide as much information to clients about HM or HMS, if you are unsure then direct them to a good source of information. The website below is excellent.

 

Thank you for reading this article.

Information regarding HMS and HM is available at www.hypermobility.org

Kinesiology Taping Course

Kiniesiology Taping Coruse

This exciting one day clinical Physiotherapy course will enable participants to:

  • Develop their understanding of the role of Kinesiology taping
  • Develop expertise in the application of Kinesiology Tape for common clinical conditions
  • Become proficient at applying Kinesiology  tape effectively to a variety of regions
Venue: Coventry University

Date:       Saturday 8th December 2012 ( 9 am : 4.30pm)

 

Tutor: Lesley McBride, MSc (Manip Ther); MMACP; MCSP; HPC; PgCert HEd

 London 2012 Olympic Physio,England Rugby Football Union Physiotherapist, Guest lecturer MSc Manual Therapy, Coventry University, MACP Clinical mentor, Lead Physio Coventry University Sports Centre, Experienced researcher, clinician and educator

 

Fee: £95 (Includes all taping materials)

Contact: Gerard Greene, MSc (Manip Ther); MMACP; MCSP; HPC;PgCertEd

                                                          Ph: 07968 011832

Email: greenegerard@hotmail.com

*other taping courses are available but Lesley McBride is an excellent teacher with a lot of exepierience in sports physiotherapy, well worth the money.

Thanks

TA Physio