Back pain is the largest cause of disability in the UK and specifically, lower back pain (LBP) accounts for 11% of all disability in the country (NHS 2016) making it something that we see everywhere, be it:
personally (you have it or have had it)
at home (family, friends, flatmates, probably your pets as well)
at work (colleague’s worsening pain from sitting all day; worsening pain from being on feet all day; someone just looking for something to complain about at the ‘water cooler’)
About 80% of us will experience lower back pain at some point in our lives and nearly 43% are estimated to have ‘chronic’ lower back pain, lasting over three months. I write this blog post with a bit of an ache as I start to think about my back!
What is the most effective way to deal with LBP?
Time and time again, with all the research and anecdotal evidence reviewed over the last couple of decades, exercise comes out as one of the (if not the #1) most effective ways to relieve lower back pain as guided by a Physiotherapist in an appropriate and safe manner.
Once instructed appropriately, it is the most affordable, time efficient and valuable option that can be done at home, alone in the gym or if you are one of my patients, waiting for your tube/uber/bus to arrive. But why do we do it? Just because a physio told you to?
Why is exercise good for us and why does it reduce pain?
We all know that we should exercise. We should all know that we should exercise for lower back pain. But the factors or benefits involved with exercise, other than changes in “strength and flexibility” are overlooked or not discussed as often as they should. The European Spinal Journal (2012) highlighted that LBP is multifactorial and is not just changes in the muscles and the skeleton; this blog post aims to give an idea of what else happens to us when we exercise.
Please note this is in relation to non specific/mechanical based symptoms where serious pathology and diagnoses have been ruled out by a professional.
What happens within our bodies when we start to exercise and move better?
Physiology changes – blood flows / the nervous system moves and changes at a local level
Descending inhibition – opiod changes within the brain / serotonin activated (THE GOOD STUFF/’drug cabinet’ in the brain starts to change for the positive)
Altered beliefs/perception – initially, exercise is tough but it gets a hell of a lot easier, once we stop worrying and stop setting up to fail by staying on the couch for hours.
Physical strength/load tolerance – we move better and cope with more when we exercise correctly but this is overlooked at times. “The pain might feel similar, but you’re doing twice as much” – this can sometimes be a good thing!
Social / Environment – an increase in exercise reconnects us with the world – whether seeing familiar faces at the gym, being in the fresh air in a park or being part of a sports club
Predicted Expectations – improved perceptions of self / confidence and internal locus of control
Changes in Corticol/Brain Networking – improved functioning of the brain, for example, the motor cortex can lead to improved output and reduce pain controlling signals
Distract – it’s good to focus on something other than pain! (can be helpful to stop pain)
Stress/autoimmune changes – cellular changes within the brain can improve skin / bodily functions / anxiety states / inflammation – which all affects pain
When we start to look at what happens within the body, we start to realise how powerful exercise can be for pain, for our health and wellbeing. If you have Lower Back Pain (or have had LBP), or know someone that does, safe and appropriate exercise can do the world of good – now you can start to explain why!
For more information, you can also view our health guide’s section on back physio. To get in touch with us, call 020 7603 0040 and learn about how our physiotherapists could help improve your LBP.
A Scar is defined as an ‘area of fibrous tissue that replaces the normal skin after injury’; where we usually think of them from surgical procedures, accidents or the baddie from the Lion King.
They can be rooted emotionally in relation to trauma or surgery or persistent pain for many years (orthopaedic surgeries, cancer/tumour removal, facial injuries etc); or it could just be that affected area of the body that gets ignored and you change habits over time (a lesion on the sole of the foot, childhood injury etc) ; or they can be associated with positive times – tattoos and piercings can also be included in this conversation (ie, an area of skin that is not “normal”) . There could be scars within the body that are below the surface on the body (eg an old muscle or tendon that healed with additional adhesions or fibrous tissue) or the normal superficial scars we would think of.
Regardless of the reason for the scar, they will always refer to the past (for better or worse) and either way, they are now part of us and with us for the rest of our lives. We can also havescars that are quite happy on the body and cause no complications apart from an aesthetic change; the purpose of this blog is to discuss the effects of scars that can cause complications.
Physiotherapy is almost always advised after orthopaedic surgery (hip replacement, ACL reconstruction, shoulder decompression) to rehabilitate the affected and surrounding joints, to strengthen muscles that have weakened over time etc etc. The Physio may also use certain manual therapy techniques to alleviate tension on the scar, to break down adhesions that are causing pain or preventing better movement. This is done well within the first few months to a year post surgery/injury during rehabilitation – but what happens over time? What happens to that scar and the surrounding areas years afterwards?
Scar tissue is unfortunately not the same as normal tissue; after an injury or surgery, the fibrous tissue that builds up is typically tighter and if the scar has affected deep into the muscle, it can also affect strength. This can lead to pain, dysfunction and other complex complications.
Postnatal rehab -Caesarean / C-sectionscars – can impact on pain anywhere in the body (due to the size, direction and depth of the incision), most commonly the lower back/sciatic nerve is affected but headaches and the neck can also be affected. The scar represents a surgery that went through a lot of tissue and muscles (predominantly the abdominals, among others) – the body has to heal, change and compensate physically to the demands of the scar and the subsequent weak muscles; as well as the impact of having a child to look after (more bending and lifting, less sleep etc).
Furthermore, there can be emotional effects of a scar after a pregnancy: anecdotally, we hear of sensation changes across the midrift (“I can’t even look at the scar, never mind touch it”, “feels like nothing is there”) which can leave women feeling a little helpless. There can also be issues concerning aesthetic changes, but this blog won’t discuss that any further. So we have a body or system with more demands placed upon it but with a tight and fibrous scar and associated muscle weakness; it can feel like the body is playing tug of war with itself! Physiotherapy and rehabilitation can help these problems, but the scar cannot be ignored! The impact it has on pain, movement and the ‘self’ can be huge.
ACL reconstruction from 15 years ago – the old fashioned orthopaedic scar from an ACL surgery can involve a large thick slug like band down towards the kneecap. Minimal pain is reported from these procedures, but the scar and associated weaknesses can cause complications; changes in distribution of weight through the feet, walking style, or increased/decreased hip/foot pressure can be routed from that pesky scar! During the surgery, the incision has gone inside the joint and through a lot of structures many years ago.
Let’s compare the brain’s history and opinion of that knee versus the opposite, normal one with no surgical history – which knee would complain the loudest? The one with the trauma, fibrous tissue and compensation patterns would typically be the most affected. Again, there could be an emotional component to the scar; eg, a constant physical reminder of pain/trauma or a sign of impairment/weakness which reaffirms the tight and weak state of the affected area.
Physiotherapy can help identify where and what the scar is affecting and help try and restore as much normality as possible. At the moment we do not have the technology to restore trauma/injury/surgery type scars back to factory settings but there are various tools and techniques that can be applied to get increases in functional movement and hopefully alleviate pain. Changing our beliefs and perceptions of scars can open the door to more positive changes for the benefit of our physical and mental health.
From the outside looking in, you may think that a mat Pilates class looks like a rather sedentary activity. Most of the session is spent lying down either on your back, stomach or side. Sounds rather relaxing!! However, with practise and using the principles based around concentration, control and balance – all of which require an enormous amount of strength and effort, you can gain so much.
What is Pilates?
Pilates aims to strengthen the body in an even way, with particular emphasis on core strength to improve general fitness and wellbeing.
Pilates was developed by Joseph Pilates who believed that mental and physical health were closely connected. His method was influenced by gymnastics, boxing and wrestling. Joseph immigrated from Germany to New York in the 1920’s where he opened his first studio and taught his method, originally called ‘contrology’ for several decades!
Who is Pilates for?
Pilates can offer something for people of all ages and levels of ability and fitness from beginners to elite athletes. For athletes, including dancers, Pilates can complement training by developing whole-body strength and flexibility and help reduce risk of injury. Mat-based Pilates can be particularly beneficial as it is easy to practise at home or at the gym with no special equipment needed.
What are the benefits?
Focus and Improve your core strength
Every class offers one of the most effective and challenging ways of developing core strength and stability. A strong core (abs, back and glutes) boosts your overall athletic output and daily function. This increased strength and control of your core will help you avoid injury and improve your posture and muscle tone.
Increase your muscular endurance and flexibility
There is some evidence to show that engaging in mat Pilates for a mere 60 minutes per week significantly improves abdominal stability, hamstring flexibility and upper-body muscular endurance.
Maintain the Health of your spine
Pilates mat exercises will help if you have any issues with the health of your back and spine. Pilates can be particularly helpful for people with pain caused by excessive movement and degeneration of the vertebrae, discs and joints. Pilates, also helps balance the sides of the body, aiding in creating postural symmetry. This will also help to prevent injuries caused by uneven stress patterns. The movements and exercises involved improve mobility in the hip and shoulder joints, preventing excess stress on the spine. Pilates places heavy focus on the proper alignment of the back. This focus will make you more aware of how you hold yourself from day to day and will inevitably improve your posture.
Improve your balance and body awareness with the 8 Principles of Pilates;
Concentration, promoting the mind-body connection. As you focus and become mindful of each body movement, Pilates states you will receive optimum physical value from each movement as well as enhance your body awareness.
Centering. During your Pilates workout, you should consciously bring your focus to the center of your body. As you focus within, this Pilates principle suggests you will bring calm to both your body and spirit. Pilates called the centre of your torso the “powerhouse,” from which all energy for exercise is derived.
Control. Pilates’ method is based on mindfulness, including proper, safe and complete muscle With proper control, you utilize the exact and correct form, leaving no part of your body unattended.
Precision. Movements are slow, of good quality and precise. Quality over quantity is key!
Breathing. Deep, controlled, diaphragmatic breathing activates blood circulation and awakens cells and muscles. By focussing on the breath, this helps engage your core more effectively and aids with flow
Alignment. From head to toes, the Pilates method stresses good posture and awareness of the placement of all parts of your body. We always try and keep your body aligned with a neutral posture
Flow. Pilates routines are completed through a gentle flow. Grace, ease and fluidity are the intention Joseph Pilates applied to all exercise. Continuous, smooth, and elegant movement as you transition from one pose to another will bring strength and stamina according to this principle.
Integration. Breath, control, mindfulness, centering, alignment, and precision unite as the many groups of muscles work together to support and govern movement. Practicing each of the above principles achieves Pilates’ goal of an integrated mind-body workout.
Interested in Joining a Class?
From 4th June 2019, we will be starting weekly Mat-based Pilates classes at our South Kensington Clinic in the Evolve Wellness Centre.
This will be lead by Lauren Castledine-Wolfe, Senior Physiotherapist and Pilates Instructor.
To Book or for Lauren Castledine-Wolfere information contact us 020 7603 0040
What’s the best way to keep a child motivated with their physio?
It’s very dependent upon the age of child or adolescent as to the best strategy to keep them happy and keen about physiotherapy, so I have split my suggestions into some broad age groups. However, strategies certain age groups may work for a wider range of ages, and are also dependent on the patient’s developmental level, so feel free to use whichever techniques work best!
Infant (0-2 years)
At this age, children need to be encouraged to achieve the movement through play or attention. As a baby, they are not able to yet follow verbal commands, although by the age of two, they should respond to simple commands. The most important thing is to keep physio sessions very short so that they remain fun, but then try to do little bits often throughout the day.
Here are a few examples:
If we want bub to turn their head, we might wave a toy in their field of vision and then slowly move it to one side so that they follow it around. Sound cues such as a rattle can work well too, even moving your face in and out of their field of vision can work well too.
If you are having trouble with your baby tolerating tummy time, lying them on your chest and having mum or dad to look at can help them learn to love it! You may both end up having a little nap though…
With babies, we often need to do completely passive exercise as well as they can’t follow instructions yet. These sessions need to be short and enjoyable for bub, so warm up your vocal chords as singing is a great way to keep them happy and distracted whilst you do their stretches. These passive stretches get harder to complete as they get more mobile, because they get bored more quickly being in the same spot.
Getting your toddler to play whilst standing on a wedge for example can help with stretching their calves and improving their balance. Even just encouraging them to stand with straight legs and heels down whilst playing at a table can help to stretch the calves and assist with issues such as toe walking.
Pre-school (3-5 years)
At this age, children can follow commands, but still don’t really have the insight about the benefits of the exercises they are performing to assist them in managing their injury or condition. Exercises still need to be in the context of play as much as possible, with perhaps a couple of more targeted exercises which are dispersed amongst the ‘play time’, but without the child necessarily identifying them as physio exercises.
The novelty of a theraband may last long enough for them to do a few more targeted and specific exercises, but don’t expect more than one or two sets of 1-2 exercises!
This exercise may be used to improve balance, coordination and/or leg strength. You could also use coloured tiles or tape on the floor for them to use as a target to jump to. Even a line of tape along the floor or following along a floorboard without falling off can be a good balance exercise.
Using play equipment can be a great way for kids to do their physio without noticing they are ‘doing’ their physio, in this example walking up a ramp with their heels down can stretch their calves and help with toe walking.
Prep school (6-12 years)
Children of this age have now all started school, so are used to following instructions and participating in more formal and structured activities. This is the time that children can be much more actively involved in their rehabilitation process (dependent on mental and emotional development), and will do more ‘adult’ type exercises which we would normally associate with physio. However, as we know, these exercises can get quite tedious, so it is important to still keep exercise sessions as short and fun as possible to avoid a battle to get them done. Sometimes something as simple as a sticker chart can be a good motivator!
Sometimes joining a group class can be fun and keep kids motivated. It is also a great way for them to see that there are other kids doing physio too! Also, if you are having difficulty with your child adhering to a specific home program, sometimes your physio may be able to suggest another mainstream form of exercise such as gymnastics or martial arts which may be a good option for your child to attain the skills they need.
Doing exercises with mum and dad can be fun for kids, particularly if the exercises are seen as ‘I’m doing grown up exercises with mummy and daddy’, rather than ‘mummy and daddy are doing my childish exercises with me’
By 8 years of age, most children will be able to perform more traditional physiotherapy exercises in a structured environment. However, encouragement such as a sticker chart at home can be helpful with achieving compliance with the home program.
Allowing a period of free play (obviously safely and supervised) with the equipment, can help the children feel more at home and confident and allow your therapist to see them in action.
High School (13-18 years)
Whilst this age group should not really be lumped in with ‘children’, they are an age group that often requires physiotherapy, so I wanted to briefly mention them.
When presenting for physiotherapy for the first time at this age, patients will have generally sustained a specific (often sport related) injury. This means that they are fairly motivated as they want to return to activity as soon as possible. However, sometimes it will be difficult to get them to commit to a longer term program if they are recovering from surgery or have a condition which requires prolonged physio.
By this time, teenagers and adolescents will have complete insight into actions and consequences, so they can (and should be) treated like adults in that the injury should be explained to them and the reasoning behind each step taken disclosed. By being given ownership of their program and care plan, they will feel empowered to create their own recovery and if they understand the reason they are being given boundaries (e.g. it’s to protect the healing ligament), they are less likely to overstep them.
However, it is still very important to involve their parents as well, to ensure commitment to the program. It is also important to be clear about goals and timeframes from the outset, as they will lose trust and motivation very quickly if they feel they are not progressing as they should, or are not being told the full story.
Book an assessment with us
As you can see, a slightly different approach needs to be taken for children of different age groups. If you are concerned about any area of your child’s movement or they are getting any pain with activity, please do not hesitate to contact us for an assessment.
The simple answer is – Yes! Many doctors who specialise in back problems are now seeing a direct link between stress and chronic back problems
The reason is that our ancestors used the: “flight or fight” system to survive. This means that they had to be ready to fight against the enemy, or literally run away from them!
Today…it’s the same. When our brain feels in danger (real or presumed), it starts to send signals to our muscles to prepare us to fight or to run, so our muscles become more tense and the cortisol (stress hormone) starts to go around our system.
A constant state of stress will lead to muscle tightness and posture disorders. Have you ever noticed that when you are sad you start to hunch over? Try to smile in this position…I bet that is so much easier smiling with your chest opened up!
When you are in a positive state of mind, there are small biomechanical changes in our body.
Our brain is lazy…when you have been using the same pattern to try to resolve problems for years, it is difficult to suddenly switch to another way of thinking. But it is possible! It’s like when you start to exercise for the first time in a while – it feels so horrible… real torture. Then, after a few weeks, you actually start to see results – feel better, happier…the same is to be said for our brain. Try to take a moment and stop for a second – and analyse if the way you are dealing with your problems is an old pattern and if it is…try to do something different!
When you are stuck in an old way of thinking there are different things you can try to open your mind to a new solution:
Mindfulness. There are amazing apps to try that if you do not want to spend money on anything that you do not know fits you. Try the app “calm” and take 10 minutes to follow the training
Stretching helps to release muscle tension and you will feel better
Move! Does not matter if you prefer to go to the gym, swim, cycle, walk the important is that you move…your back will thank you! Plus… Physical activity produces endorphins which are the hormones of pleasure for our body.
Congratulations! You’re expecting! There are likely a million questions running through your head, not least of them, ‘how do I stay fit and healthy during my pregnancy to help me prepare for birth and motherhood?’ Whether or not you have tried Pilates prior to your pregnancy, it is a fabulous form of exercise to keep you strong and supple, and assist you in managing any aches or pains growing a human may throw your way!
If you don’t have any medical or obstetric complications, it is recommended that you try to complete 30 minutes of moderate exercise per day. Before starting an exercise program, it is important to check with your doctor that you don’t have any conditions which would stop you from participating. It is also helpful to have an assessment with a physio to determine any particular areas that you need to focus on.
Why is Pilates such a great form of exercise during and after pregnancy?
Pilates helps to optimise your posture, which will likely change substantially over the coming 9 months as your body adapts to the weight and size of your growing baby
The machines used in a studio class allow you to reposition your body to continue familiar exercises as your baby grows
A lot of studios have prenatal or mums and bubs classes available which can be a great way to meet other new mums
Pilates is low impact, so you don’t have to worry about your joints as you get heavier
Pilates assists with pelvic floor activation which will be helpful post birth
You can do exercises to prepare you for the birthing process, such as deep squats, using the assistance of springs
Things you should know about Pilates when pregnant
Pelvic laxity increases most in the first 3 weeks and the last 3 months of pregnancy, so this means that you need to swap to either a studio class (small group class with individualised exercises) or a specific prenatal class as soon as you are aware that you are pregnant as you want to avoid torsional exercises such as lunges and large range of motion exercises such as Russian and side splits.
As your exercises will need to be modified as your pregnancy progresses, it is important that you see an instructor who is experienced in coaching pregnant mums, or see a physiotherapist with Pilates training
If you do start to experience any lower back or pelvic pain, let your instructor know immediately and ask for a modification to the exercise. If you are still experiencing pain, you need to stop the session and organise an assessment with your physiotherapist
My favourite exercises for mums-to-be
Even though our flexion and rotation (bending forwards and twisting) become more restricted during pregnancy, lateral flexion (bending to the side) does not decrease and it feels absolutely great to get your spine moving!
Side sit ups
Once your belly ‘pops’ the direction of fibres in your abdominals changes, so normal crunches are no longer recommended, but side sit ups are still fantastic to do with the added bonus of a nice side stretch incorporated as well! After birth, new research is indicating that correctly performed abdominal crunches can actually assist in closing a diastasis recti (abdominal separation), so seeing your physio after birth is important too!
Your upper back will often get stiff during pregnancy and traditional stretches lying on your tummy will not be comfortable any more. Kneeling cat is my personal favourite as the springs give support, but allow you to feel a lovely stretch both through the upper back and the abdominals without overloading them.
This opens up the pelvis 5cm more than when you are in standing and is great preparation for birth. It is considered by many to be the most natural position to give birth in so if you are practised at the movement, you will be better able to utilise this position during your labour.
Myths related to exercise when pregnant:
I can’t lie on my back
A lot of mum’s-to-be are told to avoid lying on their back (supine) after 16 weeks due to potential obstruction of some of the major blood vessels due to the weight of the baby. However, it has been found only 4% of mothers studied had light-headedness after lying on their back. Those who did recover as soon as they moved from the supine position. This means that it is absolutely fine to lie on your back as long as you listen to your body! If you start to feel faint, roll onto your left side and wait for the sensation to pass before standing up. If this does happen to you, then you do need to avoid the position in future by propping yourself up on pillows or doing exercises in sideline instead. It is easy to modify Pilates exercises to avoid lying on your back.
I can’t lie on my tummy
Most mums will feel uncomfortable lying on the stomach after the first trimester when their bump ‘pops’, but prior to this, there is no concern about lying on your tummy. The baby is surrounded by so much fluid they won’t feel it! So it is absolutely fine to lie on your tummy for as long as you feel comfortable to do so. However, your pilates instructor or physio will be able to adjust your favourite exercises so you don’t miss out on doing them as your pregnancy progresses!
I can’t get my heart rate up
There is no maximum heart rate recommendation for exercising whilst pregnant, but it is recommended that you are able to talk at all times when you are exercising. Continual exertion above this level can start to raise the core body temperature, which we do not want to rise above 38 degrees during pregnancy. This is also something to be aware of when doing vigorous exercise on a hot day.
Now for the scary warnings…
There are certain symptoms that mean you should stop exercising immediately:
Shortness of breath prior to commencing exercise
Decreased foetal movement
Amniotic fluid leakage
Muscle weakness affecting your balance
Calf pain or swelling (can be a sign of DVT)
If you start experiencing any of these symptoms, you need to let your instructor know immediately, stop exercising and seek medical assessment as soon as possible. However, these issues are very uncommon and exercise during pregnancy if you are otherwise healthy is very safe (and enjoyable!).
Returning to Pilates after birth
You can return to Pilates 4-6 weeks after giving birth if you had a normal vaginal delivery without complications, but need to wait 8-12 weeks after a C-section. Make sure you get clearance from your Doctor to return to exercise and if you had any stitches after your delivery it is highly recommended that you see a women’s health physio prior to returning to activity.
The two main concerns after delivery for most mums:
Pilates can help with improving your pelvic floor control after birth, as most exercises involve the activation of the pelvic floor to assist with trunk stability. However, if Pilates exacerbates any symptoms you may be feeling, or if you are not seeing improvement in your ability to activate after 2-3 sessions, an assessment by a Women’s Health physio will be invaluable.
The important thing to know about an abdominal separation is that it is completely normal to have up to a 3cm separation at the height of the belly button as the abdominals have stretched to accommodate your baby. What we need to see after birth is that this starts to lessen and that you can generate tension in your abdominals without the tummy ‘doming’ (popping out). If you notice you are ‘doming’ during your Pilates class, you need to alert your instructor as the exercise will need to be modified for you. Binding the tummy for the first 2-3 weeks after birth will also help reduce the abdominal separation.
Overall, Pilates is a great way to stay fit and strong during and after your pregnancy. Please do not hesitate to contact us if you have any further questions about whether Pilates is right for you!
Every time that I go to the physio she tells me: “You need to move!”
And now you’re telling me that it’s bad?!
Let me explain. Have you ever heard: “too much, too soon”?
Sport is actually the best thing that you can do for yourself, but in some cases, if you don’t pay attention to the signs that your body gives you, you may incur injuries. There is a fine line between sport giving you benefit, and sport that might cause injuries.
Training can be a slow process – where the body needs to adapt to every change in load/speed. If we do it too fast, without giving the right time to the body to adapt, we may develop a microscopic musculoskeletal lesion – that over time will cause injuries.
Some parts of our body might be more prone to develop injuries due to intrinsic factors, such as: muscle imbalances, inflexibility, biomechanical issues (e.g flat feet), or extrinsic factors like training errors, faulty techniques or incorrect equipment.
Is there a solution for all this? Should you give up training?
Yes, there is a solution and NO you do not need to stop training.
First of all, if you are an amateur, try to learn the right way to perform certain exercises from a physiotherapist or make sure that you have a trainer that checks if you are performing exercises correctly. Then try to follow these steps:
-warm up and warm down
-increase the rate no faster than a 10% increase each week
– Make sure you are using the correct technique
– use proper equipment (e.g. shoes)
-Listen to your body and if you start to feel aches and pains is the sign that something is wrong. Consult your physiotherapist before it gets worse!
– Identify the cause of your discomfort
Is any way I can prevent the injury happening?
Yes! In our clinic we can assess your posture and functional movements through 7 tests to identify the principal areas of your body that lack mobility, strength or stability. Once we identify which area needs attention, then we can give you a personalised program to fix, and improve that specific part of your body.
Tendinopathy or Tendinitis? What are they and can physio help??
Definitely!! Physio is the first line conservative treatment for any type of tendon complaint.
What is a tendon?
Tendons are on either end of almost every muscle in the body and serve to join the muscles onto the bones. They are made of bundles of parallel collagen fibres and have different properties dependent on where in the body they are located. Tendons are structured to be able to withstand significant loads, but do not respond well to a sudden change of load, for example if one decided to attempt a 10 mile run after not running for 6 months!
Do I have tendinitis or tendinopathy?
These terms are often used interchangeably, but they in fact they refer to slightly different conditions, so it is important to question your health professional as to exactly what they are referring to as each condition requires a different treatment protocol. In the research on tendon complaints, tendinitis (also known as reactive tendinopathy) is used to refer to sudden onset pain in a tendon after a dramatic increase in activity levels or a direct blow to the tendon. Tendinosis (also known as tendon disrepair) refers to when the rate of tendon repair is not able to keep up with the rate at which the tendon is being loaded, resulting eventually in degeneration of the tendon (which is also known as tendinosis). Tendinopathy is a general umbrella term which refers to pain or dysfunction in the tendon, independent to any structural abnormality but is also often used by clinicians to refer to tendinosis.
How can physio help?
If you have tendinitis (or reactive tendinopathy), your physio will likely advise you on methods to reduce the swelling and pain in the tendon and to rest from the aggravating activity in the short term. If after an increase in load, the tendon is allowed to recover through lower level activity, then the tendon will return to a normal state, allowing it to be loaded in a controlled manner and therefore slowly adapt to the increase in load. If the load is not decreased, then a reactive tendinopathy can develop into tendinosis (tendon dysrepair).
In the tendinosis stage (also often called tendinopathy), your physio will advise you regarding an appropriate rehab program in the form of exercises and may also suggest shockwave therapy to kickstart this process. We will also assess whether there are any factors which have predisposed you to developing a tendon injury in the first place – weakness in other muscles, training surface, shoes or training regime. If you have been diagnosed with a tear in the tendon, don’t despair! Although current research suggests that tears in tendons do not heal, the body is able to increase the thickness of the healthy tendon tissue so eventually, with an appropriate loading program, the healthy segment of the tendon has returned to pre-injury size surrounding the torn portion.
Overall, if you have been diagnosed with any tendon condition, your first port of call should be your trusted physiotherapist, for a full assessment and staging of the tendon condition to facilitate optimal management and rapid return to activity.
Cook, JL, Purdham, CR. (2009) Is tendon pathology a continuum? A pathology model to explain the clinic presentation of load-induced tendinopathy. British Journal of Sports Medicine, Volume 43
Cook, JL, Rio, E, Purdham, CR, Docking, SI. (2016) Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? British Journal of Sports Medicine, Volume 50.
How to make sure that New Year’s Resolution doesn’t turn into a New Year’s Injury
If you are anything like me, you are currently feeling fairly stuffed after weeks of roast dinners and festive food, and certain that you must have shrunk your favourite jeans in the wash. The combination of this ‘permanently full’ feeling and the start of the New Year often spurs us into new exercise routines, but how to avoid causing yourself an injury?
If you are returning to your normal exercise routine after a few weeks hiatus:
Be kind to yourself!
Don’t expect you will be able to pick up right where you left off, particularly if you haven’t exercised since the beginning to December! You will likely need to start at around 70% of what you were performing prior to your break.
See our blog post about foam rollers to see how you can assist your recovery after sessions.
If you are starting a new type of solo exercise:
Make sure you have the appropriate equipment – there is nothing like an ill-fitted bike or pair of running shoes to cause trouble!
Start slow – there are many good guides available online which outline how to commence swimming, running or cycling when you are inexperienced, it is better to follow one of these rather than ‘go until you drop’
Exercise at maximum every second day, at least initially, to assess the effect of your previous session and allow your body to recover
If you are starting a new type of class exercise:
Make sure to join a ‘beginners’ class to start, even if you feel it may be too easy – better to have a nice gentle class to start than not be able to walk for a week!
Let the instructor know that it is your first session so they know to keep a closer eye on your form and provide options if they see you struggling
Don’t be shy to ask the instructor for options for an exercise if it is causing you pain or doesn’t feel right
Taking a friend with you can be a nice way to stay motivated and to feel less conspicuous as you are not the only ‘newbie’ in the class
If you are starting work with a personal trainer:
Be honest about your starting fitness level and experience with exercise. Your PT will not judge you for being a couch potato up until now, but it will help them determine the intensity of your starting workouts!
Disclose any injuries (past or present) to your PT before you start exercising so that they can ensure that they prescribe appropriate exercises
Do let your PT know if you are feeling any pain when exercising – it may just be sore muscles, but best to disclose any discomfort early and check where you are supposed to be feeling an exercise rather than injuring yourself
Tell your PT about any other concurrent exercise regimes you may be following, so they can make sure that you are not overloading your body
If at any time during your commencement of your New Year’s get fit regime you feel anything that isn’t right or any pain that doesn’t resolve in a couple of days, it is best to see your physio to get it checked out. There is nothing worse than a little niggle turning into a chronic problem just as you are starting to hit your stride on your new exercise regime. Your physio will be able to assess the injury, provide advice as to how to adjust your program, check that your technique is correct and that your equipment (e.g. your running shoes) is not causing injury.