All things exercise, injuries, treatment & rehab!
What is IASTM?
How will IASTM help?
IASTM will help you by reducing pain, improving function and increasing range of motion through a deeper approach by precisely locating regions of pathology. It does this by:
What to expect from an IASTM session?
During an IASTM session you will experience up to eight techniques to achieve the treatment goal, whether that would be to improve fluid circulation or aid remodelling of tissue. At the beginning of an IASTM session the therapist will use the tool to scan the region, for example the hamstrings, to identify any specific areas of tightness or stiffness. The area will then be warmed up and once warm the other techniques will be applied to the areas identified during scanning. The techniques are applied for up to 90 seconds per region and then for approximately 10 minutes per site. Localised inflammation will be present after an IASTM session due to the pressure applied during the session, this encourages the healing process.
What conditions can IASTM help?
Why have IASTM vs normal soft tissue massage?
IASTM can be performed as a sole treatment or within a normal soft tissue massage treatment session. It is a more targeted treatment to specifically focus on the injured tissue with the use of a tool.
If you would like to learn more about IASTM or more about what we do in general, please get in touch. Equally, if you would like to book an IASTM session then click here and we would be more than happy to help.
What Is Dry Needling?
Dry needling is an invasive technique, using a very fine needle inserted into the skin to release myofascial trigger points. Trigger points are a hypersensitive region within a muscle that can cause pain and can present as a tight band within the muscle or a nodule, commonly referred to as ‘knots’. These trigger points can cause pain at the area and often refer pain around the region of the trigger point too. Dry needling helps in the release of the trigger point and the pain or discomfort that can be felt because of it.
What to expect from a Dry Needling treatment
What conditions can Dry Needling help?
By using dry needling in conjunction with other treatments, it can help with different conditions in which myofascial tension occurs, such as:
Calvo-Lobo C, Pacheco-da-Costa S, Martínez-Martínez J, Rodríguez-Sanz D, Cuesta-Álvaro P, López-López D. Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized Clinical Trial. J Geriatr Phys Ther. 2016;41(1):1–13. doi:10.1519/JPT.0000000000000079
Cotchett, M., Munteanu, S., Landorf, K., Effectiveness of Trigger Point Dry Needling for Plantar Heel Pain: A Randomized Controlled Trial, Physical Therapy, Volume 94, Issue 8, 1 August 2014, Pages 1083–1094, https://doi.org/10.2522/ptj.20130255
Fusco P, Di Carlo S, Scimia P, Degan G, Petrucci E, Marinangeli F. Ultrasound-guided Dry Needling Treatment of Myofascial Trigger Points for Piriformis Syndrome Management: A Case Series. J Chiropr Med. 2018;17(3):198–200. doi:10.1016/j.jcm.2018.04.002
Gildir S, Tüzün EH, Eroğlu G, Eker L. A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache. Medicine (Baltimore). 2019;98(8):e14520. doi:10.1097/MD.0000000000014520
Kietrys, D., Palombaro, K.M., Azzaretto, E., Hubler, R., Schaller, B., Schlussel, J.M., Tucker, M. (2013) 'Effectiveness of Dry Needling for Upper-Quarter Myofascial Pain: A Systematic Review and Meta-analysis ',Journal of Orthopaedic & Sports Physical Therapy, 43(9), pp. 620-634.
Kubo, K., Yajima, H., Takayama, M. et al. Eur J Appl Physiol (2010) 109: 545. https://doi.org/10.1007/s00421-010-1368-z
Morihisa R, Eskew J, McNamara A, Young J. DRY NEEDLING IN SUBJECTS WITH MUSCULAR TRIGGER POINTS IN THE LOWER QUARTER: A SYSTEMATIC REVIEW. Int J Sports Phys Ther. 2016;11(1):1–14.
Shariat, A., Noormohammadpour, P., Hossein Memari, A., Ansari, N., Cleland, J and Kordi, R. Acute effects of one session dry needling on a chronic golfer’s elbow disability. J Exerc Rehab, 2018, 14, 138-142
Lower back pain
One of the most common injuries golfers experience is lower back pain (Robinson et al., 2018). With the repetitive rotation of a golf swing and bent over stance players perform, the stress through the back is high. Torque (rotational force) created through the pelvis and lumbar spine can overload and strain muscles, ligaments and tendons of lower back. Although muscle and ligament injuries are most common, other injuries to the lower back include disc, degenerative arthritis and bone stress fractures. Back injuries are more common in amateur players then professionals and slightly more common in men than women (Batt,1992).
Golfers and Tennis Elbow
A D Murray, L Daines, D Archibald, R A Hawkes, C Schiphorst, P Kelly, L Grant, N Mutrie (2016) 'The relationships between golf and health: a scoping review',Br J Sports Med.10.1136(096625)
A McHardy, H Pollard (2005) 'Muscle activity during the golf swing', Br J Sports Med, 2005;39:799–804.(doi: 10.1136/bjsm.2005.020271).
M. E. Batt (1992) 'A survey of golf injuries in amateur golfers',BrJ Sp Med, 26(1)(63)
P Robinson, I Murray, A Duckworth, R Hawkes, D Glover, N Tilley, R Hillman, C Oliver, A Murray (2018) 'Systematic review of musculoskeletal injuries in professional golfers',Br J Sports Med,10.1136(099572 ).
Running is a great way to stay active and healthy but with an increase volume or intensity in training, injuries can occur. Here are some of the most common running injuries along with some advice on how to help relieve the symptoms and reduce your likelihood of injury in the first place.
What is it?
Often referred to as Achilles tendonitis or tendonosis, Achilles tendinopathy affects the tendon at the back of the leg. The Achilles tendon connects the muscles of the calf (gastrocnemius and soleus) to the back of your heel and helps with plantarflexion (pointing your foot). Symptoms of Achilles tendinopathy usually develop gradually and include stiffness and pain around the Achilles region which is worse in the morning, but it often eases quite quickly. It may be sore when you start activity but quickly reduce as you continue and is often sore the next day. The tendon may be painful to touch and swelling may be present at the area of the Achilles tendon affected.
Why does it occur?
Whilst running, the foot should move through dorsiflexion during heel strike and plantarflexion during the push off phase of a stride. This repetitive movement means the muscles and the Achilles tendon are working constantly, in a spring-like fashion. Runners have a high chance of developing Achilles tendinopathy due to overuse, which disrupts the structure of the tendon and causes detriment to the spring-like mechanism.
Increases in loading are the biggest contributor to the onset of Achilles tendinopathy, whether this be from training or competition. Also, reduced recovery between training sessions, training on different surfaces and poor or different footwear are all factors that can contribute to the development of symptoms.
Predisposing factors for Achilles tendinopathy include gender – it is more common in males - type 2 diabetes and genetic predisposition. Altered lower limb biomechanics such as reduction in range of motion of the ankle joint and restricted flexibility of the calf muscles also contribute to Achilles tendinopathy arising.
5 Benefits of Pregnancy Massage
1. Relieve aches and pains
Throughout pregnancy, there are many physiological changes that occur to a woman’s body that can affect the way she moves and the way she feels. For example, the extra weight of the growing baby shifts the centre of gravity forward and the natural curve of the lower back becomes more exaggerated, which can contribute to the common problem of lower back pain. Muscles can become achy and tense and the hormones released during pregnancy can cause ligaments to soften and increase their laxity (Calguneri et al., 1982), which may contribute to pain around the back, hips and pelvis. Massage is a great way to help with these aches and pains. It can help to release the tension found in muscles and alleviate some stress on weight-bearing joints. In a study completed by El-Hosary et al. (2016), massage was found to be effective in helping back pain, headaches and muscle cramps in pregnant women.
2. Improve blood circulation
Pregnancy massage can improve blood circulation, therefore increasing the amount of oxygen rich blood that is delivered to the soft tissues being worked on. Massage can also help with blood pressure (Moeini et al., 2011). It also stimulates the lymphatic system, which helps with the removal of waste material from tissues of the body.
3. Aids relaxation
One of the more important benefits of Pregnancy Massage is that it provides time for the mother to unwind, helps her relax and relieves stress. Massage can help pregnant ladies with anxiety and depression (Field et al. 2007). Field et al. (2004) found that after massage, pregnant ladies had higher levels of dopamine and serotonin, those ‘feel good’ hormones that help with anxiety and depression and suggested that pregnancy massage benefits mum and baby.
4. Improves sleep
Hollebach et al. (2013) reported that massage during pregnancy is associated with a better quality of sleep. By reducing any stress and anxiety mum may feel, massage may help the mum to get a better night’s sleep. Also, by helping relieve any aches or pains, mum might feel more comfortable in sleeping positions that allow her to get a good night’s rest.
5. Enjoy the experience of carrying baby
With all the changes going on, it is important for mums-to-be to relax and enjoy carrying their baby. Mums who are more relaxed, comfortable and happy can enjoy the experience of being pregnant. Pregnancy massage is a great way to help Mum enjoy this time and make the experience unforgettable.
Massage After Pregnancy
After 9 months of pregnancy, labour and birth, it’s safe to say the mum’s body has been through a lot! Now is the time to recover, relax and enjoy spending time with your baby. Massage is a great way to help the body to recover and give the new mum a bit of time to herself to relax and recuperate.
Call today if you have any questions about pregnancy massage or to book your pregnancy massage appointment. If you have any concerns or current conditions, it is best to consult your doctor before having pregnancy massage.
The festive season has begun and it is always an exciting time of year. It is the perfect opportunity to rest and let your body recover. A perfect opportunity to surprise your loved one with a Christmas gift, a sports massage voucher from PLPR, designed by staff member Leah Boal. An example voucher can be seen below!
Often, we take a break from exercise over the festive period and return in the new year with a sudden increase in exercise, often in line with New Year resolutions. This acute increase can however lead to injury, as described in a previous blog post by Park Lane Performance and Rehabilitation.
To keep yourself healthy over the festive period, we recommend that if you reduce your activity, you build it up slowly in the New Year and place emphasis on recovery periods. A post-Christmas sports massage would be a perfect way to recover and can be redeemed until April 2019.
If you would like to purchase a Christmas Voucher (60 mins £40 & 30 mins £25) then please call Ben on 07988988728 or email email@example.com
Al & Ben completed the Yorkshire Marathon on Sunday 14th of October in a very damp York. Fortunately the wind of 24 hours earlier had settled down and initially it seemed like perfect conditions for a good time but it never stopped and was a miserable day in the end. Now that the dust has settled from completing their first marathon, Al and Ben reflect on the experience.
Ben - I wouldn't say that I hit the wall. My pace definitely slowed and I felt like I had lost power from about 16 to 21 miles, but mentally I kept strong and like Al, used a number of explicit phrases to ensure that I did not walk. I knew that if I walked, I would not get moving again. There was one point that was mentally quite tough, as I looked up to see a female athlete power walking in front of me and I couldn't catch her! In the end I got a second wind and went past!
Did anything help you through?
We raised over £500 for The Whole Autism Family. Al tells us "It has been brilliant to raise money for The Whole Autism Family. The charity is very close to my heart as it was set-up by my cousin and his wife in light of their experience of the support (or lack of) for families with Autistic children. It certainly helped to keep me going when it got tough."
How has the recovery gone?
Ben - In the grand scheme of things not too bad. The only thing that took a while was the calf where I have had a previous muscle injury. But after about 5 days it was back to normal. One thing that I have noticed is that I have felt drained for the two weeks since, and a couple of gym sessions have resulted in some quite heavy DOMS.
Al - I've been surprised by how quickly I recovered. I expected to be walking like John Wayne for around a week afterwards but within a couple of days the muscle soreness settled down. I think the biggest difficulty has been getting a decent sleep, I felt pretty knackered for the whole week afterwards.
Thank you to everyone who sponsored us and all the support we received in the lead up to the race and on the day, it was a massive help!
The final countdown has begun, we are now just 30 days from our first marathon. Uh oh!
Training over the past month or so had been going well for the most part. We managed to clock up some decent mileage and felt fairly good in the process. However, the past couple of weeks have thrown up a few problems. Firstly, whilst on a long training run where we were aiming to complete 18 miles, Ben pulled up at 16.5 with fairly severe glute/hamstring/calf pain. Unable to complete the last couple of miles, we stood like two teenagers by the side of the road for his Mum to pick us up! Fortunately it has settled down and Ben has been able to run, however the test of a longer run is still awaiting.
Then this week, after nailing a ParkRun PB and two decent paced 10k’s, I’ve been struck down by a mystery stomach bug that has knocked me for six and has been followed up with a full blown cold. No running for the next few days at least at a vital time in my training. I was hoping to get the final 20 miles big run done and hen taper off but I’ll have to put it back and hope things go ok. The only benefit has been shifting a couple of KGs in the process, which should help me on race day!
So, 30 days to go and still a lot of work to do. Not quite as confident at this particular moment as I was a week or so ago, but that’s all part of the journey.
Although you probably know a bunch of people who have had surgery on their ruptured Anterior Cruciate Ligament (ACL), they are relatively uncommon injuries. The reason we always hear about them is their severity in terms of short-term problems, time missed from sport or activity and their longer-term implications. ACL injuries are common in sports that include deceleration, landing, pivoting and cutting such as basketball, football, netball and rugby. They are also very common in snow sports. In clinic we see a large number of ACL injuries during the ski-season! The majority of ACL injuries occur in non-contact situations, meaning that the cause was not a direct blow to the knee by another person or object.
It is commonly cited that Women are at least twice as likely to rupture their ACL than Men, although a recent meta-analysis put this ratio at 1.7x higher in female athletes than males (Montalvo et al. 2018). Either way, if you are a female netball or football player reading this, then that still sucks.
You may have read a lot about ACL injury prevention programmes, there are a huge number out their claiming that they can stop it happening, each having varying degrees of success. In reality it is impossible to completely prevent any injury, however we can take measures to improve the likelihood of avoiding this pretty devastating injury.
Most recently, we have shown that 4 weeks of jump training can reduce knee valgus by almost 40% (Colclough et al. 2018). In this study, a group of female gymnasts completed a jump training programme for 15 minutes as part of their warm-up, 3 times per week. They found reduced knee valgus in both a tuck back somersault and drop jump.
Whilst in each of these cases the studies show that reductions in knee valgus can be achieved, it is unclear whether this will occur in other tasks. However, we have also found that knee valgus is correlated across several different tasks (Jones et al. 2014; Munro et al. 2017) therefore it is likely (but not definite) if we can reduce valgus in one task it will be reduced in others, therefore reducing ACL njury risk.
ACL injuries cannot be avoided completely. However, we can implement strategies to reduce the risk of injury overall. The best strategy to employ is a rounded programme that includes strength & jump-landing training whilst making sure you are getting relevant feedback on your performance throughout.
If you would like more information about reducing your risk of injury (not just ACL) then get in touch!
- “What’s my risk of sustaining an ACL injury while playing sports?” A systematic review with meta-analysis. Montalvo et al. (2018), BJSM.
- Understanding and preventing ACL injuries: Current biomechanical and epidemiologic considerations - update 2010. Hewett, T. E., Ford, K. R., Hoogenboom, B. J., & Myer, G. D. (2010). North American Journal of Sports Physical Therapy, 5(4), 234e251.
- The effect of videotape augmented feedback on drop jump landing strategy: Implications for anterior cruciate ligament and patellofemoral joint injury prevention. Munro & Herrington (2014). The Knee.
- A preliminary study into the effect of jumpingelanding training and strength training on frontal plane projection angle. Herrington, Munro & Comfort (2015). Manual Therapy.
- The Relationship Between 2-Dimensional Knee-Valgus Angles During Single-Leg Squat, Single-Leg-Land, and Drop-Jump Screening Tests. Munro, Herrington & Comfort (2017). Journal of Sport Rehabilitation
- The effects of a four week jump-training program on frontal plane projection angle in female gymnasts. Colclough, Munro, Herrington, McMahon, Comfort (2018). Physical Therapy in Sport
- Is There a Relationship Between Landing, Cutting, and Pivoting Tasks in Terms of the Characteristics of Dynamic Knee Valgus? Jones, Herrington, Munro, Graham-Smith (2014). AJSM
Many people extol the virtues of a good sports massage for a number of reasons - stress reduction, injury prevention, recovery, reducing muscle soreness and improving movement - but does the evidence support this? In short, yes and no. There are a number of positive studies and also those showing no effects, although most of the studies undertaken have some flaws.
In this blog, we will look at each of the proposed benefits of massage and briefly discuss the evidence available to determine the usefulness of massage.
Effect on stress, mood and anxiety
This is one area where almost complete consensus exists, massage makes you feel better! A number of studies have shown that massage can relieve anxiety and increase feelings of relaxation. Weinberg et al. (1988), Hemmings (2000) & Cowen et al. (2006) have all shown that massage reduces tension, fatigue, anxiety & depression whilst improving mood. This is supported by Leivadi et al. (1999) who found that anxiety levels and cortisol levels both decreased following a period of regular massages. Zeitlin et al. (2000) also showed that massage can reduce anxiety before an academic examination whilst Szabo et al. (2008) found that massage pre-training was beneficial for reducing the perceived effort of participants in their subsequent activities. Massage can also result in the release of endorphins, otherwise known as the 'happy hormone' (Kaada & Torsteinbo, 1989).
Effects on muscle soreness (DOMS) & recovery
DOMS is a common problem for those who are new to training or have increased their training intensity and/or volume. DOMS causes significant pain and reduces an individuals capacity to function. Massage is commonly used to help alleviate DOMS with significant reductions in soreness reported in several studies (Farr et al., 2002; Hilbert et al. 2003; Zainuddin et al., 2005; Bakowski et al., 2008). It appears that the most effective time to have a massage to reduce the likelihood of DOMS is 2 hours post-activity. Whilst massage doesn't help to prevent loss of strength and function post-activity, a massage at any time point is likely to reduce the feelings of soreness being experienced which is always positive!
Many athletes will tell you that having regular massages is a large part of their success. The evidence to support this is lacking however, with active recovery being shown to be more beneficial than massage. That being said, the power of placebo is huge and may account for the consistently positive reports around massage.
Effects on Range of Motion (ROM)
Reduced ROM can influence movement, performance and possibly injury risk, therefore having adequate ROM for function is vital. There are several mechanisms available to increase ROM, including massage, stretching and foam rolling. However, static stretching may impair force production and may make tendons more compliant (which isn't a good thing if you have a tendon problem!). Foam rolling clearly has some positive effects (to be dicussed in another blog) but it cannot replicate the positive mental effects of massage.
Massage has been shown to improve ROM in almost all areas of the body. Two systematic reviews have shown that massage can increase ROM at the shoulder (van den Dolder, 2003; Young-Ran, 2017), whilst Sefton et al. (2011) found increases in neck ROM following a massage intervention. Several studies have found increased ROM in the hamstrings (Hopper et al., 2005; Arabaci, 2008; Arazi et al., 2012) and the ankle (Wiktorsson-Moller et al., 1983).
Effect on injury prevention
Unfortunately, it is almost impossible to study the effect of massage on injury prevention due to the number of factors that can influence injury itself (training, age, previous injuries, strength, etc). However, there is evidence that massage can improve immune system function (Rapaport et al., 2012), reducing the likelihood of illness.
Having worked as part of a medical department who administered regular massages to all players I have seen first hand the beneficial effect it can have. In fact, the team had one of the lowest injury rates in the Premier League for several seasons. One of the benefits of regular massage is the ability of skilled massage therapists to detect specific issues and highlight them for further treatment or intervention. It is also an opportunity for players to discuss how they are feeling and report minor niggles that may prevent them from becoming a full-blown injury. This is one of the reasons we encourage all players at the rugby to get regular massages from our student therapists.
Overall, the evidence suggests that there will be no negative effects of having a massage and the positive effects on mood, relaxation and muscle soreness are certainly helpful. So should you have a sports massage to help with your health, wellbeing and performance? Definitely, with one caveat...it is from a suitably qualified practitioner who understands your needs.
The final ride has been completed! Circa 60-65 miles to Preston and back on Saturday. The rather annoying thing is that I forgot to turn my GPS on after I had stopped at Dan’s whilst he got his bike out! So, it actually has only recorded 52.8 miles.
The journey begins tomorrow!
Importantly, the moving time was 3 hrs 56 mins for 52 miles, which means that we are at a pace on track to make the ferry. We stopped a few times on the way up to Preston, and whilst we were there, which meant that we were out for about 5 hours, but on the day, we will make the ferry with plenty of time to spare (Fingers and toes are crossed!)
Now, I need to focus on my nutrition, and have been doing so for the last 24 hours. Plenty of carbohydrates on board, ready for the intense 5 hours or so tomorrow. Then for circa 110 on Saturday. This time I will leave my GPS running.
Happily, I have now managed to raise £600 for Destination Florida, which I am delighted about. Thank you to everyone who has donated so far and I am very happy that it will go to such a good cause. I am now going to attempt to set up a live tracker, so that anyone who is interested can see my progress, so keep an eye out for that. In the mean time, everyone can feel sorry for me that this is what I have to contend with looking at for the next couple of days!
It suddenly dawned on me this morning that I have 3 months until the Yorkshire Marathon thanks to a post to a post on their Facebook page.. S**t just got real! Since I ran the Baildon Boundary Way in April my focus has been on rehab for my ankle which has gone well. Fortunately I have been running but keeping the distance mostly between 5-10km. I posted a Parkrun PB this weekend, which I was happy with after a week on drinking and eating in Devon! The sub-20min goal is still proving elusive though.
You know that serious marathon training is starting when you are out at 7:30am on a Sunday morning whilst on holiday. Part of that was due to the high temperatures we’ve been experiencing the past few weeks, but it’s also nice to get out and have the run out of the way for the day. I didn’t realise quite how hilly it was in Devon, but it was a good test for my ankle and it felt good, so happy all round.
Consistency for the runnnimg is going to be key from now on in and I am following a Nike+ run club programme to help. It’s a good combination of track, interval and hill sessions along with the weekly long run and the variety will help to keep me interested and motivated.
Keep an eye on our Instagram and Facebook pages over the coming months for more regular updates on both mine and Ben’s progress.
After a difficult couple of months for personal reasons, and interrupted training schedules due to my holiday, the training is well underway once more! A two-week holiday was just the chillout that I needed amidst all that has been going on. Luckily for me, it was all inclusive which usually means that I pig out for the entire two weeks that I am away. This time around however, I made a conscious effort to eat well, with the knowledge that I have the bike ride approaching (and my first full marathon shortly after that!). I also managed to get to the gym 10 out of the 14 days that I was away and although I did not use the exercise bike there, I kept up with my S&C programme. As a result, I have returned home in great shape and was able to get back on the bike again last week, feeling just as good as I did prior to the holiday.
So, as I mentioned in the 3rd episode of the blog, I have got “the bug” for this cycling now. So much so, that on Thursday evening, we were cycling our normal route up to Dunham Massey when I had a drastic realisation that my equipment was not good enough.
We were on the return leg, coming down the mile road from Carrington to Flixton (admittedly after the usual pit stop in Lymm). I turned onto the mile road, and my cycling buddy says, and I quote, “right, let’s get a shift on”. So, I happily obliged, picked up speed and in the process, overtook a pleasant cyclist, who was on a relaxing ride, wearing his pink cap. Shortly afterwards, I had reached terminal velocity and I was starting to feel a little bit fatigued trying desperately to get more speed up. At this point, the cyclist wearing the pink cap accelerated past me, looking extremely smug with himself. I couldn’t help but completely throw my toys out of the pram. There is no way that I should be being overtaken, and my competitive nature meant that I came to the conclusion that it was my bike that had let me down. I was in 14th gear, trying to go faster, but the bike wouldn’t let me.
So, on Friday, I headed to Evans cycles and upgraded my bike, which can be seen in the picture. I would very much like to be tested again against the rider in the pink hat. Just to clarify, I have nothing against pink caps, however it was the most distinguishing feature.
I headed out on Sunday on a 16 miler, with a time of 58 mins 28 seconds, averaging 16.6mph, which is above the speed that we need for the London to Paris ride. Considering I was in a new riding position on an unfamiliar bike, I was very happy. It is amazing how much of a difference a better bike makes!
I am away on a conference for the rest of this week, but look forward to getting out early next week for a bit of distance!
You will have struggled to miss the story about Mo Salah injuring his shoulder during Liverpool's Champions League Final defeat to Real Madrid. With some clamour to ban Sergio Ramos and an Egyptian lawyer threatening him with a €1bn lawsuit it is clear that this story has generated some interest. Egyptian football fans face a worrying wait to see if their star player will be fit for the World Cup in a couple of weeks time.
We have decided to look at the injury in more detail and the possible treatments Salah may receive in order to get him fit as quickly as possible.
What actually happened?
What are the likely injuries?
My initial thoughts were that Salah had either damaged his acromioclavicular joint (ACJ) or fractured his clavicle (collarbone), with the clavicular fracture obviously being an immediate problem, whereas an ACJ injury could have been managed allowing Salah to continue. However, it has been reported that Salah dislocated his shoulder, meaning that his humerus bone was separated from its socket within the scapula (shoulder blade). This is an extermely painful injury (from personal experience!) although I would be inclined to say that he subluxed the shoulder rather than dislocated it. The difference here being that with a subluxation the shoulder is partically dislocated and the humeral head pops back into the socket, whereas a dislocation results in the humerus staying out of the joint in the majority of cases.
Despite the Egyptian FA's assertion that the X-ray showed that Salah simply had a sprain of the shoulder ligaments, this is actually impossible to ascertain from this test. X-rays cannot show ligament damage, they simply show us whether there is any damage to the bone. Therefore it would be more accruate to assume that the X-ray showed no bony damage, which in itself is significant in this case. A bony Bankart lesion involves a fracture of part of the glenoid of the scapular and is relatively common in traumatic shoulder dislocations. An early repair of this type of injury via surgery is important to reduce the likelihood of recurrent issues. This would have been extremely difficult to manage for the World Cup and would likely have forced Salah out.
What is the likely treatment?
Working in rugby we see a significant number of injuries to all three of these structures, with very differing management and long-term prognosis. The initial treatment for each includes placing the arm in a sling to minimise any further damage to the injured tissue and those around it, whilst also trying to help manage the pain the individual is experiencing. We will generally manage minor ACJ injuries (grade 1 and some grade 2) ourselves with therapy, rehabilitation and appropriate taping.
Any more significant ACJ injuries (some grade 2 & grade 3), clavicular fractures and shoulder dislocations will be referred to specific shoulder specialists for further investigation and surgical management. There is strong evidence that surgery to help stabilise the shoulder joint following first time disclocation is key in reducing the likelihood of recurrent dislocations. This is now a common first line treatment in most athletes and involves around a 12 week period of rehabilitation prior to returning to full activity.
What are the implications for his club?
Not only did Liverpool lose their star player in the biggest game of the season, it is likely they will lose him for an early portion of next season too. With the 25th of June being the earliest date Egypt will finish their World Cup campaign, the earliest Salah should return is mid-September, therefore meaning he may miss the first month of the new season. Theo Walcott's rehabilitation from a similar injury lasted four months in total and he still felt the psychological effects many months later.
It will be interesting to see how this story develops and the long-term impact of the injury on Salah's career.
In summary, the training so far for the Destination Florida charity cycle has been phenomenal! So far the donations page stands at £283.37 which is fantastic, but it is now time to give it that extra push. I never thought I would get “the bug” for cycling, as historically it is not something that I have enjoyed. I managed to get out with Dan for the first time in preparation for the event, and we planned a 40-mile route.
I awoke, bright and early on Sunday morning (with a slight hangover from the Royal Wedding party that I attended on Saturday), to find the most perfect cycling conditions imaginable. Empty roads (the Sunday drivers hadn’t yet awoken), gleaming sunshine, the slightest of breezes… what could possibly go wrong???
I switched Strava on from Dan’s in Worsley, and then headed out onto the East Lancs road. We took it steady as it was the first substantial distance that we had both done and we didn’t want to burn out too early. We battled the rugged conditions of the cycle paths and the Sunday morning cycle traffic all the way to the end of the East Lancs, before turning and heading into Warrington. We passed McDonald’s, where we stopped and sat out in the sun for a coffee (I resisted the temptation for a Big Mac). It was a very pleasant break, although I don’t think the locals appreciated two men sat in lycra outside their local fast food haunt. It attracted some funny looks.
Back onto the bikes we headed towards Thelwall, and even managed to find time to stop for a selfie. Onto Lymm, where we went through the town centre and had a full debate about the pros and cons of stopping for a pint – unfortunately the pubs were all shut as it was still silly o’clock on a Sunday morning.
Onto Partington and Carrington, flying along thinking about the last sprint home, when catastrophe struck. On the bend between Partington and Carrington, I struck a pothole. This pot hole resembled more of a crater in the road surface, extending from the kerb to the centre of the road, on the crest of a blind hill, and it split my inner tube right down the middle. Whilst we were attempting to repair this, to no avail, we were watching other cyclists, who knew the roads a little better, come over the blind crest of the hill onto the wrong side of the road to avoid the terrible surface. Even cars were having to slow to a crawl to navigate the conditions. That road surface will cause a serious injury or even a loss of life, so it’s about time that the council did something about it! They have been notified but unfortunately, up to this point 3 days later they have failed to acknowledge the conversation.
So, a catastrophic puncture calls for one thing. A call to the absolute legend that is my Grandad! Within minutes, he had dropped everything that he was doing and came to rescue me and my bike, before I would have picked it up, smashed it to pieces and threw it over the fence that I was stood next to! Hopefully, this doesn’t happen somewhere between Dieppe and Paris as I think he may be a little more reluctant to drive and meet us! Lesson learnt for me though, buy some spare inner tubes, rookie mistake!
What’s next for me then? I am continuing with the personalised S&C programme & meal plan given to me by Chris Hobbs during the week. My recovery is centred around stretching and foam rolling, and I will most definitely be booking in for some torture with Sam at the Urmston clinic. During the week I attended a course titled “Understanding Pain and Myofascial restriction”, led by GB boxing Physio, Ian Gatt. It was a fantastic course and I was lucky enough to receive treatment on my Quads with Hawk Grip instruments. They were well worth it, and my Quads have felt brilliant since, so I will do a separate blog piece on the benefits of myofascial release at a later date!
Since my last marathon blog post I have been plugging away with training for the Baildon Boundary Way. This isn't your usual half-marathon, as you can see from the photo it is often muddy and always hilly! I have posted previously about the race and my aim to beat last years time of 1:53. I am pleased to say I managed to beat that, completing the course in 1 hour 50 mins. I was a bit gutted to miss out on sub 1:50 by about 10 seconds, which was my aim before the race but happy to pull out my best performance on my fourth attempt.
I did struggle on the hills this time around, an ankle injury I picked up a little while back (I missed a step whilst carrying Billy and managed to damage my syndesmosis a bit) left me with very little power from my left leg from a dorsi-flexed position. It doesn't cause me any problems on flat and slight inclines, but left me with little more than a shock absorber on the steeper hills - and there were a few of those! Some strength, balance and power work to do over the next few months to get that one sorted.
After the race we did notice that a diversion that had been forced on the organisers meant another hill had been added to the course this time, much to our delight! The descent in this case was through a lot of mud and leaves, I managed to fall on my backside 3 times on the way down, hopefully nobody caught it on camera!
So, my marathon preparation for October has been progressing well. As we all know, I am making it a habit to be easily coaxed into some form of mad activity. Usually the culprit is Allan Munro, however this time he is not responsible. Another one of my mates rang me during the week, and I quote, with “an idea that I’ve been thinking about for a while.”
So, it turns out that this idea was a bike ride from London to Paris, via Newhaven and the Avenue Verte. After short deliberation I agreed, and Dan then said, and again I quote, “oh by the way, it’s a 24-hour challenge”. Great.. the last time my backside sat on a bike was my final year of university on the way to placement.
The serious point of this blog, is that I now I have decided to do this for charity, and I am going to explain my rationale for this. Sometimes, raising money for charity for me personally is often a difficult concept, as it is hard to see where your money goes. Not in this case. My ex-supervisor at UCLan, Mandy Dunbar, has provided the perfect inspiration for this challenge, and it is about time that I showed my gratitude to her for her help with my career progression over the past few years.
Each year, Mandy, along with a huge number of other volunteers, dedicate eight days of their time (as a minimum) to an organisation called Destination Florida, a Mancunian based charity that takes children with life-threatening or severe medical conditions on a once in a lifetime trip to Florida to experience the fun and enjoyment of some of the world’s best attractions. What an opportunity for these children, but what people don’t realise is the enormous amount of effort that goes on behind the scenes to make this trip possible. Approximately 110 adults dedicate their time to deliver a mobile hospital, consisting of doctors, nurses, physiotherapists, helpers and carers for the week-long trip.
These children, who in cases, have extremely limited mobility and require equipment to help them move, receive full time medical support, for a trip that enables them to forget the demands of everyday life and enjoy the kind of week away that we take for granted.
To assist with this cause, I have set up the following donations page. Before you consider whether or not to donate to the charity, I would implore you to read the following Destination Florida web page, and have a look around the website. You will then realise how amazing this organisation is and will be able to see exactly what you are contributing towards. I would like to thank you in advance for your support and let’s raise as much money as possible for these children.
Whilst you are considering whether or not to donate, you can all have a chuckle at the thought of me puffing, panting, sweating, cursing and complaining of a numb backside as I feel every bump along the course of the 24-hours. It will all be worth it for me, as I know the money raised it will all be for a fantastic cause! I will post regular updates, to keep everyone informed of my progress along the way, and will also video the trip!
So, my initial marathon blog after introducing the idea of completing a marathon. The good news is, that I have been progressing nicely with my runs. A couple of 7k outings around Urmston, a 9k and this weekend I decided to venture for a 15k around the meadows.
My initial 7k runs were comfortable, still limited by the shoulder bouncing up and down. By the time it came around to the 9k, I was well underway with the shoulder strengthening work and was able to pick up the pace without any further shoulder issues….momentarily. I soon found that this was a bad idea and the lungs and legs became the limiting factor. I still thought I could set the pace that I was comfortable with from last year, 4min 30secs per km. One thing that became apparent with the increase in distance and pace was that I had not paid enough attention to my nutrition. I had eaten a small lunch approximately 4 hours prior to my run. I remember distinctly, feeling hungry and low on energy approximately 6k into the run, coinciding with the time I ran past a number of takeaways and restaurants in Urmston town centre. The temptation to stop and have a kebab was immense, but I soon realised I am an athlete in the making, and pushed on. I made a mental note that I had to improve my nutrition moving forward. Subsequently I have invested in protein supplements and I am eating the correct foods in preparation for my runs. I will do another post around nutrition at a later date.
On Sunday, I suggested to Allan that we go on a longer run, and he was happy to oblige based on the fact that he has got the half marathon coming up shortly. I demolished a lovely carbohydrate based breakfast a couple of hours before the run and I took on plenty of fluids. We set off at a fair pace and I was comfortable up until about the 9k mark (although I do remember thinking at the 6k mark, using expletives, that we were not yet half way), at which point I definitely started to feel the pace and then the distance increase. There was definitely a psychological barrier that I had to overcome, as I knew the route and roughly how long was left. The discomfort started with minor tightening of the right hip flexor and a slight bit in the right hamstring. Thankfully I was able to dig deep and push through the psychological barrier to the end! So why did I start to tighten all of a sudden?
It is likely to do with a sudden increase in workload, which can be explain in a previous blog post. In the days prior to the run with Allan, I had been to the gym 4 times, focusing on strength training on 3 out of the 4 days. My younger brother was keen to join in with this, therefore I had to push myself that little bit further to show him who is boss! He also needed to train his aerobic fitness as the weather had affected his football training, so on one of the days we did a partner workout of 10,000m on the rower, which was not part of my initial training plan.
So, to summarise, I have increased the distance, but now it is time to let my body recover and complete a couple of shorter runs. I do not want to acutely overload my body or it will lead to injury. I will continue with my strength training, resuming tomorrow, as this is massively beneficial to running performance, as evidenced here. I cannot emphasise enough how important strength training is to running performance and I encourage you to read the blog post!
The nights are getting lighter, the weather is getting warmer and there are lots of people pounding the pavements and clocking up the miles. Running season is now in full flow and it is this time of year that we often speak to runners about how to improve their training and avoid injuries. I am still amazed that despite clear evidence to support the positive effects of strength training on endurance performance and athletes like Sir Mo Farah extolling the virtues of strength training, many runners still avoid lifting any weights.
In this blog we will discuss some of the popular myths we hear from runners who do not undertake any form of weight/resistance/strength training and the benefits of incorporated it into your training program.
Myth #1 - if I do weights I will get heavier
Simply lifting weights will not result in you turning into Arnold Schwarzenegger. Bulking up and getting heavier is not that simple. The shear volume of internet and magazine articles and social media posts about getting 'ripped', 'stacked' or looking like Tom Hardy or Chris Hemsworth should tell you this.
The volume of weights you need to lift to put on serious muscle mass is way over the amount you would be lifting as part of your running training programme. The amount of time you spend running will far outweigh your time in the gym making it almost impossible to gain weight. If you are, it is more likely to be a nutrition problem than a training issue.
Myth #2 - strength training is an added bonus to running training
For all the reasons I will discuss later in this post, strength training should be a integral part of a running training program to improve performance and reduce risk of injury, not something seen as an added bonus.
Myth #3 - Bodyweight exercises are enough for runners
The forces our body experience during running are much greater than bodyweight exercises alone can train us for. Typically we would expect vertcial ground reaction forces (the force we experience when we land during each step) of at least two times our bodyweight during running - so an average person weighing around 70kg will experience at least 1400N of force (equivalent to ~140kg) during each and every step they take during a training run. Hopefully you can see why doing a bodyweight squat simply will not cut the mustard.
It is recommended for optimal performance that athletes are able to squat at least 2x their own body weight. In fact, during rehabilitation from injury we often require our patients to be able to single leg squat or leg press 1.5x their body weight to ensure they are robust enough to start jumping and running training. In practice therefore, we would expect a 70kg patient to single leg squat with a 35kg external load; or single leg press 105kg.
Myth # 4 - lifting weights will give me DOMS
DOMS (delayed onset muscle soreness) is most often caused by a high volume of unaccustomed training or eccentric loading. Put simply, if you have a good training programme which is personalised to you, then you are unlikely to experience DOMS. If you have never done any strength training before, then you may experience some soreness after the first few sessions, but as you become accustomed to the strength training then DOMS is unlikely.
The benefits of strength training.
This now brings me nicely onto the benefits of strength training. When done correctly and as part of a well structured program, strength training can both improve performance and reduce injury risk. Strength training can build the platform for injury-free running and a more robust system that has the ability to adhere to the regimen of mileage, speed and tempo work you have set. Here are some of the benefits proven by research:
- increased performance (ie. quicker times)
- increased VO2 max
- improved resting metabolic rate
- improved body composition (more muscle, less fat!)
- improved running economy
- decreased injury rates
If you would want to improve your running performance but are not sure where to start why not book in with one of our Team or try a Strength & Conditioning class?
It’s now been a month since my original marathon training blog so it’s time for an update. During that time I have managed to persuade Ben to join me! I’m not sure how enthusiastic he is about the idea at the moment but it will help with his return to activity following his shoulder operation.
The first month or so has been all about building a base fitness and getting my body used to running again after a prolonged break. I have focused on shorter runs (~5-10km) but with a decent tempo and getting my 5k time down. I managed a sub-21min Parkrun down in London a few weeks ago but would like to be sub-20 ideally.
One invaluable tool is a decent GPS and HRM watch to help track the intensity of runs and keep me in the right zone so I don’t tire too quickly. I’ve currently got a TomTom Multisport which certainly does the job but plan on upgrading to the TomTom Runner 3. The new watch can store music which will be invaluable when I start upping the mileage and I hate carrying my phone so it seems like a good option.
It’s now only 7 weeks until the Baildon Boundary Way half marathon. My aim is m to beat my time of 1:53 from last years event. I’m in similar shape at this point so I’ve got some work to do! It’s a very hilly finish to the race as you can see in the profile below, so along with increasing my mileage I will be doing plenty of hill runs.
So far there hasn’t been any sign of the Achilles trouble that I had in the second half of last year. I’ve been keeping up with regular strengthening and massage to try and keep it at bay. I am also foam rolling my calves and using a golf ball to roll out my plantar fascia on a regular basis. I am wary that I will be upping the mileage and hill work though so this will be even more valuable over the next 6 weeks or so. However. I’m confident that if I stick to my acute:chronic workload plan I’ll stay injury free.
6 weeks of hard work to come in prep for my first race of the year but I’m ready for it!
For fans of rugby union, the 6 Nations is a prospect to look forward to. It was a cracking start to the tournament with some interesting results. Those of you watching England’s dominant win over Italy, may have been unfortunate enough to hear the agonising screams from Ben Youngs early on in the first half, audible above the crowd. The scrum half was making a pass, when a player collapsed on his standing leg, making it fall into a horrendous angle. In medical terms this is into excessive knee valgus, meaning that the knee collapses inwards due to a force to the outer side of the joint.
The media and his club Leicester Tigers have reported that Youngs sustained an injury to his Medial Collateral Ligament (MCL), which is consistent with this mechanism. So what does this actually mean?
Technical bit out of the way, what does this mean for Ben Youngs? If the injury is as reported, an MCL rupture, then Ben Youngs faces a lengthy spell on the side-lines. Often, this may require surgical intervention particularly if other structures are injured alongside, but it can in some cases also be managed non-operatively.
Whatever the outcome is for Youngs, he will have to follow a strict rehabilitation protocol. This will focus initially on reduction of swelling and regaining range of motion, which can be challenging. Soft tissue massage and cryotherapy (cold treatment) will both likely be utilised in this stage. Emphasis will be placed on proprioceptive exercises. Proprioception is the ability to know where your limb is in relation to space, which is often compromised following injury. Failure to address this in early stage rehabilitation can potentially lead to risk of re-injury moving forward. Good examples of early stage proprioception exercises are single leg balance, progressing to eyes closed or to an unstable surface such as a BOSU.
The gym-based rehabilitation will continue long after return to rugby specific rehabilitation, even once back playing. Studies show that with knee injuries such as ACL reconstruction, it is recommended to continue rehabilitation and strengthening up to 12 months post-return to play!
It will be interesting to see whether Ben Youngs requires surgery on his knee. Once this is decided we can continue the blog with a more in-depth picture of the rehabilitation path that he will follow. He has a long journey ahead whichever decision is taken, and we would like to wish him the best of luck from all at Park Lane Performance and Rehabilitation and Sedgley Park Rugby Club.
What are your aims for PLPR in 2018?
It’s been so great to join the team at PLPR for the last 6 months. I have loved meeting all of the regular patients and working with them to help manage whatever injury they are struggling with. I have treated a lot of new patients at the clinic too, it’s been brilliant to get to know them and treat them from the onset of injury right through to walking out the door fit and healthy. Although I love the company of all my patients, there is nothing more satisfying than helping them get back to level they want and watching them leave injury free! In 2018 I hope to continue to increase the client base and bring the clinic to the attention of more people in the Whitefield area.
Over the past month the team and I have been preparing and developing the plans for the new postnatal “Mummy & Me” exercise classes. I have such a passion for helping mums regain that confidence and fitness they had pre-pregnancy, it can seem really daunting but exercise can make you feel so much better physically, mentally and emotionally! I can’t wait for the classes to start in the next month and to meet all the lovely mums and babies that come down.
Looking further forward into 2018, hopefully these classes can lead to the development of more classes running out of Sedgley Park. I would love to assist in antenatal exercise classes, helping to provide a safe and enjoyable way to exercise during pregnancy no matter what stage the individual is at. We have also been discussing the possibility of starting some chair based aerobic classes for the 60+ age group, reducing the risk of a multitude of health issues, it would also be a great way to help our older population stay mobile and have some fun with friends.
I have also taken over medical provision for the SPRUFC Colts, Minis and Juniors sections, I have really enjoyed meeting all the youngsters and parents who turn up rain or shine on Wednesdays and Sundays. Having an individual to provide pitchside cover and treatment for the under 18’s at the club has helped the club provide more specific treatment for any injuries that occur. I have really enjoyed discussing ways of evolving the fitness and conditioning of players to help them reach their maximum potential with Allan and Ben and hope this will continue into 2018.
What are your personal aims for 2018?
I am getting married! Due to refurbishments I am now getting married 6 months earlier than expected- this is very exciting however has also made me focus so much on March that I haven’t given the rest of the year too much thought!
Despite not having any definite plans I would like to continue to expand my skill set by going on some training courses, as geeky as it sounds I love to learn new treatment methods, skills or exercises that I can use to provide my patients with the best possible treatment I can!
2018 is going to be a year of so many new challenges for me, I can’t wait to see how it goes!
The acute:chronic workload model has gained a lot of attention over the past year or so after a series of research papers were published showing it's ability to predict injury in team sports - a full list of these publications can be found here. The model provides a ratio of recent training load (acute) to training over a prolonged period (chronic), usually the most recent week vs the previous four weeks. This can be calculated using a number of different variables - distance covered, weight lifted or minutes*RPE (rating of perceived exertion).
To work out the ratio, the acute workload value is divided by the chronic workload value. So for example if both acute and chronic workload was 3000m the ratio would be 1, whereas if acute was 3000m and chronic workload was 1500m the ratio would be 0.5. The figures below show how this would look when this is calculated in practice, using high speed running distance as the workload measure. Graph A shows acute workload measures over 4 weeks, with graphs B & C showing the addition of the chronic workload after 4 & 5 week respectively. Graph D shows the acute:chronic workload relationship over the course of a full season.
According to the research papers that have been published thus far, an acute:chronic workload ratio of 0.8-1.3 is regarded as the sweet spot, with injury risk being relatively low in this range. A ratio of 1.3 to 1.5 shows a slight increase in injury risk, whilst a ratio of >1.5 is regarded as the danger zone, where injury risk is significantly elevated. You may also note from the figure below, undertraining increases your risk of injury! So having a complete rest week may not be the most beneficial training method, however a tapering week, where workload is lower than usual would be more advantageous from an injury risk perspective.
In terms of applying this workload model to real-life, there are some spreadsheets available online to help with the calculations. It is important to consider cross-training to help maintain training loads whilst injured or when thinking about returning to play.
In the second of our series of blog posts, Clinical Director Ben Oliver tells us about his aims for 2018.
What are your aims for PLPR in 2018?
At PLPR we are delighted with the success of our first few months of business. We have built up a substantial client base and it has been a pleasure to assess, treat and rehab all of you! We are looking forward to continuing and developing over the coming year. In 2018, we aim to refurbish the clinic. We want to modernise the room and use some innovative designs to make the clinic an even more desirable place to receive treatment.
As Allan has already mentioned in the previous blog, Chloe will be introducing some post-natal classes which we are very excited about! We have already started to provide strength and conditioning sessions to the Colts at Sedgley Park rugby club, aiming to develop the players for the brutal demands of senior rugby. As of this year we have also begun to roll out sessions to the junior section at the club, introducing the youngsters to resistance training and rugby specific gym based conditioning. This aims to provide a pathway through to senior rugby!
What are you personal aims for the year?
Having recently had shoulder surgery, my short-term goal is to focus on my rehabilitation and practice what I preach! In October, I started my PhD, which has meant that I am doing less clinical work, with Chloe taking over the client base and doing a fantastic job. My focus will remain on this PhD for the foreseeable future and I will be continuing with my first team role at Sedgley Park rugby club. On an activity front, after persuading me to take part in the Baildon Boundary Way last year, Allan has persuaded me to take part in the Yorkshire marathon in October. This will be difficult from a time perspective; however, it has always been on my bucket list so there is no time like the present! With Georgina (my girlfriend) living in Hull and being a keen horse rider, it will give me the perfect motivation (and training partner in the Horse) to complete it!
Again, I would like to thank each and everyone of you that has been a part of our initial 6 months and we look forward to an exciting year ahead!
this week has seen the start of my marathon journey, I’ve been back out pounding the pavement and clocking up the miles. Running 26 miles is quite a daunting prospect, and thinking about training for this does make me wonder why I am doing it! I have signed up to run the Baildon Boundary Way in April for the fourth time to give me an early goal to aim for. I think that having smaller more achievable goals along the way is going to make a huge difference to keeping me motivated.
I managed to get down to Burnage Parkrun on Saturday morning, despite the cold, wet weather. I was really happy to come in at sub 22 minutes having not run properly for a few months. This was all despite Lake Burnage which was knee high and meant you lost feeling in your feet for a few hundred yards (see image!), and a tumble towards the end!
In order to make sure I don’t overtrain and help avoid injuries I have adopted the acute:chronic workload model for my training - see separate blog post on this subject. There has been a great deal of hype around this model and it’s ability to predict injury in team sport athletes. Basically it compares your most recent week of training against the previous 4 weeks. It can be calculated using a number of variables, I have decided to use ‘distance/time x RPE’ to give me a workload value. Time x RPE is a commonly recommended method but I feel it doesn’t give a full picture of how hard I have worked. If I cover 10km in 45mins then I will surely have worked harder than if I cover 10km in 1 hour, right? But if my RPE is 8 vs 6 respectively (workload equates to 360 in both cases) then I don’t really get the credit for the work, so the addition of distance should help (workload = 1.78 vs 0.83 respectively). Whilst this method may have some flaws (like anything) it is certainly an improvement on the previous 10% rule.
So week 1 down, many more to go. The journey has started well but there are plenty of challenges ahead.