Issue 2 - June 2004 - Print Version

WELCOME

Welcome to the second issue of Physio4Life newsletter. As our client list continues to grow, so do our members of staff, to meet demand. This month we would like to welcome some new additions to the Physio4Life team;

IRENE ALLEN - a senior state registered physiotherapist, who qualified in 1997 in South Africa.

Her 12 year career as a gymnast inspired her interest in physiotherapy. Irene has gained experience in a variety of private clinics in the UK and South Africa. She is also a qualified Health and fitness consultant and lecturer. She specialises in exercise rehabilitation (including Pilates), cervicogenic headaches and knee injuries.

AMANDA ADAMS - is also a senior state registered physiotherapist and has additional skills in acupuncture, manipulation and osteopathic techniques. Amanda has worked for Nottingham Rugby Club and at several international sporting events including Hong Kong Rugby 7's, gaining extensive experience in treating sports injuries. Her specialist area of expertise is in shoulder conditions, having worked at the prestigious Nottingham Shoulder and Elbow Unit for two and half years.

Do We Know How To Run?

It is that time of year when people are in training for triathlons and marathons. 2 out of 3 runners are injured each year. The irony is that everyone talks about different causes of injuries including intensity of training, running surfaces, shoe design but not about how we run.

Top runners pay as much attention to developing core stability (abdominals, lower back and gluts) as they do to ensure correct body alignment. But the most fundamental biomechanical consideration in running concerns the feet. The question is should we be forefoot runners (up on your toes) or should we heel strike?

Argument for Forefoot

1. Landing on the heels is asking today’s shoes to absorb 3-6 x the body’s weight. Landing on the heel requires the foot to remain in contact with the floor for longer so it is argued that this can cause more injuries.
2. Running with a heel strike puts a greater loading on the muscles whereas forefoot running spreads the loading, encouraging muscle elasticity in the hamstrings, calves and foot flexors - absorbing shock and generating elastic rebound in the calf and thigh muscles allowing them to work together to absorb the body’s weight.
3. Chronic ailments such as iliotibial band syndrome and shin splints are caused by excessive pronation, supination and shock loading of the limbs. Landing mid foot increases the work of the foots soft tissue support structures increasing their strength and possibly reducing the risk of injury.

Argument For Heel Strike

1. On the other hand it can be argued mid foot running increases the demand on the foot's shock absorbing structures, making them susceptible to conditions such as plantar fascitis.
2. Excessive forefoot running can lead to a shortened Achilles tendon which can then result in Achilles tendonitis.

Running is often practiced and not taught as a skill. In recent years due to absence of a method to teach running Dr Nicholi Romanov developed the Pose method. He advocates the running pose is a whole body Pose which vertically aligns shoulders, hips and ankles with the support of the leg, while standing on the ball of the foot. He believes this technique is the most energy efficient resulting in faster race times, freer running and fewer injuries.  (www.posetech.com) This method is increasingly being used in training camps. In making the changes runners who currently land on their heels will find themselves using their Achilles and are prone to initial soreness. We are aware of this at Physio4Life and consequently we are witnessing more injuries from people changing their running styles too suddenly without adequate training and rest. We advise a gradual change in running style, preferably during your off season. Whilst training, remember to incorporate drills to condition muscles and it may also be beneficial to have your biomechanics assessed at Physio4Life. (See page 3)

This Months Patient Advice : Achilles Tendonitis by Amanda Adams

It is estimated that 11% of all running injuries are due to Achilles Tendonitis.

The Achilles tendon (TA) is a large tendon at the back of the ankle that connects the large calf muscles (gastrocnemius & soleus) to the heel bone (calcaneus).

Like ligaments tendons are strong but not particularly flexible. It can become inflamed through overuse and other contributory factors. The TA has a poor blood supply which is why it can be slow to heal and is less resilient to micro-trauma.

SYMPTOMS

1. Pain and tenderness over the tendon (commonly about 3cms above the insertion)
2. Swelling around the tendon
3. Pain and stiffness especially taking first few steps in the morning
4. Limited ankle flexibility
5. Lumpy build up of scar tissue (pump lump)

Achilles tendonitis is often an ailment of athletes because they do activities that involve sudden stops and starts as well as jumping that stress the tendon.

OTHER CAUSES

1. Overuse of the tendon with tight calf muscles
2. Increase in activity / duration of training
3. Improper footwear/ training surface
4. Excessive pronation

If your feet roll in (flat arches) this will increase the strain on the TA because it twists the muscle and causes inflammation.

WHAT CAN THE PATIENT DO?

Initial management is aimed at reducing oedema (swelling), pain and resolving inflammation.

1. Rest and apply cold therapy or ice
2. Wear a heel raise which will take some of the strain
3. Anti-inflammatory drugs

WHAT CAN PHYSIOTHERAPY DO?

1. Identify the causes and prescribe orthotics to correct foot biomechanics if needed
2. Advice on how to change your training methods
3. Tape the back of the leg to take the stretch off the tendon
4. Ultrasound / Acupuncture treatment to reduce pain and inflammation
5. Soft tissue mobilisation
6. Prescribe an eccentric rehab. programme (see next page)

Eccentric Rehabilitation Programme

In the acute stages physiotherapy can help with inflammation and pain. During which time the athlete is inactive apart from gentle stretching. After this period the following exercises are recommended to start rehabilitation.

Increase your training slowly The TA needs time to strengthen eccentrically to sustain the extra stress of running longer distances.

During an eccentric contraction the muscle lengthens under active tension. Tensions developed during eccentric contractions are greater than those of concentric or isometric contractions (muscle shortens) so the training effect is superior.

Workout comprises of :

1. Warm up
2. Stretching
3. Eccentric strengthening
4. Stretching
5. Ice

Warm up should involve 5-10mins of gentle cardiovascular exercise. Ideally this should be non-weight bearing e.g. cycling. The purpose of this is to warm up the muscles to prepare them for the strengthening and stretching exercises.

STRENGTHENING EXCERCISES

Ankle to toe walks

20 steps each foot. 3 sets. Step forward with straight knee. As the heel contacts the ground slowly lower the toes in a controlled manner. Rock forward over the foot and push up on your toes.

Heel drop and calf raise

12 times. 3 sets. Stand the edge of a step with both feet. Do a calf raise and then lower the heels off the edge slowly to the count of 4. Advance to doing on single leg.

STRETCHING EXCERCISES

Gastrocnemius

Calf stretch against wall with leg outstretched, knee straight and heel on the floor.

Soleus

Calf stretch with knee bent and heel on the floor. It is important to gradually progress your training programme, avoid excessive hill training and incorporate rest into your training programme. It is recommended you should only increase running distance by 5-10% per week.

BIOMECHANICS

Mal-alignment of the lower limb is often a contributory factor to Achilles tendonitis pain. Increased pronation stresses the tendon. Orthotics are placed in the shoe to correct this. Physio4Life can use the latest Gaitscan™ technology to assess individual biomechanics - see next page.

Foot Biomechanics and Gait Analysis by Mark Saunders

The foot forms part of the kinetic chain that exists throughout your body. Thus poor foot mechanics can lead to pain not only in your feet, but also in your knees, hips and back.

Structural or biomechanical problems in your feet can alter your running or walking pattern (gait).

The TOG Gaitscan™ System

Poor foot biomechanics can lead to a number of musculoskeletal problems e.g. shin splints, Achilles tendonitis, plantar fascitis, stress fractures, knee pain, ITB, back / hip pain and bunions.

The majority of overuse injuries will have a component caused by foot biomechanics.

At Physio4Life we carry out a 1hr biomechanical assessment which includes a video analysis of you walking or running, which can be slowed down to show abnormal movement at the foot, knee and hip. You will also walk across the gait scan plate, as you do this thousands of tiny sensors capture the distribution of pressure throughout the sole of your foot over time. From your step the computer then displays a 2-D and 3-D visual representation of the pressures under your feet.

The foot plate will highlight timing anomalies during the gait cycle and compare pressure distribution between each foot. With all this information, video analysis and a full biomechanical and musculoskeletal screening Physio4Life are able to decide whether orthotics would be beneficial for you.

The TOG GaitScan™ System In addition Physio4Life is able to give you a tailored rehabilitation programme with advice on return to activity or your chosen sport.

Could You be a Candidate for Orthotics?

What are Orthotics?

Customised orthotics are medical insoles that are custom made to correct your specific foot imbalances. Orthotics work in a similar way to braces on your teeth, by gently exerting pressure on your feet to bring them back into proper alignment. They simply slip into your shoes/trainers to provide control and support.

Foot orthotics help to control the speed of foot movement and are particularly beneficial to anyone who runs or plays sport where there is high impact involved ( football, tennis etc ).

Foot orthotics come in many varieties and it is important that the correct orthotics are given. There are a variety of materials, postings, and additions that need to be considered for each individual and the type of activity.

Physio4Life specialise in sports orthotics as well as everyday wear. We are currently using the latest thermomemory plastic which is a semi-flexible Material and is ideal for absorbing shock and controlling foot movement. This makes it an excellent device in preventing overuse injuries in runners and improving sport performance. This material comes with a lifetime guarantee and, in our opinion, far out performs its rivals for comfort and performance. It must be stressed that poor foot biomechanics is the norm rather than the abnormal. Physio4Life will recommend orthotics when we believe they will positively correct your imbalances, alleviate pain and reduce further overuse injuries from training.

Massage Therapy by Jenny Strachan

At Physio4Life our Massage Therapist, Jenny Strachan, offers a variety of massages, including sports, or deep tissue massages, designed to relieve tension, increase flexibility and improve muscle tone.

Sport massage is a combination of deep tissue and stretching techniques working deep into the muscles to relieve stiffness - this breaks down trigger points and adhesions which realign the muscle fibres. Sport massage can be given pre- and post-event for improved performance.

Pre-event, it is used to warm you up, ensuring the muscles work optimally and also decrease the chances injury. Post-event, it helps with recovery by clearing out waste products thus reducing the occurrence of muscle soreness.

Massage can relieve anxiety before and after an event.

Nevertheless, you don't have to be an athlete to benefit from this deep tissue massage - day to day life can cause a chronic build up of tension, often around the shoulders and neck, which can be greatly reduced through deep tissue massage techniques.

Jenny also offers relaxing Swedish Massage, which combines classical massage moves to reduce both physical and emotional stress. The benefits of this kind of massage include improved blood and lymphatic circulation, muscle relaxation and promotion of healthy skin.

Jenny is available:

Mon & Tues 6.30-9pm
Wed 2-9pm and Sat 8am-2pm

Physio4Life Helps London's Air Ambulance

Accidents are the biggest cause of mortality in the UK. It is claimed that one in three accident victims dies unnecessarily and pre-hospital treatment is recognised as the key way of saving the lives of many of these victims...

HEMS - the Helicopter Emergency Medical Service based at Royal London Hospital in London's East-End - is unique in being able to get a specialist doctor to the scene of an accident within minutes. They are therefore able to treat the patient in the so-called 'golden hour' - the time immediately after an accident when their chances of survival are highest.

Since their launch in 1989 they have flown over 14,500 missions and are the only HEMS service in the UK to carry a doctor specifically trained in trauma, a paramedic and two highly experienced pilots.

At a rescue, speed is everything - the helicopter has the maximum speed, at sea level, of 200 mph though their normal cruise speed is about 175-180 mph. They usually fly at 1500 feet over London and can be on scene and by the patient's side within 12 minutes in most cases.

Every year the sponsored HEMS helicopter undergoes a rigorous maintenance check up, which can take up to 3 weeks. There are usually resources available to pay for a substitute helicopter, but last year due to a shortage of funds, the Helicopter Emergency Medical Service had to stay grounded for this period.

If you wish to make a small contribution to help maintain and support this vital service, please find a donation tin at our reception.

Every little helps!

Touch Rugby

Touch Rugby or TOUCH, as it is known, is a minimal contact sport that is played worldwide by men, women and children of all ages. The game emphasises running, agility and ball handling skills such as passing and catching. Looking something similar to Rugby, without the tackling, scrumming, kicking and the like, the aim of the game is to score tries. Played on a flat surface, half the size of a conventional sports field, Touch rugby is "The Game taking the World by Storm "..

It's a great summer sport with lots of social aspects. Physio4Life have entered their very own mixed team!

Special thanks to the players:

Laura, Helen, Rachel, Sinead, Amanda, Sheldon, Chris, Neil, Scott, Lawrence, Rob, Mike, John, Adam, Paul and Mark!

5th May –19th June
Wed. 7pm- 9pm
Wandsworth Park.

Ocean Rowing Society Atlantic Rowing Race

Remember our boys from the 1st newsletter (pictured here) attempting to row the Atlantic in the Ocean Rowing Society Atlantic Rowing Race (which is also dubbed the world's hardest)??

Here at Physio4Life, we are the official and proud sponsors of the team formed by James Doust and Nigel Gower, We have some good and bad news for you! To give you a little background on the race - it started in January 2004 in Tenerife in the Canary Islands and finished in the Caribbean island of Barbados in March, which is a straight-line distance of 2,900 miles in 2 months.

Good news- they have officially done it!

54days: 09hrs: 38mins: 20secs

But, unfortunately not without difficulty, as they capsized 2.6 miles of Port St. Charles / Barbados. A huge wave surprised the team and broke right next to them, with the boat being side-on to it. The wave picked them up and tumbled the boat throwing James and Nigel off. It was an utterly helpless moment, everything happened very quickly and with incredible force. Luckily no bones were broken. The greatest disappointment to the boys was the loss of the film and video footage along with the diary and the log book.

Nonetheless, what can we say but it is a true achievement of a lifetime!!

Summer Offers

Free back assessment

Most of us suffer at some time during our life from pain in the back.

Back pain is referred to in different ways such as arthritis, spondylosis, rheumatica, a slipped disc or when it concerns pain extending into the leg, sciatica.

So if you continue to have recurring problems with your back or suffering with your first episode or if your back pain remains a mystery to you - It may be beneficial to consult a health care professional.

At Physio4Life, we are offering an opportunity of a 15 minutes free back assessment. This will include a quick examination of your spine, posture, biomechanics and muscles. From this you can be advised what Physio can offer or we can recommend other treatment possibilities.

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