Do It Yourself guide to treating long-term sciatica

21 May

This week’s blog is a case study which focuses on how to self-treat long term tension or ache in the back of the leg.

The client had undergone lumbar spine surgery just over twelve months previous which had been successful in treating disc-related low back pain.  However she subsequently developed an ache in the back of the thigh and gluteal area.  This was most pronounced with sustained sitting, so work and long term car journeys were a problem for her.

Examination revealed sciatic nerve tension.  In standing she could reach as far as her knees and when sitting with her legs stretched out in front she was unable to achieve an upright position.

Treatment was directed to some tender areas in the gluteal area and hamstrings but the main thrust of treatment was directed at stretching the nerve.  This was a timely process as is the nature of dealing with nerve tissue as it is the most resistant and irritable tissue in the body.

Most of the onus was on the client to carry out stretches in between treatments and I saw her every two weeks at which time I was able to apply extra tension to the nerve through certain positioning techniques.

After approximately two months she was able to touch her toes when sitting with her legs stretched out in front, and almost reach her ankles when standing.  Whilst pain remained at a much reduced level I was confident that with continuation of the self stretching techniques she would gain further improvements in flexibility and a corresponding reduction and eventual absence of the thigh pain.

I have shown below the progression of stretches which should be used in addressing sciatic pain, each of these to be done consecutively as the previous one becomes easy to do.  By following this sequence a graded increase in tension can be applied to the sciatic nerve without irritating it and causing an exacerbation of symptoms.  If low back pain is present at the same time then stretches should be applied gently and should be guided by the back ie if pain worsens then ease off.

 

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How good curves give pain a swerve

13 May

This week’s blog is about basic anatomy of the spine, essentially the shape of the spine.  The spinal vertebrae are divided into three groups – the neck, the upper back and the lower back.  The neck and the lower back both have an inward or concave curve which is called a lordosis.  The upper back has an outward or convex curve and this is called a kyphosis, however this term is often used to describe an exaggeration of that outward curve.  The upper back region (thorax) is where the rib cage is located and so tends to be more rigid then the neck and lower back and is susceptible to stiffness and sharp stabbing pains, whereas the other two areas tend to be subject more to wear and tear due to their greater flexibility.

The curves of the spine are present to help attenuate loading forces, often but not exclusively in the downward direction.  If the spine was straight like a plumb line then compressive forces would just accumulate at the base of the spine where it joins with the pelvis – this would lead to early onset wear and tear.  Exaggeration of the curves leads to postural strain where the shoulders become rounded and the head tends to poke forward, ultimately this causes muscular tension and ache and leads to wear and tear at the junctions and apex of each curve.

When viewing the spine from behind it should be straight however it is common to see curvature, often in the form of a shape of an ‘s’ which has been stretched lengthwise – this is described as scoliosis.  Scoliosis can be present temporarily in cases of low back pain where the body is compensating to unload a painful joint or disc.  It can be present due to uneven leg length which gives the impression of a raised pelvis on one side.  And it can be congenital.  Scoliosis is not always painful but due to the uneven structure of the spine it almost always causes joint stiffness and muscle shortening.

If you’re thinking of having some physiotherapy for back pain then take a look in the mirror and see if you fit into either of the shape categories above ( you will probably need someone else to look at you to get a true appreciation ).  In most instances you won’t be able to change the contours of your spine drastically, but if you visit a good  Manchester physiotherapy clinic then you should be able to get a good spell of relief.

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Comedy and Physiotherapy; when banter should take second place

7 May

This week I’m looking forward to seeing Jerry Seinfeld in Manchester.  I’m a big fan of him and Larry David and I loved the Seinfeld series when it was on back in the 90′s which seems so long ago now.

There was one episode in particular which stood out for me because Larry and George Costanza were both going to get treatment from a Physical Therapist ( as they are called in the US ), and what I found funny was the conversation they had as to whether they should talk or not while getting a massage.  Jerry said he did talk because he figured the therapist would get bored otherwise, George said that talking would spoil his enjoyment of the massage but would talk anyway because he would feel guilty if he did enjoy it!

In life there are certain transactions which take place which allow for idle chit-chat, like getting a hair cut, a taxi ride, or even checking out at the grocery till.  Physiotherapy shouldn’t be one of those situations – at least not at the first and sometimes second consultation.

My job is to get information from the client to determine what is the cause of their problem, and then continue to get feedback during treatment to monitor change and improvement.  Yes I’ve got a sense of humour and am easy-going but I’m n0t going to ask you where you’re going for your holiday or what restaurant you went to last night, not at least until your condition is improving.

I know what it’s like because I’ve been on the receiving end myself when I was getting social commentary at the first appointment and I thought ‘hang on, I’m paying you to make me feel better not be my pal’.

So if you like a bit of conversation, great – that I can do.  But more importantly if you’re serious about getting better then make sure you get to a sports injury clinic that’s equally serious about getting you better!

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How to eat your way out of an injury

1 May

Last week while treating an achilles tendon problem I was answering all of the questions that the gentleman was asking me as to what he should be doing to help his injury and get back into all of the normal physical pursuits that he enjoys.  Then he threw a curve-ball at me when he asked what foods he should be eating.

This is one of I’ve not given much thought to in the past but having read a recent article which I posted on twitter I advised him that turmeric, ginger and capsaicin (found in chillies, red peppers) were good for reducing inflammation.  Problem solved – a bit more heat in the next curry!

So I was a bit curious about this and decided to carry out an internet based literature review, and here are the findings.

Lemon and Limes are good for cuts and grazes.  Certain types of honey are actually useful when applied to a wound.

For bone healing one immediately thinks of calcium and milk.  Low fat natural yoghurt and sardines have a good ratio of calcium content per gram.

For connective tissue like tendon/ligament/cartilage, collagen is the most important part of the make-up of these tissues.  Collagen is found in dark green vegetables like Kale, spinach, asparagus, and red fruits and veg like peppers, beets and tomatoes.  (that’s the reason mother always told you to eat them!).  Eating plenty of these will also help keep wrinkles at bay.

If you think back to science class you will probably remember amino acids being the building blocks of all body tissue and of course the greatest source of amino acids is in protein rich foods.  However a high protein diet can often promote or prolong inflammation which is not good for healing overall.

And as with the list above, what you take in is not always what your body actually absorbs – this can depend on what you team your food up with.  But to put it simply it’s a case of having a good balanced diet without too much salty, sugary or processed food.  And yes alcohol can be beneficial aswell, in the right amount.

So if you have an injury and can’t get to a sports injury clinic, why not try a holistic approach and try to eat yourself better using some of the advice above….sardine saag for starters?

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The challenging transition to forefoot running

20 Apr

Last week I interviewed my friend Peter Cammack who is preparing for his fourth Iron Man, and he gave some great insight into what the biggest challenges are in doing an endurance event, where the enjoyment comes from, and how he benefits from regular sports massage while training.

In our conversation afterward he reminded me of how I helped him make the transition from normal running to forefoot running.  Now it may be a fad but it seems that forefoot running is quite a hot topic amongst runners of late.  The benefits being that there is less wear and impact on the lower limb with forefoot running, hence improving performance.

So Pete thought he’d give it a go and, probably as most people would found it quite a challenge initially.  Running like walking seems to be quite a natural thing to do and everyone has their own style.  So suddenly Peter had to actually think about how he was running in order to apply this technique effectively.

He then found that with different forces on the body he was getting aches that he had not experienced previously despite the many miles that he runs, and it mainly manifested in the calf muscles.

After twelve weeks he felt that he made the transition successfully and this was from a combination of several things.  He had to modify his technique slightly because despite having appropriate footwear – Newton trainers – he was not improving.  He had actually gone from one extreme to the other -from the normal heel strike pattern, to landing with the metatarsal heads (the ball of the foot), but with the front of the metatarsal heads as if kicking the ground.  The slight change then was to land on the bottom of the metatarsal heads, as if ‘padding’ the ground.

He then had to address the discomfort which we did through targeted massage therapy of the irritated muscle, but the breakthrough came when acupuncture was used.  An immediate improvement was noticed and he has not had any problems since.  And the ultimate outcome is that he now runs quicker!

This was one of those occasions where I was really pleased to have acupuncture as part of the treatment arsenal, because while I find it good for rotator cuff injuries and tennis elbow, it can really work wonders with some of the more meaty muscles of the body like the calf, hamstring and quadricep.

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Interview with the Iron Man

14 Apr

One of my clients is now preparing for his fourth consecutive Iron Man and I was wondering what drove him in this pursuit which requires intense discipline and many hours committed to training, often in solitude.

I asked him what were the main challenges he faced in his training and competing, what he likes so much about Iron man, and how he benefits from regularly having treatment at a manchester sports massage clinic.

Watch this short video to hear his answers.

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The Human Grand National

9 Apr

This weekend is a big one for Liverpool with both football clubs Everton and Liverpool facing each other at Wembley in the FA cup semifinal, and of course the Grand National at Aintree – one of the more exciting events in the horse racing calendar.

Not without controversy of course due to the brutal demands on the horses and subsequent high injury rate with the inevitable ‘putting down’ of some horses in the worst instance.  Not to mention the injuries to the jockeys either but of course that is of little concern to horse lovers and animal welfare spokespeople.

Of course the human equivalent of the same race is the steeplechase which took it’s name from the equine event, which is no less demanding but obviously a lot less risk to the participants.

A likelier comparison would be the ‘spartan race’ which is basically an obstacle race over several miles.  Participants get to enjoy running through mud, rapelling down steep gradients, hurling tyres, chopping wood, crawling under barbed wire, negotiating walls, crossing streams via a rope, and often timetabled at the coldest and wettest time of the year.

While the risks of injury are much greater than rolling an ankle while jumping over a hurdle, at least there’s no risk of being euthanised by an overzealous sponsor or medic!

So if you fancy a bit more of a challenge than football on a Sunday morning or a run through the woods on a Saturday afternoon, give the Spartan race a go, and remember where to go to for your sports injuries in Mancheseter.

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