4 out of 5 people are reported to suffer from lower back pain in their life-time. This causes great inconvenience and can result in a significant time off work.
Your lower back, also known as your lumbar spine, consists of 5 vertebrae bones located above the triangle base of the spine in the pelvis. This area is curved with a natural inwards curve called a lordosis. The main function of the lumbar spine is to support the structures above. The lumbar spine moves in all ranges of motion with the most of the movement coming from the bottom 2 vertebrae.
There are multiple causes of lower back pain; these include disc and muscular issues, facet joint problems and neurological, degenerative and hereditary causes. Lower back pain can present with pain going down into the legs. It is also important to know that not all lower back pain can come down this route; on occasion pain can originate from internal organ problems such as kidney or bladder issues. Lower back pain is not just caused through injury. Sitting at a desk, being pregnant and those carrying young children are common aggravating factors. These are just some examples of the causes of lower back pain.
At Herts Pain and Injury, we will carry out a full medical assessment of your lower back pain. Your osteopath will take an extensive case history and perform an appropriate physical examination to ascertain the cause of your pain and plan your treatment. Your osteopath will be able to offer you a range of treatment options as well as advice on your rehabilitation. This advice could be in the form of exercises, life style changes in order to help prevent further problems later on. Your osteopath can also refer you for imaging, including an MRI scan, where applicable.
Your Osteopath will complete a thorough case history; they’ll ask you questions about your injury, medical history, occupation, hobbies, activity levels and anything else they feel is relevant. This helps them build a picture and understand your injury.
They’ll then make a decision as to whether you require any further investigations such as MRI’s, X-rays or blood tests. If necessary they can refer you onto the appropriate professional.
Once they have got the information they need they’ll move onto the physical examination. It’s really helpful if you can wear nice stretchy clothes such as gym clothing, so that your movement isn’t restricted and they can easily see how your joints are moving.
They will ask you to go through a few different movements so they can observe your range and quality of movement. They may also perform certain neurological and musculoskeletal tests to help ascertain a diagnosis.
Once a diagnosis has been formed, they will explain this to you and go through their treatment plan. Treatment will vary for each individual case, but generally speaking it will involve a combination of hands on treatment and exercise advice.
Each shoe is designed with something in mind; a running shoe, typically isn’t the best shoe to be wearing in the gym for weightlifting or CrossFit style training.
For training in the gym, you want a nice stable heel, a bit of a heel drop and not too much cushioning. This gives you a nice stable base. Whereas for running, particularly long distances, you may want something with a little more cushioning.
Do you have any pre-existing injuries or issues?
Existing injuries should be taken into account when choosing your shoes.
For example;
If you have a history of Achillies issues, shoes with a zero heel drop probably aren’t the most suitable due to the extra strain on then tendon.
If you’re suffering with a painful big toe, a slightly stiffer shoe might be more appropriate to prevent excess strain through the joint.
Do you suffer with osteoarthritis in the knees? A shoe with more cushioning may give you a bit more shock absorbency for your knees.
Do you have particularly wide or narrow feet?
Different brands come up in different sizes to suit the various foot shapes. If you have a slightly wider foot, you need to accommodate this. Don’t try to squeeze into a pair of trainers just because you like them (I’ve definitely been very guilty of this in the past!).
‘Altra’ running shoes are great for people with wide feet, they have a really wide toe box to allow for splaying of the feet when you run!
What sort of surfaces are you running on?
Are you running on road, on rough trails, on grass, on a treadmill? All of these factors should be considered when choosing a shoe!
What sort of distance are you running?
This will potentially impact your choice; you may be quite comfortable in a light minimal shoe for short distances but as you increase your distance you might find you need something a little more supportive.
Should you get your gait analysed?
If your planning on running, I would say yes! If you’re looking for more of a ‘gym’ shoe Its not necessary!
There are a few things you should bear in mind when;
Make sure it’s by someone who knows what they are doing. A lot of running shops provide gait analysis but it’s not always by someone experienced.
Make sure they’re looking at your feet, ankles, knees and hips when you’re running. Not just your feet.
Try to ensure the shop sells a variety of brands. Certain brands are better for different people so you want to have some different options.
The knee is the most commonly injured area of the body during running with ‘Runner’s Knee’ being the umbrella for a number of conditions such as anterior knee pain syndrome, patellofemoral malalignment and ITB syndrome. Although they are classed under Runner’s Knee, they can be common in other sports such as walking, skiing, biking, jumping and field sports.
Runner’s knee causes a dull, aching pain around or behind the kneecap dependant on the condition. For example ITB syndrome will cause aching on the outside of the knee. You may feel these symptoms when you are:
Walking
Climbing or descending stairs
Squatting
Kneeling
Running
Sitting down or standing up
Sitting for a long time with the knee bent
If you are experiencing knee pain I recommend you see Osteopath or Sports Massage Therapist to assess the root of the problem, especially if it is recurring. There are many causes of Runner’s knee such as:
Overuse of the knee
misalignment of the kneecap
complete or partial dislocation of the kneecap
flat feet
weak or tight thigh muscles
inadequate stretching before exercise
Depending on the cause of Runner’s knee will depend on how it is treated, but if you are experiencing any symptoms there are a few things you can do to relieve them.
Rest – This will reduce inflammation and therefore reduce pain in the knee. Resting doesn’t mean you need to do nothing, you can still train your upper body, do yoga or pilates giving the knee sufficient rest. Due to common fears, resting will not create a dramatic drop in your running fitness, if anything it will enhance it. Use short term recovery for long term health benefits Rest and Recovery are key parts to training, which are massively overlooked. When planning your training regime, factor in rest time during the year, I normally take off time for a week or two in the summer after my races have finished and a week or two over christmas as well as some downtime after big races. Look at any major sport, they have an off season where they take a few weeks to ease their training off, recover and reset. They then start pre season and build that base back to ready for the next season.
Ice – 20mins at a time and wait at least 1hour before icing again. The more severe the inflammation will require more ice treatment.
Mobility – If certain muscles are tight, they can pull the knee and place added pressure on the joint, some basic yoga moves and mobility exercises can help to free up the joint and reduce symptoms. If your patella isn’t tracking properly then you may need specific exercises to realign the knee. It is always best to seek professional advice if you are unsure of what treatment or rehab you need.
Strength Training – Once the pain is reduced, strength training can significantly reduce Runner’s Knee symptoms and reduce the risk of it returning. Studies have shown that greater strength in the glutes provides more control at the knee joint when landing during the running stride. Below are some good exercises to kick start the glutes
Slingshot Clams
Place a resistance band around your knees
Keep the hips stacked on top of each other and don’t let the top hip roll back as you open the hip.
Perform 10 reps on each side, repeat for 3 sets.
Glute Bridge
Bend your knees so your feet are flat on the floor and knees are at 90deg
Rest your head back and place your hands down by your side
Squeeze your glutes and lift your hips up so the shoulders, hips and knees are in a line
Repeat 10 times for 3 sets
Slingshot Crab Walks
Place a band just above your knees
Start with your feet hip width apart
Take a large step out to the side then bring the trailing leg back into hip width apart
Keep your knees tracking over your feet and make sure they do not cave in.
Take 5 steps to one side, 5 steps back repeat 3 times.
Have a rest
Perform this for 3 sets.
Strengthening the rest of the legs including the quads, hamstrings and calves are all key to a strong running stride. Squats, lunges, deadlifts and calf raises are all key moves that will build up a base strength in the legs and core. If you are unsure of technique, reps, weight etc for any of these moves, don’t hesitate to drop me a message and I will be more than happy to help you with this.
Tennis Elbow, officially known as ‘Lateral Epicondylitis’ is inflammation of the tendon that attaches to the outside aspect of the elbow (Normally Extensor Carpi Radialis Brevis). Although commonly seen in tennis players, its also caused by a variety of other things.
What are the symptoms?
Normally patients present with pain and tenderness around the outside of the elbow, at the point at which the tendon attaches. They may also experience pain down into the forearm and in some cases there may be localised swelling.
Picking things up can exacerbate the symptoms, often I find that people particularly notice it when doing normal daily things like picking up the kettle to make up a cup of tea!
Repetitive movement of the wrist may also aggravate the symptoms.
Is it tennis Elbow or Golfers Elbow?
its important to differentiate between the 2 prior to commencing any form of treatment or rehab; Tennis elbow occurs on the lateral aspect of the elbow (outside). Golfers elbow occurs on the medial aspect (inside).
What causes it?
Tennis Elbow is normally caused by repetitive wrist movements, such as playing tennis or using a skrewdriver etc. The forearm muscles that extend the wrist become overworked and the point at which they attach to the elbow becomes irritated and inflamed. This then leads to pain and dysfunction.
How do you treat it?
In most cases, tennis elbow can be treated conservatively (i.e. with manual therapy such as osteo/physio and exercises).
Your Practitioner will assess your symptoms and perform a full examination to ensure that Tennis Elbow (or lateral epicondylitis) is in fact the correct diagnosis.
Every patient is different and the treatment will differ from person to person but generally speaking;
Treatment normally involves a combination of soft tissue and articulation to the elbow and forearm. They will most likely also treat the shoulder and wrist and possibly even the thoracic spine and neck. This is because 1) As a result of the tennis elbow you may have started to compensate elsewhere and/or 2) The reason it occured in the first place may be because of an issue or restriction elsewhere.
In some cases they may also choose to use Medial acupuncture alongside the treatment.
This will then be followed up with exercises you can do at home. These will normally involve a variety of exercises including; eccentric exercise for the tendon, exercises to address any restrictions elsewhere that may have lead to the injury in the first place, and some self massage or trigger therapy work.
The Osteopath may advise a tennis elbow strap whilst doing activities that particularly aggravate the symptoms. The theory behind these straps are to create a false insertion point for the muscle to take the pressure off the attachment site in order to allow it to heal.
If conservative treatment doesn’t resolve the issue, In some more severe cases a corticosteroid injection may be advised by your GP.
Think this might be something you’re suffering with?! Why not pop and have a chat with one of our therapists?
The hamstring is split into 3; Semimembranosus, Semitendinosus, and Biceps Femoris. It attaches to the pelvis, runs down the back of the thigh to the lower leg and attaches just below the knee. It’s main job is to bend the knee but it also assists with other movements.
The hamstring is commonly injured in sports. Both ends of the hamstring have very poor blood supply meaning it can take a long time to heal. The middle part of the hamstring (the muscle belly) has a great blood supply which means a speedier recovery!
Hamstring strains or a ‘pulled hamstring’ can range from Grade 1 where you may feel a slight tightness but are still able to walk, to a Grade 3 where you could have severe pain and weakness and you may need crutches to walk. There will be swelling and bruising around the area.
What are the symptoms of a hamstring strain?
Sudden severe pain during exercise – You may feel a popping or snapping sensation
Pain in the back of the thigh when walking or bending forwards
Swelling and/or bruising at the back of the thigh
General tightness and tenderness at the back of the thigh
What may lead to a hamstring strain?
Poor flexibility
Lack of warming up
General stiffness
Poor low back mobility
Poor running mechanics
Low back and pelvic pathologies or imbalances
What should you do?
If you think you’ve pulled you’re hamstring…
Stop what you’re doing – playing or training through the pain is only going to make the injury worse and slow down the recovery time.
Ice it – 15 mins at a time.
Seek the advice of an professional…(Osteopath, Physio or Chiropractor. They’ll be able to advise you on the best course of action, whether that be hands on treatment, referral to another medical professional or exercise rehabilitation.
I’m constantly being asked the difference between an Osteopath, Physio and Chiropractor…in short it really does depend on the individual therapist but here are some of the main differences.
Training
Osteopaths spend 4-7 years at university and graduate with a masters degree. The training is very musculoskeletal, with an emphasis on treating the body as a whole.
Physios spend 3 years at uni and graduate with honours degree. Their training covers musculoskeletal conditions as well as respiratory and cardiac conditions. Some of their placements may be based on hospital wards.
Chiropractors typically spend 4 years at university. Their training is also predominantly musculoskeletal based.
Treatment
Osteopaths work very holistically, they’ll look at the body as a whole. Their treatment may involve manipulations or HVT’s (clicks), soft tissue massage, stretching or joint articulation. They will also probably give you exercises to do at home alongside treatment. Some osteopaths may use other modalities such as dry needling or taping alongside the osteopathy.
Physios tend to be very good at rehab. A lot of physios particularly NHS physios may concentrate solely on exercise rehabilitation rather than hands on treatment. This completely depends on the individual therapist as some may well be very hands on! Some physios may choose to specialise in different areas so its important you choose a physio that suits your needs.
Chiropractors concentrate predominantly on HVT’s (clicks) and work on the basis that things are ‘out of alignment or subluxed’. Generally speaking their treatments tend to be a lot shorter in length. Some chiropractors will still use x-rays within their consultations, this isn’t particularly helpful within a clinical scenario unless you’re concerned about a specific condition or injury!
As I said…this varies massively between practitioners depending on their background, training and personal experience.
This is a statement I hear all the time, one that has developed with no
real evidence. If you are of healthy weight, have healthy knees and are not
subject to osteoarthritis then there is nothing to back up that running will
cause osteoarthritis in your knees. Sure, there are risks of injury through
running, but this is also true of swimming, cycling, weight lifting and of
course… being inactive. The knees are the most prone area to injury in runners
but there are ways we can reduce this risk. Build the points below into your
regime to help minimise the risk of injury during your running journey.
Strength Training
Running is a whole body exercise, strengthening your legs, hips, back
and abdominals can improve your running stride and delay fatigue. Variations of
squats, deadlifts and lunges are fundamental exercises to factor into your
strength training and with good technique will strengthen your legs, core and
back. Many knee injuries can be linked to weak or imbalanced muscles, often
coming from the hips. Isolating the glutes with exercises such as glute bridges
and clams help stablise the hips and knees and therefore reduce the risk of
injury.
Periodisation
Your running schedule should not be the same all year round, periodising
your training will improve your speed, strength, power, aerobic capacity etc,
reduce the risk of injury and will keep it interesting. Structure your training
into 4-8weeks blocks each with a different focus to improve your training.
Starting with a base foundation fitness and muscular endurance is a good place
to start before moving onto strength and power stages. There is an inverse
relationship between volume and intensity, meaning that when one increases, the
other decreases. During strength and power phases the intensity of your
training will be very high but the volume will need to drop to allow your body
to recover and get the most from your sessions. As you are starting to build
your distance up and endurance becoming the key focus, the intensity will drop.
Below is the most basic chart you will find on the relationship between
intensity vs volume.
Treatment
Self Treatment – Stretching, self
massage, mobility training
These are all things you can do yourself at home. Stretching can be done
in front of the TV in the evening to improve any extra tight muscles you have,
more importantly you need to be doing dynamic stretches before you train
to warm the muscles up, and stretches after training to help return muscles
back to their original length before your session. (Check out our free 5km
running plan on our homepage for
some pre and post running stretches).
If you have any knots or tight muscles, applying some pressure to the
area can help alleviate these. If you aren’t sure what you are doing, ask a
professional for some advice.
If you are not moving correctly the risk of injury is greatly increased…
performing some moves in the gym or at home to help mobilise joints and muscles
can greatly reduce the risk of injury.
Professional Care – Sports Massage,
Osetopathy, Physiotherapy, Coaching
Living with pain should not be normality (sore muscles after a workout
is allowed) if you are suffering with muscle or joint pain, get checked out by
an osteopath or physiotherapist and get the problem sorted. Life and training
will be much more fun if you aren’t in pain!
I recommend our friends at Herts
Pain & Injury Clinic who I see regularly to keep me in check and injury
free!
Regular sports massage will help muscles recover and work out any knotted or
tense muscles that have tightened up. Pre and post race massages are also great
to ensure you go into your race as prepared as possible and recover faster!
Having a professional coach to structure your training can prevent you
from over training, make you stronger, faster, fitter and ultimately help you
enjoy your target race! Want to have a chat about how a coach could help you
with your running? Contact Us
now and we can see if our coaching style is suited to you!
5 Ways An Osteopath Can Help you During Your Pregnancy!
1.Symphysis Pubis dysfunction OR SPD
Symphysis Pubis
Dysfunction tends to present as pain, burning, grinding or clicking at the
symphysis pubis (joint in the pubic bone). Pain may radiate into the groin,
pelvic floor, front of your thigh or lower abdomen.
Ladies with
symphysis pubis dysfunction often have difficulty walking, going up and down
stairs, standing on one leg, getting in and out of the car and turning over in
bed.
Symphysis
pubis dysfunction is thought to be caused by a variety of factors;
pelvic instability and/or asymmetry,
increased lumbar lordosis (curve of
the lower back),
weakened muscles,
rectus diastasis
poor hip function
Hormonal factors – leading to hypermobility
Over doing-it whilst pregnant
Poor posture
Lack of exercise pre pregnancy and
during pregnancy
Weight gain
Previous pregnancies
Increased maternal age
Previous difficult labours
Our Osteopaths will look at how your body functions as a whole and work with you to regain optimal function. This may involve stretching out muscles, mobilising joints or giving you exercises to work on any weaknesses. Working with your Osteopath throughout your pregnancy can help alleviate or prevent these symptoms from occurring.
2. Pelvic Girdle Pain
This is
where you get pain around the pelvis, it tends to swap from side to side and is
often associated with low back pain and/or pubic pain. The pain tends to be
worse when weight bearing or twisting e.g. turning in bed or getting out the
car. It can also cause referred pain.
This again
is thought to be due to the pelvic instability as a result of the hormonal
changes, altered posture and weight gain.
An osteopath can identify any instability or asymmetry and help you address it with a combination of treatment and exercises.
3.Coccyx pain
Coccyx pain
is more common in women due to the shape of their pelvis anyway…The added
weight gain, hypermobility from pregnancy hormones and the altered pelvic positioning
puts more pressure on the coccyx and increases the chances of suffering with
coccyx pain whilst pregnant.
By working on the musculature that attaches onto the coccyx and the joints around the pelvis, we can help take the pressure off the coccyx and improve the symptoms.
4. Back pain
Throughout
your pregnancy, your posture changes drastically. The changes that occur, will
be different in every women and every pregnancy. It’s important that your body
is able to adapt to these changes. If it can’t adapt to the changes, you’ll
start to notice aches and pains. An Osteopath will be able to help you adapt to
these changes, making you much more comfortable.
5. Hip pain
As your
bump grows throughout your pregnancy, you may find you start to turn your hips
out when you’re walking to make it more comfortable. This can put strain on your
hip joints. If your hips are generally ok and you have no issues pre pregnancy,
then you should be able to cope with this adaptation for the time that you are
pregnant. If however you have an underlying hip issue that hasn’t been
addressed you may find that you struggle to cope with this change.
An
Osteopath can work on your pelvis, low back and hips to help you adapt to these
changes. They can also advise what to avoid and certain exercises that may
benefit you!
Don’t suffer in silence! Just because you are
pregnant, doesn’t mean you should be in pain!
Find yourself a proper training programme that increases the distance gradually over time. This should include a variety of running sessions and rest days. Rest days are just as important as the run days. We work closely with a highly experienced running coach at Finishing Line and would highly recommend them!
Stretching and mobility work
It’s important to work on your mobility and flexibility, some people prefer to just do their own stretching others prefer going to regular yoga sessions! Whichever works best for you.
Strength training
Try and incorporate some strength training into your programme. The stronger you are the more resilient to injuries you will be.
Stop if you get a niggle – don’t train through an injury
You’re better off missing a few sessions and getting an injury looked at rather than working through the pain and causing yourself more damage. A niggle can very quickly turn into a full blown injury.
Regular sports massage
Sports massage can improve your recovery rate, mobility and general performance! A good therapist can also pick up any underlying issues that might not necessarily be causing any pain before it becomes an issue!
Suitable footwear!
Its important you buy shoes
that are suitable for your feet and running style. Find yourself a specialist
running shop that accesses your gait and advises on which shoes are best suited
to you.
