Hip, knee or ankle problems with running? (take the test)

Take the 30 second test below:

Step 1 - Stand on one foot and perform a single leg squat, go as deep as you can (or as far as your mobility will allow).

Step 2 - Watch yourself in a mirror and note what your movement looks like.

Step 3 - Now compare your movements to the video below.

Do your mechanics look more like the video on the RIGHT or the video on the LEFT?

The video above shows 2 different sets of mechanics. The left side shows 'good' mechanics, the right side is 'poor'.

You might need to watch the video several times but you will see in the right video the biomechanics are not as efficient as the video on the left.

In the video in the right you will see:

1. The knee drops in heavily (adducts and internally rotates).
2. The left hip drops and loses alignment (trendelenburg sign)
3. The general balance and proprioception is poor.

The single leg squat is a great way to assess for this type of poor mechanics. However you will generally find that if an individual presents with these mechanics in the test it will carry over into their walking or running pattern (or gait).

These type of poor mechanics (video on the right) are often linked to knee, shin, ankle and foot pain of various type. The reason for this is that the mechanics in this type of movement are poorly aligned and inefficient. The knock on from this is that tissues - muscles, tendons, ligaments, fascia and cartilage - are put under increased stress and are subjected to increased 'shear' forces.

The good news is that in most cases these poor mechanics can be corrected and are often linked to imbalanced or weak muscles (core / gluteals etc). However with simple rehabilitation exercises these problems can largely be corrected.

Now before I finish I have to say that what is written above is a very simplified version of what can occur,  but the purpose of this post was to present the basics of what poor running mechanics can look like.

If you need a more in-depth analysis it's best to book an appointment with one of us.

Stretching Your Hamstrings - 9 different variations for you.

We often get asked at the clinic about how best to stretch the hamstrings. 

The truth is there is not a single method that is 'best' for all people and all injuries. 

Some stretches work better for certain problems. This is largely due to the fact that different stretches will bias (or target) different aspects of the muscle and different methods change the 'type' of stretch you get. 

In addition any experienced therapist will know that some individuals 'feel' a better stretch with one method when compared to another. This can vary from person to person. For that reason it's often best to try a few different methods of stretching, before deciding on which one to stick with.

Below are 9 different ways to stretch your hamstrings, try a few of them a 'feel' what works best for you:

For a full size printable copy of the stretches click here.

P.s. There are many more methods for stretching the hamstrings that are not included above, however this should be a good starting point.

P.p.s I have a couple of stretches that are my personal favourites. For example, the No1 stretch that I use is the second one from the bottom. There are a few reasons I prefer this stretch, but the reasons are a bit lengthy to go into on this blog post. Again this one doesn't work well for all people but it's one I use often. 

The best way(s) to ice an injury

So you have just injured yourself - you know you must ice the injured area, but have you ever thought about the best way to do that?

There are several ways to ice an injury, certain circumstances make some methods more appropriate than others. For that reason this blog post will outline a few of the best icing methods and give you some examples of when they are most appropriate to use.

Ice baths

This method is largely used after activity where it is believed that there has been wide spread micro-trauma to the muscle tissues of the legs (or lower limbs). I.e. running (distance), cycling, rugby, football, hockey, squash etc. This is a very general icing method, all areas of your legs will be iced equally, because of that this application is best used where there in not a specific injury.   

Micro-trauma, or tiny tears in the muscles, usually occur after intense or prolonged bouts of exercise. Everyone from elite athletes to your average gym goer can make use of this type of icing. The primary benefits of ice bathing include reduced muscular soreness, reduced metabolic activity (swelling) and flushing of 'waste' products in the muscles.

How to apply this type of icing (time required: 5-15mins)

Step 1. Fill your bath up to waist height with cold water (10-12°c). Depending on where you are and the time of the year your bath may run out at this temperature with the cold tap only, if not you'll have to add ice to get the temperature cold enough.
Step 2. Sit in the cold water, yes it will be chilly! From experience the first couple of minutes will be the most uncomfortable.  

Ice cube massage

This is a very direct method and one of the most aggressive forms of icing that can be used. It is great for use on small areas of inflammation (or tendinitis type injuries). Some examples of the type of injuries I'll often prescribe this for are Achilles tendinitis, golfer elbow, tennis elbow, patella tendinitis, plantar fasciitis and ankle sprains. If the area that needs to be iced is no more than about 3x the size of a 50pence piece this method is perfect.

How to apply this type of icing (time required: 5-7mins)

Step 1. Take an ice cube and grip it with a piece of kitchen towel (or something similar) leaving part of the ice cube exposed.
Step 2. Massage the inflamed area working in a figure of eight or circular fashion.

Gel ice packs (or a bag of peas) - available to buy here
Most people will be familiar with the method of icing. As with the other methods the primary reason for icing in this way is to limit localised swelling and to control pain levels. This type of icing is best used when the injury site is larger and more diffuse. The type of injuries you will want to use this method of icing with will be injuries such as a bruised quadriceps (thigh) muscle or a tear to the hamstring.

How to apply this type of icing (time required: 10-15mins) 

Step 1. Take your ice pack or peas out of the freezer and wrap them with a thin kitchen cloth or towel.
Step 2. Place the ice pack over the injury site, you can use tape or a bandage to lightly hold it in position. 

Instant ice packs - available to buy here
This application is essentially the same a using a standard ice pack or peas. These instant ice packs are more convenient because they do not need to be stored in a freezer. The can be stored anywhere and as their name suggests they can be used instantly. They do not start off cold, they contain to chemicals within the bag and once the two chemical are mixed the ice bag goes cold within a couple of seconds.

These are the ice packs I use if I'm working with a sports team on the touch line. They are useful as it means I have an instant 'ice' treatment available to me when I need it, without the need of having access to a freezer. These are ideal for putting in the boot of your car for a 'just in case' scenario. Although they are very useful there are two draw backs with these ice packs. Firstly they don't get quite as cold as gel ice packs - though they are cold enough in an emergency. The second problem is they can only be used once, after which they must be thrown away. As I said they are really only for use when there is no other option.

How to apply this type of icing (time required: 10-15mins)

Step 1. Squeeze ice pack and shake to mix the chemicals.
Step 2. Place the ice pack over the injury site, you can use tape or a bandage to lightly hold it in position. 

As always if you have any questions regarding this post please feel free to email us...

All You Need To Know About Lateral Ankle Sprains!

Ankle sprains are very common in sport. The most common type of injury to the ankle is damage to the ligamentous structures. The four most commonly injured ligaments are the anterior talofibular (ATFL), calcaneofibular (CFL), posterior talofibular (PTFL) and the anterior inferior tibiofibular (AiTFL). Out of those, the most frequently injured in sport is the ATFL.

The names of the ligaments sound complicated but they just describe the bones that the ligaments attach onto, for example the anterior talofibular is the ligament that joins the talus (*) and the fibula (∆) together and is called anterior because it sits more forward than its posterior counterpart!

The usual way of injuring the ATFL is by pointing your foot (plantarflexion) and twisting it inwards (inversion).  Once an ankle sprain is suspected, rest, ice, compression and elevation should be applied immediately. If possible, place the ankle in a bucket of icy water for 1 minute, take it out for 1 minute and repeat 10 times. This should be done every hour or as often as possible for the first 48 hours. This will help to keep the swelling down and will help with diagnosis when you go to see a sports therapist/physiotherapist.

The sprain should be graded from 1-3; 1 being only a partial tear of the ligament with next to no swelling and grade 3 being a complete rupture of the ligament with a lot of swelling.

Once you have pain free non-weightbearing movement, exercises can start to be prescribed by your therapist. These should continually be progressed which is why it is important to see your therapist at least on a weekly basis to make sure the exercises you are doing are safe and effective and to ensure you aren’t doing anything too strenuous too soon!

If you want some more advice on your ankle sprain then I am contactable via my email address.. sara.theringwoodclinic@gmail.com or you can book an appointment with us by visiting our website www.theringwoodclinic.co.uk or phoning us on 01425 480030.

Kinesiology Tape - What is it?

Have you seen the brightly coloured tape that lots of athletes are wearing at the Olympics this summer and wondered what it is? It is called Kinesiology tape and comes in a variety of colours – blue, black, pink, beige and also in a variety of designs including a union jack one that has been worn by some of the GB volleyball squad and also by runner Dwain Chambers. Kinesiology tape was founded about 25 years ago by Dr Kenzo Kase and has become increasingly popular with other brands now being introduced including Rock Tape. All different types of kinesiology tape are very similar but vary on the application strategies that are taught on their courses.

What Does It Do and How Does It Work?

Kinesio tape is not restrictive like normal athletic tape, and plays a different role entirely. Kinesio is designed to support muscles and joints without preventing movement. The tape has patterns on the adhesive side (see fig. 1) that can help to lift the skin in different areas to assist with lymph drainage during inflammation and can relieve pressure on nerve endings, decreasing pain.  Also, because the tape is non-restrictive it allows athletes to fully engage in their sport and not focus on painful areas.

Fig. 1. This picture shows the adhesive side of some pink Kinesio tape. The lines wave horizontally along the tape.  

Kinesio UK suggest the tape can be worn for up to 3-5 days but should be applied an hour before exercise or showering.  There is limited research to show the effectiveness of the tape up to 5 days after the application date and in my experience, no matter how well I stick the tape down it usually starts to peel off and fray after the second or third day.

It can be used for injury prevention and relief from muscle tightness to allow freedom of movement during sporting or everyday activities.  Additionally it can be used to assist in the treatment of muscular strains, shoulder pain (see fig.2) and to reduce swelling by using a variety of application techniques.

Fig. 2. This picture shows how the tape can be applied to help treat biceps tendonitis.

In order to apply it effectively, practitioners need to go on a course which is run by the Kinesio Taping Association. Both myself and Alex have been on such courses that allow us apply the tape effectively to gain maximum benefits.

If you would like to know more about kinesiology taping visit www.kinesiotaping.co.uk or comment on this blog and we would be happy to answer any of your questions. Additionally, you can visit our facebook page www.facebook.com/theringwoodclinic and write on our wall!

Sever's Disease - Achilles Heel Pain (Children 8-15 years old)

Sever's disease affects growing adolescents in the 8-15 age category. A child suffering with Sever's will complain of pain around the back / base of the heel bone (called the calcaneus).

The basics 

Put simply the Achilles tendon, at it's attachment to the heel, becomes inflamed. This can occur for a few reasons however normally the primary issue is that the growth plates in children at this age are yet to full develop and are therefore more susceptible to 'overuse' type injuries. In a growing child weight bearing activity will generally aggravate the injury. This occurs because there is too much force being placed on the tendon attachment during weight bearing activity.

Risk factors

Sever's disease is a very similar issue, in nature, to Osgood Schlatters (OSD) and is effected by many of the same risk factors, e.g. increased activity, leg length discrepancies, recent growth spurts, poor bio-mechanics in sporting activities, tight calf musculature or being over weight / obese.

|| Osgood Schlatters occurs at the knee ||

|| Severs Disease occurs at the Achilles heel ||

Treatment / Management

The good news is that most children will 'grow out' of this injury within 2 week - 6 months. It is important it's managed carefully in the mean time though. If managed incorrectly there is the possibility of a calcification (permanent bony deposit) developing at the base of heel.

Generally decreased activity will be required. This is usually on a the basis of pain free activity, meaning that pain free activity is fine, painful activity is not. 

As with OSD the same treatment options are applicable for Sever's Disease: 

Treatment for Sever's will involve:

1. Rest (or relative rest) - by 'relative rest' I mean that ALL activity must be pain free. If an activity causes pain then rest must be enforced. 
2. Soft tissue techniques (massage) to free up the tight muscular tissue. 
3. Bio-mechanical screening - to make sure no unnecessary force is being generated at the foot, ankle or heel. 
4. Light stretching - only when appropriate. 
5. Ice / cold treatment - to help manage the inflammation. 

Two things you must not allow your child to do if they have Sever's disease:

1. Train / play through pain. 
2. Stretch heavily if it causes pain.

25 Random Facts about Sara...

Sara is a graduate of University of Hertfordshire and a member of the Society of Sports Therapists.

Sara has experience working a season at Brumbies RFC (Super 15 rugby team) and with competitors at the Virgin London Marathon.

Sara's full profile is up on the main website's 'about us' page.

Below is a less formal introduction - Sara has written a similar blog post to this one that I wrote in early 2011, 25 random facts about me.

So with out further ado here are the 25 random facts that Sara wanted to share with us...

1) I have a younger sister called Helen and a younger brother called David 

2) My degree in Sports Therapy was 4 years instead of 3 because I did a placement year in my 3rd year in Australia with the Brumbies

3) For my education - I went to a private primary school in Eastleigh; Bournemouth School for Girls for secondary school and sixth form and went to the University of Hertfordshire to get my degree

4) My favourite subject at school was PE and my least favourite were English and Science. Ironically, my best subject in pub quizzes is now the science round!

5) I have completed Bronze, Silver and the majority of my Gold Duke of Edinburgh Awards

6) I have been horse riding from the age of 4

7) I have two horses called Jaffa and Nutmeg

8) I have visited, on holiday, places including the East and West coasts of the USA, Canada, Mauritius, Zante, Corfu, Menorca, Portugal, France, Malta, Ireland and Australia, however I have never been to Scotland

9) I used to have a bad phobia of snakes, however I forced myself to watch TV programs such as 'Venom Hunter' before going to Australia as I thought I would be coming across snakes regularly...however I didn't see a single one! It did make me less scared of snakes.. but I still don't like them very much

10) I was born with little toes that crossed over the top of my 4th toes and didn't have this rectified by surgery until I was 18

11) I was born in Poole Hospital and have lived in the same house with my parents for my whole life (except for when I'm at uni)

12) I love the countryside and when I'm in London can't wait to get back home again!

13) My favourite film is Love Actually, although I can only watch it at Christmas time!

14) I joined the kayaking club at uni and enjoy paddling on white water/rivers (however I don't have a boat so can't paddle very easily currently!)

15) I own a yellow mini which is called 'Custard'

16) I love to bake cakes and other sweet treats in my spare time - some are more successful than others!

17) If I had a super power I would be able to fly because I hate sitting in traffic jams (especially on hot days!)

18) I met my boyfriend Matt at the kayaking club at uni and we have been together ever since

19) I like playing netball and have played in the Northern and Southern Hemisphere!

20) My favourite sport to watch is rugby

21) My favourite colour is pink but I love all pastel colours!

22) Christmas is my favourite time of the year

23) I am still really close to my friends from secondary school even though we all went to different universities across England and Wales

24) I love talking about injuries to other therapists or to members of the public - I find it really interesting and could talk for hours

25) My favourite ride at Thorpe Park is 'Saw' and at Alton Towers is 'Air'!

If you would like to book in with Sara please either call 01425 480030 or use our online booking system.