Sports Injury

On: Tendons and Ligaments

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Tendons tether muscle, ligaments link bone.

But both can be damaged, become weakened, or scarred.

So how can we, both as practitioners and people, prevent this, or at least minimise its impact?

Prevention is always better than a cure, and therefore ensuring the tendons (when reading tendons, assume ligaments as well, although there are differences in all sorts of subtle ways) remain strong is vital.

Note – If you are currently taking medications, especially certain antibiotics, check with the pharmacy regarding soft tissue effects. For example, Fluoroquinolone antibiotics have a rare side effect with regards to soft tissue, so if you are prescribed those, it may be sensible to reduce training load during and after the treatment.

Tendons can be trained, like any other tissue, and research indicates that they respond best to cycles of isometric tension, of approx 10 – 30 seconds, with 30 – 50 seconds rest. Initially, it doesn’t even matter what joint position you are in, as long as the tendon is under tension, and pain free. Over time, you can increase the load and the number of cycles you carry out, to ensure continued development.

There is also some evidence that longditudinal supplementation with collagen (preferably from biologically similar connective tissue) is beneficial, especially when consumed with vitamin C.

Once you have a stable, platform, you can work on repairing any scarring or weaknesses in the tissue by using long duration concentric / isometric / eccentric training movements, through the pain free range of motion. For example, a squat under light load, with all three phases taking 10 seconds, although this time is individual.

Finally, there is also some evidence that early, and safe return to loading after injury can help reduce the time to competition, since the stimulus causes the scar tissue to form beneficially, rather than scattered.

TLDR: tendons can be strengthed, healthy tendons can increase your overall performance, isometric exercises are beneficial to tendon health.

Flow and glide

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To move smoothly, all your tissues need to flow and glide. If they cannot, or do not, then the body will attempt to compromise. And eventually, it can fail. This leads to restriction, pain and immobility. Which can of course create a viscious circle of reduced ability.

What can cause changes in the glide? Joints we all sort of understand. Pain, swelling, inflammation and instability will lead to changes around that joint. But the soft tissues can also experiene those, leading to a conceptual stickiness, where tissues simply don’t want to move over each other smoothly. Some stickiness can be temporary, some can be more permanent (scarring), but stickiness within the system can lead to drag on the tensegrity, reducing the adaption capabilities. This is why you can see limitations in the shoulder and find the solution in the ankle, why mobility exercises that improve tissue range of motion can reduce pain globally, and why it is sometimes so hard to achieve complete resolution in a presentation. You haven’t dealt with the underlying lesion.

The thing is, trying to get your head around this is only the first element of treatment. and it can be particularly difficult, to detach from the description and go looking, or listening, to where another problem lies.

Treat close, check the chain, look at the centre, improve the chain, repeat.

On: The power of words

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Words have power. This has been known for a very, very long time.

The words we say to each other, the words we say to ourselves and the words we use to describe the world around us.

By reframing the words we use, we can change the way we view the universe. Even the language we speak with changes the way we interact with the world around us.

The internal monologue we have can change our entire day, or even path of life. So does everyone elses. And of course, these things can be deep and challenging to deal with, so are far beyond the remit of such pages here.

With that in mind, the following are suggestions that can allow us to catch ourselves in simple situations that may then offer benfit to the way we approach certain circumstances.

For example. You injure a knee on a run, which limits your mobility while it heals. If you start telling yourself that you cannot do things because of your knee, then you are creating limitations within your mindset. However, simply by saying that in spite of the knee you can do activities that maintain your fitness, you will optimise recovery, improve your mindset and view the current difficulty in a better light. That is not to say that it is not a difficulty, but the perspective shift of the barrier changes its height.

Or. Change “I can’t” to “how can I?” Shift the view of the problem.

Within a medical setting, we often get patients expressing suffering. Suffering is subjective, valid and to be believed. However, as a professional, you can help reframe the situation by the use of your language patterns to check in with what they are experiencing. From suffering to experiencing does not and should not invalidate their personal reality, but may help explore what it means at that point.

Again, within a medical or caring setting, empowerment is important. If we help someone, we can often disempower them and either create passisivity or an unbalanced dynamic. So instead of helping, consider or ask how you can support them. If they have limited abilities for any reason, then this can help set the correct tone for them to communicate their needs, rather than having your “help” thrust upon them.

If you have repetitive and perhaps tedious tasks to help those around us, from small children and work colleagues to aging relatives, and find yourself saying that you’ve got to, reframe it to get to. I’ve got to take the kids to football – I get to watch them learn new skills. I’ve got to see my grandfather this afternoon – I get to spend time with my grandfather. And so forth.

And sometimes, if you don’t know what to say, say nothing. Supportive silence is much underrated and certainly underused. Slow down, check in with yourself and say nothing.

In spite – because of

Can’t – how can

Suffering – experiencing

Got to – get to

Silence.

Onwards.

On: Testing and Imaging

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Just because you can, doesn’t mean you should.

As a clinician, there are a huge range of tests and investigations available. Blood tests, scans, investigations, the list of what you can order goes on and on.

Some of them are quite invasive and unpleasant for the patient to go through. Others can expose them to small doses of radation. And all of them have a cost.

How do you choose which to use? The first step is to listen to the person and understand their clinical history. From that, and in conjuction with an appropriate and consented examination, one develops differential diagnoses. And only then, do we start to consider tests to confirm or exclude the diagnosis.

And of course, we have to consider, or at least should take into account, what we will do with the result of the test.

Blood tests can give an idea of the current status of many organs, but if you are complaining of UTI symptoms, i don’t need bloods, I just want a non invasive dip and will treat according to that. However, if I believe that you are anaemic and want to understand why, then a blood test may help, and guide the treatment. And if I believe there is something complex, where it shouldn’t be, then I will want to image it, whilst referring you to the most appropriate speciality.

This is especially true for complex and expensive imaging routines, such as MRI or CT. If you have simple musculoskeletal back pain, and no indication for surgery, then an MRI is not going to change matters. If your clinical history indicates a complex presentation that may require intervention then an MRI or CT is an effective next step. For context, a CT is Computed Tomography, essentially a three dimentional thin slice x-ray model, which is good for seeing hard structures. MRI is Magnetic Resonance Imaging, and best suited to soft tissues and organs.

However, far too many professionals request tests as a holding pattern, so that they feel they are doing something, and are reassuring both the patient and themselves that they are being proactive. This is not a judgement on clinical practice, simply an observed trap that we all fall in to and should be aware of.

So, as a patient, or patient advocate, take the time to check with the person what the test is for and why they think it will help. This will give them the opportunity to educate you, explain their thinking and hopefully answer any questions you may have.

From knowledge comes understanding. From understanding comes courage.

What cost fitness?

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What cost fitness?

Occasionally, people complain about gym prices, the cost of personal trainers and kit.

Only occasionally though. Because if you understand the value, you wouldn’t complain about the cost. Other than kit. There’s always a new shiny toy to try, and past a certain point, none of which will really improve your performance.

If you’re stronger, you’re less likely to die early, unforeseen events excepting. If you’re fitter, you are more likely to survive a hospital admission (being admitted to hospital is really bad for your health). If you’re healthier, life seems easier, because you have a greater capacity for stress.

Now, fitness is different to wellness. Wellness is a never-ending feast of rubbish, where a huge number of people, both honest and exploitative play. You might benefit from a yoga and meditation session (both are demonstrably good for you), but you don’t need yoni steaming and jade eggs. And you certainly don’t need to spend 300 pounds on any of them.

Fitness is far more measurable and relatable.

At the most basic, you need nothing more than you already have to improve your fitness, other than knowledge.

However, if you know nothing, then the next step is to ask an expert, or at least a professional. This is where gyms, trainers and such come in.

Do not ask the internet, as you have no filter on what is good or bad. As an internet guru, I could tell you to do 5k every other day and 50 burpees for breakfast but if you’ve got a medical condition, or an injury, or the most exercise you take is picking up the remote when you turn off your laptop after working from home all day, then I may actually kill you. Unlikely, but possible.

Instead, find someone you can have a conversation with, who can answer pertinent questions and give you honest answers. You may need to pay for their time but hey, you wouldn’t ask your next door neighbour to help fit a kitchen unless they are already skilled in it.

If you can’t afford that route, then go to the library and read a book. Lots of fitness people have written books and at least they’re relatively validated. And the walk there is a good start.

So, to loop back to the start, pricing. A gym has significant running costs, a personal trainer is not working 40 hours a week and is self employed. In the end, it is a return on investment question “am I getting out what I am paying in?”

As an example, a local CrossFit box charges £75 per month for 3 sessions a week. But for that you are getting equipment, expertise, time, and a quality environment. A local council gym may charge £30 a month, but you won’t be getting the expertise and programming, so you’d better know what you’re doing on your own (hint- that 12 reps/3sets on each machine will rapidly lead to plateau and boredom).

How does this tie in to us? We are professionals. We treat injuries, and have over 20 years of working with people. We coach, and work with trainers who actually care and understand their jobs.

If you want to live longer, healthier and perhaps even happier, come talk to us.

The first step is the hardest, but the most rewarding.

On: Advocacy

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I don’t have your best interests at heart. Why would I? I have my own stuff to deal with once our interaction is over. The criticism, fear of failure, and self doubt in my mind. Administration, other patients, personal and family concerns, my own health issues, background noise, the passing comment from a colleague that got stuck in my head and keeps rattling around, the alerts and distractions on the screen in front of me. That’s not even counting the 30 or 40 other interactions I will have today, another 8 patient appointments and the meetings related to those.

As a medical professional I try my best to push those aside, to silence them and focus on you. To give you the time and attention you need and deserve, to bring the years of training and experience to bear on your behalf. To know when to treat, when to advise and when to refer. And hopefully at the end of our consultation together, as we conclude our interaction, you will feel listened to, reassured and aware of the next steps.

But I don’t have the time to advocate for you, to have your long term best interests at heart and ensure a life plan is laid out before you. You simply get the time slices I can afford, amongst all the other pressures.

Thats your responsibility. It has to be. This is a 2 way relationship. Come to me for treatment, support, advice and reassurance. Then take control of the other elements yourself, to make sure everyone is working towards the overall goal of longevity and optimal health.

Be your own advocate.

On: Rehabilitation / Prehabilitation

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The best way to recover from an injury is to not have an injury.

Other than the sort you simply cannot predict, the majority of injuries are caused by poor preparation or the inability to adapt dynamically to the situation.

Rehabilitation goes through three main stages.

  • Pain management
  • Ranging
  • Loading

First, control the pain. This is both passively and actively. Once the pain is a under control, it is a return of function, within that pain free zone. Optimise the range of motion, or activity that is available without causing excessive complaint. Finally, the loading phase, where we return to activity, initially graded and then competition.

This is, of course, a gross simplification of the tasks at hand, offers no insight into the variety of techniques considered, but is offered as a thought guide for the observer.

As stated at the beginning, the best rehab is prevention, through prehab. Prepare better, prevent problems.

Everybody has a weakness, a compromise point, or an area that appears to be less effective, so train those out to become more capable.

Seek professional input if you are prone to niggles, seek professional input for coaching if required and build steadily. Social media is not your coach, a search engine doesn’t replace a doctor.

Damn, I’m tired. 

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Early mornings, coupled with late nights. 

Physically hard days.

Poor or restricted diet with an increased training load. 

Mental stress and prolonged concentration. 

All of these and combinations of them can lead to fatigue. Will lead to fatigue, given sufficient time. This in turn leads to micro mistakes, poor neural timing and eventually injury. 

Fatigue can hide behind coffee, sugary snacks and stubbornness but is easily spotted if you look for it.

Not recovering fully in the time you would normally expect to, regularly less than 7-8 hours sleep, using more stimulants to keep going, an elevated resting heart rate, more coughs and colds, an elevated or stressed breathing pattern, and poor focus and mental control are all signs to check. 

If in doubt, back off. Good decisions are rarely made tired and a day of down time will almost never lose the race. 

Get the basics right first 

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It doesn’t matter what supplements you take, what your morning ritual looks like, who your guru is or whether you prefer goji berries, blueberries or beetroot as your preferred superfood, if you’re not getting stronger, faster or any achieving any measure you’re aiming for, there’s something not working. 

Nothing happens without enough sleep, enough water, enough high quality macronutrients. If you don’t get the basics sorted first, you’re building your castle on sand. 

So before you start spending on the latest expensive magic product, check you’re getting:

7- 8 hours restful sleep

2-3L water / fluids

75-150g protein

Plenty of vegetables and berries

No? 

Figure those out then move forwards. Basic consistent steps climb mountains. 

Why you don’t need your osteopath

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If you can squat, full range of motion, feet together and flat on the floor, arms above your head, you don’t need your osteopath.

If you can train without unexpected pain or discomfort, you don’t need your osteopath.

If you can be in one position for a long period of time (for example driving to competition) and know how to unstick yourself, you don’t need your osteopath.

If you can jump out of bed after a good nights sleep and not “feel your age”, you don’t need your osteopath.

If you do a regular mobility practice and have a solid knowledge of how to get yourself moving out of most issues, you don’t need  your osteopath.

Otherwise, call us and we’ll teach you: 01420 544408

And keep our number close for those acute, it just happened, injuries as well!