Archive for April, 2017

However, if you are a keen runner there is also every chance that you have had a frustrating layoff with one or more of the most common injuries, which can interrupt your training.

The four most common running injuries we tend to see are:

1. Runners Knee
2. Shin Splints
3. Plantar Fasciitis
4. Achilles Tendonopathy
   

Let’s briefly deal with each in turn:

Runner’s Knee

This is a lay term that can lead to some confusion as it can encompass injuries such as iliotibial band syndrome (ILTB) anterior knee pain (AKP) and patella tendon injuries, all of which are completely separate injuries that may be chronic (gradually appear over time with overuse) or acute (due to sudden injuries).

ILTB 

The pain occurs on the outside of the knee joint, is worse during running but eases when you relax. This can be caused by tightness in the ilio-tibial band, poor foot function, i.e., over-pronating feet, unsuitable shoes and excessive training.

AKP or Chondromalacia Patella 

The pain is mostly around the kneecap, often just on the inside or below but can also radiate to the back of the knee. It occurs because the tracking of the kneecap within the femur as you bend your knee is altered. This can be due to muscle imbalances in the thigh or hip – some muscles are pulling too strongly and some are simply too weak. Inflexibility is another common factor here as is overpronation or poor foot function.

Patella Tendinopathy 

Even the casual runner can suffer from this although it tends to be more common in more high-impact sports injuries involving bursts of activity. The pain is usually localised to the tendon and starts with pain after exercises but can progress to debilitating pain through exercises. Most recent research has shown inflexibility of the hamstrings and quadriceps is very common; also the alignment of the patella (the kneecap) and the biomechanics of the feet can have a significant impact on this condition.

Shin Splints

This is another lay term that can encompass any of the conditions described below:

• Compartment Syndrome
• Stress Fractures
• Medial Tibial Stress Syndrome

All of these commonly experience pain on the inner side of the shin during exercise and even at rest in more chronic cases. The individual history needs to be carefully taken to distinguish between them. The individual’s training, lower limb biomechanics, flexibility, and muscle strength must all be carefully assessed in addition to their running shoes in order to determine the cause and appropriate solution to the runner’s pain.

Plantar Fasciitis

This refers to pain on the underside of the heel which often radiates down the inside of the sole of the foot. Pain is usually worse on activity and also after prolonged inactivity, particularly on getting up in the morning the first few steps can be very sore.

The most common cause of this is often the biomechanics of the foot due to overloading of the plantar fascial tissue. This is often described as over-pronating seen in people with flattened medial arches, or under-pronating seen in people with higher more rigid arches. Overload of the tissues can all occur if the footwear does not have adequate shock absorption or is worn out. Plantar fasciitis is common in runners and by replacing running shoes can sometimes resolve spontaneously. On other occasions, it can be very persistent which could be due to the wrong type of running shoes being worn or that an orthotic is needed to improve the biomechanics. Tight calf muscles and Achilles tendons can increase the strain on the plantar fascia. To resolve this the individual needs a full biomechanical lower limb assessment and advice about their shoes and self-help measure including stretches, ice etc.

Achilles Tendonopathy

This is due to the degeneration of the tendon above the heel and forms part of the lower calf muscles. This means the tendon is not as strong and may be liable to rupture with continued excessive sporting activity.

The pain comes on gradually and is worse on activity and any focal area of degeneration can be very tender to touch. The tendon is very stiff first thing in the morning and is often thicker on the affected side.

Again training should be looked at, muscle strength, flexibility and foot biomechanics are all factors that need to be addressed. Specialist eccentric exercise programmes are often very successful for these types of tendon problems although they need to be continued for at least 3 months.

We have only outlined the 4 most common running injuries that we see here at the Clinic. Our thorough initial assessment would enable us to identify whether you were suffering from any of these conditions or from one of the many other running injuries that we also treat.

Your treatment can include if appropriate, individual training advice, strengthening and stretching exercises, joint mobilisations, pain relief, and goal setting through a complete rehabilitation programme. We would also be able to identify and correct any abnormal lower limb biomechanics, which may predispose you to injury.

However it is important to realise that the most frequent cause of running injuries is overtraining or what could be termed the “terrible toos”: Too much, too soon, too often, too fast, and too little attention paid to pain all too often lead to injury.

If you’re suffering from a running injury and would our help. Please get in touch by calling 01380 730473.

What is Upper Limb Disorder?

Upper Limb Disorder (ULD) can affect the neck, shoulder, arm, forearm, elbow, wrist, fingers, and thumb with symptoms of tenderness, ache, pain, stiffness, weakness, tingling and numbness.

What can cause Upper Limb Disorder?

Risk factors include repetitive or prolonged tasks such as a computer or manual work. The risk is increased if these repetitive or forceful movements are allied with a poor posture.

How can ULD be prevented? 

• Changing your way of working can considerably relieve symptoms of ULD. Often, those that work in an office are prone to carrying out repetitive, uncomfortable actions or sustained positions. It is important to work with your employer to identify and change conditions that may lead to or exacerbate your condition. Take an office chair, for example, one size does not fit all and individuals have different needs related to their body size, age, abilities, and health.

• Your employer needs to encourage regular short and frequent pauses in intensive work. Display Screen Equipment Regulations require employers to train employees incorrect use of display screen equipment (DSE), provide suitable furniture, and periodic assessments if DSE is used for more than one hour daily. This may include adjustable chairs, platforms, and footrests. If the equipment is provided specifically for you, make sure you use it correctly.
  

Who can help?

Physiotherapists are the best medical practitioners for you to see if you suffer from Upper Limb Disorder. Physio is an extremely effective treatment for this condition and the earlier we tackle the ULD, the better,  to reduce your pain and stop your symptoms from becoming difficult to manage.

At Hatts, we can offer you an ergonomic assessment that will help to identify ergonomic risk factors, quantify them, and make measurable improvements to your workplace, ensuring that your jobs and tasks are within your physical capabilities and limitations. We can also offer you an effective treatment plan that will relieve your pain, restore your movement, and finally get you moving better than ever before.

For more information or to book an appointment give us a call on 01380 730473 or use online booking.

The fight/ flight response is designed to get you out of a dangerous situation. It involves increased steroid hormone releases such as adrenaline and cortisol.

This affects blood pressure, insulin release, immune function and inflammatory response. These changes result in increased heart rate, respiration rate, blood pressure and loss of digestion. Ideal when faced with a sabre-toothed tiger. Not so ideal when stuck in a traffic jam!

In a chronic situation, these stress responses affect cognitive performance, suppress thyroid function, slow down wound healing and immune response, contribute to loss of bone density, muscle strength and increase abdominal fat.

Frequent colds result from the loss of ability to fight infection. The sufferer may also notice poor sleep, loss of ability to cope, decreased confidence, difficulty concentrating and making decisions, headache, stomach upset, butterflies, irritability and lowered energy levels.

The best treatment is a multi-pronged attack on the causes of stress:

Try to address your priorities – It’s easy to get uptight about relatively trivial matters if you don’t stop and check your perspective

Social support is critical – A close friend, partner, family member or pet can provide the reassurance needed at vulnerable times

Physical exercise – Exercise changes the focus from mind to body, relieves tension and uses up excess adrenaline

Be aware that some people are more sensitive to stress than others – Monitor your mind and body for warning signals that you are starting to feel overloaded. Take action before everything gets on top of you.

You may like to try the following exercise as an instant stress buster. It is based on techniques used for meditation but you can work at whatever depth feels right for you:

Find a time and place that you can be sure you will not be disturbed and get into a comfortable position using pillows and cushions to support your body as needed. Bring your mind to your breathing. Do not try to change it; just observe your inhalation and exhalation. When your mind wanders bring it back to the breath. Initially try 10 minutes, notice how much more relaxed you feel afterwards.

Physiotherapists can provide relaxation techniques and advice on safe and enjoyable exercise programmes to build back mental and physical well being, so if you’re struggling to cope with stress, please reach out to us by calling 01380 730473 or booking an appointment online. 

Most of the research that has been conducted on glucosamine and chondroitin relates to people who are experiencing the symptoms of knee osteoarthritis.

What is osteoarthritis?

An imbalance of physiological processes leads to inflammatory cascades at a molecular level which affects the synovium, bone and cartilage and produces joint degeneration. Risk factors for knee OA include age, genetics, trauma, knee alignment and obesity. (see our OA article for more information)

What does the research say?

Reviews published in respected journals (including the British Medical Journal) in the period from 2005-7 have suggested that there is no clear benefit of oral glucosamine or chondroitin as compared to placebo. However, glucosamine is as safe as a placebo.

There have been some less rigorous studies that have suggested that glucosamine is superior to placebo with regard to effects on pain or function but this depends on which system of scoring pain and function is used. Some studies have argued that glucosamine and chondroitin affect subchondral bone remodelling and decrease structural change in the knee- this is still open to debate.

How much to take?

The Arthritis Campaign advises that it is reasonable to trial 1500mg of glucosamine sulphate daily if you have been experiencing chronic knee pain as this may reduce the progression of some aspects of OA shown on XRay and it is unlikely to cause you any more harm than taking a placebo (except to your wallet).

However, it is important to remember that it is possible to have OA changes on XRay but with no discomfort and equally a relatively clear XRay with a lot of discomforts.

Can physio help?

There is general agreement that exercise does have beneficial effects on pain and disability particularly that caused by knee OA.

Physiotherapy advice on a programme of exercise can help you get back on your feet. Generally, it is possible to advise and develop an individual exercise programme with a minimum of two sessions of physiotherapy. You can then use your exercises to maintain and improve the muscular support of your joints.

To book an appointment with one of our Physios, please call us on 01380 730473 or book online. 

Plantar fasciitis affects approximately 10% of the population. Find out about this condition, its causes, symptoms, and how a Gait Analysis at the clinic can help.

What is Plantar Fasciitis?

Plantar fasciitis is a condition that presents itself as a sharp pain in the heel of the foot. It is caused when the strong fibrous tissue that joins the heel to the ball of the foot gets irritated and inflamed. The condition is derived from the words plantar which is the bottom of the foot, and fascia which is the fibrous connective tissue responsible for supporting the arch and transmitting weight across the foot as you walk or run.

Plantar fasciitis is most commonly seen in middle-aged adults and in athletes.

What are the symptoms of Plantar Fasciitis?

The most common symptom is a sharp pain at the bottom of the heel, which can sometimes feel like walking on a marble. It is usually worse when you get to your feet first thing in the morning, or if you walk or run after a period of inactivity. In some cases, pain can also extend along the bottom of the foot where the plantar fascia extends to join the ball of the foot.

What causes it?

Irritation or inflammation of the plantar fascia can be caused by 2 main factors; intrinsic and extrinsic.

Intrinsic factors include:

– Feet with very high arches or very low arches

– Feet that roll inwards while walking

– Tight Achilles tendons or calf muscles

– Being overweight

Extrinsic factors include:

– Standing on your feet for a large part of the day – such as is the case for Teachers and Factory Workers

– Wearing footwear that does not support the foot correctly

How we can help with treatment?

Plantar fasciitis is definitely a treatable condition, with many different options available depending upon individual circumstances. At your Gait Analysis appointment, our Podiatrist will determine the cause of your plantar fasciitis and recommend a treatment plan that is bespoke to you. This could include:

Orthotics: The most effective treatment for plantar fasciitis is the use of custom orthotics, or insoles. Orthotics are are suitable for people of all ages and because they are bespoke to your foot, offer the exact support required to aid your foot’s normal function and relieve the cause of your plantar fasciitis.

Shockwave Therapy: This is an excellent treatment option for chronic or resistant cases and helps increase your healing capacity. This treatment works best alongside other treatments listed here.

Corticosteroid Injection: This can be effective at relieving symptoms in the short term. Our Podiatrist will use Corticosteroid injections in combination with other treatment options such as stretching or orthotics.

Physiotherapy: You may also see one of our team of Physiotherapists for manual therapy and an individually prescribed exercise programme to help build strength in weak muscles that could be causing your plantar fasciitis.

Massage: If your plantar fasciitis is caused due to tight calf muscles, our massage therapists can help to ease the tension in your muscles, thereby addressing the cause.

Night splint: The use of a night splint may be recommended to help prevent overnight tightness of the Achilles tendon and plantar fascia.

Find out more about a Gait Analysis and how it can help you here >

Shin splints is the term used to describe pain along the inner edge of the shin bone usually caused by repeated trauma to the area. Common amongst runners, footballers, and rugby players, find out more about this condition, its causes, symptoms, and how we can help.

What are Shin Splints?

Shin splints are medically known as medial tibial stress syndrome (MTSS) due to the anatomical location of pain which is located along the inside of the shin starting approximately 5cm above the ankle extending up to one-third of the shin bone. It often presents as a deep bruise-type pain.

It is a specific overuse injury-producing pain on activities such as running. Shin splints are more common in females than males with a 4:1 ratio but are still prevalent in men.

What are the symptoms of Shin Splints?

Shin splints typically present themselves as a deep bruise or aching pain. It is often present at the start of running which subsides after a few minutes but then can return towards the end of a run due to fatigue and a change in running biomechanics. It can also be painful first thing in the morning the day after a run. Normally, day-to-day function and walking is unhindered, but shin splints can progress if left untreated. If you experience pain during walking it may suggest a more severe bone injury such as a stress fracture.

What causes it?

Historically there have been a number of popular theories on the causes of shin splints, however, the most recent research findings suggest it is a bone stress injury and is believed to be linked to an increase in bending stress placed on the bone. The bending stress on the bone is greatest at the lower shin and this can be exacerbated due to abnormal biomechanics. There are many reasons why a person may have abnormal biomechanics which may include:

• Increased foot pronation (flat feet)
• Poor core stability
• Poor glute or hip muscle strength
• Tibial varum (abnormal bone alignment of the lower leg)
  

How we can help with treatment?

Many different options are available to treat shin splints and these will depend upon your individual circumstances. At your Gait Analysis appointment, our biomechanics Podiatrist will determine the cause of your shin splints and recommend a treatment plan that is bespoke to you. This could include:

Orthotics: Custom orthotics or insoles are one of the most effective treatments for shin splints. Orthotics are suitable for people of all ages and because they are bespoke to your foot, offer the exact support required to aid your foot’s normal function and relieve the cause of your shin splints.

Running Analysis: As shin splints is nearly always linked to running we provide specific running gait analysis to look at your technique which may highlight abnormality or technique issues which can then be worked on via various methods.

Shockwave Therapy: This is an excellent treatment option for chronic or resistant cases and helps increase your healing capacity. Shockwave therapy works best alongside other treatments listed here.

Physiotherapy: You may also see one of our team of Physiotherapists for manual therapy and an individually prescribed exercise programme to help build strength in weak muscles that could be contributing to your shin splints.

Massage: If your shin splints is due to tight leg muscles, our massage therapists can help to ease the tension which provides effective relief of symptoms.

Find more about a Gait Analysis and how it can help you here >

Flat feet is the term used to describe feet with low or no arches. In this blog article, you’ll learn about what causes flat feet in children & adults, when you should seek professional help, and what treatment options we can offer you.

Flat feet in children

Children have flat feet from birth until the foot develops, usually between 6-8 years of age. However, after this period not everyone develops an arch. This can be down to genetics and may run in the family and be inherited from parents. If there is a genetic link, this rarely causes problems.

In many cases of flat feet, the feet tend to roll inwards too much during standing and walking which causes flattening of the arches. This may be due to ligament laxity in the foot joints. This is known as pronation. This is a common reason why children have flat feet as they tend to have looser joints than adults. In rare cases, the flat foot shape can also be due to the way the foot formed in the womb, where for example, a joint may be malformed or two or more bones may be fused together. Children’s feet in these cases are stiff and flat, and the problem is usually obvious in childhood.

Flat feet in adults

The people referred to above have always had flat feet. However, occasionally a flatfoot develops later in life. This is known as adult acquired flatfoot. This is most often caused by a ruptured or weakened tendon (the tibialis posterior tendon), ligament laxity in adult life, arthritis or an injury-causing stiffness and distortion of the joints of the foot. In all these cases there is often pain and limited daily function. Some people with neurological conditions such as spina bifida, muscular dystrophy, or cerebral palsy may develop flat feet due to muscle weakness secondary to disease of the nervous system. In neurological cases, the feet are stiff and the deformity tends to get worse over time.

When should I consult professional help?

You should consult a podiatrist if:

• Your feet cause you a lot of pain when standing or walking
• Your shoes wear out very quickly
• Your foot or feet seem to be getting flatter
• Your feet seem very stiff
• You cannot feel your feet normally, or they seem weak

What can be done about flat feet?

In many cases, no treatment is needed. This is when there are no symptoms such as pain. If you have pain in your foot, ankle, or lower limbs, it may be due to your flat feet. If you or your child experience pain you should consult a podiatrist for a professional opinion. If your pain is due to your flat feet a podiatrist may prescribe custom-made orthotics, which are medical insoles made specific to the needs of the individual. In some cases, surgery is required to straighten the feet. If you require surgery your podiatrist will refer you to a podiatric surgeon or orthopaedic surgeon

How we can help with treatment?

Orthotics: Orthotics are an excellent treatment for people with painful flat feet or flat feet that are causing pain elsewhere such as the knees due to poor biomechanical control. Our orthotics are suitable for people of all ages and because they are bespoke to your foot, offer the exact support required to aid your foot’s normal function and relieve the cause of your pain. To assess if orthotics are suitable for you, book in for a Gait Analysis appointment.

Physiotherapy: If your flat feet are caused by muscular tightness, injury, or weakness, you may also see one of our team of Physiotherapists for manual therapy and an individually prescribed exercise programme to help build strength in weak muscles that could be causing your flat feet.

If you suspect you’re suffering from flat feet, we can help. Book your Gait Analysis appointment online or by calling us on 01380 730473. Appointments are available at any of our clinics in Devizes, Marlborough or Frome