Tuesday 4 August 2009
New website!!!!!!
Great news, our new website is live! Visit IntelligentTrainingSystems.com for course information, research, course locations and much more.
Wednesday 29 April 2009
Where is my pain coming from?
Referred pain is a term used to describe the feeling of pain in a part of your body adjacent to or at a distance from the site of an injury's origin. Despite this being studied increasingly, there is no definitive answer regarding the mechanism behind this phenomenon. Physicians and scientists have known about referred pain since the late 1880s yet the true origins and causes of referred pain are unknown. However, we do know that referred pain can come from a number of areas, like: the thorax (pneumonia, pulmonary embolism, ischemic heart disease and pericarditis), from the spine (radiculitis) and from the genitals (testicular torsion). Commonly though pain is referred from your spine. Often you can get pain in a variety of (almost unlimited) areas, more commonly in your hamstrings, calves, groins, shoulders all referred from your back. Less commonly but equally as impactful, you can get referred pain in your jaw, hands, feet and other more peripheral areas.
The jaw is perhaps an unusual area to get referred pain. In these cases, as long as cardiac tests are negative, do check alternative causes like increased biomechanical loading from the shoulders, spine and nerves. Typically you can get jaw pain from the median nerve being tethered, the costo-vertebral joints (rib joints) being stiff, as well as fibrosis/thickening in muscles around the neck and scapula. Sometimes the exact cause is sometimes difficult to find, but with some thorough investigation and a knowledge of biomechanical screening you can pick out the causes and confirm them by doing a ‘test-exercise’ and seeing how the pain changes. For example we had a lady come to us with jaw pain and she had been cleared of any cardiac involvement and her jaw was checked clinically too, and it was fine. She did however get jaw pain when she ran. On screening her biomechanics she presented with tight median and sciatic nerves, a rotated pelvis and a stiff upper thoracic spine. We started by showing her some sciatic nerve mobilisations and within 3 days she came back and confirmed that her pain when running had reduced significantly. Previously she was getting jaw pain after running for 10 mins, and now she was able to run for 30 mins. Further work mobilising her sciatic nerve and a mobility exercise programme for her median nerve and upper thoracic spine resolved her problem completely within 4 weeks.
While it’s obviously important to get the cardiac side of things checked and cleared when you get jaw pain, if there are no cardiac implications, the causes of pain are often biomechanical. Get someone in your area to check your biomechanics and work on any mechanical problems you may have. It may well help your jaw pain, back pain, knee pain or any other pain you may have. The only problem is that we have only trained about 500 Biomechanics Coaches™, but there’s more being trained every month…………keep your eyes out and if you’re lucky, you’ll find one in your area.
The jaw is perhaps an unusual area to get referred pain. In these cases, as long as cardiac tests are negative, do check alternative causes like increased biomechanical loading from the shoulders, spine and nerves. Typically you can get jaw pain from the median nerve being tethered, the costo-vertebral joints (rib joints) being stiff, as well as fibrosis/thickening in muscles around the neck and scapula. Sometimes the exact cause is sometimes difficult to find, but with some thorough investigation and a knowledge of biomechanical screening you can pick out the causes and confirm them by doing a ‘test-exercise’ and seeing how the pain changes. For example we had a lady come to us with jaw pain and she had been cleared of any cardiac involvement and her jaw was checked clinically too, and it was fine. She did however get jaw pain when she ran. On screening her biomechanics she presented with tight median and sciatic nerves, a rotated pelvis and a stiff upper thoracic spine. We started by showing her some sciatic nerve mobilisations and within 3 days she came back and confirmed that her pain when running had reduced significantly. Previously she was getting jaw pain after running for 10 mins, and now she was able to run for 30 mins. Further work mobilising her sciatic nerve and a mobility exercise programme for her median nerve and upper thoracic spine resolved her problem completely within 4 weeks.
While it’s obviously important to get the cardiac side of things checked and cleared when you get jaw pain, if there are no cardiac implications, the causes of pain are often biomechanical. Get someone in your area to check your biomechanics and work on any mechanical problems you may have. It may well help your jaw pain, back pain, knee pain or any other pain you may have. The only problem is that we have only trained about 500 Biomechanics Coaches™, but there’s more being trained every month…………keep your eyes out and if you’re lucky, you’ll find one in your area.
Tuesday 3 March 2009
Hamstring Injury Advice from Martin
Hi, I’m continuously getting questions about hamstring injuries in rugby and what to do about them, so I thought I’d put some info together with the latest thoughts and ideas from a clinical and biomechanical perspective……..
One of the most common injuries in sport is to the hamstrings. Typically though, although the pain often presents itself in the hamstrings, its often due to biomechanical load from another area that is not functioning correctly. Even if you tear the hamstring during sprinting, the underlying cause is often biomechanical, and unless that cause is addressed the problem will become recurrent or simply just not go away. You could even just have a hamstring that feels tight or won’t stretch out properly, either way the cause is often biomechanical.
Often these biomechanical causes are due to the pelvis or spine. A ‘rotated’ pelvis, (which is where one side of pelvis stiffens in an abnormal position) can go unnoticed for many years until the compensations start to cause problems. A rotated pelvis can increase the pressure on the hamstrings partially because it puts more tension through the muscle. In addition, these pelvic problems coupled with a stiff lumbar spine and stiff upper back can increase tension on the sciatic nerve. This in turn puts extra pressure on the hamstring.
Your pelvis can be abnormally rotated during day to day life by unaccustomed lifting or carrying, performing a repetitive movement abnormally or perhaps compensating for another biomechanical issue elsewhere in the body. In rugby, pelvic problems can be caused by a tackle, an awkward fall, scrummaging or landing awkwardly during a line out. In other words most things that occur during a rugby match! When the pelvis rotates, the piriformis muscle in the back of your hip goes into a protective spasm to minimise the pressure going through the joint. This spasm effectively prevents the joint from functioning correctly and so other areas have to compensate. If the problem is caught early enough, treatment will help. Simple therapy can mobilise the joint and improve its function. If however the problem is left for more than 6 weeks, the muscle will change its composition and become fibrotic and so be unable to function normally. In theses cases treatment will help in the short term, but whenever you start training again the hamstring problem recurs because the fibrotic muscle in the pelvis is still compromising the function of the joint and so putting more pressure through the hamstring.
This process can also affect the sciatic nerve. The problem is that when the piriformis muscle in your hip goes into spasm, it causes the sciatic nerve to become tight. It does this because the pelvis doesn’t move as well as normal, so the nerve becomes stiff and also because the nerve can run through the very piriformis muscle that’s in spasm. The body cannot allow damage to the sciatic nerve, its one of the main nerves in the body, so the muscles that would protect it go into a protective spasm. One of which is the hamstring group.
This protective spasm of the hamstrings can cause a number of problems that cause symptoms in the hamstring itself. It can make the hamstring feel tight and stiff. It can make the hamstring feel inflexible as it’s under constant tension. It can also cause a functional muscle imbalance. In other words, if the hamstrings are found to be ‘weak’ in comparison to the quadriceps (quads), one of the causes of this muscle imbalance could be the inability of the hamstring to fire correctly due to its state of tension, rather than it being fundamentally weak.
To manage this cause we first have to return the abnormal muscle tone in the piriformis muscle to normal. In other words you have to do ‘anti-spasm’ exercises for the muscle. Stretching or flexibility work just won’t cut it – it helps in the short term, but the tension returns in time. How often do you stretch to loosen a muscle, only to find the short term benefit disappears after a few hours or less? You need to return the muscle to normal function, not just stretch it. That is why stretching the hamstrings isn’t always the answer to your hamstring problems (in fact mobilising your sciatic nerve is far more effective in these cases). Once the spasm in your piriformis muscle is eradicated as much as possible, then the joint will rotate naturally back into its normal biomechanical position, so reducing the tension on the sciatic nerve and also the hamstring itself.
When the pelvis is back in place you should perform exercises to stabilise it. In other words exercises that educates your muscles to control your pelvis and trunk without them needing to go into spasm. Part of this process is achieved by so-called ‘core stability exercises’. See a local expert in sports injuries, they should be able to guide you through the biomechanics phase and the next stabilise phase.
The work we have just described is usually sufficient to eradicate the hamstring pain that is gradual in onset. In the case of a hamstring tear which was caused perhaps by a high velocity movement like sprinting, it will be necessary to compliment the work we have been describing with a progressive hamstring and pelvic rehabilitation programme as well. But please note that unless the biomechanical causes have been eradicated, then the treatment and rehabilitation process is unlikely to be successful in the long term. This is one reason why hamstring problems become recurrent – the biomechanical causes are not eradicated.
There are other causes of hamstring pain, these are not the only ones, but it is common enough for you to need to understand it, especially if your problem is not going away.
The main other biomechanical causes of hamstring problems are stiffness (or dysfunction) of the lumbar spine (lower back) and thoracic spine (upper back). Stiffness in either of these areas can increase the load on the pelvis and thereby affect the load on your hamstring. Think about when you walk or run, as your left arm and shoulder come forwards, at the same time, your right hip and leg are moving forwards. Meanwhile the opposite body parts are moving in the opposite direction – they are going backwards. Each side of the body works in unison to maintain balance and equilibrium while we move. So if one part of that chain of events does not function properly another has to compensate. So if we have a stiff upper back for example, and one shoulder can’t move as forwards as it needs to when you run, there is another part of the body that will take the strain – often it’s the pelvis.
If you suspect this background is affecting your hamstring injuries, try this exercise which is referred to as an anti-spasm exercise for the piriformis muscle in the pelvis.
4-sign exercise
Technique
1. Sit on a chair and cross one leg over the other as in the picture.
2. Place both hands on the inside of your knee.
3. Pull your knee up into your hands.
4. Pull up @ 20% of maximum effort, just enough to engage the muscles in your hip.
5. This is a static contraction, so make sure the leg does not move.
Instruction
1. Hold for 20 seconds.
2. Do 4 sets on each leg.
3. AM and PM
4. Before & after periods of activity or inactivity.
In the body, things are not always as they seem. Just because your pain or tension is in the hamstring doesn’t mean that’s where it is originating from. Always check the causes of your problems, they rarely exist where you think they do.
One of the most common injuries in sport is to the hamstrings. Typically though, although the pain often presents itself in the hamstrings, its often due to biomechanical load from another area that is not functioning correctly. Even if you tear the hamstring during sprinting, the underlying cause is often biomechanical, and unless that cause is addressed the problem will become recurrent or simply just not go away. You could even just have a hamstring that feels tight or won’t stretch out properly, either way the cause is often biomechanical.
Often these biomechanical causes are due to the pelvis or spine. A ‘rotated’ pelvis, (which is where one side of pelvis stiffens in an abnormal position) can go unnoticed for many years until the compensations start to cause problems. A rotated pelvis can increase the pressure on the hamstrings partially because it puts more tension through the muscle. In addition, these pelvic problems coupled with a stiff lumbar spine and stiff upper back can increase tension on the sciatic nerve. This in turn puts extra pressure on the hamstring.
Your pelvis can be abnormally rotated during day to day life by unaccustomed lifting or carrying, performing a repetitive movement abnormally or perhaps compensating for another biomechanical issue elsewhere in the body. In rugby, pelvic problems can be caused by a tackle, an awkward fall, scrummaging or landing awkwardly during a line out. In other words most things that occur during a rugby match! When the pelvis rotates, the piriformis muscle in the back of your hip goes into a protective spasm to minimise the pressure going through the joint. This spasm effectively prevents the joint from functioning correctly and so other areas have to compensate. If the problem is caught early enough, treatment will help. Simple therapy can mobilise the joint and improve its function. If however the problem is left for more than 6 weeks, the muscle will change its composition and become fibrotic and so be unable to function normally. In theses cases treatment will help in the short term, but whenever you start training again the hamstring problem recurs because the fibrotic muscle in the pelvis is still compromising the function of the joint and so putting more pressure through the hamstring.
This process can also affect the sciatic nerve. The problem is that when the piriformis muscle in your hip goes into spasm, it causes the sciatic nerve to become tight. It does this because the pelvis doesn’t move as well as normal, so the nerve becomes stiff and also because the nerve can run through the very piriformis muscle that’s in spasm. The body cannot allow damage to the sciatic nerve, its one of the main nerves in the body, so the muscles that would protect it go into a protective spasm. One of which is the hamstring group.
This protective spasm of the hamstrings can cause a number of problems that cause symptoms in the hamstring itself. It can make the hamstring feel tight and stiff. It can make the hamstring feel inflexible as it’s under constant tension. It can also cause a functional muscle imbalance. In other words, if the hamstrings are found to be ‘weak’ in comparison to the quadriceps (quads), one of the causes of this muscle imbalance could be the inability of the hamstring to fire correctly due to its state of tension, rather than it being fundamentally weak.
To manage this cause we first have to return the abnormal muscle tone in the piriformis muscle to normal. In other words you have to do ‘anti-spasm’ exercises for the muscle. Stretching or flexibility work just won’t cut it – it helps in the short term, but the tension returns in time. How often do you stretch to loosen a muscle, only to find the short term benefit disappears after a few hours or less? You need to return the muscle to normal function, not just stretch it. That is why stretching the hamstrings isn’t always the answer to your hamstring problems (in fact mobilising your sciatic nerve is far more effective in these cases). Once the spasm in your piriformis muscle is eradicated as much as possible, then the joint will rotate naturally back into its normal biomechanical position, so reducing the tension on the sciatic nerve and also the hamstring itself.
When the pelvis is back in place you should perform exercises to stabilise it. In other words exercises that educates your muscles to control your pelvis and trunk without them needing to go into spasm. Part of this process is achieved by so-called ‘core stability exercises’. See a local expert in sports injuries, they should be able to guide you through the biomechanics phase and the next stabilise phase.
The work we have just described is usually sufficient to eradicate the hamstring pain that is gradual in onset. In the case of a hamstring tear which was caused perhaps by a high velocity movement like sprinting, it will be necessary to compliment the work we have been describing with a progressive hamstring and pelvic rehabilitation programme as well. But please note that unless the biomechanical causes have been eradicated, then the treatment and rehabilitation process is unlikely to be successful in the long term. This is one reason why hamstring problems become recurrent – the biomechanical causes are not eradicated.
There are other causes of hamstring pain, these are not the only ones, but it is common enough for you to need to understand it, especially if your problem is not going away.
The main other biomechanical causes of hamstring problems are stiffness (or dysfunction) of the lumbar spine (lower back) and thoracic spine (upper back). Stiffness in either of these areas can increase the load on the pelvis and thereby affect the load on your hamstring. Think about when you walk or run, as your left arm and shoulder come forwards, at the same time, your right hip and leg are moving forwards. Meanwhile the opposite body parts are moving in the opposite direction – they are going backwards. Each side of the body works in unison to maintain balance and equilibrium while we move. So if one part of that chain of events does not function properly another has to compensate. So if we have a stiff upper back for example, and one shoulder can’t move as forwards as it needs to when you run, there is another part of the body that will take the strain – often it’s the pelvis.
If you suspect this background is affecting your hamstring injuries, try this exercise which is referred to as an anti-spasm exercise for the piriformis muscle in the pelvis.
4-sign exercise
Technique
1. Sit on a chair and cross one leg over the other as in the picture.
2. Place both hands on the inside of your knee.
3. Pull your knee up into your hands.
4. Pull up @ 20% of maximum effort, just enough to engage the muscles in your hip.
5. This is a static contraction, so make sure the leg does not move.
Instruction
1. Hold for 20 seconds.
2. Do 4 sets on each leg.
3. AM and PM
4. Before & after periods of activity or inactivity.
In the body, things are not always as they seem. Just because your pain or tension is in the hamstring doesn’t mean that’s where it is originating from. Always check the causes of your problems, they rarely exist where you think they do.
Monday 5 January 2009
Get Rid of Back Pain in 2009
In case you weren’t able to come to our ‘How to manage your own back pain’ session the other month, I thought it may be helpful to run an article on the outcomes of that session and some ideas as to how you can help your own back pain. We will be running reviews and new sessions in the New Year, so please keep your eyes out for them if you are interested, or speak to Sinead.
One of the most disabling and common ailments in our society today is back pain. In fact according to a top researcher, lower back pain is as common as headaches in modern society. A recent study showed that if you see your GP with your back pain, if he then refers you to a specialist, who then sends you for X-rays and MRI scans, the accuracy of diagnosis is 15-20%. A frightening yet little known fact. Unfortunately the principles of modern medicine mean that the medical profession cannot treat an injury without an accurate diagnosis; is there any wonder why the incidence of back pain has doubled every 10 years for the last 30 years? As you can imagine, the problem is made even worse when you have had back pain for some time. The problem is that when you have had an injury for more than 6 weeks, another part of your body will start to compensate so you can have new pains as your condition deteriorates. So you can actually end up with more than one injury due to the mechanical compensations, which makes diagnosis even more difficult. We need to shift the paradigm and look at back pain differently.
Scientists, called Biomechanists, have been looking at back pain quite differently for some time. They look at the mechanical causes of back pain rather than focusing on the pain itself. They have found that they get better results by managing the biomechanical causes than many in the medical profession achieve by treating the symptoms. In fact independent research has shown that if you see at Physiotherapist over a 6 week period for your low grade back pain, your average improvement will be around 39% in functional capacity (the capacity of your back to perform work). If however you were to perform an exercise programme to manage the mechanical causes of your back pain, your average improvement would be around 141%. A profound difference and one that cannot be ignored.
This biomechanical approach is rapidly taking over from the medical approach in popularity as a much more effective method of treating back pain.
The most interesting thing about this method though, is that patients can be shown how to use it to look after themselves. This reduces the risk of them becoming reliant upon an individual therapist or doctor, and interestingly their compliance with their exercises programme is higher too.
Of course no single method can be the panacea of all ills, but what we are finding is that if the mechanical causes are addressed, the pain can subside without treatment on the 'injury', whatever it might be. Sometimes treatment is also required, however, but often people find that once they've committed to an exercise programme addressing the causes of their pain, they are then more able to manage the problem themselves. Then if local treatment is necessary, it is more likely to be successful, as the mechanical causes are no longer present.
Lets look at one of the most important tests called the 4-sign. If any of you have internet access you can ‘Google’ Patrick Fabre test and you will find more information about it there.
Test:
Relax your knee donw to a confrotable posoition. Look at the height of your knee from the imaginary line running throuhg your other knee, running parallel to the floor. Your knee should be only 2 – 3” higher than this line. Now try the the other leg and see if there is a difference in knee height from the imaginary line when you compare each side.
Results:
There should be symmetry, with the right side range of movement the same as the left. As a guide, the distance from the knee to the imaginary line should be no greater than 2 – 3”. If you have asymmetry where one knee is higher than the other there are some exercises that will help.
Meaning:
If one knee is higher it means that there is a muscle in your hip that is tight or in spasm. This can limit the movement in your pelvis and in turn can put more pressure on your back, causing pain. A simple exercise to reduce the spasm in your pelvis can help the pelvis to move again, thereby taking the pressure off your spine.
One of the most disabling and common ailments in our society today is back pain. In fact according to a top researcher, lower back pain is as common as headaches in modern society. A recent study showed that if you see your GP with your back pain, if he then refers you to a specialist, who then sends you for X-rays and MRI scans, the accuracy of diagnosis is 15-20%. A frightening yet little known fact. Unfortunately the principles of modern medicine mean that the medical profession cannot treat an injury without an accurate diagnosis; is there any wonder why the incidence of back pain has doubled every 10 years for the last 30 years? As you can imagine, the problem is made even worse when you have had back pain for some time. The problem is that when you have had an injury for more than 6 weeks, another part of your body will start to compensate so you can have new pains as your condition deteriorates. So you can actually end up with more than one injury due to the mechanical compensations, which makes diagnosis even more difficult. We need to shift the paradigm and look at back pain differently.
Scientists, called Biomechanists, have been looking at back pain quite differently for some time. They look at the mechanical causes of back pain rather than focusing on the pain itself. They have found that they get better results by managing the biomechanical causes than many in the medical profession achieve by treating the symptoms. In fact independent research has shown that if you see at Physiotherapist over a 6 week period for your low grade back pain, your average improvement will be around 39% in functional capacity (the capacity of your back to perform work). If however you were to perform an exercise programme to manage the mechanical causes of your back pain, your average improvement would be around 141%. A profound difference and one that cannot be ignored.
This biomechanical approach is rapidly taking over from the medical approach in popularity as a much more effective method of treating back pain.
The most interesting thing about this method though, is that patients can be shown how to use it to look after themselves. This reduces the risk of them becoming reliant upon an individual therapist or doctor, and interestingly their compliance with their exercises programme is higher too.
Of course no single method can be the panacea of all ills, but what we are finding is that if the mechanical causes are addressed, the pain can subside without treatment on the 'injury', whatever it might be. Sometimes treatment is also required, however, but often people find that once they've committed to an exercise programme addressing the causes of their pain, they are then more able to manage the problem themselves. Then if local treatment is necessary, it is more likely to be successful, as the mechanical causes are no longer present.
Lets look at one of the most important tests called the 4-sign. If any of you have internet access you can ‘Google’ Patrick Fabre test and you will find more information about it there.
The Test:
Start:
Sit on a chair or stool and cross one leg over the other as shown in the diagram fig 1.
Sit on a chair or stool and cross one leg over the other as shown in the diagram fig 1.
Test:Relax your knee donw to a confrotable posoition. Look at the height of your knee from the imaginary line running throuhg your other knee, running parallel to the floor. Your knee should be only 2 – 3” higher than this line. Now try the the other leg and see if there is a difference in knee height from the imaginary line when you compare each side.
Results:
There should be symmetry, with the right side range of movement the same as the left. As a guide, the distance from the knee to the imaginary line should be no greater than 2 – 3”. If you have asymmetry where one knee is higher than the other there are some exercises that will help.
Meaning:
If one knee is higher it means that there is a muscle in your hip that is tight or in spasm. This can limit the movement in your pelvis and in turn can put more pressure on your back, causing pain. A simple exercise to reduce the spasm in your pelvis can help the pelvis to move again, thereby taking the pressure off your spine.
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