ACL INJURY ASSESSMENT & REHABILITATION PROTOCOLS

HAVE YOU SUFFERED AN ANTERIOR CRUCIATE LIGAMENT INJURY? 
Arguable the most devastating injury that an athlete may encounter within their sporting career (especially soccer and skiing). Here is a blog to give you all the information you need to assess & rehab it!

ACL FUNCTION- 
Prevent anterior translation of the tibia relative to the femur. Together with the PCL It limits hyper-extension, hyper-flexion & internal rotation of the knee.

FACTS

• ACL Accounts for only 1% of all football injuries but the long term effects can be significant to the long term health of the knee joint.
• 30% of cases reported ACL damage in isolation
• 50% of cases involve Meniscal damage
• 90% of 'ELITE' players will return to play within 12 months
• In the 'GENERAL' population a study of nearly 6000 reconstructed knees showed that only 60% returned to pre- injury fitness levels, only 44% returned to full competitive matches.
• Those who have damaged their ACL are more at risk of OA than those who haven't.
• Women are 3 times more likely to tear the ACL in football & 8 times more likely to suffer ACL injury than men in other sports
• Women higher risk due to anatomical, hormonal factors and neuromuscular differences.

HISTORY

• Associated direct trauma such as a tackle is very rarely involved.
• ACL tears often occur via non-contact trauma.
• Players often report uncontrolled twisted movement
• Caused by pivoting (foot stuck), landing from a jump (on a bobble or with poor balance) or sudden deceleration
• ACL tears occur when the knee is slightly flexed and the hip adducts (falls inward). In medical terms this is known as the 'point of no return'.

SIGNS & SYMPTOMS

•  Popping/ snapping sensation
•  Loss of control
• Spasm of he quadriceps muscles around the knee
• Rapid almost immediate swelling due to bleeding in the joint capsule
• Feeling of something being out of place
• Apprehension on weight bearing
• Pain (but not in all cases)

If you are not diagnosed immediately but suffer reoccurring instability report to your GP

INVESTIGATION: If ACL damage is suspected the weapon of choice is MRI but X-Ray may be used to rule out a tibial plateau avulsion fracture.

ASSESSMENT
I have attached links (to YouTube) to provide advice on how best to assess a suspect ACL tear.
It is critical you check other structures of the knee to rule out meniscal/ cartilage damage or differential diagnosis of Patella subluxation.
Expect loss of ROM due to swelling or other joint damage.

TESTS
1- Lachmans test (most reliable) https://youtu.be/TMbSVFc-J3Q
2- Anterior draw https://youtu.be/IxyuDnRSggU
3- Lelli test https://youtu.be/44W5MER9IAA
4- Pivot Shift Test https://youtu.be/yOztSsiL2ng

It is rare for an ACL Tear to be isolated, familiarise yourself with the term 'O Donaghue's triad' which suggests likelihood of an:
1- ACL TEAR
2- MCL TEAR
3- MEDIAL MENISCUS TEAR

RECOVERY
ACL Tears do not heal, therefore once the structural integrity of the joint is lost, it either needs to be repaired by surgery or an athlete can focus on improving functional control through stability & strength training.

1- Non-operative treatment:
50% of Patients rehab without surgery but will have to change their levels of activity or are within the less physical active group. Those who are 100% confident with their stability may continue at the same level.
2- Surgery
Usually occurs after extensive prehabilitation, Swelling must be reduced, strength regained, joint range maximised, balance & control optimised before operating.
PROCEDURES- two methods are used in ACL surgery, both are considered as very good.

1.   Hamstring graft
2.   Bone Patella Bone

3- Graft re-rupture
Despite surgery and extensive rehabilitation re-injury is common. Interestingly there is a 7% chance of injury to the post operative limb and the uninjured limb.
Higher injury rates are likely in those under 30 who are still taking part in competitive events/ fixtures.  

LONG TERM
It is important that expectation management is given in terms of long term knee degeneration.
Ultimately there is high correlation between articulate cartilage injury and osteo-arthritis regardless of how good the management of the injury has been. There is also a link between quadriceps weakness & the development of OA within 10 years.

REHABILITATION
Recovery from ACL injury requires a comprehensive rehabilitation program.
Should surgery not be needed the athlete is likely to progress quicker. That said if an athlete tries to return before physically & psychologically ready then chances of re-injury/ instability are much higher.

PROTOCOL
the rehab protocol for ACL is broken into 4 phases.

1. Protection & Controlled Mobilisation: Gait retraining, Reduce pain, swelling, regain optimal rand elf motion, EMS to stimulate inhibited muscles such as VMO.
2. Controlled Training: Core stability, strengthened injured limb, balance, flexibility
3. Intensive training: Hopping, landing, dynamic balance, endurance running, soccer specific dynamics
4. Graduated Return to Play (RTP) & outcome testing: Consisting of the elements in phases 1-3 at higher intensity with increased difficulty

  OUTCOMES
Good Yo-Yo tests results, Triple Hop, bi-lateral leg strength, Good star excursion, slow progression into full match play.

THE AUTHOR
Based in Woking, Surrey, Gary Lewis MSTA, has an extensive history working within football & sports rehabilitation. For advice or to book an assessment contact can be made directly via the FB page.

ANTERIOR SHIN SPLINTS, COMMON CAUSES & HOW TO REHAB

Anterior Shin Pain (Shin Splints) common causes & rehabilitation by Gary Lewis, (Rehabilitation Specialist, OSSM Dip  

This is a common injury that many people suffer through walking or running. It is prevalent in a military population during activities such as  'weighted marches' but the question is why?

We can apply either a bottom up or top down approach in order to recognize the causes of this annoying problem. I also suffered with this for many years as a youngster in the army but like most people I gritted my teeth & got on with it.

In essence the area around the front of the shin (tibialis anterior) becomes overloaded, it is prone to fatigue.
Other terms people use to describe symptoms include:
- Burning
- Heavy
- Slapping uncontrolled foot drop of the affected limb.
- Ungodly pain

As soon as the physical activity is over symptoms tend to settle almost immediately.

So here's the reasoning using a 'bottom up' approach.
The body has two types of muscles these are either postural or phasic.
Postural muscles have a high blood supply utilising slow twitch fibres and are therefore able to work for long periods. The muscle fibres fire alternately so that there is a constant contraction. The main postural muscle of the ankle complex is the Soleus, a member of the calf group or plantar flexors.
The soleus is a bit of a bugger it is also known as the second heart! Not only does it help us to push off our toes (imagine a calf raise) but It also helps to drive blood from the feet back up toward the heart. It works constantly to ensure that we are able to stand up, without it we would fall over. Being such a busy muscle it is prone like other postural muscles, to shortening.

A simple test to assess your Soleus length is the Knee to Wall assessment. A normal Soleus will have a range of at least 8cm, of course de-generative changes to an ankle joint will have an affect on the muscle length aswell.
If Soleus is short then the opposing major muscle, in this case Tibialis anterior will be forced to lengthen to compensate. This places excessive strain on the muscle which has to work very hard to pull the ankle up against the powerful calf group!
It is here that we see a dysfunction occur!

Tibialis anterior is a phasic muscle it's function in life is to decelerate the speed at which your foot strikes the floor.
It utilises fast twitch white muscle fibres (type 1 & 2). Unlike slow twitch fibres, fast twitch are prone to fatigue very quickly as they have a poor blood supply. (Although tibialis anterior has modified some of its fast twitch fibres to house a greater blood supply)
Either way tibialis anterior can't resist the strain the Soleus places onto it and has to do some recruiting elsewhere to get the job of lifting the ankle upwards done!

It calls upon smaller muscles to contribute in particular we see increased activation in the muscles that lift the little toes and the big toe up known as the 'toe extensors'. The result of this problem is really overdeveloped extensor tendons in the feet and clawed looking feet.

The answer to the issue we have just described is to:
- Apply self- administered fascial release using a foam roller or similar apparatus.
- Seek Massage therapy or Acupuncture as these are far more effective.
- Employ regular Flexibility of the Soleus using a slant board as much as 3-5 times per day, holding stretches for 30-90 secs or until a natural release is felt will also help.
The second main cause of anterior shin pain requires an understanding of how we walk or run combined with a top down approach. The walking dysfunction we will focus on now is known as 'toe clearance'.

So here's the reasoning using a 'Top Down' approach
During walking and running the body Is in either a stance (foot on floor) or swing phase (leg off floor). As the swing phase of gait commences a normal fully functional Iliopsoas flexes the hip up, causing the knee to bend and ankle to lift off the floor. Inadequate strength in this critical hip flexor to
effectively 'drive the thigh' upward as the limb accelerates in the swing phase, will see an individual barely clear the floor with the foot. On occasion the affected individual may report 'stumbling' 'tripping' during events.
The body compensates for the weakness by forcing the muscles of the shin (tibialis anterior or toe extensors) to work even harder to lift the ankle. Again leading to immediate fatigue and pain.

The answer to this issue is to strengthen the Iliopsoas through maintaining neutral spine and practicing hip flexion on a single leg or in back lying. I prefer to do this with a lightly colored theraband for resistance. Controlled repetitions of 10-15 @ 2-4 sets with a tempo of 2-2-2 will help.

I hope you have enjoyed this blog, please feel free to contact me via PM for further advice or to book a assessment should you require any rehabilitation, soft tissue work or acupuncture.

Anterior Shin Splints common causes & rehabilitation

Anterior Shin Pain (Shin Splints) common causes & rehabilitation by Gary Lewis, (Rehabilitation Specialist, OSSM Dip  

This is a common injury that many people suffer through walking or running. It is prevalent in a military population during activities such as  'weighted marches' but the question is why?

We can apply either a bottom up or top down approach in order to recognize the causes of this annoying problem. I also suffered with this for many years as a youngster in the army but like most people I gritted my teeth & got on with it.

In essence the area around the front of the shin (tibialis anterior) becomes overloaded, it is prone to fatigue.
Other terms people use to describe symptoms include:
- Burning
- Heavy
- Slapping uncontrolled foot drop of the affected limb.
- Ungodly pain

As soon as the physical activity is over symptoms tend to settle almost immediately.

So here's the reasoning using a 'bottom up' approach.
The body has two types of muscles these are either postural or phasic.
Postural muscles have a high blood supply utilising slow twitch fibres and are therefore able to work for long periods. The muscle fibres fire alternately so that there is a constant contraction. The main postural muscle of the ankle complex is the Soleus, a member of the calf group or plantar flexors.
The soleus is a bit of a bugger it is also known as the second heart! Not only does it help us to push off our toes (imagine a calf raise) but It also helps to drive blood from the feet back up toward the heart. It works constantly to ensure that we are able to stand up, without it we would fall over. Being such a busy muscle it is prone like other postural muscles, to shortening.

A simple test to assess your Soleus length is the Knee to Wall assessment. A normal Soleus will have a range of at least 8cm, of course de-generative changes to an ankle joint will have an affect on the muscle length aswell.
If Soleus is short then the opposing major muscle, in this case Tibialis anterior will be forced to lengthen to compensate. This places excessive strain on the muscle which has to work very hard to pull the ankle up against the powerful calf group!
It is here that we see a dysfunction occur!

Tibialis anterior is a phasic muscle it's function in life is to decelerate the speed at which your foot strikes the floor.
It utilises fast twitch white muscle fibres (type 1 & 2). Unlike slow twitch fibres, fast twitch are prone to fatigue very quickly as they have a poor blood supply. (Although tibialis anterior has modified some of its fast twitch fibres to house a greater blood supply)
Either way tibialis anterior can't resist the strain the Soleus places onto it and has to do some recruiting elsewhere to get the job of lifting the ankle upwards done!

It calls upon smaller muscles to contribute in particular we see increased activation in the muscles that lift the little toes and the big toe up known as the 'toe extensors'. The result of this problem is really overdeveloped extensor tendons in the feet and clawed looking feet.

The answer to the issue we have just described is to:
- Apply self- administered fascial release using a foam roller or similar apparatus.
- Seek Massage therapy or Acupuncture as these are far more effective.
- Employ regular Flexibility of the Soleus using a slant board as much as 3-5 times per day, holding stretches for 30-90 secs or until a natural release is felt will also help.
The second main cause of anterior shin pain requires an understanding of how we walk or run combined with a top down approach. The walking dysfunction we will focus on now is known as 'toe clearance'.

So here's the reasoning using a 'Top Down' approach
During walking and running the body Is in either a stance (foot on floor) or swing phase (leg off floor). As the swing phase of gait commences a normal fully functional Iliopsoas flexes the hip up, causing the knee to bend and ankle to lift off the floor. Inadequate strength in this critical hip flexor to
effectively 'drive the thigh' upward as the limb accelerates in the swing phase, will see an individual barely clear the floor with the foot. On occasion the affected individual may report 'stumbling' 'tripping' during events.
The body compensates for the weakness by forcing the muscles of the shin (tibialis anterior or toe extensors) to work even harder to lift the ankle. Again leading to immediate fatigue and pain.

The answer to this issue is to strengthen the Iliopsoas through maintaining neutral spine and practicing hip flexion on a single leg or in back lying. I prefer to do this with a lightly colored theraband for resistance. Controlled repetitions of 10-15 @ 2-4 sets with a tempo of 2-2-2 will help.

I hope you have enjoyed this blog, please feel free to contact me via PM for further advice or to book a assessment should you require any rehabilitation, soft tissue work or acupuncture.

Running Injuries Facts!

RUNNING INJURIES

Question:
WHO TAUGHT YOU TO RUN?

Answer:
YOU LEARNED THROUGH TRIAL & ERROR, WATCHING OTHERS

PROBLEM:
- Running is free!
- It uses large muscle groups over 200 muscles...
- Anyone can do it, however it doesn't mean you are doing it efficiently.
It is easy to train the body to complete a movement badly.

Bodies are intricate machines that respond to stress & exercise but like water, they follow the path of least resistance to complete a task.
Unfortunately this will present as:
- Poor lazy technique
- Injury
- Recruitment of the wrong muscles.

In a sport like running, the margins of victory & injury are small. Maintenance of your body's tissues & having the ability to DEVELOP correct  technique are essential.

It does confuse me how even though we know all of this we still don't invest in our only mode of transport...our bodies

I know a lot of recreational runners, who don't seek regular
treatment hopefully the following will make you have a think....

FACTS
- Running injuries account for 37-56% of annual injuries in sport
- Approx 3.6 to 5.5 injuries per 1000 hours (of all runners not per individual)
- Runners also take part in other sports which contribute to overuse injuries
- Body weight at mid stance (when you are loading a single leg) is magnified by 3-5 times through limbs, other factor such as;
- Muscle strength,
- How spongy or springy your gait is
Will play a part...

MATHS
- Take a man/woman with an avg stride length of 1.6m
- They will take approx 1175 steps per mile
- Consider the runner  is 60kg with a 2.5 (me being nice) x body weight at impact.
- Total ground forces are 220 TONNES, 110 TONNES PER LEG!!
- At a pace of 7 min per mile with 0.2 secs in the stance phase you will strike the floor over 5100 times in an hour of running.

Huge amounts of stress and load on the tissues, if you already have poor bio- mechanics/ technique, you will get hurt eventually. So a foam roller and some stretching isn't going to be enough....

The body will respond by laying down new baby tissue (scar tissue) to adapt and become stronger, however this tissue needs to be aligned correctly to ensure it is as functional & flexible as possible. Deep tissue massage will ensure that the effort you make pays dividends....

As always please continue to share the page.

TRIGGER POINT PAIN EXPLAINED... BLOG

TRIGGER POINT (TP) PAIN BLOG
I hear people say 'I have a trigger point in my shoulder' all the time, most don't understand what it actually is or know how to treat it effectively. In truth you can get them anywhere there is muscle tissue.

SYMPTOMS
You are likely to be suffering from a TP if you present with any of the following symptoms in your muscles for no apparent reason;
- Sore
- Achy
- Deep
- Throbs
- Tender to touch
- Uncomfortable but can't quite get to it

DEFINITION
Janet Travell stated that a 'Trigger Point' is an "irritable locus within an excitable band of taught tissue".
Put simply a TP is a build up of tight fascia (connective tissue). Usually the size of a pea (more commonly known as a 'Knot' in most cases.

SO WHAT?

TPs ACT LIKE ROADBLOCKS

Something so small will have a massive impact on the ability for tiny bundles of muscle fibres (some 1/1000 the width of a human hair) to function correctly.
TPs act like little roadblocks (SEE RIGHT 'TP COMPLEX) sat within the belly of a muscle & will cause you to move differently or adapt your posture to 'cheat' a basic movement such as a squat per say. This eventually becomes permanent to the way the brain determines normal movement patterns & breaking the cycle is a hard fight as the problem compounds further.

 

HOW LONG TO DEVELOP A 'TP'

It only actually takes about 7 minutes of poor posture for a TP to develop

EXAMPLE OF A TYPICAL / COMMON TP PATTERN
I meet many people who spend hours behind a desk or have a rounded upper back & forward head posture. This forces the shoulder blades to naturally tip forward putting huge strain on the Trapezius muscle to try & regain normal shoulder blade function.
It is these individuals who tend to suffer bouts of mysterious shoulder muscle pain or strangely start to have headaches or jaw pain. But why?

TWO TYPES OF 'TP'
You can have either a:
- Reflex point
- Trigger point
                                                                                                              

REFLEX POINT

REFLEX POINT

The red 'Dots' illustrates a Reflex point.
It is tender to touch with no referral pattern to other extremities of the body.

TRIGGER POINT
PICTURE 3, if you have a 'True TP, when the area of the Red 'Dot' (or pea sized taut tissue) is pressed the symptoms typically refer away, causing pain to the 'Red shaded area', the upper traps presenting as head aches or migraines....

TRUE TRIGGER POINT PATTERN

MAPPING
All muscles are different but TPs over the years have been mapped through studies of cadavers, so a good 'Level 5 Remedial Massage Therapist' will know where to look to locate them

MAPPING OF COMMON TPs

HOW CAN I HELP
The only way to reduce symptoms is through application of a Neuro-Muscular Technique (NMT) (again only an experienced Level 5 Remedial Masseur is insured/ experienced to deal with this).

NMT
If you refer back to the definition, TPs are caused by 'Excitable' bands of tissue, suggesting that the neural system plays a huge part in this phenomenon.

An NMT works to:
1- reduce the blood flow to an area to essentially 'Starving the tissue of a blood supply' for a very short period (approximately 60 secs).
2- The pressure outside of the tissue sees blood pool around it.
3- When the therapist releases the hold, it allows oxygenated blood to flow at high pressure in into the tissue essentially 'resetting' the muscle tissue.

Following application of an NMT general massage & light stretching (to maximise new length of tissue) is applied to encourage blood flow & remove any waste products through the lymphatic system.

PAINFUL
Not a pleasant technique but still very effective, In all cases perceived pain of the client should not go above 8/10 when treated & direct pressure must be maintained until the perceived pain reduces down to a 3/10 (or no longer than 60 secs, the same area can be treated 3 times).
The pain will slowly subside due to the lack of oxygen being delivered to the tissue (part of the resetting process)

If you suffer these symptoms, have impaired movements & terrible Posture feel free to either ask for advice or book in.

KINESIO TAPING FOR PERFORMANCE

KINESIOLOGY TAPING BLOG
The concept of Kinesiology or 'Movement' taping has been in existence since the 1960's but has shot to popularity in the last few years with many famous sportsman seen using it to enhance performance.

Initially regarded as a FAD and placebo, studies are now starting to provide evidence that supports the use of kinesiology taping.
A recent paper I read on Patella-Femoral (knee) pain suggested that correct application of this taping strategy had a positive effect in reducing an individual's pain and elicited an improvement in performance. Depending on your sport and what level you compete, the  margins for victory can be small, wouldn't you like to try something that is affordable and could make the difference between winning and losing.

THE SKIN
Within the layers of the skin and encompassing the joints there are specialist receptors that identify stretch, strain, pain, hot, cold, vibration, pressure.
All of these receptors provide the brain with a picture to inform it of what is going on around the body, allowing it to transmit its positional sense, this is also known as Sensory input.
The brain then uses this information to coordinate subsequent movements, also known as Motor output.
By placing the target tissue on a comfortable stretch you are in fact exposing these receptors deep within the skin. The tape is then applied to alter the message being sent to the brain.
 
AN EXAMPLE OF HOW THIS CAN BECOME A PROBLEM
Following injury the central nervous system in the brain starts to receive an incorrect SENSORY INPUT (Picture) from the injured tissue this can be attributed to any of the factors listed below:

• Offloading the injured limb (possibly with crutches to protect form further damage)
• Pain due to swelling & cell death
• Loss of flexibility through not using the muscles around the joint
• Loss of joint range of motion due to reduced use through pain
• Loss of strength (1% for every day of immobilization)
• Ligament damage
• Joint damage

The body will always adapt to the environment in which it is exposed to, leading to changes in its movement patterns. The result of a poor picture going in to the brain, is a faulty MOTOR OUTPUT (order) in this case could be an individual displaying a limp without noticing and or using the good leg more to compensate for the weaker ankle)

Depending on the application of the tape, the aim of the clinician is to place the tissue in a position to illicit the correct sensory input (message in), in turn ensuring the movement coordinated by the brain promotes a correct motor output.


RIGID TAPING
As demonstrated here in taping the ankle for stability of the lateral ligament complex. Rigid taping only provides feedback and support to a joint for around 10 minutes before becoming loose and ineffective.
It is non-elastic, restricts full range of the joint and is compressive affecting the blood supply.
Not that I am knocking an age old taping strategy but in my experience it is far more useful when trying to limit someone post injury to prevent further damage & support the PRICED protocol
WHY KINESIOLOGY TAPING?
In contrast to rigid taping, Kinesiology tape is waterproof, elastic, light, allows full range of motion & is cost effective lasting up-to 3-5 days depending on how it is applied. I have  tried to Rigid tape Football players  before matches but it either stops them putting their boots  on or affects the blood flow and is uncomfortable.

DOES THE COLOUR MATTER?
I hear people talking about the various colours of the tape and how more effective one is compared to the other or stickier.....

In truth all tapes are the same however there is some cognitive reasoning behind the colours which is as follows:

• Blue- Applied to provide a cooling effect (cognitively) to areas of injured soft tissue suffering from increased blood flow, swelling, inflammation
• Black- Absorbs the sunlight better when playing outside which activates the adhesive far  more effectively
• Red- Provides a warming effect to weak or inhibited muscles to (cognitively) allow an individual to 'feel' the area working
• White- Used in clinical backgrounds such as hospitals
• Beige- Used in some sports due to its similarity to skin colour

 WHAT CAN IT TREAT?
The answer to this is virtually anything from the following lists and much more:

• Shoulder joint pain
• Knee Pain
• Headaches
• Swelling
• Patella tendon pain
• Shin splints
• ITB Friction syndrome

5 MAIN ROLES OF KINESIOLOGY TAPING 

1- MUSCLE IMBALANCE
The tape is elastic and has a natural recoil at 50% tension, this essentially means that if you apply the tape (one square) to the body (also known as an anchor strip) with no stretch, then take the tension up-to 50% the tape will always recoil back towards the original anchor. This is a significant factor when applying to the muscles to achieve a particular effect (explained below)
 
Inhibiting muscles- Applying the tape from the point where the muscle inserts to the point where it originates to effectively 'lengthen the tissue' and help to 'switch it off' should it be overworking. the example to the right demonstrates an inhibition application to the Gastrocnemius and Soleus of the Triceps Surae muscle Group. This could therefore be useful for someone presenting with tight overused calf. Individuals who are in a running program, mid season sports or suffering muscle pain

Facilitating muscles- Applying the tape from the point where it originates to the point where is finishes or inserts will help to 'switch on' and shorten to activate the tissue. Facilitation is useful for people who present with weakness in postural muscles, it can help individuals to activate muscles that help stop the back from hunching or shoulder blades from rounding and tipping forwards.

2- POSTURAL INEFFICIENCY
If individuals are suffering from poor posture such as a rounded upper back from too much sitting or driving the tape can be used to facilitate a change to body position and help maintain awareness of keeping correct posture. In my experience it works well at helping maintain a neutral pelvis and shoulder position, limiting pain in the lower back and neck.

3- CIRCULATORY AND LYMPHATIC DRAINAGE

Following injury such as a direct impact through a tackle in football or intense exercise such as long distance running, the body goes through a process of removing dead cells and commences the laying down new ones also known as repair and regeneration. This is completely normal and part of the tissue healing process however if it not managed correctly then your tissue will remain weak, exposing you to long-term chronic problems

 As a remedial masseur I would not be keen to 'touch' or 'massage' tissue post injury (up-to 48 hrs) instead I could help to support the healing process with a Lymphatic application in conjunction with ice intermittently, every ten minutes for the first 8 hours (anything after the first 8 hrs is generally for pain relief).
The body has lots of specialized cells called lymph nodes that help to remove any waste products and damaged cells through 'The Lymphatic System'
The two pictures show how the tape can help to 'draw' the lymph towards the nodes in conjunction with the circulatory system. 
Following tissue damage, pain is normally present due to swelling which irritates free nerve endings leading to a feeling of pain
This application will help to 'lift' the tissue and promote fluid flow/ circulation and reduction of pressure in turn limiting pain.

4- LIGAMENT, TENDON, JOINT INJURIES
LIGAMENTS:
The tape can be used to support strained ligaments such as those found in the ankles (following an inversion, trip or fall), knees or even to support dislocated shoulders following excessive loss of control at a joint. A simple joint ligament application could be all you need to complete a run or event with peace of mind

TENDONS: 
The most commonly injured tendons in the body are the Achilles and patella which are tasked with transmitting huge amounts of force from the quadriceps and triceps surae group
Kinesiology tape can be applied to help offload Tendons and reduce pain, stiffness... essential if you suffer from problem injuries such as tendonitis or partial tears due to overuse.
This is vitally important when you consider how the quality of tendon fibrils reduces when most individuals pass the age of thirty. The image to the right shows a really effective achilles tendon offload, I prefer this for long distance runners, triathletes.

5- FASCIA ADHESION'S

The tape can also be applied to ensure the CORRECT movement of connective tissue known as FASCIA. If fascia is restricted the body will very quickly develop relative flexibility and cheat to produce a movement. A full explanation of FASCIA can be found below

MUSCLE& FASCIA HOW DOES IT WORK
 Fascia is like a giant web, it is a connective tissue that lines the bones, the organs, it separates muscles into working compartments, functional chains & lines every cubic centimeter of the body.
Fascia is so important in movement, when there are muscular dysfunctions present such as poor gluteal activation the fascial connections to other muscles compensate to stabilize the pelvis. Unlike a muscle that has a start & finish point, fascia actually pulls against itself to provide stability a term known as tensegrity. Interestingly it is also now believed that if you strip all the muscle off the skeleton the remaining fascia is strong enough to maintain the shape of the body. Fascia is now believed to be responsible for attaching up-to 80% of a muscle to bone in contrast to tendons which account for the other 20%  

HOW SHOULD FASCIA MOVE

Imagine throwing a pebble into a pond, you would expect the wave like ripples to flow away, this is the same concept with fascia, it supports effortless movement of the body.
Overuse, tissue trauma & injury affect the composition of the fascial connection which leads to changes in the way your muscles & body move.

If you think this type of therapy could help you in one of the five different ways discussed please get in contact for advice or to book an application. 

Enjoy my blogs & even if you found this useful, please share my work and help me to promote Primal Movement Solutions to the masses

Self Myo-fascial Release (Foam roller) common errors & useful tips

The application of a foam roller to support the recovery & performance of muscles has been steadily on the increase over the last five years or so. Applied correctly it can be a very useful tool, however in most cases poor understanding of what you are trying to achieve physiologically leads to misuse

Problem
I continue to see (almost daily), token efforts (rolling too quickly or not along the path of a muscle) on the Foam Rollers supplemented by incorrect use. This will in fact have a damaging effect on performance & potentially promotes injury.

So where does the term SMFR originate: 
Self- Your providing the therapy
Myo- Latin term for muscle
Fascia- Connective tissue

Muscle & Fascia how does it work

Fascia is like a giant web, it is a connective tissue that lines the bones, the organs, it separates muscles into working compartments, functional chains & lines every cubic centimeter of the body.
Fascia is so important in movement, when there are muscular dysfunctions present such as poor gluteal activation the fascial connections to other muscles compensate to stabilize the pelvis. Unlike a muscle that has a start & finish point, fascia actually pulls against itself to provide stability a term known as tensegrity. Interestingly it is also now believed that if you strip all the muscle off the skeleton the remaining fascia is strong enough to maintain the shape of the body. Fascia is now believed to be responsible for attaching up-to 80% of a muscle to bone in contrast to tendons which account for the other 20%  

How should fascia move

Imagine throwing a pebble into a pond, you would expect the wave like ripples to flow away, this is the same concept with fascia, it supports effortless movement of the body.
Overuse, tissue trauma & injury affect the composition of the fascial connection which leads to changes in the way your muscles & body move.

Test your fascial movement
1- If you place your hand lightly on your forearm, try moving the skin in all direction & observe how it is highly mobile and there are no restrictions,
2- Now do the same placing the hand lightly on the ITB running down the side of the thigh, there will be a significant difference,

  Fascia can be described like an orange, 
Skin- The orange skin can be likened to our skin,
Superficial Fascia- The white pyth lying between the orange skin & the segments can be likened to  our superficial (closest to the surface of the skin) layer of fascia
Deep Fascia- Once inside the orange you'll notice it is broken into large triangular segments, further broken into compartments housing the pips. This is known as the deep fascia

Why use a foam roller?
Daily living activities, posture & exercise force your body to regenerate & progressively adapt to the stress placed upon it. In response, the body lays down scar tissue, this must be realigned for it to function correctly, imagine ironing the crease out of a shirt.
You will also find that during 'rolling' you may find 'knots' also known as trigger points (excitable band of tissue), these are like roadblocks that sit in the muscle & considerably reduce muscle function/ movement.

Correct application of SMFR will
- Re-align scar tissue
- Remove Trigger Points
- Improve flexibility
- Reduce over activity in dominant muscles
- Improve circulation & delivery of nutrients
- Remove waste products

Do not
- Roll over varicose veins
- Roll over Joints
- Roll over inflamed areas

Techniques
The concept of foam rolling or fascial release is an aggressive & intrusive technique, in simple terms you are giving the muscle a deep tissue massage.
Deep tissue massage will inevitably cause bleeding & inflammation within the tissue that leads to pain on function or during movement, this may sound bad, but it supports all the positive aspects listed above.
Foam rolling every single day will however, reduce the ability for a muscle to recover & could incite further injury as individual continue to train whilst working deep into tissue.

Fascia re-alignment
Muscles & Fascia are surrounded by a substance that is similar to hard jelly, as you roll slowly through the muscle the jelly changes into a liquid which exposes the fascia and scar tissue. this takes 60-90 seconds of slow focused through the tissue. Be wary not to wade into the muscle to prematurely, treat the muscle like a good woman, romance it, get it in the mood and then go deep! Your more likely to get what you want at the end of the process :)


Trigger pointing as a foam roller technique
Imagine tying a knot into a rubber band, you can pull it tight but the knot will not go anywhere, reducing the stretch. Therefore prior to rolling through a muscle it is useful to trigger point (applying direct pressure by hand or with the roller/ Hockey/Tennis Ball) first to remove these knots to allow full dynamic flexibility of the muscles.
If your hip flexors have knots present you will lose the ability to extend the hip, compromising glute activation, it would therefore make sense to release the hip flexors first, to improve contraction of the glutes.
How to identify a trigger point When slowly rolling the muscle if you come across a localized painful area of tissue, apply no more than a 8/10 pressure to the area for up-to 60 secs 3 x times if needed, until the pain reduces to a 2/10 or you feel a release. The reason we are only applying 60 secs of pressure and not longer is due to the reduction in oxygen flow to the cells. If the hold is applied for too long you can have a negative effect on the tissue causing it to die.


Recommendations
1- Alter the depth of the roller so that you target the superficial layer of tissue to promote general movement of the 'connective web'
2- Only target the deep fascia a day or so after exercise or during prolonged bouts of inactivity to improve circulation & reduce scar tissue build-up. Deep tissue rolling can reduce muscle soreness after heavy training by upto 40%
3- Trigger pointing is safe prior to exercise or competition,
4- Do not foam roller deep 24hrs before an event or training, you will have a terrible session

I hope you enjoyed the blog, if you learned something please take the time to like and share with your friends and colleagues, I am also on Facebook 'Primal Movement Solutions'.

Suffering from re-occuring injuries & cant work out why? Best take a read

My favorite analogy in rehabilitation is that "people treat their bodies like cars and only get them fixed once they have broken down". 

Over the years I have met all sorts of people from sportsman to gym goers and office workers, they all complain to me about re-occurring injuries. Some of the most common examples of these 're-occurring issues' are listed below;

• Ankle inversions when running or playing sports such as football
• Lower Back pain
• Calf Strains
• Shin Splints
• Knee pain
• Neck & Shoulder pain

Regardless of what type of symptoms people suffer from, in most cases they are not willing to invest in getting their injuries rectified. Poor understanding & lack of knowledge prevents individual's from realizing the importance of getting these problems solved immediately, most punters believe that time is a great healer & the body will get better....but will it? of course it won't,

It does frustrate me when I see people complain and grumble to me about their injuries, requesting my advice yet in most cases they are not willing to take ownership for themselves and are happy to go and spend £60-80 on a pair of fashionable non functional trainers or go out for a expensive night on the town rather than seek rehabilitation.

Its time to wake up
If your car breaks down & starts to fall apart or becomes too expensive to run you exchange it or buy a new one. You cannot do this to your body, it suffers day in day out and in most cases you are not  maintaining it.

The aim of this BLOG is to support the last few paragraphs & to do this i will use a model known as the Cumulative Injury Cycle.

Tissue Trauma
Occurs when force or load is applied to the tissues of the body (muscles, ligaments, tendons), which they cannot withstand.
Trauma can be caused;
Progressively-  Raging from weeks, months to years through poor posture such as hunching whilst sitting at a desk, or training the same muscles without rest, repetitive movements (the list is endless).
or
Traumatically- via a direct impact such as a hard tackle in sport, a twist of the ankle while running or a fall.
Following trauma or general exercise the tissues break down under stress & the body commences a repair process. Using protein in your diet the tissue progressively grows back stronger (hence the need for rest, In marathon running the cardiac tissue can break down by up to 15 percent).

Inflammation
When tissue is damaged the body goes into a alarm phase, a release of histamines stimulates nerve endings to tell the brain that there is a problem. The sub-acute inflammatory response generally lasts up-to 72 hours, within this period you can expect to see the following;

•  Swelling  (caused by chemical release)
•  Redness/ bruising (caused by bleeding)
•  Heat (caused by increased blood flow)
•  Pain on Function (Tissue is damaged & the pressure caused by pressure from fluid release

The Cardinal Sin 
Once the pain on function settles, people believe the problem has been solved when in fact the damaged ligaments & muscle are only at 30% their potential strength 3 weeks post injury. The people that suffer regular injuries tend to sneak back to sport within a week or two, quickly breaking down again and yet wander why they can't stop suffering the 'same injury'

Muscle Spasm 
Inflammation triggers a muscle to spasm as a protective response to prevent further damage. It can last a few days to a week but will restrict the ability to move the muscle through range which leads to a loss of flexibility & joint range of motion. You will start to move differently to produce a movement by way of compensation placing 'STRESS' on other structures.

Adhesion

The image to the right shows how adhesion's or 'knots', 'trigger points' are formed. These act like roadblocks within the tissue preventing it from stretching fully during functional movements. It is essential that these are addressed immediately to regain normal muscle firing patterns. Stretching will only improve the length of the surrounding tissues, the knots are left unaffected & will remain until they are treated accordingly. 
A knot can be formed within 7 minutes of holding a poor posture

Scar Tissue
Scar tissue is also laid down to help re-enforce the strength in the weak/baby tissue. Scar tissue does not get aligned like other tissue it is rather haphazard & does not give to stretch which can lead to further issues with flexibility & movement patterns.

Altered Control & Muscle Imbalance
The pain you feel causes changes to the way in which your brain interprets the position & movement of the joints & muscles affected by injury which leads to altered control.
Relative flexibility occurs which is how your body tries its hardest to achieve movements by any means necessary, an example being; someone who suffers with tight calves has to lift their heels to do a full squat or has to pivot more from the hip to alleviate for the loss of range at the ankle, putting strain on the lower back.

In summary
The injury cycle continues in a vicious circle leading to chronic problems that starts to affect other parts of the body.
I am a Remedial Masseur/ Rehabilitation specialist with years of experience following the exposure to hundreds of progressive/ acute injuries. I can work with injured tissue & apply contemporary techniques/rehabilitation to regain full function & prevent injuries from coming back;

Please inbox me for further advice or to book in.