Human, Injury Management

Lower Back Pain

At some point in everyones life they will likely suffer back pain of various degrees, some people more than others. Why this is, is not fully understood. Continued research allows us to gradually develop a better understanding. For instance 15 yrs ago the advice for back pain was to lie flat with a hot water bottle, but this is seen as detrimental and that movement does help back pain.

Causes

Back pain can be caused by many things such as a direct trauma, chronic overuse or an underlying illness where the pain is being referred from elsewhere. It is really important to seek professional help to rule out any more serious health issues if the pain is constant, non-mechanical and there is unexplained weight loss.

Causes of lower back pain can include the following

  • Fractures to the vertebra can occur due to direct trauma such as a fall or stress fractures brought on by overuse
  • Nerve root compression can occur due to disc herniation
  • Spondylolysis caused by repeated hyperextension and rotation
  • Spondylolisthesis which is the slipping of one vertebra on another
  • Spinal stenosis is the narrowing of the spinal canal due to bony changes
  • Labral tears and rim lesions in the hip joint can refer into the back

The above conditions can be diagnosed with relative ease and treated accordingly however the following structures can also cause back pain and are harder to diagnose

  • Muscle
  • Fascia
  • Nerves
  • Vertebral disk
  • Ligaments
  • Joints (capsule and cartilage)

In many cases lower back pain can be caused by more than one of the above structure. Sometimes the body can over react to pain and injury by causing muscles too spasm to protect the area, which does have it benefits as it prevents further injury of that area, however this increased tension can also cause discomfort and will need treating. Due to the involvement of multiple structures and the fact that these structures are more difficult to pinpoint in assessment does mean that when being treated there is sometimes a need to try a treatment and see if it works. It may take several alternatives before something is found so don’t be disheartened if your therapist takes some time to pinpoint the best treatment method.

Treatment

There are many treatments that a qualified professional can employ and here is a list of possibilities

  • Pain medication- in the early stages anti-inflammatories can be useful in helping to reduce muscle spasm and inflammation but after sometime it is thought that they can hinder the healing process. As a result caution should be taken when taking medication. A chat to a doctor can often help to decide what would be best for you. Something that is cheap and has relatively few side affects is ice. Ice in the early stages can reduce inflammation and relieve pain. Don’t use heat in the early stages.
  • Rest- this may be advised depending on the injury. A fracture for example, may require complete rest. In other cases reduction in volume, intensity or avoiding aggravating activities may be advised during early recovery with a plan to increase activity levels gradually.
  • Massage- a deep tissue massage and trigger point work can often elevate tension, reduce pain, encourage healing and increase mobility.
  • Mobilisations- these are gentle oscillations to a joint which can help elevate pain and reduce tension, which can help decompress and loosen joints.
  • Manipulation- is a high velocity manuaver performed to a vertebral joint to achieve the same effect as a mobilisation but often at a faster rate. This should be performed by a chiropractor/osteopath.
  • Dry needling/acupuncture- Needling is thought to help reduce tension and relieve pain. Acupuncture can also help with well being and energy levels.
  • Taping- Taping is not a sole treatment but something used to complement others. It is good with helping posture and proprioception. It can help with swelling reduction and relieve some pain. However research is mixed on the effectiveness of tape. Tape should not be something a patient becomes reliant on but a part of the whole process.
  • Cupping- this is a treatment method that needs further research but has a potential to help towards decompressing soft tissue such as fasciae and muscle. Using cups with movement could potentially be the most effective way to use cups. While there is not much research don’t be put off if your therapists suggests this as an option as you might find it effective. It does leave marks that look like bruises but the skin has not experienced a trauma like a bruise so they do not hurt.
  • Stretching- a therapist can apply some passive stretches or use muscle energy techniques which require participation from you. It encourages a muscle contraction and then relaxation to encourage lengthening. Stretches may also be prescribed to you as homework.
  • Exercises- This is probably the most important element of recovering from a lower back injury. This also requires commitment from you as an individual and is probably the area that therapist find the hardest to get clients to perform. I can’t stress how important it is to get your exercises done. You will recover quicker, stronger and are less likely to have it recurring. So please do your exercises to help strengthen muscles and mobilise joints.

Exercises

Some simple back friendly exercises to mobilise and strengthen

Shoulder bridge

The shoulder bridge is a good basic exercise to start with. Below is a link to an entry level version which is a good place to start. There are many variations that are progressively harder but start basic and gradually build. https://www.youtube.com/watch?v=d2I8_VBJPGM

Key points to remember when doing a shoulder bridge

  • Engage your gluteal muscles (butt muscles) and deep core muscles before beginning the movement
  • Keep your pelvis level by pushing through your heels evenly
  • Don’t over extend through your back at the top of the movement
  • Remember to breath
  • When progressing onto leg lifts or heel lifts maintain a level pelvis and don’t let it dip

Hip twist

Is a great way to mobilise and stretch through the lower back. This exercise can be performed as a continuous movement or held at the end of your range to get a bit more of a stretch. This link shows the movement pattern https://www.youtube.com/watch?v=ONB4d84SXRc

Things to remember when doing a hip twist

  • Keep both shoulders on the floor and look the opposite direction to your knees
  • Move within your pain range.
  • Breath and take it slow, relax into the movement
Human, Injury Management

It is time to sort those injuries out

The end of the hockey season is upon us, our bodies are starting to feel the accumulation of all the hard work put in. Mentally and physically fatigue is starting to show, now is the time to allow yourself to recover and address any niggles or injuries picked up.

Recovery

Recovery is often overlooked by many athletes but is the key to making gains in physical and mental performance.

” Train smart not hard”

is something I say regularly to athletes I have worked with, especially endurance athletes. Often athletes believe that poor performance is due to not training hard enough, but often its because they don’t integrate enough recovery time into their training. Due to this athletes become stale and progress does not occur. However, by making sure recovery occurs in training on a regular basis will allow the body to adapt and adjust to the stresses placed on it during training. Further to this training volume and intensity need to also be adjusted to create stress on the body. If we did the same all the time the body would not get fitter and performance levels would not improve. This means that during the off season, in any sport, not just hockey, a good amount of recovery time needs to be scheduled in before training commences.

Once the season is finished it is okay to take a week off and not doing any physical activity. Yes you might loose some fitness but this can easily be retained in no time from a well constructed training plan. Low level activity can be reintroduced after a week to allow a gradual increase in volume with the intensity being relatively low. This begins to build a base for the rest of your fitness and it is always a good idea to build a broad endurance base. Taking up other sports like cycling or swimming are great for this. They have less impact on joints but build cardio fitness.

I slightly digress, so a bit of time out allows the mind and body to recovery from the high intensity hockey season. It reboots and refreshes the system, it is also a good time to see your sports therapist or physiotherapist, to address any injuries or niggles and allow them time to recovery.

Addressing injuries or niggles

During your down time it is good to pinpoint any injuries or niggles that have occurred throughout the season even if you feel you have recovered from them. Once pinpointed you can develop a strength and conditioning training plan, which you can implement during your off season. This will allow you to return to pre-season training with any weaknesses or imbalances addressed reducing your incidence of injury during the season.

Key areas to address in hockey players

Through my time working with hockey players I have identified three areas, that if worked on during the off season could help prevent injuries during the hockey season.

  1. Develop a deep core through specific exercises such as Pilates. I specifically haven’t used strengthen as developing deep core muscles is more than just strengthening them, it is often down to learning how to activate these muscles (transversus abdominis, pelvic floor and multifidus), and not using global muscles groups to perform these exercises. By developing the deep core allows the body to stabilise for any activity. This in turn allows you to develop stronger global muscles increasing global strength, power and speed. Without a well developed deep core you will sustain injuries as you increase the intensity of training.
  2. Work on releasing your hip flexors (Iliopsoas). So often hockey players come to me complaining their hamstrings are tight or their gluteals hurt. This is more often than not down to tightness in the iliopsoas. Hockey has a large amount of hip flexion causing the iliospoas to be in a contracted position, encouraging it to shorten. This causes anterior pelvic tilt, which subsequently puts the hamstrings on stretch as well as the gluteal muscles. This gives the perception that the hamstrings are tight when in fact they are not. In regards to the gluteals they feel tender because they are also in a stretched position. This causes the gluteals to not activate as well and therefore make it difficult to strengthen them. This creates more work for the hamstrings as they will compensate for the gluteals not activating. So the hamstrings have a pretty hard time playing hockey. By stretching and releasing the iliopsoas regularly you will keep the hamstrings and gluteals a lot happier.
  3. After releasing the iliopsoas the hamstrings and gluteals can then be strengthened. By doing this you will increase hip stability, reduce injury and allow a good foundation for speed and power to be built on. Including gluteal bridges and nordic hamstring curls can go a long way in reducing your injury risk.

The off season is a great time to get on top of everything so that you come back into the season stronger and better prepared that the previous one. This will help your performance and reduce your injury risk. So go out there enjoy the warmer weather and work on yourself.

Horse & Rider, Human

Balanced Rider

When we ride our trusty stead, we try and develop balance, straightness and suppleness in our horse so that they can carry us more effectively and efficiently. However, how often as a rider do you develop your own balance, straightness and suppleness? I would hazard a guess, not as frequently or diligently as you do your horse. With the winter almost over and spring on the horizon, now is a really good time to begin focusing and developing yourself for your horse. They will appreciate it!

We often hear the words “balanced rider” being banded around but what does this really mean? A balanced rider can encompass so many things. Here are just a few to consider when talking about a balanced rider

Force Balance

When the word balance is used, most people will automatically think of the ability to balance against gravity, for example, when standing on one leg or on a beam in gymnastics. This is balance and does play a huge part in riding a horse. If you are not balanced then gravity unfortunately takes control and a rider may fall off or come close to it. If this component of balance is something that you find difficult, think how that affects your horse’s balance. If you are carrying a child or small animal that keeps moving and wriggling around, you have to make adjustments so that you don’t drop them and sometimes this ultimately doesn’t work and a fall occurs. The consequences could be injury to both parties and a feeling of letting someone down. This is something that your horse could experience when you are not balanced and fall off. So to help your horse, working on your basic balance would go a long way to helping to make their job of being a ridden horse easier and less stressful for both parties.

Strength Balance

When I talk about balance of strength, I am referring to muscle strength. This can be left and right dominance. The majority of people are right-handed and are therefore stronger in their right hand or arm. Balance of muscle strength can also refer to agonist and antagonist muscle pairs. If there is an imbalance between these then injury can occur. While this is really important, for this blog it is not of focus but something that will be addressed in the future. So going back to left and right dominance, it is a natural occurrence but it is something we can decrease by working and training our non dominant side. This will even our strength out from one side to the other making our aids more consistent side to side when riding. By doing this a rider can further balance their horse out and be more supportive on their horse’s non dominant side.

Tension Balance

Muscle and soft tissue play a huge part in movement biomechanics for horse and rider. If an area is tight this will affect the body globally and also affect how your horse moves. You may not think this is so, however you may be shocked at how much you actually do influence your horse’s movement.

About 5 months ago, I injured my back playing field hockey. I had pain in the right side of my lower back which resulted in a huge decrease in range of motion, strength, force absorption and suppleness in my hips and back. However, I still attempted to ride and it was definitely an attempt. In walk I was not too bad, nor was my horse but going into trot was another story. My horse looked lame on both reins, feeling pretty low at being injured myself, having the prospect of my horse being lame as well, just would have been the last nail in the coffin. I was lucky enough to have my instructor present and being an equine bodyworker myself, we got to work straight away to fix him. Firstly we lunged him still with tack on and were happily surprised to see that he was not at all lame but instead moving rather well. It was therefore put down to rider influence. This surprised me hugely. While I know we influence our horses, I didn’t think by this much. Let me put this into a little bit more perspective. I am a small rider standing at 5ft2″ and 53kg. If my horse was small perhaps this would be understandable but my horse is 16.3hh, maybe a little taller and probably weighs near if not more than 700kg. So you can see that we can influence how our horse moves quite considerably, even minor things that we don’t realise could have an affect.

Soft tissue tension can affect mobility of the body causing decreased movement in various areas. It can also affect how different muscles activate, for instance, when there is a lot of tension in the iliopsoas muscle (hip flexors), this can affect your gluteus medius (one of your many butt muscles). The gluteus medius helps stabilise the lower back so will really kick in when performing rising trot. When the iliopsaos is tight it causes the gluteus medius to become stretched and it doesn’t like it. As a result it doesn’t activate as effectively, thus not stabilising through the lower back. No matter how much you try and strengthen the gluteus medius, it won’t make a difference until the iliopsoas is released and the gluteus medius is no longer stretched. Once this muscle can activate, then strengthening can occur and the body can function as a unit.

Anatomical Balance

Unfortunately, sometimes the way we are built means that we will have some differences from side to side or back to front. We were born like this and this is something we can’t always change, or we may have sustained an injury causing an anatomical difference. However, we can give ourself the best chance possible by being aware and doing something about it.

How do we develop ourselves so that we become the balanced rider that is talked about so much? Well there are many ways and here are some ideas below.

Massage

A massage is not just a luxury or something at a spa, a good sports massage will help with the following

  • Reduce muscle tension
  • Increase flexibility
  • Improve circulation and recovery
  • Help activate muscles
  • Reduce injury risk
  • Improve wellbeing

A good massage therapist will be able to help with improving posture off and on the horse. It is also good practice to be seen around the same time your horse receives bodywork so that one of you doesn’t undo the hard work put in. So when your horse is next scheduled for a session also schedule yourself in.

Pilates

Pilates was developed by Joseph Pilates to help rehabilitate soldiers during the war. It is used now to help people strengthen their core. However it is a bit more than this. Pilates does focus on your deep core muscles but it also develops better movement patterns by encouraging co-activation of deep core muscles and global muscles. I work with athletes and non athletes and while the athletes look strong, they tend to not use their deep core muscles but their global ones. They therefore find the more advanced Pilates exercises often easier but when you take them back to just using their deep core muscles they find this very difficult, unlike non athletes. Due to this, athletes that favour their global muscles will sustain injuries. Pilates teaches people to activate and use their body in a more functional and long lasting way.

Pilates is brilliant for horse riders as it allows a deeper understanding of one’s body. Equipilates™️ was developed specifically for horse riders by Lindsay Wilcox-Reid and is a combination of Pilates and other movement therapies to develop that body awareness and allow a rider to have a deeper connection with their horse. If you have an Equipilates™️ instructor near you, it is worth signing up to regular classes. Over time you will notice a difference. However, if you do not have an Equipilates™️ instructor close by, a normal Pilates class will still make a huge difference.

Things you can do when you ride

There are many things you can do without spending extra money or too much extra time. These include videoing yourself. This will highlight whether you are sitting evenly and what posture you adopt during all gaits and can be quite an eye opener. Often we are unaware of little things like this due to our bodies adapting and normalising them. It feels wrong when we correct them but in time your body will adjust to this being normal. The next step to really highlight any issues would to be to do regular no stirrup work. This will allow you as an individual to lengthen through the leg and hip and work hugely on balance force, especially when transitioning down. As you progress, using Franklin balls would further develop your awareness, balance and connection with your horse. Lastly, and this does cost a bit of money but having lessons with a riding instructor who understands core engagement is worth its weight in gold. Having someone tell you when and how you need to activate and seeing the results transfer to your horse in real time, is a huge learning curve and something you will then use throughout your riding, even when hacking.

So the above are just a few things you can do to become that balanced rider. There are others but the above would be a good first step in the right direction.

Human, Injury Management

What is K-Tape all about?

What is K-Tape all about?

Most people have heard of K-tape (kinesiology tape), or at least seen athletes wearing it. There is a strong belief with some that tape is used for injuries (which it can be), and as a result don’t want to visibly give their opponent a psychological advantage. However k-tape has more uses than when injured.

For instance it can be used for the following

  • To help posture and proprioception
  • Improve recovery
  • Help prevent re-occurence of injuries
  • Reduce bruising, swelling, and pain
  • Increase flexibility

How can k-tape help posture and proprioception?

We are all being told about poor posture and that we need to be mindful to improve it. K-Tape applied in the correct manner can help remind individuals of a better posture. For example it can be used to help draw the shoulders back for those working for long periods of time at a desk so that they don’t slump. It can also be used in sport to remind an athlete on limb position (proprioception). A good example is with horse riders, it allows long lasting corrections to be made to a riders position and balance, which in turn allows the horse and rider a deeper partnership.

K-tape can help recovery, reduce bruising, swelling and pain

The way that K-tape works is that when placed on the skin it helps lift and decompress the tissues beneath. This is thought to help decrease muscle tone, allow easier movement between muscle fibres and increase circulation. This in turn allows for more rapid removal of inflammation, excess fluid and by products of exercise or injury. This is turn can help reduce bruising, swelling and chemicals causing pain. K-tape can therefore help recovery after exercise and injury making it very useful to have in your sports bag.

Increase Flexibility

Rocktape®️, which is the brand of tape I use on a regular basis, developed Powertaping™️. Which is meant to help develop neuromuscular function and movement along myofascial chains of movement. Myofascial chains was developed by Thomas Myers and is termed Anatomy Chains (which is a very interesting read if you want to learn more!). Powertaping™️ can potentially help treat pain, improve flexibility, delay muscle fatigue, and reduce imbalances. The way Powertaping™️ is thought to work is by the tape stimulating the sensorimotor system through cuteness afferent nerves. This in turn sends signals to the brain causing small adjustments to movement patterns to be made affecting proprioception. It is also thought that tape can alter the nociceptive pain pathways through the pain gate mechanism and lastly decrease tone in muscles allowing an increase in flexibility.

As you can see the way the tape affects the body interlinks and has several outcomes that are beyond just injury management. K-tape is a great tool to help injuries but can be used for so much more as stated above. Apart from massage I find it is one of the most useful treatment options to have at hand and works well with other treatment modalities. It is easy to carry round, apply and it can be used for up to 5 days. Rocktape®️ also have many colour and pattern choices, which also goes down well with clients. Lastly K-tape can be used on horses to help in a similar way to humans but I feel this is an area for its own post in the future, so watch this space.

Further information on Rocktape®️and how it can help movement can be found here blog.