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Hip and knee pains can occur due to injury or for any number of reasons and therefore it is important to always visit your practitioner for diagnosis and advice so that you can obtain the correct treatment for your condition.  However, here is a little self help advice that may just help you relieve some tight tissues that can result in hip and knee dysfunction and pain.

This video demonstrates two stretches that are common culprits for these complaints. (It may appear that the video has been cut short and in a way it has; I shortened it as I was speaking too much with information that may have confused you.) The first stretch is for the Psoas muscle and the second stretch is for the TFL/ITB. The only thing you may like to add to the second stretch, to make it more effective, is to raise the arm toward the ceiling, on the same side that you have the knee in contact with the floor.

1/ ILIO-PSOAS STRETCH

The ilio-psoas muscles are one of the major postural muscles; it is the main hip flexor whose origin is the anterior (front) surface of the 12th thoracic to the 5th lumbar vertebrae of the spine and attaching to the lesser trochanter of the femur (thigh bone).
Anterior_Hip_Flexes_ilio-psoas-muscles

When these muscles are tight/dysfunctional they prohibit you from taking a full stride, altering the movement of lumbar vertebra, this can lead to lower back pain, increased lumbar lordosis or an antalgic stance as well as possible hip/groin pain or, in guys (obviously), testes pain (read this if this is of interest to you).

2/TENSOR FASCIA LATAE

The tensor fascia latae (TFL) muscle originate from the iliac crest and insert into the iliotibial band (ITB); aiding in hip stabilisation, flexion and abduction. The ITB runs along the lateral or outside aspect of the thigh, to the lateral condyle of the tibia, or bony bit on the outside of the knee; crossing both the hip and knee joints. The TFL is an important stabiliser structure of the lateral part of the knee as the joint flexes and extends and therefore, they can cause a lot of hip and knee problems.

Iliotibial Band Syndrome

Iliotibial Band Syndrome

SELF-TREATMENT 

Soft tissue work – with your prickly ball or jack-knobber or foam roller (READ MORE HERE)- (we carry all of these at the clinic).

Increase flexibility – by doing daily stretches demonstrated in the video at the beginning of this blog.

Strengthening exercises – stretching is not going to do it all. The mentioned muscles may be having to work too hard because they are compensating for other muscles that are not firing properly. A plan of exercises to strengthen these involved muscles is needed. Your practitioner will be able to tell you which muscles are involved. The most commonly involved muscles are weak gluts as well as foot pronation causing incorrect alignment and function. However, please visit your practitioner as she/he will be able to advise you.

Hope you find this helpful.

Written by Anne French, BSc(Hons), MSc Chiropractic, D. C.

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Running the Marathon? You may need some help…

runners-injuries

With the Brighton Marathon just around the corner, here is an insight into the types of injuries you may come across and some top tips on how to avoid them…

 

Here are some common causes of injuries while training…

Over-training

Runners often focus on endurance and stamina work rather than overall strengthening of the entire lower body. The first indicator of over training is aches and pains. When a patient presents with aches and pains, its best to deal with it sooner than later. If caught early, one to two days of rest is usually all that is needed. But, aches and pains that are ignored can become more significant. The tissues break down and can become an injury if not addressed promptly, it can then take weeks to resolve the issue.

Abrupt changes in training

Adding five miles to that daily run or altering the pace are actually abrupt changes in regimen that can spark an injury. It will become worse if symptoms start and a runner tries to work through it.

Poor footwear

Old, worn out trainers wont offer the support you need to be pounding the streets and the wrong size shoe can cause issues too. Too small and you’ll suffer with blisters, too big and it increases the lever arm so force through the calf muscles are increased and the Achilles Tendon can break down. Running shoes should ideally be changed every 350-500 miles depending on body type and training style.

Muscle imbalance

The most common cause of injury among runners is an imbalance with the muscles. Training should go beyond running and should certainly include strengthening and stretching work. Muscles can become tight and over active while others can become weak and underactive – this can cause major problems down the line whether it is to those specific muscles or to others in the same chain. For example weak gluteal muscles can cause problems at the knees, shins and ankles!

Here are some common areas of the body that are likely to come under strain during your training…

Hip Flexors

Anterior_Hip_Flexes_2The hip flexors are a group of muscles that pull the knees upwards towards the core. They begin in the lumber region of the back and connect into the femur (thigh bone). The hip flexor muscles can become inflamed or can even rupture. Hernia’s, trapped nerves and inflammation and rupture of the adductor muscles cannot be ruled out in this area either.

Inflammation

Symptoms can include pain in the groin when you lift your knee to your chest, tightness or swelling in the groin and pain may disappear when training but return afterwards.

The best way to treat inflammation is to rest until the pain has gone. Applying heat to the area will also help.

Rupture

Symptoms include a sudden, sharp pain in the groin, weakness in the area and pain when lifting the knee to your chest. If you think you may have ruptured your hip flexors, you should cease training immediately, applying ice and pressure to the area. Rehabilitation will include lots of rest, a gradual and progressive stretching and strengthening program. A complete rupture of the muscle is rare and would usually require surgery.

Anterior Knee Pain

knee-ligamentsKnee pain can arise from a range of conditions affecting the front of the knee. The knee is made up of 2 bones and the kneecap where various ligaments, muscles and tendons surround it to keep it in place. There are some common causes of knee pain for runners: softening of the cartilage on the back of the kneecap; over pronation (the way your foot strikes the ground when you run doesn’t allow shock to be absorbed properly); stiff hip joints; tight hamstring, calf and quad muscles or lack of strength in the quad muscles.

Symptoms of anterior knee pain can include pain along the medial side or just below the kneecap that gets worse when using stairs or going up/down hills. It can be worse with prolonged sitting and can be described as a dull ache. Sometimes people describe a cracking or grating of the knee and suggest it can ‘catch’ or feel like it ‘gives way’.

Immediate treatment consists of ice and rest and rehabilitation will include stretching the major muscles in the leg to decrease pressure on the kneecap and strengthening muscles to help the kneecap glide correctly.

‘Shin Splints’

Shin pain is very common in runners and it is often referred to as ‘shin splints’. However this is a very generalised term and there are 'shin splints'several different conditions that can cause this pain. Knowing the cause is most important for treatment. Causes include medial tibial stress syndrome, tibial stress fracture, chronic compartment syndrome, calf strains, nerve compression and referred back pain.

 

Medial Tibial Stress Syndrome (MTSS)

This is pain on the inside of the tibia bone bought on by running and can take hours/days to ease. It is often associated with over pronation of the foot when running meaning that shock isn’t absorbed properly. It can also be linked to continually running on hard surfaces or wearing worn out or wrong running shoes. Treatment involves rest from running as well as stretching and massage of calf and shin muscles. Correct footwear will need to be looked at and a review of training programmes to see if anything could make the condition worse.

Tibial Stress Fracture

With a tibial stress fracture, runners will often suffer pain after running however the pain normally gets worse and can last longer after each run. Runners may also suffer from a sharp rising pain when they’re in bed at night and can have tenderness over the area on the tibia. Stress fractures can be caused my repetitive loading of the bones and they are more common in women. A stress fracture can be confirmed by an x-ray and rest of 6-8 weeks from running is essential. A review of training programmes again is essential and a rehabilitation programme is vital to return to running.

Chronic Compartment Syndrome (CCS)

Chronic compartment syndrome is a pain in the lower leg muscles whilst running. The pain eases with rest and can often feel like cramp or a tight, burning sensation. CCS can be caused by leg muscles increasing in size thus becoming too big for the surrounding tissues. The surrounding tissues aren’t flexible enough to accommodate the increase in size and this causes increased pressure which can lead to nerve damage and reduced blood flow in the muscles. On examination a doctor or sports injury specialist may not find a problem because CCS only occurs during exercise. Rest will ease the pain but it will more than likely return when you start training again. If this is the case, surgery is often required.

Achilles Tendon

achilles-tendonAchilles tendon problems are another common complaint amongst runners.  The Achilles tendon connects the gastrocnemius (calf muscle) to the heel bone. The Achilles tendon can become inflamed (tendonitis) or it can be strained or ruptured.

Tendonitis

Tendonitis is the inflammation of the Achilles tendon usually due to overuse or from an injury to the Achilles. Achilles tendonitis can often be painful at the beginning of exercise and often ease during exercise. The pain usually presents as a dull ache again after exercise. Treatment involves resting, stretching and strengthening and adapting your training programme. Not over-training is key. Introduce new exercise slowly to allow your body time to adjust. Wearing the right type of footwear can be important, flat-footed shoes can put more strain on your Achilles. Allow for a proper warm up and try to vary your training programme.

Strains or ruptures

Strains and ruptures are the most common Achilles injuries. They occur when you make a sudden movement or overstretch the tendon – usually when jumping, lunging or falling. Sometimes these injuries can make it hard to walk or put your foot on the floor. Symptoms include immediate pain just above the heel turning to a dull ache, limited movement of the ankle and swelling or heat around the Achilles. Treatment will depend on the severity of strain or rupture but rest, ice and elevate is your first port of call. Rehabilitation will include stretching and strengthening.

If you are in need of help whether it is to just diagnosis your condition or to receive treatment and training advice then please give us a call. If you are ever unsure- always contact a Sports Injury Specialist or GP.

Written by  Natalie Harris – BSc Sports Therapist, MSST

And so this month see`s the Brighton Marathon and with it Spring well and truly underway. Everyone is up and running this month, walking, biking running, hop skip and jumping, and generally glad to be alive and being active now the weather is better and the days are longer.

 

So as you grab those luminous lycra shorts and prepare to roller blade ten miles along the sea front be sure to warm up warm down and increase the amount of exercise you do gradually as your body wakes up from the slumber of winter.

 

Tendon and ligament damage can occur through improper training regimes or over enthusiastic exercise. Over use of joints or repetitive strain injuries are commonly caused through excessive running or sports. Runners with injuries such as shin splints, knee pain, Achilles tendon problems, Iliotibial Band Syndrome or general foot or ankle pain can all benefit from acupuncture treatment, increasing healing time and enabling a return to training or work and not chronic or recurring injury.

 

Acupuncture works by stimulating the body’s energy, (Qi) the electromagnetic activity created through chemical reactions on a cellular level.  The excitement and activation of the body’s energy draws blood to the area. In Chinese medicine we say Qi is the commander of the blood and blood is the mother of Qi to describe the yin yang interconnected nature of this phenomenon.

 

In other words exciting the electromagnetic field in an injured knee draws blood to the area, and the blood contains the healing aspects of the immune system such as white blood cells, lymphocytes etc to draw away waste products and stimulate tissue repair.

 

The other mechanism at play in acupuncture treatment is the systemic factor. We not only work on the local area but on the deep organs and systems of the body to strengthen the immune response. The classic one I see is people who suffer chronic tendon strains and suffer a systemic “blood deficiency” i.e. there isn’t enough extra blood to repair and nourish the tendons and allow healing to take place. Including points to stimulate this aspect of the body and include blood building foods in the diet allows the body to complete what it is trying to do.

 

Acupuncture is very effective at treating musculoskeletal injury but sometimes a structural problem is contributing to an injury and chiropractic or osteopathic treatment is necessary first in order to correct this before acupuncture can be used to strengthen or speed up repair.

 

We all have our limits and sometimes we all need help from outside of ourselves, here at Coast we try to provide everything you need to live as fully as possible. Now go outside and play!

Written by Jeremy Marshall

Our bodies are truly amazing.  They cope and adapt to the various stresses and demands we make on them every day and we hardly ever give them the respect and care they need and deserve until – one day they start to hurt or we can’t do something we used to be able to do. Then we feel let down and bewildered as to why? The truth is we need to care for ourselves more than we do and this is how we can care for our joints, those miraculous things that allow us to bend and twist in multiple forms.

Yoga

There are 206 bones in the human body which makes for a lot of joints. The range of motion of these joints vary depending on the type of joint e.g. ball and socket joint of the hip or hinge joint of the elbow. These joints can be injured by direct trauma such as a fracture; subluxation; sprain; daily increased wear and tear of incorrect movement patterns (which most of us have) or incorrect dietary habits resulting in inflammation and lack of repair. What we are really talking about here is Osteoarthritis. Symptoms are typically joint pain, swelling and stiffness.

Treatment options :

Chiropractic or Osteopathy manipulations of the spine and peripheral joints can decrease joint tenderness and improve function.

Massage around the painful area will improve circulation and reduce pain and swelling.

ExerciseInitially, exercise may increase pain, however, gentle exercise has long-term benefits with positive effects on physical function, fitness and activity levels. Try Pilates, Yoga or swimming.

Dietary Modification Research has proven time and again that diet can affect the body’s ability to heal and repair itself so it is vital that we eat foods that are beneficial to our health and well-being. Nothing surprising here – surely. So what’s beneficial?  It’s the same diet that you always hear me talking about. Reduce protein, simple carbohydrates and saturated fats, alcohol and coffee from your diet and all processed foods. Ultimately – an organic vegetarian diet (produces an alkaline environment in the body) with a good source of omega 3 oils is the way to go. This diet is low in protein (protein produces an acidic environment = pain) but rich in nutrients needed for rebuilding and repair of joints.

The next question for me is – ‘Do we get enough of these nutrients in our diets these days?’ The answer sadly is ‘Probably not.’ The way that our food is now grown results in a product that is lacking in nutritional value (have you noticed food just doesn’t taste like it used to?). Even if we were living in an ideal world where all the crops were grown organically and therefore they were regularly rotated and full of nutrients because they were grown naturally in a richly nutritious soil. When it comes to a arthritic joint – we want to repair the joint surface and we will need more than the RDA (recommended daily allowance) which, for example, is the lowest amount you need to not get scurvy, not the amount you need the heal and repair your body. So supplements and vegetable juicing are the easiest way to pack those nutrients in.

If you would like to know which nutrients you need, you can always make an appointment with me at the clinic. Meanwhile, here are some supplements that are beneficial in either joint health and/or repair:

Omega 3 oils – everyone should be taking these as we are just not getting enough in our diets. Each individual cell in your body has a wall that sounds it. That wall needs to be highly permeable, allowing products to enter it as well as exit. Omega 3 oils increase cell permeability where as poor oils e.g hydrogenated fat, decrease the cells permeability by making the cell wall rigid. Omega 3 oils are essential and sadly lacking in our diets. Be sure to take a good source of this oil that has been filtered from heavy metal contamination if it is from a fish source.

Sources – fish, nuts and seeds, flax, green leafy vegetables.

Omega 6 oils – effective in part due to its conversion to Prostaglandin E1 – anti-inflammatory pathway (as is omega 3).

Source – borage oil, black currant seed oil, evening primrose oil.

Oleic Acid – olive oil. Research link

Glucosamine Sulphate and Chondroitin Sulphate – may both play a role in wound healing by providing the raw materials needed to manufacture molecules called glycosaminoglycans that are found in skin, tendons, ligaments and joints. They are also reported to reduce pain. Glucosamine sulphate has had a lot of research done on it (which is unusual for a nutrient as most research is conduct by pharmaceutical companies, and they can’t patent a nutrient)and most of it is really positive. E.g. research link

Antioxidants – Vitamin C/E – are important against oxidative, free radical damage and also for the creation of collagen which is found in bones, ligaments, blood vessels and tendons; also important in the creation of neurotransmitters (serotonin, nor-adrenaline and dopamine) which control our moods, mental clarity and pain levels. Eat a rainbow of colours in your diet and you’ll be getting some but will you be getting enough?

Sources – peppers (red, orange, yellow, green), carrots, tomatoes, red cabbage, blueberries etc.

Vitamin D – boy – there is so much research being done on this vitamin at the moment and a deficiency in this vitamin is being linked to so many conditions including poor joint health. There is no way we get enough of it in the UK (hardly any sunlight) so take a supplement.

Bromelain – is a protein-digesting enzyme derived from pineapple. Some 200 medical journal articles attest to its effectiveness in treating inflammatory conditions by blocking inflammatory chemicals and digesting excess fibrin, a chemical contributing to osteoarthritis.

 

Herbs

These beautiful botanical miracles are truly amazing (which is why pharmaceutical companies are very effectively limiting their use in Europe). Get them while you can.

Curcumin – is a herbal extract from turmeric and is as effective as cortisone for anti-inflammatory needs but without the cortisone side-effects.

Ginger – anti-inflammatory and pain reliever.

Devil Claw – anti-inflammatory and pain reliever.

Boswelia – it shrinks inflamed tissue, builds cartilage, increases blood supply and helps to repair blood vessels. I love this herb.

 

Topical Treatment Options

These are also herbs but made into and highly absorbable gel that can be applied to the skin to reduce pain and swelling. We carry both of these at the clinic.

Horse Chestnut – contains a compound called aescin that acts as an anti-inflammatory. It can be applied to an affected area every couple of hours to reduce swelling.

Arnica – great at reducing pain and inflammation.

 

I know what you’re thinking – ‘Too much effort. Why not just pop a pill?’

Short-term use of NSAIDs (such as Ibuprofen) can be helpful when used for inflammation that results from traumatic injuries (sprains/strains etc). However, long-term use of these medications can cause a host of unwanted side-effects. The way they work is to block the prostaglandin inflammatory AND anti-inflammatory pathways. Another point that I feel is highly relevant, is that NSAIDs do not actually correct the cause of the pain. In fact they cause intestinal permeability, which leads to more inflammation. A person taking NSAIDs medication is seven times more likely to be hospitalised for gastrointestinal adverse effects which the FDA estimates leads to 200,000 cases of gastric bleeding annually resulting in 10,000 – 20,000 deaths each year.

Why take something that is non-beneficial and possibly detrimental to your health (life expectancy) when there are safe and effective natural options.

Make the effort. You’re worth it!

Written by Anne French

Well done all you Brighton Marathon runners. What a great atmosphere from some great people.

It was my great privilege to try to help those runners that found their way to my portable massage table outside the clinic on Church Road. Interestingly – not one of my many patients that ran the Marathon needed my help. (Could it be that they already know how gentle I am with soft tissue work – or – that they are in such good shape?)
So much fun mixed with so much pain. Don’t know how many of you did it. Such conviction.

Congratulations and see you next year.

Richard Husseiny, our Sports Therapist, has been with Coast since the first day we opened. In that time he has completed a BSc (Hons) Sports Therapy, LSSM Dip and MSST and is currently on the home run of his MSc in Strength and Conditioning.

Richard has worked with focused determination to achieve his goal of training professional athletes and all that hard work has paid off because he has been taken on as the Strength and Conditioning Trainer of the Olympic diving team. Way to go Rich!  We are really happy for you.

 

Rich has written this months blog on an injury that many runners suffer with, unnecessarily, Iliotibial Band Syndrome.

 

 

Iliotibial Band Syndrome           

The marathon season is fast approaching, with 2 of the UK’s most popular marathons close by. If you are running either the Brighton or London marathon this year, you should be well into you’re training and hitting double figure distances. Having miles under your belt is the key to successful marathon running. Yes, interval training will enhance your aerobic condition and improve your ability to run at a higher VO2%, but running economy is optimally enhanced by the volume of miles that you do.

 

The nature of distance running, and that of cycling, means that the linear, repetitive stride pattern can cause overuse injuries very quickly, if you fail to look after your body. Stretching AND a well-structured strength plan are essential for better performance and optimal tissue quality. Without this in place, common injuries can occur such as ITB syndrome.

 

Iliotibial Band Syndrome

 

 What is the ITB?

 The Iliotibial band (ITB) is a superficial thickening of tissue. It attaches from the TFL (tensor fascia latae) and the butt (gluteus maximus) muscles; tracks down the outside of the thigh and inserts just below the knee. The ITB is therefore involved with the running stride (flexion and extension of the hip) and also acts to stabilize the knee.  ITB Syndrome arises with the repetitive rubbing of the ITB over a bony part of the knee called the lateral femoral epicondyle, causing inflammation and resulting in pain.

 

Symptoms

 Symptoms range from a dull to sharp pain in areas around the knee, which can spread up the length of the lateral thigh to the hip area. This may not occur until mid way or even after your run. It may be fine on the flat but could swiftly increase with hill runs due to exaggerated hip flexion. This is not an injury that suddenly occurs; without doubt it is due to increased muscle stiffness and the repetitive load when increasing mileage.

 

Treatment

 Symptoms may subside with total rest, but that isn’t going to get you prepared to run. This is where we can help at Coast Clinic. The following 3 aspects of treatment we offer are key:

 

1)      Soft tissue therapy

2)      Flexibility training

3)      Well structured strength plan

 

 1)      Soft tissue work will release the tense musculature, release the myofascia and help the ITB run smoothly over the thigh muscles. It will also reduce any scarring that has built up in the tissues and release muscle tension through the whole area. This then buys you time to work on developing your own flexibility.

 

2)      Daily stretching and foam rolling is essential when training for a marathon. This will maintain and develop the improved tissue quality achieved through soft tissue manipulation. This must be kept up, foam rolling is a great way to prepare for any physical exercise both before and after.

 

 

3)      Strength work is also vital to performance. Muscle imbalances are very common, and can cause problems such as ITB syndrome. The very nature of marathon running is highly repetitive, which quickly highlights weak musculature. If a butt muscle (e.g. gluteus medius – which is an important hip stabilizer) is weak on one side, the hip range of movement, stability and function can quickly become compromised. Therefore, identifying any weaknesses and prescribing specific strengthening exercises are very important. Further benefits to strength work include improved muscle strength, joint stiffness (different to musculature stiffness) and tissue quality, lead to further improvements to performance and injury prevention.

 

We offer all these services at Coast (and we carry foam rollers). We can enable you to prepare and compete at any level from amateur races to the Olympic Games.

Written by Richard Husseiny, Sports Therapist.

Richard has his own blog. If you would like to follow him you can find him at  http://richardhusseiny.blogspot.com

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