NB: This is a blog of our personal opinions, and is provided as a brief overview of things we think you might find interesting.

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  • Spring has sprung, the daffodils are finally out in the verges at Mitton; lawn mowers fill the air around Ashchurch. The sound of leather on willow emerges from the Vineyards; whilst the rugby club emit their final “3 cheers” of the season. Meanwhile the inhabitants of Walton Cardiff are taunted by the smell of charcoal and the promises that holds.

     

    Gardeners are out in force, and their backs are complaining about the unaccustomed activity; the fast bowler’s knees and shoulders are aching with their newfound workload, and the front row’s battered necks and spines are complaining after a long season of abuse.

     

    It’s times like this, that you can really appreciate the friendly service at a clinic such as Tewkesbury’s Back In Action (on Church Street), where the chiropractor can manoeuvre the bones and joints back into smooth motion, and the massage therapist can coax and cajole the muscles into releasing some tension and working properly again.

     

    But tread carefully, those who dare to enter there; for the unwary may be assigned a course of exercises, or given home-work to assess your strains of daily life; or, horror of horrors; be advised to drink more water, and less caffeine. For at Back In Action, our main aim is to keep you out of our offices as much as possible; to strengthen your back so that we don’t have to patch it up again later, to improve your function in daily life (and sporting performance) so that you don’t suffer an injury in the first place.

     

    If you are suffering pain from a mechanical cause, then give us a buzz on 01684 291 261 and see if we can help. If you’re unsure about your particular condition, then ask for a free chat, with no obligation, for some general advice.

    Spring in Tewkesbury

    Spring in Tewkesbury

    Spring in Tewkesbury

    For members of @Tewkesbury RFC & @Tewkesbury Cricket Club, this may also be a timely reminder that adult players receive a 1/3 discount, whilst juniors (U18) can be treated at 1/2 price.

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    This coming week is chiropractic awareness week, so… what actually is chiropractic?

    Typical chiropractic treatment consists of far more than the spinal manipulative therapy that most of us think of. We take an holistic approach to our patients, realising that whilst the spine may be a central source of many of our pains and problems, it is far from the only cause. We therefore assess the health status of the entire patient, not just the spine; and advise on how best to treat the whole patient. Chiropractic intervention can be active or passive; that is, it can include advice or coaching in self-care (the patient takes an active part in their care), or it can include physical therapy such as massage, manipulation, mobilisation etc (the patient is a passive participant in their care).

    You will also find that much of chiropractic care is aimed at helping you to help yourself. The chiropractor can only do so much; we can treat what needs to be treated, but for your body to heal, it needs your help. Your chiropractor may give you a wide range of advice, including the use of other therapies, of exercises you can do, or lifestyle changes that may help your body (eg the ergonomics of your car seat; or nutritional advice), or coaching/educating on things like sleep hygiene or pain science. We are more than happy to share the management of your condition, both with your GP and other therapists.

    Through all these things, we aim to aid you in maximising your recovery, minimising any future recurrence, and to help you to manage any future episodes without the need for intervention. For patients on a maintenance programme, we aim to provide relief before any pain becomes bothersome, and to remind and encourage you with self-care techniques; helping you to fulfil your potential in life.

    You can find out more here:
    www.chiropractic-uk.co.uk/chiropractic-care
    www.sportsinjuryclinic.net/treatments-therap…/…/chiropractor

    Chiropractic for Back Pain

    Evolution of Back Pain

    Chiropractic is meant to help you heal better

    Chiropractic - Evidence-Based, Patient-centered, Interprofessional, Collaborative

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Let’s take a look at facet syndrome.

    Facet syndrome is the irritation of the structures that form the facet joints – the small joints in the spine, which control movement. These can be irritated by pinching or stretching of the capsular ligaments which surround the joint, as a result of repeated micro-trauma, or as a result of local inflammation. Facet syndrome classically includes pain referred away from the location of the injury, which may follow typically pain referral patterns. Pain at the site of the facet is often a local, sharp sensation, whilst the referred pain is often duller, more achey and more diffuse. Stiffness or locking of the affected joint is a common sign, and the surrounding muscles may tense up, or even go into spasm, to protect the damaged joint. Both the original locking, and the resultant muscle spasm can result in very painful, or outright limited motion in a certain movement; and may even experience antalgia – that is, a posture or gait designed to hold a less painful position, such as leaning the body to the side; or keeping the neck flexed.
    Facet syndrome has a nasty habit of becoming a recurring problem for the individual sufferer, sometimes lasting hours, sometimes days, sometimes weeks; but often coming back. Regular exercise, and manual therapy seem to work best at reducing these recurrences.

    You can find out more here:
    www.physio-pedia.com/Facet_Joint_Syndrome
    www.chiro-trust.org/back-pain/what-is-facet-syndrome

    Facet Syndrome

    Facet Pain Referral Patterns

    Facet Syndrome

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Let’s take a look at iliotibial band syndrome (ITBS).

    AKA ITB friction syndrome

     

    People who participate in intense physical training, such as runners, cyclists, and military recruits, are most susceptible to ITBS. They may notice a sharp pain that comes and goes at the outside of the knee. Over time, the pain may become more pronounced.

    The iliotibial band is a wide strip of fibrous tissue that extends down the outside of the upper leg. It begins at the top of the pelvis, at a bony prominence called the iliac crest, and travels down the outside of the thigh, continuing over the outside of the knee joint. The bottom of the IT band attaches to the top of the tibia (shinbone). One of its functions is to help stabilize the knee joint.

    The IT band may rub uncomfortably against the bony bump on the outside of the femur at the knee. It may also compresses other soft tissue near the knee joint, such as a bursa or fat deposits near the knee, causing painful irritation. Either of these actions may result in the IT band itself becomes inflamed or otherwise injured.

    Pain is usually felt at the outside of the knee; but can also come up the thigh, or into the side of the pelvis. When mild ITBS may only feel knee pain at the middle or end of a workout, but as the condition progresses, you may feel pain while simply walking or going down a set of stairs.

     

    You can find out more here:

    www.physio-pedia.com/Iliotibial_Band_Syndrome

    www.sportsinjuryclinic.net/sport-injuries/knee-pain/iliotibial-band-syndrome

    Iliotibial pain locations

    Taping for ITB

    Foam Rolling for ITB

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Teninopathy 08 March 2019 | Comments (0)

    Let’s take a look at tendinopathy.
    AKA Tendonitis

    Tendinopathy is irritation and pain localised in or around a tendon, which is a band of fibrous tissue that connects muscle to bone and transmits the force and action of the muscle. Injury is usually a repetitive strain, or overuse injury; but can also be an acute traumatic tearing.
    Tendons are designed to withstand bending, stretching, and twisting, but they can become inflamed from traumatic injuries that leave them with torn fibres or other damage or, more commonly, fail to heal or scar following overuse.

    The pain of tendinitis can be significant and worsens if damage progresses because of continued inappropriate use of the joint. Most damage heals in about two to four weeks, but chronic tendinitis can take more than six weeks, often because the sufferer doesn't give the tendon time to heal. In chronic cases, there may be restriction of motion of the joint due to scarring or narrowing of the sheath of tissue that surrounds the tendon.
    The POLICE protocol for tissue healing should be applied; with ice massage and the optimisation of the tendon load (rest, massage, gradual strengthening – finding the Goldilocks zone between too little and too much) being particularly useful forms of treatment for these conditions; whilst more severe or chronic cases may require steroid injections or even surgery.

     

    You can find out more here:
    www.nhs.uk/conditions/tendonitis
    www.sportsinjuryclinic.net/sport-injuries/general/tendonitis

    Ice Massage for Tendinopathy

    Tendinopathy

    Factors Affecting Tendon Repair

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Let’s take a look at the perception of chronic pain.

     

    Pain is weird, brains are weird, they don’t really know what’s going on in their own body; they have an opinion, but opinions are not the same as facts.

    First of all, there is no nerve that carries signals of “pain” from the body to the brain. The messages that nerves actually carry are things like “hot” “cold” “pressure” “stretch” or even “harm”. The brain takes these messages, and interprets them within the context that past experience provides.

    Pain, therefore, is a highly subjective, personal experience. It is easily altered by experience, hopes and fears, and even the language used when giving or receiving explanations.

    It is supposed to be.

    Pain isn’t a report on what is going on in your body – that’s the job of the nerve messages. Pain is a protective mechanism; it is supposed to make you act appropriately to the report on what is happening to your body. Pain can under-react (ignoring harmful information due to lack of experience); it can be appropriate and proportional (if you sprain an ankle, it’s supposed to hurt – to stop you doing something silly on it), or it can over-react (that chilli isn’t actually dissolving your tongue in a vat of acid).

    Pain is a construct of the brain; and brains can get… bored… and that stinging nettle rash that was nothing much, can become agonising when your brain has nothing else to think about. Pain can be learned – to prevent you from doing the same thing again. Pain can be made actively worse by worrying about it (that stinging nettle rash again, or concern about someone you know who had something similar) as you rehearse the sensation of pain.

                                                                

    This all means that we can feel pain in a part of the body that has no damage, most especially, we can continue to feel pain in a part of the body which used to be damaged, but in which the damage has healed. That pain is absolutely real; it’s just that the brain became so good at feeling pain there; it is now misinterpreting other signals as being painful. Essentially, it has become phobic.

     

    So what can we do about it?

    Well, we can retrain the brain. We can reassure the body that actually, these movements, these touches are okay. We can learn to think about the pain differently; to challenge the brain’s beliefs about what is happening. Gentle manual therapy can calm the brain’s over-reaction to stimulus. Finding things that don’t hurt (movements and exercises), and repeating them often, can push back on the boundary for what is felt as pain. Cognitive behavioural therapy (CBT) can change the way we think about the pain, and learn how to more appropriately interpret the signals arriving from the body. Even just reading this post can potentially help you understand, and feel differently about pain.

     

    Find out more here:

    www.tamethebeast.org

    https://youtu.be/RYoGXv22G3k

    www.physio-pedia.com/Psychological_basis_of_pain

    https://youtu.be/C_3phB93rvI

    http://www.greglehman.ca/pain-science-workbooks/

    Opinions =/= Facts; Pain =/= Damage

    Pain is NOT an accurate measure of tissue health

    Pain can be under-protective, appropriate, or over-protective

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Let’s take a look at piriformis syndrome.
    AKA deep gluteal syndrome (DGS).

    Piriformis syndrome is a form of sciatica where the sciatic nerve is compressed or irritated by the piriformis muscle. The piriformis muscle is a muscle deep in the buttocks and is a primary stabilizer for the hip, lifting and rotating the thigh away from the body. It is used whenever we walk, shift our weight from one foot to another, or maintain balance. Care needs to be taken with diagnosis to rule out the possibility of other structures compressing the nerve, or of simple trigger points with the muscles of the buttock which can cause pain mimicking piriformis syndrome.
    Piriformis syndrome can be either a primary or a secondary condition; and sometimes both at the same time. This means that it can happen of its own accord, and potentially cause other issues such a sprain in one of the joints of the pelvis; or it can be a reaction to another problem, such as a sprain in one of the joints in the pelvis. This can, of course, be a self-repeating cycle, creating chronicity.
    Pain is usually felt in one buttock, going down the back of the leg into the calf and foot; the leg and foot pain is often accompanied by numbness and a tingling sensation. You can even experience weakness in the muscles as well; it is often worse in the morning, whilst sitting or walking up slopes or stairs.
    The single most common cause of piriformis syndrome in men is sitting with the wallet in the back pocket. If you do this, please stop (or continue, and then pay me to tell you to stop).

    You can find out more here:
    www.physio-pedia.com/Piriformis_Syndrome
    www.sportsinjuryclinic.net/…/hip-groin-…/piriformis-syndrome

    The anatomy of piriformis syndrome

    Use a foam roller to treat piriformis syndrome

    Home stretch for the piriformis muscle

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Let’s take a look at myofascial pain syndrome (MPS).

    MPS is a common cause of pain and is characterized by pain arising from tight bands of muscle known as trigger points, which often result in pain that is felt away from the site of injury. This pain away from the site of injury is a type of referred pain; where the brain gets a bit confused as to where the pain is coming from, such as shoulder pain as a result of liver pathology, or pain in the left arm as a result of cardiac issues. This pain tends to be dull and heavy, whilst the pain at the site of the injury itself can be dull or sharp, but is usually more intense – at least when challenged.
    Trigger Point Therapy can be very effective at relieving MPS, though it can also be a very painful treatment; it works best when combined with stretching and strengthening exercises. As always though, identification and treatment of the underlying cause leads to the best outcomes – often stress or posture related, but can be down to injury, regional pain, or something systemic like fibromyalgia.

    #TriggerPoints #MyoFascialPainSyndrome #ReferredPain #Massage #Tewkesbury

    You can find out more here:
    www.physio-pedia.com/Myofascial_pain
    www.webmd.com/pain-management/guide/myofascial-pain-syndrome

    Myofascial Pain Syndrome - trigger point pain referral from the Glute. Medius muscle

    Myosfascial Pain Syndrome - trigger point pain referral from the Scalenes muscle

    Myofascial Pain Syndrome

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    Let’s take a look at leg length inequality (LLI). AKA: Anisomelia or Leg Length Discrepency).

    NB: We do not treat leg length inequality itself; though we may be able to helpw ith some of the causes of a functional LLI.

     

    None of us are built straight; we might have a nose that points slightly to the left, an ear that’s lower than the other, or a breast that’s larger than its twin. In about 90% of us, one leg is longer that the other; and the vast majority of the time, this is not a problem. Sometimes that LLI can be functional - caused by other things such as a collapsed arch in the foot, or a muscle imbalance; whilst other times that LLI can be structural - one bone longer than the other, but accommodated by the body so that it has little or no impact upon the individual.
     

    However, a long-standing LLI can cause secondary problems elsewhere, especially the pelvis and spine, as you want your eyes level to the horizon. These problems will tend to be low-grade overuse injuries, and often misdiagnosed to start with; typically responding to treatment of the secondary issue, but recurring; or responding but not resolving.

    In the case of a functional LLI the best course of action is to identify why the LLI exists, and treat that root cause; in the case of a structural LLI (that is symptomatic), then an artificial lengthening of the short leg may be worthwhile; by the use of a heel lift, foot lift, or building up the sole of one shoe.

     

    Establishing how great the inequality is can be difficult, expensive, and often pointless; given that your body can adapt and accommodate it, it often just needs a little help. One of the best (and cheapest) ways of establishing the extent of any LLI is to simply stand on flat ground, with you pelvis and lower back freely mobile (which may or may not require treatment to achieve); and then stand with one foot raised by a pile of paper; repeat on the other side; and decide which felt more comfortable. If you do notice a beneficial difference; then alter the size of the pile of paper until it feels most “right”; and that would indicate the size of any correction you can trial to see if it works. Basic orthotics to raise the heel or foot can be bought in most pharmacists, or on Amazon; for anything more complicated we would advise consulting a podiatrist.

     

    You can find out more here:

    www.physio-pedia.com/Leg_Length_Discrepancy

    www.chiro-trust.org/advanced/the-kinetic-chain

    Function leg length inequality

    Structural leg length inequality

    Leg Length Inequality

    At Back In Action we also offer free chats. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your no obligation free chat.

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    TOS is a term used to describe the compression of the brachial plexus; a grouping of nerves in the neck and shoulder region. Compression of these structures can cause pain, tingling, numbness and weakness from the shoulder and into the arm – often described as ‘sciatica in the arm’; but can also be felt in the neck or even into the face. Compression is usually caused by tension in the muscles that the plexus passes through or alongside, but can also come from the top ribs or joints of the neck. Symptoms are often aggravated by raising the arm/s up; this is a fairly common condition amongst people who work with their arms held high, such as hairdressers or some machine operators. Common causes of TOS include trauma, stress, repetitive strain, posture or congenital abnormalities (such as extra ribs); though sometimes the root cause is simply unknown. TOS is most common in women aged 25-45.

     

    Treatment is aimed at identifying and nullifying the root cause if possible; at relaxing, stretching and strengthening the muscles of the neck, or, failing that, then mobilising the joints of the neck, shoulder and upper ribs. Where TOS is caused by a congenital abnormality then referral to an orthopaedic surgeon may be warranted.

    Diagnosing TOS is often not easy, as there are so many other conditions which present similarly; such as carpal tunnel syndrome, tennis elbow or rotator cuff tear. Indeed it happens that a nerve damaged at one point becomes more susceptible to damage elsewhere along its length, this is a called a double crush injury.

     

    You can find out more here:
    www.sportsinjuryclinic.net/sport-injuries/upper-back-neck/thoracic-outlet-syndrome

    www.chiro-trust.org/neck-pain/is-it-my-neck-or-thoracic-outlet-syndrome

    Forms of Thoracic Outlet Syndrome

    Stretches for Thoracic Outlet Syndrome

    Nerve Flossing for Thoracic Outlet Syndrome

    At Back In Action we also offer free consultations. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your free no obligation consultation.

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    Shin Splints 18 January 2019 | Comments (0)

    Shin splints are common in people who do a lot of springing on the balls of their feet, such as runners, tennis players and fell-walkers. They aren't usually serious, but can stop you from exercising and may get worse if you ignore them; it's important not to run through the pain. They can usually be treated at home by following the POLICE protocol, and should start to get better within a week or two.

    Shin Splints typically present with dull, diffuse pain in the inside front of the shin, which comes on during activity; which may be tender to touch. There may also be some muscle tightness, or loss of flexibility at the ankle. Although mild swelling sometimes occurs, notable swelling of the lower leg, numbness, weakness and discolouration are not associated with shin splints and should prompt evaluation for other disorders, such as compartment syndrome.

    Shin splints tend to come on with people who have recently increased their training, whilst those who over-pronate the ankle, have flat feet, or a leg length inequality are also susceptible. Running on hard, or uneven surfaces can also aggravate this condition, as can wearing older shoes which have lost their cushioning.

     

    You can find out more here:

    www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain/shin-splints

    www.physioadvisor.com.au/injuries/lower-leg/shin-splints

    Front line treatment for shin splints

    Typical presentation of shin splints

    Shin splints

    At Back In Action we also offer free consultations. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your free no obligation consultation.

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    Let’s take a look at acute care. Please note that acute means very recent, it does not comment on severity. In this case, we’re talking about the first 3 days after injury, and that isn’t severe enough to justify A&E (or if they release you with nothing too much to worry about). If your problem is not improving after 3-4 days, then it may be time to seek a diagnosis with more specific advice and care.

     

    The best, and most important piece of general advice (after first aid) is POLICE:

    PROTECT – This may be a splint, or a brace; or it may be the application of common sense; basically, avoid aggravating factors; surprisingly enough, they can aggravate things.

    OPTIMAL LOADING – Movement is essential to allow full perfusion of oxygen and nutrients (and white blood cells and serum), allow the body to actively heal itself, and minimise scar formation; this also means not to be afraid to use the injured area – let the pain guide you here; just don’t over-load things either. NB: We used to call this “Rest”, but too many people took us too literally, and assumed it meant bed rest.

    ICE – Real ice is better than fake cold from gels and sprays; but often less convenient. Always wrap your ice pack in a thin layer of dry material; this prevents you getting an ice burn. For the first day or so use it in bursts of <5 minutes, repeating every 20-30 minutes. After that, use bursts of 10-15 minutes, repeating every 60-90 minutes.

    COMPRESSION – Has a dual effect, it minimizes excessive oedema, by not allowing it room to expand, and provides an element of support to a joint, allowing the ligaments more rest. Don’t wear strapping for more than a few days without seeking further advice (unless it’s bandaging for an open wound, or a broken bone, obviously).

    ELEVATION – Helps drain oedema, blood and lymph from the area, basically, try to keep the injured area higher than the heart so it can drain – obviously, easier with limbs than torso injuries; don’t use for more than a couple of days.

     

    You can find out more here:

    www.sportsinjuryclinic.net/treatments-therapies/cryotherapy-cold-therapy/rice

    www.physioadvisor.com.au/health/injury-rehabilitation/rice

    Acute Injury Care

    Acute Injury Care

    Acute Injury Care

    At Back In Action we also offer free consultations. This will take about 10-15 minutes where we can talk in general terms about your condition, and see if we can point you in the right direction for treatment. Whether that is with ourselves, someone else, or on your own at home. Call today to schedule your free no obligation consultation.

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