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.
Friday, 21 November 2008
Running with an Injury or Over Training
Injuries can affect us all regardless of age, sex, fitness or ability, but we can manage or limit the number of times we get injured; and we can do this by going back to basics. A topic which has been written about numerous times, but we are not talking about strength levels, stretching or core stability, we mean back to your basic biomechanics.
By regularly assessing your biomechanics you can help eliminate and prevent many injuries and problems. One of the fundamental causes of injury is the body compensating for weak biomechanical links in your kinetic chain which can cause unaccustomed load that in turn result in pain and injury.
Example:
Calf injuries are common in sports people and are caused by a number of different issues. Flat feet, high arches, tight calves, poor preparation and previous injury to the calves or associated joints are all typically considered when trying to prevent calf injuries. One commonly overlooked, but very relevant cause is a tight sciatic nerve.
If the sciatic nerve is tight or not moving freely within the structures that surround it, then the muscles in the area of stiffness provide the nerve with protective spasm during locomotion. In other words they contract to minimise the pressure on the nerve while you move at high speeds. If the nerve is loaded or stretched too much, the muscles can spasm enough to cause themselves to tear or cramp up - which can feel like a tear. The stiffness in the nerve may well be near the point where the nerve runs through the calf muscle, and so that can be why you have the injury in the calf.
To check to see if your calf injuries are related to your sciatic nerve, try this test:
Test
Lay on your back and get a team mate to lift your leg straight up. Tell them to stop when you start to feel a tension or stretch in your leg. Notice where this tension is felt. You can feel it in the hamstring area, but could be anywhere below the knee, or indeed in your buttock or back. If you feel it anywhere outside your hamstring area, the stretch you feel may be nerve related. In this example the stretch may be in the calf, which might indicate that the nerve is tightest there and can be causing the calf injuries.
Then slowly ask them to move you leg across the midline of the body, in other words move the leg so it is above your other leg. Do not allow your leg lower at all when you do this. If the stiffness increases, and especially if the tension is felt into your calf, then there is likely to be a nerve element to your calf damage.
By regularly assessing your biomechanics you can help eliminate and prevent many injuries and problems. One of the fundamental causes of injury is the body compensating for weak biomechanical links in your kinetic chain which can cause unaccustomed load that in turn result in pain and injury.
Example:
Calf injuries are common in sports people and are caused by a number of different issues. Flat feet, high arches, tight calves, poor preparation and previous injury to the calves or associated joints are all typically considered when trying to prevent calf injuries. One commonly overlooked, but very relevant cause is a tight sciatic nerve.
If the sciatic nerve is tight or not moving freely within the structures that surround it, then the muscles in the area of stiffness provide the nerve with protective spasm during locomotion. In other words they contract to minimise the pressure on the nerve while you move at high speeds. If the nerve is loaded or stretched too much, the muscles can spasm enough to cause themselves to tear or cramp up - which can feel like a tear. The stiffness in the nerve may well be near the point where the nerve runs through the calf muscle, and so that can be why you have the injury in the calf.
To check to see if your calf injuries are related to your sciatic nerve, try this test:
Test
Lay on your back and get a team mate to lift your leg straight up. Tell them to stop when you start to feel a tension or stretch in your leg. Notice where this tension is felt. You can feel it in the hamstring area, but could be anywhere below the knee, or indeed in your buttock or back. If you feel it anywhere outside your hamstring area, the stretch you feel may be nerve related. In this example the stretch may be in the calf, which might indicate that the nerve is tightest there and can be causing the calf injuries.
Then slowly ask them to move you leg across the midline of the body, in other words move the leg so it is above your other leg. Do not allow your leg lower at all when you do this. If the stiffness increases, and especially if the tension is felt into your calf, then there is likely to be a nerve element to your calf damage.
A problem with your sciatic nerve may also indicate you have problems with your back that you are unaware of, in which case, it may be worth seeing a specialist sports health professional to get them to check it out for you.
If during all this your stretch is felt in your hamstring, then it is unlikely you have a nerve related issue. If at any time you feel tingling or numbness in your leg (especially your lower leg), then chances are your tight sciatic nerve is implicated in your calf problems.
If this is the case then you can gently mobilise the nerve to reduce its impact on the surrounding muscles. A simple exercise called a slump can help.
Exercise
Sit on a table where your legs can hang freely without touching the floor. Slouch down with your head down and your chin touching your chest. Note at this point if you have any feeling of tension or stretching.
Then slowly straighten your leg. As soon as you get to the point of light tension or a gentle stretch, slowly lower your leg again. Build up gradually to repeating 15 x 3 sets, once or twice per day.
Please note that if at ay time you feel tingling or pins and needles, you are taking the leg too straight, so reduce the range – ‘more is not better’!
There are a number of other biomechanical issues, like tight nerves, that can cause injury and also compromise performance. At Mobilis Performance we have created a series of courses that teach sports coaches, personal trainers, physios, osteopaths, chiropractors and sports therapists, tests like this to use when working with your players/athletes/clients. For more information, visit the Mobilis Performance website.
Tuesday, 28 October 2008
Trans Abs
To follow up from one of my latest blog posts I’ve been inundated with people wanting to find out more about the Trans Abs piece we did on 8th October. We have done more work about this in the last 2 weeks and have tested another 4 people who have had diastasis rectus and we can confirm that when they engage Trans Abs their rectus abdominus separation widens. There is some degree of hollowing in some of them (we estimate that it’s those who have the most tension in their linea alba), but they all demonstrate a widening of their separation. This raises further questions about the conventional wisdom of doing Trans Abs work to help diastasis rectus. I am linking up with Mark Maybury in the next few months to start to measure these people and put a paper together in a more formal way. There are too many unanswered questions – as we understand more I’ll publish it here.
Monday, 20 October 2008
CSP congress
I was at the CSP Congress for the first time ever last weekend and it was a great show for us. As well as it being very productive for my partners Mobilis Healthcare, there were many people who showed an interest in the biomechanical screening and foot biomechanics courses that we run and how this links to their clinical work. We are linking more closely than ever with Kate France (Podiatrist) who runs foot biomechanics courses and we’re linking her work with our own to produce a more complete series of courses for you. As this develops I’ll let you know.
Wednesday, 8 October 2008
Separated Rectus Abdominis (Diastasis recti) – are we rehabilitating them correctly?
Those therapists amongst you will know about Diastasis recti, a separation between the left and right side of the rectus abdominus muscle, which covers the front surface of the abdominal area. It is another name for the more commonly described Split Rectus Abdominus. It is caused by pregnancy and the rectus muscle being stretched by the baby in the uterus. It is most common in the later trimesters and more so with multiple births or repeated pregnancies.
A diastasis recti looks like a ridge, which runs down the middle of the abdominals. It stretches from the sternum to the navel and increases with abdominal muscle contraction. In the later part of pregnancy, the top of the pregnant uterus is often seen bulging out of the abdominal wall when rectus is engaged. An outline of parts of the unborn baby may be seen in some severe cases.
Post natally you can check if your client/patient has Diastasis recti by laying them supine with knees bent (crook lying) and get them to raise their heads. You commonly see a central ridge protrude in the centre of Rectus Abdominis and if you palpate above the navel you should feel a soft gap between two hard muscles. Measure the space of the gap using your fingers (this is called a Rec Check). If the gap is greater than two finger widths, your client/patient may be suffering from separated muscles.
No treatment as such will help pregnant women with this condition, although exercise may help, but there is limited evidence that exercise will resolve the problem. However postnatally conventional wisdom suggests that after any discomfort has settled it is reasonable to start some light abdominal work, but do not work the obliques initially. Understanding their origin and insertions reveals any oblique contraction will most likely exaggerate the split of Rectus. Conventional wisdom suggests to start with pelvic floor work and stabilising work using Transversus Abdominis (Trans Abs) with the pelvis in the correct position, then do co-activation work with pelvic floor then progress to try and shorten Rectus by doing inner range work. The production of relaxin (a hormone that is secreted in abundance when pregnant) effects the collagen make up in the linae alba (the central tendon in rectus abdominus) and may be a cause of the diastasis. As soon as the placenta is delivered the increased secretion of relaxin reduces to normal, but the effects can last for up to 5 months and breast feeding will keep it higher than normal until your client/patient has stopped. This may affect how quickly the Diastasis recti will reduce.
Please be careful while working Transversus Abdominis though. While conventional wisdom is sometimes right, it sometimes isn’t, let’s challenge it now. If you look at the origin and insertion of Transversus Abdominis and consider its function, logically when it contracts it will pull the rectus apart further, much the same as contracting the obliques would. There is no evidence to suggest that doing Trans Abs work is the right thing to do, its just something that we all do, without it seems, much thought as to why. Just think, if the Trans Abs inserts into the aponeurosis of rectus (anteriorly below the navel and posteriorly above the navel), any Trans Abs contraction should pull the rectus apart further. So why do we work Trans Abs initially with a diastasis recti?
Actually we’ve measured the split of rectus using Ultrasound scanning and it does separate further when Trans Abs is engaged. I am collaborating with a colleague, Mark Maybury, who is an Extended Scope Physiotherapist specializing in Ultrasound scanning, and we plan to do a paper on this – to challenge conventional wisdom in this field. We hope to have it completed in the next few months, please come back and see what we find, I’ll put the paper here when it’s completed.
What is your experience with this condition?
A diastasis recti looks like a ridge, which runs down the middle of the abdominals. It stretches from the sternum to the navel and increases with abdominal muscle contraction. In the later part of pregnancy, the top of the pregnant uterus is often seen bulging out of the abdominal wall when rectus is engaged. An outline of parts of the unborn baby may be seen in some severe cases.
Post natally you can check if your client/patient has Diastasis recti by laying them supine with knees bent (crook lying) and get them to raise their heads. You commonly see a central ridge protrude in the centre of Rectus Abdominis and if you palpate above the navel you should feel a soft gap between two hard muscles. Measure the space of the gap using your fingers (this is called a Rec Check). If the gap is greater than two finger widths, your client/patient may be suffering from separated muscles.
No treatment as such will help pregnant women with this condition, although exercise may help, but there is limited evidence that exercise will resolve the problem. However postnatally conventional wisdom suggests that after any discomfort has settled it is reasonable to start some light abdominal work, but do not work the obliques initially. Understanding their origin and insertions reveals any oblique contraction will most likely exaggerate the split of Rectus. Conventional wisdom suggests to start with pelvic floor work and stabilising work using Transversus Abdominis (Trans Abs) with the pelvis in the correct position, then do co-activation work with pelvic floor then progress to try and shorten Rectus by doing inner range work. The production of relaxin (a hormone that is secreted in abundance when pregnant) effects the collagen make up in the linae alba (the central tendon in rectus abdominus) and may be a cause of the diastasis. As soon as the placenta is delivered the increased secretion of relaxin reduces to normal, but the effects can last for up to 5 months and breast feeding will keep it higher than normal until your client/patient has stopped. This may affect how quickly the Diastasis recti will reduce.
Please be careful while working Transversus Abdominis though. While conventional wisdom is sometimes right, it sometimes isn’t, let’s challenge it now. If you look at the origin and insertion of Transversus Abdominis and consider its function, logically when it contracts it will pull the rectus apart further, much the same as contracting the obliques would. There is no evidence to suggest that doing Trans Abs work is the right thing to do, its just something that we all do, without it seems, much thought as to why. Just think, if the Trans Abs inserts into the aponeurosis of rectus (anteriorly below the navel and posteriorly above the navel), any Trans Abs contraction should pull the rectus apart further. So why do we work Trans Abs initially with a diastasis recti?
Actually we’ve measured the split of rectus using Ultrasound scanning and it does separate further when Trans Abs is engaged. I am collaborating with a colleague, Mark Maybury, who is an Extended Scope Physiotherapist specializing in Ultrasound scanning, and we plan to do a paper on this – to challenge conventional wisdom in this field. We hope to have it completed in the next few months, please come back and see what we find, I’ll put the paper here when it’s completed.
What is your experience with this condition?
Monday, 8 September 2008
Possible Leg Length Discrepancy
Hi Martin
I am working with an athlete and have just done the normalise tests with him.
His left leg is 5 to 7 mm longer than his right. Downing’s test was fine so in my eyes suggests that he has actually got one leg longer than the other. Gillett’s test was positive (there did seem to be a little movement on both sides but not great).
In his upper body there was high tone on right erector spinae in the thoracic spine, high tone on left upper traps, mild left scapula winging when standing and rotated to the right (right shoulder back, left shoulder forward) sway back posture.
What is the best way ahead? If he does have a leg length discrepancy, do we pop an insert in the shoe of the shorter leg? This would obviously mean dramatically altering his training for a long period for his body to adjust. Do we leave it? The athlete is 18 years old and is currently on 30 miles a week. He has been up to 40 miles a week last cross country season. He and his coach are looking to up the mileage to 50 for this cross country season. He has no history of any injury. I think this may change though when the mileage goes up. He is in the top 40 in England for 1500 metres in the under 20 age range. A very dedicated athlete.
I would welcome any comments you can make on this.
Hi ‘Coach’
He may indeed have a genuine leg length discrepancy if Downing's is negative. However if Gillett's is positive (and I notice on the screening form that the 4-sign is positive on the left side too) it is possible that his pelvis is still rotated, remember Downing's is just one way of establishing if the pelvis is functioning correctly. So I'd do the anti-spasm exercises and the exercises that work the other areas that biomechanically load the pelvis (all the other tests that are positive in the Normalise screening) and then re-measure.
When the pelvic (and other tests) come back negative, then see how the leg length discrepancy measures. If it's still longer then a heal raise may be appropriate depending upon the exact discrepancy. If that was the case I'd send him to an Orthotist or Podiatrist (or even a musculo-skeletal therapist who was experienced in this type of thing) for the prescription. If however the leg length has been reduced by the biomechanical work then we know it was from the pelvis and he may well not need a raise.
Generally though, there would need to be quite a good argument and significant discrepancy before we should consider heel raises for anyone.
I hope that helps.
Martin
I’ll let you all know how this athlete gets on with that advice and see how he improves over time.
I am working with an athlete and have just done the normalise tests with him.
His left leg is 5 to 7 mm longer than his right. Downing’s test was fine so in my eyes suggests that he has actually got one leg longer than the other. Gillett’s test was positive (there did seem to be a little movement on both sides but not great).
In his upper body there was high tone on right erector spinae in the thoracic spine, high tone on left upper traps, mild left scapula winging when standing and rotated to the right (right shoulder back, left shoulder forward) sway back posture.
What is the best way ahead? If he does have a leg length discrepancy, do we pop an insert in the shoe of the shorter leg? This would obviously mean dramatically altering his training for a long period for his body to adjust. Do we leave it? The athlete is 18 years old and is currently on 30 miles a week. He has been up to 40 miles a week last cross country season. He and his coach are looking to up the mileage to 50 for this cross country season. He has no history of any injury. I think this may change though when the mileage goes up. He is in the top 40 in England for 1500 metres in the under 20 age range. A very dedicated athlete.
I would welcome any comments you can make on this.
Hi ‘Coach’
He may indeed have a genuine leg length discrepancy if Downing's is negative. However if Gillett's is positive (and I notice on the screening form that the 4-sign is positive on the left side too) it is possible that his pelvis is still rotated, remember Downing's is just one way of establishing if the pelvis is functioning correctly. So I'd do the anti-spasm exercises and the exercises that work the other areas that biomechanically load the pelvis (all the other tests that are positive in the Normalise screening) and then re-measure.
When the pelvic (and other tests) come back negative, then see how the leg length discrepancy measures. If it's still longer then a heal raise may be appropriate depending upon the exact discrepancy. If that was the case I'd send him to an Orthotist or Podiatrist (or even a musculo-skeletal therapist who was experienced in this type of thing) for the prescription. If however the leg length has been reduced by the biomechanical work then we know it was from the pelvis and he may well not need a raise.
Generally though, there would need to be quite a good argument and significant discrepancy before we should consider heel raises for anyone.
I hope that helps.
Martin
I’ll let you all know how this athlete gets on with that advice and see how he improves over time.
Monday, 11 August 2008
Visit Mobilis Performance at the LIW, Birmingham NEC, Stand 5150
Mobilis Performance will be attending the Leisure Industry Week (LIW) show at the NEC in Birmingham, 23rd – 25th September, on Stand 5150."Leisure Industry Week is the ultimate event for everyone in the leisure industry. It’s the show that attracts thousands of leisure professionals for hundreds of different reasons every year" (LIW, 2008).
In addition to promoting the ‘Biomechanical Screening courses for Injury Prevention and optimal performance’, we will be carrying out biomechanical screens that you can use on your clients throughout the 3 days. Or, just drop in for chat about our courses and our up and coming Diploma which will qualify Personal Trainers as 'Biomechanics Coaches'.Also, WIN PRIZES!
Free prize draw; Put your business card or details in to the draw pot and you could win:
1st Prize – a FREE Normalise course
2nd Prize – 25% discount on a course
3rd Prize – 10% discount on a course
See you there!
For more information on Leisure Industry Week please visit the official LIW website.
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