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Is tennis elbow just about an inflamed tendon?

May 16, 2011 By 2 Comments

Occasionally, a patient reminds you not just of what osteopathy can do to reduce pain and improve health, but what is truly distinctive about its outlook and approach.

power lifter

Weight Lifter (this is not Liz!)

Liz (not her real name) is a successful personal trainer with a distinguished sports career in kick-boxing and competitive weightlifting at a national level.

Three years ago, she sustained an elbow injury whilst training. She initially tried to power her way through the pain, but rapidly found that the slightest stress – even carrying a mugful of tea – caused sharp, debilitating pain.

Her GP referred her to a local orthopaedic unit which rapidly confirmed his diagnosis of lateral epicondylitis, more commonly known as tennis elbow. She was initially referred for physiotherapy, followed by acupuncture. When this initial approach failed to deliver results, she was then given two successive steroid injections, equally unsuccessfully. The next step involved an arthroscopy and “extensor tendon release” surgery, and finally an injection of platelet enriched plasma into the tendon – none of which provided durable relief from the pain and handicap.

In desperation, Liz decided to consult the local osteopath in Uxbridge, located in her main gym club. The young woman I met was complaining of crippling shoulder as well as elbow pain; she was on a prescribed combination of strong drugs (Neurofen Plus, Tramadol and Diazepam) that had no lasting effect; and above all, she was angry and depressed at feeling so crippled and making no progress towards a recovery she viewed as vital if she was to pursue her fitness career.

My clinical examination confirmed all the soft tissue features typically associated with tennis elbow, but careful palpation of the elbow joint provided another critical clue: the articulation between the radial head and the humerus was slightly subluxed (i.e. “out of alignment”), generating structural soft-tissue stress that would remain unaltered until the joint was realigned.

From the instant the radio-humeral joint was reset, Liz’s relief was palpable. It required a few more sessions to rehabilitate the chronically strained related tissues in the shoulder, neck and mid-back; but essentially, Liz had not looked back, is making steady and increasingly rapid progress towards full recovery – and is gradually resuming weight-training.

Osteopathy’s view of this case is that body structure and function are permanently interrelated. If Liz’s elbow tendon was chronically injured and inflamed, was another related anatomical mal-alignment inhibiting the healing process? Addressing that question provided the key to solving Liz’s “intractable” elbow pain.

If you are suffering from tennis elbow or any other repetitive strain injury, do not hesitate to contact us for help or advice.  We are an osteopaths in Ealing and also in Uxbridge.

Filed Under: RSI, Sports Injury

When stretching a tight hamstring or calf muscle does not seem to help

March 25, 2011 By Leave a Comment

Sometimes patients come for treatment for an apparent hamstring or calf strain when persistent massage and/or stretching has not helped.

Muscle tissue tends to recover from injury quickly due to the rich blood supply; it is designed that way in order to repair and restore mobility as quickly as possible, so if it does not seem to be improving, the chances are it is not just a ‘muscle problem’.

In fact a problem is rarely isolated to just one muscle; the chances are that associated muscles will be involved, (both those that assist it and those that do the opposite movement), and the joints that are moved by the muscle action, since these are all part of an integrated musculo-skeletal system. Also, the fact that body movement tends to require a cascade of multiple joint motion and muscular coordination implies that an apparent strain in one place may be the symptom that something else is not able to do its job properly, and the pull won’t resolve until the primary cause is corrected. In addition, all these structures rely on constant and plentiful blood nutrient supply, waste product drainage and controlling nerve supply to function adequately.

London Marathon 25.04.2010 (217)All these factors are important considerations when dealing with an apparent muscular impairment, and osteopathy can assist the process towards optimal recovery by suitable evaluation, diagnosis and treatment.

Incidentally, I have seen several cases where a muscle injury turned out to have been exacerbated or even caused by excessive stretching itself. In particular, watch out after exercise when muscle fibres are already fatigued, and stretch slowly and gently to restore normal working length rather than going for broke.

In general, my take on stretching does not focus on specific muscles per se; I think of it as moving the joints through their full normal range of motion (and not beyond). After all, that is the function of muscle action, and if the joints are healthy and happy, then the muscle groups tend to take care of themselves.

Training for the London Marathon? You probably realise there are just 3 weeks to go! If you would like a sports massage in Ealing (or deep tissue massage) or Uxbridge – please get in touch.

Filed Under: Massage, Running, Sports Injury

Preparing for the London Marathon

March 24, 2011 By Leave a Comment

London MarathonWith less than four weeks to go until this year’s London Marathon I just wanted to highlight one of our very first blog posts – Treating injured marathon runners osteopathically.

We hope your preparation is going well, but if you have picked up an injury, as osteopaths in Ealing and at the Fitness First gym in Uxbridge, we may be able to help. You may also find James’ experience of receiving osteopathic treatment for an Ironman race helpful.

Good luck with the training – not long to go now!

Filed Under: Running, Sports Injury

Substitutes – stay warm and ready for action!

November 25, 2010 By 1 Comment

Rugby in the rainI am an osteopath during the week, but an assistant coach on Sundays at Ealing Trailfinders, my son’s rugby club.

At the various tournaments the club enters, I am always struck by the sight of the substitutes standing shivering-cum-frozen on the side of the pitch. They are not waiting to join the fray so much as exposing themselves to the risk of injury.

I have witnessed many half-hearted and selective warm-ups on the rugby pitch, but no matter which team sport is involved, there are two conditions necessary to ensuring a substitute is ready for action:

  • Firstly, he or she (and the rest of the team) must have engaged in a credible, whole-body, warm-up routine;
  • Secondly, he or she must keep active and warmed-up (with runs, lunges and passes) whilst awaiting the call onto the pitch.

Having taken this opportunity to moan about athlete’s insufficient readiness for sudden bursts of physical performance, let me also point out that many, if not most, of the athletes we treat in our clinic experience injuries because they do not have convincing warm-down and stretch routines at the end of a session, or get warm-up and stretch routines mixed up.

Confused? Please don’t hesitate to contact us at the Ealing clinic (020 8566 0767) or Uxbridge (01895 2000 50).

Filed Under: Muscle sprain, Running, Sports Injury

Cold, not heat, may be best to manage the symptoms of back pain

August 13, 2010 By Leave a Comment

One of the most common approaches when faced with back pain is that heat is used for symptom relief. Patients will run a warm bath, fill a hot water-bottle or apply the “deep heat” balm. They then tend to report short-term relief, followed by a relapse, or frequently, a worsening of the pain.

It boils down to this: if for any reason, a joint or joints in your back have become injured and inflamed, the muscles around that joint will tense up, partly as a natural reflex of the body to guard against further stress on these inflamed joints, and to prevent the resulting additional pain. Muscle tension in itself can increase the aching sensation, but may not tell the whole story.

Heat will cause the surrounding muscles to relax, creating an initial sense of wellbeing. However as they do relax, they can also leave the injured joints more exposed to stress, and if there is any inflammation, a hot pack will tend to encourage it, so should not be used persistently.

On balance, a more sensible remedial measure is to apply a cold pack (wrapped in kitchen roll to prevent frostbite) to the area causing pain, as this will tend to have a fairly powerful – if temporary – anti-inflammatory effect. Apply for 10-15 minutes, every hour or two.

Bridge to Health are registered osteopaths in Ealing and Uxbridge. If you have any questions regarding injury pain management, please email us (help@bridgetohealth.co.uk) or call either clinic – 020 8566 0767 (Ealing) or 01895 20050 (Uxbridge).

Filed Under: Muscle sprain, Sports Injury

How to prevent painful shin splints

March 2, 2009 By Leave a Comment

Shin splints is a term that, in essence, simply refers to lower leg pain. It is a common injury amongst runners, especially long distance runners, but it can manifest in anyone whose prime activity involves running or jumping.

Typically, shin splints are divided into three separate conditions.

Anterior compartment syndrome (ACS) – this is pain felt on the front of the shin. When we exercise our working muscles need an increased amount of blood to provide the oxygen they need, as this blood supply increases so does the size of the muscle. A thin but tough layer of tissue called fascia that keeps the muscles separate and contained surrounds muscles. As the working muscle expands, the fascia must stretch to accommodate, however in the case of ACS the fascia does not expand sufficiently, causing an increased pressure in the muscle and pain.

Medial Tibial Stress Syndrome (MTSS) – typically felt on the inside of the shin, directly on the side of the bone, this condition is caused by stress between the outer layer of the shin bone and tendon attachments. Typically seen in runners with ‘flat feet’ where the constant rolling inwards of the feet pulls on the shin bone via the tendons causing an irritation and inflammation of the bone.

Stress Fractures – constant repetitive impact gradually leads to a weakening of the bones and small hairline fractures appear causing a great deal of pain. This does not only occur in the shin but is also seen in the heel and up into the neck of the thigh bone.

What are the causes of shin splints?

  • Poor running biomechanics – when you run what does your foot do? We don’t often give this much thought… we just run! There’s a lot that should happen in the split second your foot is in contact with the ground.
  • Using the wrong shoes – for sports or activities that involve repetitive impact, make sure your shoes are giving you the support and protection you need.
  • Muscle imbalances, restricted joint movement, especially around the foot and ankle.
  • Sudden changes to your training – what type and level of training are you doing? Have you progressed gradually to this level? Sudden increases or a sudden change of surface you are training on will over-stress your lower limb.

How can I prevent shin splints?

  • Warm up properly before every training session.
  • Spend plenty of time stretching at the end of your session, especially your calf and shin muscles.
  • Try to avoid excessive running on roads. Stick to grass, tracks or cross-country.
  • Ensure your shoes are giving your foot the support it needs. For runners, make sure you have shoes specifically fitted to your running style and be aware of when to retire them, generally between 500-700 miles.
  • Keep well hydrated.
  • Spend time training in other sports to vary the training effect, especially sports which involve lateral, side-to-side, movements.

The most important point to consider with these injuries is to listen to the messages from your body. If you feel any new ‘niggles’, aches and pains, especially in the lower leg, don’t ignore them. These are overuse injuries and the body needs rest to help them recover. It is a common trait of the long distance runner to ignore these signs for fear that resting will affect future goals, but think about the big picture, eventually, if left unchecked these pains may develop into a debilitating condition that may prevent any running for several months.

Bridge to Health are offering running assessments for anyone who is concerned with their training and the risks of developing injury, followed by any relevant treatment and rehabilitative exercises. Please contact the clinic for more information.

Filed Under: Running, Sports Injury Tagged With: , , , ,

Sports Massage and Osteopathy

February 10, 2009 By Leave a Comment

We often have patients come to us for a Deep Tissue Sports Massages to relieve tension, work-out aches and for simple relief of stress. This is a great treatment to work into knotted muscles, and stimulate blood flow. Although we provide such treatment as a specific service, we are always looking at the body through osteopathic eyes and we often find that although the massage will achieve the desired result, the effect is not always as long lasting as it might be with a more holistic approach to treatment.

Sports massage is extremely effective for patients involved in… you guessed it… Sports! By treating the working muscles before training or competing, performance can be enhanced, and massage post event will speed recovery. But you don’t have to be a high level athlete to reap the rewards.

We often use these massage techniques as an integral component of broader osteopathic treatment. It must be added that the reason some patients like this kind of treatment is that it is quite simply an enjoyable and relaxing treatment in its own right.

The Bridge to Health Osteopathic Healthcare clinic is located in Uxbridge town centre, 4 minutes walk from Uxbridge station on the Picadilly and Metropolitan underground lines (so we are just a hop from Hillingdon, Ickenham and Ruislip). Nearest car park is Cedars, off the roundabout on Oxford Road.

Filed Under: BridgetoHealth, Massage, Osteopathy, Sports Injury, Stress Relief / Management Tagged With: , , , ,

More patients' stories: running the Ironman, and living with chronic back pain

January 20, 2009 By Leave a Comment

Two more patients’ stories have been added to the testimonials page:

Both were first published in our monthly newsletter. Click here if you would like to subscribe to the  Bridge to Health newsletter. It’s free, easy to sign-up, keep informed about what’s happening at Bridge to Health, tips and advice for a healthier lifestyle, plus special offers too.

Filed Under: BridgetoHealth, Osteopathy, Running, Sports Injury Tagged With: ,

Treating and preventing repetitive strain injury

June 9, 2008 By Leave a Comment

Several of our patients are being treated for Repetitive Strain Injury (RSI for short) – most frequently tennis elbow and achilles tendonitis – and other patients often ask us about what lies behind RSI. Today’s post aims to provide some basic answers to these queries.

What is Repetitive Strain Injury?

Repetitive Stain Injury is an “umbrella diagnosis” that accounts for a wide range of musculoskeletal pain disorders as a result of overuse of the body. This is most often experienced in the arm due to occupational strain.

(Musculoskeletal = bones / muscles / tendons)

The pain is usually a sharp stabbing pain which initially comes on once the aggravating cause has ceased, however this may then go on to flair-up more often. There are many conditions that fall under this term such as Tennis elbow, Carpal tunnel, Thoracic outlet syndrome, Tendonitis and many more.

What is the cause?

When a movement or action is repeated over and over, the tissues of the body become overused and begin to break down. This leads to a build-up of inflammation as the body tries to repair the damage. Typical triggers are sporting injuries where an action is constantly repeated, for example running, swimming, serving a tennis ball can all trigger these conditions. Also, hobbies such as playing the guitar, fly-fishing, you name it! However, the most common cause of RSI in the modern age is overuse due to occupational strain and the biggest culprit of all is the computer keyboard – especially laptop computers.

How to fix/cure RSI

The most important element of the healing process is rest to allow the body to heal the tissue; however the dilemma faced by most patients is how to recover from an injury such as this when the causative factor is the one which puts food on the table. Other treatment methods are cryotherapy (using ice/cold water to help heal sprains) to reduce the inflammation and manual therapy such as osteopathy, physiotherapy and acupuncture.

Others methods involve applying a joint splint or forearm compression bandages to alleviate the pressure on the muscle insertion point.

How can I prevent Repetitive Strain Injury?

For many office-bound people, inevitably the bulk of the day is spent on a laptop but this needn’t be a guarantee that you will be affected by RSI.

  • Seek advice on correct setup of your workstation, both at work and at home;
  • Take regular breaks throughout the day, even if some are just 2 minute breaks, to stretch the arms, shoulders and back;
  • Maintain good hydration at all time: you should be aiming for 1.5 to 2 litres of water each day. Tea and coffee are diuretics which lead to an increased expulsion of water from the body, leading to dehydration;
  • Ensure a well balanced natural diet which avoids refined and processed foods and includes plenty of fruit and vegetable intake, as it is vital for promoting tissue health;
  • Maintain good posture, this is important at all times but especially when at your desk as long periods in a poor position (typically slumped) will lead to poor circulation and nerve conduction and increase the risk of developing RSI;
  • Ensure regular exercise, which is essential for muscle health, 30 minutes of walking a day is a great boost for circulation and will improve overall health in many ways;
  • Seek good manual therapy, as it is a great way to keep muscles and joint moving correctly; a regular Osteopathic maintenance treatment will help.

If you have the symptons of RSI, don’t put off doing something about it. Bridge to Health Osteopathic Healthcare is based in Uxbridge, West London where we specialise in workplace based musculoskeletal complaints – visit our website at www.bridgetohealth.co.uk.

Filed Under: Muscle sprain, Osteopathy, RSI, Running, Sports Injury Tagged With: , , ,

Using hot/cold water and ice for burns, muscle sprains and migraines

May 27, 2008 By 2 Comments

One of the oldest, cheapest and most powerful remedies available to man is widely forgotten or misused today – we are referring here to hot and cold water, and treatments known as hydrotherapy.

As holistic osteopaths, we routinely prescribe hydrotherapy to support musculoskeletal treatment (treatment working on muscles and the skeleton): well used, water has a unique ability to stimulate the body’s tissues and healing mechanism.

At a very basic level, hot water attracts blood to the area to which it is applied, cold water draws blood away from the area.

A common misconception is the use of a hot bath or hot water bottle to calm an acute backache or joint sprain – whilst it may provide immediate relief, you will feel much worse shortly after, as the hot water draws more blood to already inflamed and congested tissues.

It is important to use hydrotherapy in a specific and reasoned manner – a few helpful examples include:

  • For a kitchen low-grade burn, run the wound under cold water for 10-15 minutes, then apply a lightly-wrung cold water compress (e.g. flannel or tea-towel) for several hours thereafter.
  • For any acute muscle strain or tear, or ankle sprain, apply a cold water compress or an ice-pack wrapped in a paper towel (frozen peas from the freezer will do as well) – apply for roughly 10 minutes every hour until the pain and inflammation abate. After a couple of days, the tissues can then be more actively treated by manual therapy.
  • In the case of more chronically inflamed tissues, hot and cold applications are used to stimulate local blood circulation and tissue repair, and drain waste matter and toxins away from the affected area. Hot and cold packs can be used for localised applications, but a shower head is excellent over a larger area like the back. Apply hot source for one minute, cold for 30 seconds, and alternate 3 times, finishing with cold, then rubbing local area vigorously.

Routine contrast (hot/cold) showers are an excellent form of whole-body revitalisation treatment. For the brave, whole body dry frictions, followed by a cold shower or bath, form a powerful routine treatment to boost the immune system. However, they must be avoided in the case of people whose immunity is already weak or run down.

A final thought for migraines, which are thought to be caused by excessive blood vessel constriction, followed by rebound dilation causing the migraine through increased cranial pressure. At this point, distraction hydrotherapy – using a hot water footbath combined with a cold head compress – can have a powerful effect in drawing blood away from the cranium, and thus reducing or shortening migraine symptoms.

Filed Under: Hydrotherapy, Muscle sprain, Sports Injury
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