Monthly Archive for February, 2010

So if UGGs are bad, how are Crocs?

You may have read about my view that UGG type boots can be bad for your feet and knees, well someone asked me today- what about Crocs? 

How good are Crocs for you

How good are Crocs for you?

 While they score low on style, Crocs actually score very high on being anatomically moulded with correct support being provided for the foot and hence ankle.  Not only this, but the very material that Crocs are made of are excellent for shock absorption and minimizing stresses and strains to the feet and ankles. 

The whole issue about shoes is that they should help to support the structure and mechanics of the foot and of course be comfortable and reduce shock being transmitted through the foot.  Crocs do this well, UGGs do this poorly.  

Looking at the inside of a Croc it is easy to see that it has has a contoured surface with arch support and a good heel cup that nestles your heel bone.  This heel cup and arch support help to maintain the mechanical alignment of the foot, ankle and knee.  In particular they minimise pronation, which is the movement that occurs in the foot when the foot rolls from the outside of the heel to the front of the big toe,  pronation can stress the ankle and knee joints and muscles. 

UGGs are they bad for you?

Could UGG type boots be bad for you?

UGG type boots however support the foot very poorly, they do not provide enough support to the heel bone (calcaneus) and the sole of the shoe does not have sufficient arch support.  For someone who is flat footed these shoes (along with shoes like ballet pumps) can be a big problem as they stress the sole of the foot, can lead to ankle and even knee pain. In children whose feet are still developing and growing particular care must be taken.

Judo is a dangerous sport- or is it just the pursuit of excellence that’s dangerous?!

Physiotherapy north west london for judo injuries

What allows 1 sports person to escape injury free- and the other to be beset by injury troubles?

A couple of weeks ago I conducted an injury screening for 2 members of the Great Britain Judo team.  I concluded that Judo is a dangerous sport!  This was the week before they were representing GB in a Judo tournament- who knows they may be representing GB at the 2012 Olympics!  How did we come into contact with these Judo players?  Well…

At BOOST PHYSIO we are privileged to be a Talented Athlete Scholarship Scheme  physio clinic (TASS- click here for more info about TASS).  What’s TASS I hear you ask- it is a Government funded programme to support and fast-track young sporting talent, the potential medal winners of the future- and BOOST PHYSIO is one of the clinics looking after these athletes.  Click here to view a Video about TASS.

So during this athlete screening I had to screen 2 female judo players which left me with the philosophical question- why do elite athletes have so many injuries and what leads some to succeed and others not?

One of the girls had broken her arm and her wrist  previously and had a thumb injury, the other had a dislocated thumb – all from Judo.  But these girls were tough- training hard in conjunction with their strength and conditioning coaches.  I wondered to myself- are these injuries simply the consequence of contact sport, or is it something else, perhaps the extreme lengths to which elite sports people push themselves to achieve excellence?  Could an ability to recover better from injury allow one to  to succeed while another fails?

I’ve never seen a 19year old athlete who’s had a steroid injection for an injury before (usually it’s over 30’s and sometimes those in their 20’s), so when I did this hit home and reminded me the extremes to which sports people push their bodies in pursuit of their dreams.

Rafael Nadal’s poor performance at the Australian Open seems to be put down almost entirely to injury from pushing himself too much, some critics even wonder if he’s going to be able to come back in the same way because of his injury problems.  I’ve had to treat injuries of various county level tennis players ranging from 10 to 17 years old.  The one who I think gets pushed the hardest is the 10 year old boy- whether it is him or his mum who does the pushing I am sometimes not too sure- but when kids under 14 come regularly for physio for various injuries one asks the question- is this simply the cost of the pursuit of excellence or is this abnormal.  Furthermore could it be that what dictates whether he will ever make it to Wimbeldon is actually his physical make-up and pre-disposition to injury that may make him miss 1 or 2 critical seasons of training and competition?

A recent article in the Telegraph talks about the mounting concern over the Winter Olympics casualty list and safety of the various sports- it would seem that the sports and events themselves are becoming more extreme, not only the athletes themselves who are pusing the boundaries all the time.  Clearly there is a huge psychological element to why and how athletes push themselves to the extremes.

Enough philosophising- to sum up it is clear to me that to even aspire to elite sporting success requires enormous physical sacrifice and dedication, along with mental tennacity and extreme focus.  But that to succeed in achieving the pinnacle of one’s sport will almost always be dictated by the ability to ward off  serious injury. I firmly believe that those athletes on the winners podium have their genetic code to thank in warding off career stopping injury in what Darwin would call survival of the fittest!

So the reason why I have always achieved sporting mediocrity must be down to my genetic code- it just aint good enough :-)

Shoulder Injury? Could it be the rotator cuff?

Physiotherapy for rotator cuff injury NW London

This is an image of the front of the right shoulder showing examples of some tears to the rotator cuff of the shoulder

written by Jolene Sher, Senior Physio

 

What is the Rotator Cuff?

  • The shoulder joint is a ball and socket joint, formed by the ball-shaped end of the upper arm (the humerus) and a shallow socket on the edge of the shoulder blade (scapula). This allows for a large range of movement in many directions. Stability within the joint is provided by the muscles, with some support from the ligaments. The main muscles that give this stability are the Rotator Cuff muscles.

 

  •  The rotator cuff is made up of a group of four muscles (called the subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons. The tendons wrap around the shoulder, forming a cuff around the ball of the humerus providing the stability during movement of the arm.

 

  • On top of the shoulder joint is a bone called the acromion. In the gap between the shoulder joint and the acromion is a space that some of the rotator cuff tendons run through.

Types of rotator cuff injury

Rotator cuff injury is a general term to describe inflammation or damage to one or more of the muscles or tendons that make up the rotator cuff.

Rotator cuff tendonitis

  • The tendons of your rotator cuff can become inflamed. It most often affects the tendons which run underneath the acromion. When a tendon becomes trapped or squeezed, it’s known as impingement syndrome. Pain usually comes on gradually.
  • This is when the muscles or tendons that make up your rotator cuff become completely or partially torn. It may be a result of a trauma, such as a fall, or due to tiny tears to the tendon through use and wear over time. Pain usually comes on suddenly.

Rotator cuff tear

 How does it start and who is affected

Rotator cuff injuries may occur due to one or more of the following:

  • Poor movements (e.g. repetitive or overhead activities) or poor posture around the shoulder are usually factors that can cause adverse strains and stresses in the rotator cuff.
  • Lifting or pulling an object that is too heavy for you or lifting it in the wrong way.
  • Landing on an outstretched hand to break a fall. Rotator cuff injuries often occur if you dislocate your shoulder.
  • Wear with age.
  • Muscle imbalance (When some of the muscles in your rotator cuff are stronger than others).
  • Musculoskeletal disease (e.g. rheumatoid arthritis)

 

Shoulder pain affects around one in five people in the UK and rotator cuff injury is the most common cause.

Symptoms

Symptoms of a rotator cuff injury may include:

  • Pain and tenderness over your shoulder (it may radiate down the arm) especially when you raise your arm out to the side, reach behind you or lift or pull a heavy weight
  • Pain at night, particularly when you sleep on the affected side
  • A feeling of weakness in your shoulder
  • A limited range of movement in your shoulder
  • Clinical findings from the Doctor or Physiotherapist. This includes special tests to pick up signs of shoulder impingment.
  • Medical treatment: Commonly used interventions are advice (e.g. rest and ice), medication (e.g. anti-inflammatories or analgesics), corticosteroid injections and/or referral for physical therapy.

Diagnosis

  • MRI
  • Ultrasound scan
  • X-rays cannot diagnose rotator cuff injuries. 

Treatment

Conservative Treatment (Non-surgical treatments)

Physiotherapy Treatment

  • Appropriate initial assessment- NB history and observation.
  • Initial treatment is to help alleviate pain and inflammation. This can be achieved with ice, rest, soft tissue release and the use of electrotherapy modalities.
  • Identifying predisposing factors such as posture or ergonomics (work/sport positions) and pre-injury level of function.
  • Appropriate referral to a specialist if need be.
  • Rehabilitation to return to work/sport:

ü      Stabilisation – to ensure that the shoulder joint can remain stable under increased tension.

ü      Strength – to make the shoulder strong in all movements (using gym based exercises)

ü      Function – enhancing the shoulder’s ability to cope with the demands needed to get back to pre injury level

Surgical treatments

If unable to treat it conservatively surgery may be indicated, for example to repair a tear in your rotator cuff or to remove calcium deposits.

Prevention

To prevent rotator cuff injuries, make sure you:

  • have the correct technique when playing sports or doing activities that use your shoulder, particularly overhead motions
  • do exercises and stretches to keep your rotator cuff muscles strong and supple

Icy Winter Injuries- what have we been treating?

Physiotherapy for winter injuries

We've been busy dealing with winter related injuries :-) People who've slipped on the ice and those with winter sports injuries

The icy weather over Christmas and early January led to A+E departments being rushed off their feet with injuries from people and cars slipping on the ice.  Many patients and friends have been asking us what type of injuries have we been treating at BOOST PHYSIO relating to the bad weather… well unfortunately shoulders have born the brunt of these injuries….  here is part of the list:

  • 26 year old man who fell on his shoulder, referred by his GP to see me 4 weeks after slipping and falling on his shoulder (xray was normal).  When I saw him it was immediately apparent that he had a more significant injury than usual, sent him back to GP requesting MRI which has shown an impact fracture to the shoulder and a muscle injury too.
  • A man who fell and dislocated his shoulder (ouch!!)- he is doing well thanks to great treatment by Jolene
  • 2 other men who have fallen onto their shoulders
  • a Snowboarder who has injured his shoulder
  • We have now started having enquiries from patients who broke their ankles or wrists and are coming out of plaster (after 6weeks) so watch this space!

Some of our these experiences have shown how a good musculo-skeletal physio with specialist experience and knowledge will pick up injuries that others will often miss!

Weekend Warriors Watch Out!

Physiotherapy clinic specialising in sports injuries Hendon NW London

Don't be a Weekend Warrior- make sure your fitness level matches your activity level

The key to injury prevention is always in the preparation! The ‘Weekend
Warrior’ patients that we see, are all guilty of doing too little training
during the week and not being adequately fit for playing their sport.

Don’t forget that training should be specific
to your sports, so if you are playing football,
cycling may be helpful but running and
shuttle sprints would be better. The most
common football injuries that are treated at
BOOST PHYSIO are hamstring, calf and groin
muscle injuries.
Most of our patients who have injured
themselves in sport do not warm-up. Spend 10
minutes warming up. Don’t confuse warmingup
with stretching, these are two different
things. Warming up involves aerobic exercise
to raise the heart rate and body temperature
gradually and should include activities specific
to the sport being performed. For sports like
football and netball starting with jogging and
progressing to a faster run for short shuttles
is important. During the last 2 minutes of
the warm up then do specific stretches to
the high risk areas such as the quadriceps,
hamstrings, groin and calf muscles – this
ensures there is sufficient elasticity in
the muscles.
While the research on stretching is
controversial as to whether it actually
reduces the chances of an injury, you will
not find an elite athlete who does not spend
time stretching.

BOOST PHYSIO starts Blogging

The BOOST Blogger- Steven Berkman

I’ve been wanting to start a Blog about BOOST PHYSIO for over a year! Somewhere to express thoughts, ideas, comments, discussion about some interesting patients and events going on here at BOOST PHYSIO. Finally I’ve gotten around to it- and many thanks to Clinton Gomer from Energy House Digitial who are amazing and do all our web related things for making it happen!

I guess the biggest problem now is going to be how to keep me quiet!! I guess you could just ignore me!

Enjoy- Steven Berkman