Ever thought about running a marathon?

Pondered it for months but then thought better of it so not to make your existing ailments worse?

This is common thought process of would be marathoners, and majority fall into the last category where they consider it but then decide that in the best interests of their body, they should opt not to.

Well this recent study carried out by Horga et al (2022) investigated one issue which many believe will worsen if they train for a marathon. Lets be honest, it’s not necessarily the one off event of the marathon that poses the biggest challenge, it’s the consistent dedication and relentless training mileage that one has to endure in order to reach the start line with any degree of confidence. And it’s the cumulative effect of the incremental mileage which many believe has a negative effect on the body.

The authors of this study looked at the lumbar spine, and the impact a marathon training programme had on the structures within it. The findings were positive to say the least!!

Many would assume that training for and running a marathon would cause damage to the various structures, and potentially accelerate any degeneration you potentially already have in the area….this piece of research found otherwise.

The authors tracked 28 asymptomatic runners taking on the London marathon for the first time. To do this they carried out an MRI of their spine at the start of their training plan 16 weeks before the marathon, and then another MRI 2 weeks after the marathon. They then compared the changes they saw on MRI between the two timepoints, giving us a good snapshot of the effect the training plan and running mileage had on the spine.

In short, the study found that running 500 miles over 4 months plus a marathon for the first time had no adverse effects on the lumbar spine, even when early degenerative changes were present.

Additionally, there was evidence of regression of sacroiliac joint abnormalities* so in fact the running plan actually had a positive impact.

If you’d like to view this study then click here

So, in terms of take home messages –

1. Don’t limit yourself based on theories you have picked up along your journey without critiquing it’s validity
2. Quite often with many issues, doing something is better than doing nothing, fair enough, running a marathon may be an extreme analogy to support this, however, if we apply the findings of this study to perceived less traumatic/damaging activities then surely we feel more able to get out and get moving.

As always thanks for reading guys!

• Sacroiliac dysfunction refers to pain or discomfort in the sacroiliac joint, which is the joint that connects the sacrum (the triangular bone at the bottom of the spine) to the ilium (the uppermost part of the hip bone). The sacroiliac joint is responsible for transferring weight and force between the upper body and the legs. When there is a problem with this joint, such as inflammation, injury, or wear and tear, it can result in pain, stiffness, or difficulty with certain movements. Sacroiliac dysfunction is a common condition that can be caused by a variety of factors, including trauma, arthritis, pregnancy, or even poor posture. Treatment options typically involve a combination of physical therapy, pain management, and lifestyle changes to help manage symptoms and improve overall function.

Have you recently had a diagnosis of KNEE OSTEOARTHRITIS (OA)?

Now, I bet your mind is running away with you thinking what things should I STOP doing. How many of you are thinking about the things you should START? Or even the things that you currently do that you should definitely KEEP!

Well this study by Voinier and White (2022) provided us with an overview analysis of many studies that investigate the impact of daily activities such as walking, running and other recreational sports upon the progression of OA.

At Move4 we hear so many patients coming in with preconceived ideas of injury and the bodies reaction to the ageing process. The majority of people we speak to believe that the only way to reduce the speed of degeneration and reduce the impact of ageing caused by issues such as OA is to take things out of the equation, and limit their exposure.

Before doing this…..STOP

This authors conclude with the following statement –

‘We summarized the findings of 20 reviews and an additional 12 original studies. We found consistent evidence that common forms of PA (walking, running, and certain recreational sports) are not related to structural progression of knee OA, and can be safely recommended to patients with, or at risk, for knee OA.’

If you’d like to read the study in more detail then click here

Now what are the take home messages from this study, and this blog post

1. Walking, running and other widely accessible physical activities are NOT associated with an increased risk of OA, and should be an integral part of your approach to dealing with the issue.
2. A diagnosis of OA should be non limiting and initial consideration should be given to the things you can do, and NOT the things you should stop doing

Thanks for reading guys!

The status quo with regards to back pain and specifically lumbar spine disc issues, is that without surgery, they wont heal.

Most feel like once sciatica starts as a result of a disc pathology, then it’s essentially a death sentence and they will have to suffer the effects for the rest of their lives.

Now wait a minute…read this article (well only if you have specific access through your university or are prepared to pay for it….don’t get us started) and question what you’ve heard!!

This article by Chiu C. (2014) in Clinical Rehabilitation looked into the response of discs with varying degrees of pathology over time, in patients who undertook conservative management (non surgical).

The findings are staggering…

The rate of spontaneous regression (reduction) of a herniated disc was found to be:

96% for disc sequestration

70% for disc extrusion

41% for disc protrusion

13% for disc bulging

Complete resolution occurred in 43% of sequestrations and 15% of extrusions. Most regression occurs within the first year and could happen as early as 2-3 months.

Now, many of you may be wondering what all these words mean. So for those with a thirst for knowledge, here is an explanation –

Disc sequestration – a type of spinal disc herniation. It can occur in any part of the spine, including the cervical (neck), thoracic (mid-back), and lumbar (lower back) region. Sequestration occurs when part of a the disc is detached and migrates away from the main part of the disc.

Disc extrusion – a type of spinal disc herniation that occurs when a portion of the disc nucleus (the gel-like center of the disc) is forced out of the annulus (the outer layer of the disc) and into the spinal canal. This can put pressure on the spinal cord or spinal nerves and lead to symptoms such as pain, numbness, tingling, or weakness in the arms or legs.

Disc protrusion – a type of spinal disc herniation that occurs when a portion of the disc nucleus (the gel-like center of the disc) bulges out of the annulus (the outer layer of the disc) but does not completely breach the annulus.

Disc bulging – a condition in which the outer layer of the spinal disc (the annulus) bulges or extends beyond its normal confines, but does not completely breach the annulus. Unlike a herniated disc, where the inner gel-like material of the disc extrudes through the annulus, a bulging disc does not result in the disc material moving outside the normal confines of the disc.

Now back to the practical implications of this study and what it means to us all.

Essentially the biggest takeaway has to be that although it may feel like the only option when you’re in pain, being patient and giving your disc some time to recover may help you to avoid surgery.

Now, with the pressures we’re seeing in the NHS, surgery may not be an option you are provided with very soon, but at least now you can have some hope that with time, the issue may well resolve of its own accord.

On important thing to remember is whenever we have pain for sustained periods of time, this will lead to a number of issues. We most likely will develop compensatory movements that have assisted in reducing the pain and loss of function in the short term, but actually cause us more issues in the long term. We will also have a certain amount of muscle wastage (atrophy) in certain areas, which may not cause any immediate issues once the pain has subsided, but if left unaddressed it is likely that at some point it will lead to other issues.

The good thing is, all of the above is easily address with physiotherapy.

So, if you are currently suffering with lower back pain, give us a call and we will help you naviaget back to full health and kick that can into another postcode!

If you’ve ever pulled a muscle, you’ll testify to the fact that it’s not the most comfortable thing to experience. Now common sense suggest that we should wait until the pain we’re not getting any pain or are at the very least moving normally again to begin our rehab (in whatever form this takes). However, research from Bayer et al (2017) suggests otherwise.

Rehabilitation following a muscle injury typically involves a multistep approach that aims to help the injured muscle heal, reduce pain and inflammation, regain strength, and ultimately, return to normal activities.

Here are some common steps in a muscle injury rehabilitation program:

1. Rest and Ice: The initial stage of treatment involves rest and protection of the injured muscle. Applying ice to the area can help reduce pain, swelling, and inflammation.
2. Pain management: Over-the-counter pain medication, such as ibuprofen (although this is a blog in itself) may be recommended to help manage pain and swelling.
3. Stretching and Strengthening: Gentle stretching exercises can help improve flexibility and range of motion. As the muscle begins to heal, the physio will progress to strengthening exercises to help restore muscle strength and stability.
4. Gradual Return to Activity: As the injured muscle heals and regains strength the aim is to gradually return to normal activities. Your physio will work with you to develop a plan that includes specific activities and exercises to help you safely return to your normal level of activity.

The point which this study shines a light on is number 1.

The authors suggest that we could gain huge benefits by progressing from stage 1 to 3 much more quickly, within days in fact!

Here’s what the authors concluded –

‘This study shows the clinical consequences of protracted immobilization after a recreational sports injury. Starting rehabilitation 2 days after injury rather than waiting for 9 days shortened the interval from injury to pain-free recovery and return to sports by 3 weeks without any significant increase in the risk of reinjury’.

This has potentially massive implications for people who take part in sport, as 3 weeks can be as much as a quarter of the meaningful season in some instances. Therefore any ways to optimise the speed in which we can return to play without compromising the risk of further injury should be looked at much more closely.

Now obviously if you have sustained a high grade muscle injury we wouldn’t suggest managing this yourself.

A thorough understanding of the structures involved and methods that can be employed to safely navigate the early days is crucial.

A physiotherapist is an expert in anatomy and physiology, and can facilitate your management to ensure you maximise each day. By utilising a physio following a muscle injury you are significantly increasing the chances of benefitting from the outcomes suggested by the author of this paper.

The sooner you get assessed, the sooner we can get to work at getting you back out doing what you love, so don’t delay!

If you’d like to read the article in full click here

Exercise can be an effective form of pain relief for various types of pain, including chronic pain conditions such as osteoarthritis, fibromyalgia, and low back pain. Regular physical activity can help to increase strength, flexibility, and range of motion, which can reduce pain and improve function. Exercise also releases endorphins, natural pain-relieving chemicals in the body, which can help to reduce pain perception.

Aerobic exercises such as walking, swimming, cycling, and dancing are good options to improve cardiovascular fitness and can help to reduce chronic pain. Strength training exercises such as weightlifting, resistance band training and bodyweight exercises can help to build muscle and bone strength and can improve balance and stability which can help to reduce the risk of falls and injuries.

Yoga, tai chi, and other forms of mind-body exercise can also be helpful in managing pain. These exercises focus on breathing, stretching, and relaxation techniques, and can help to improve flexibility, reduce stress and anxiety, and promote a sense of well-being.

Now we obviously know all of this, and it’s our biggest challenge to educate people on the benefits of exercise. Now this recent paper within the BJSM has significantly helped our cause by concluding that exercise alone is as effective as paracetamol and NSAID’s for knee and hip OA.

This study concluded that –

‘Exercise is effective for pain and function due to knee and hip OA. Its effect is similar to that of oral NSAIDs and paracetamol at short (4weeks), median (8weeks) and long-term (24 weeks) follow-up’

However, they also note that further work is required to build on this finding, suggesting that

‘This conclusion is based mainly on indirect comparisons. Further direct evidence for OA outcomes and the long-term benefits of exercise over oral NSAIDs and paracetamol for other outcomes such as comorbidities are still needed’

To read the article in full click the link below:

https://bjsm.bmj.com/content/bjsports/early/2023/01/02/bjsports-2022-105898.full.pdf

If you suffer with Osteoarthritis and want our help at managing the issue then click below and book your appointment

I’m sure the wait has been long and painful, but once the wait is over, it’s time to get yourself prepared for your hip replacement.

Before your surgery you will be sent a number of exercises to do. These may be a little bit uncomfortable, but it is important to stay as strong as possible before your surgery. As with any surgery, if you’re strong before the surgery, this yields better results post-surgery and will get you back up and about more quickly!

If you haven’t had exercises or if you’re currently waiting for a surgical date, then please please please drop us a line. Surgery alone will not provide you the results you expect, there is some work on your end, and we can advised you what to do!

Now what can you expect after your surgery?

Post-surgery you will be taken through how to use crutches, taken through all your exercises and if needed you will be taken up and down the stairs so that you know how to use a crutch with stairs.

Most patients are shocked at how good the operated leg feels and how much more freedom they have with it. They also notice that the exercises that once were hard they are now able to do.

Be prepared to be asked to get up and about. As much as this is a big surgery, it’s incredible how far orthopaedic medicine has come, and how quickly you are able to get moving again.

 

You will also be told how often and when to use ice packs post surgically.

The same goes for exercises!

Generally you will be told to do your exercises 3 times a day (a good way to remember is before you get out of bed, when you will be stiffest. Just after you’ve had lunch and then when you get back into bed before you go to sleep!)

With walking around, before you have had your post op appointment, generally you should be on your feet for no longer than 15 minutes at a time and to get up every 1.5 hours to have a little walk.

Remember, the more you are sat still, the stiffer the joint will get!

Although there is no weight limit on what you can put through the new joint, use your pain as a guide as to how much you need to be relying on your crutches.

You will be given a post-operative appointment which is likely to be 2 weeks after you have had your surgery.

It is important that you are vigilant with your exercises every day before your next appointment as this will give you the best chance for good results.

As far as coming off the use of crutches, every person is different! Some people are off between 7 – 10 days and some take a little longer!

This is not a race.

Everyone is different and interestingly, if you are unlucky enough to need both sides done, between joints you can feel very different!

 

Top things to remember:

·         Do your exercises both pre and post-surgery

·         Give your body time to heal, if you need a nap.. take a nap!

·         The first week, even those 15 minutes on your feet will feel like a marathon

·         Allow your body to guide you through the pain, take your painkillers!

·         Ice. Ice. Ice

·         Relax, everything will work out as its supposed to if you follow the guidelines!

How long will it take to get rid of my back pain?

This is very dependant on what is causing your back pain and to an extent, how early you have done something about it! Some back pain can be reduced significantly in one session but then requires upkeep by the way of exercises to get rid of it completely. Some takes that little bit longer to get rid of the pain and may not react well to manual techniques and only reacts to stretches and strengthening exercises.

 

What are the symptoms for a slipped disc

Slipping a disc is a bit of a misnomer, what happens is the center of the disc is a bit like jelly, this can sometimes make its way to the outer shell and protrude through. When this happens you can experience, numbness or tingling or a weakness in certain body parts. If a disc is only bulging then it can reabsorb, if it has herniated (the jelly center has fully ruptured through and there is no longer an edge left to the outer shell) then it can’t unfortunately make its way back in.

 

Do I need an MRI to help

An MRI is not the be all and end all when it comes to back pain. As we age, people get natural degenerative change in there spines from relatively early on. Studies have shown that people can have very large disc bulges but be pain free and some people can have next to no bulge and have huge amounts of pain. It can be a helpful tool to show where an injection or surgery could potentially be needed but it is not a first resort.

 

What painkillers will work best for back pain

This is entirely dependent on your pain. Start off small with paracetamol and ibuprofen. The key is the be consistent. If these don’t work then talk to your GP about other medication that can be used  

 

Can I still exercise with back pain

Yes! Specially targeted exercises and stretches can make your back feel a lot better. No longer is the advise to rest in bed used for back pain. Backs like movement so doing targeted exercises will help the process of healing

 

Do I need surgery

Not all back pain needs surgery and not all surgeries will cure back pain! This is something to consider very carefully and to also exhaust all other options before considering surgery. The first step is conservative management in the way of exercises and rehab work with a physio. The next stage (depending on what is causing your back pain) is a MRI scan followed by an injection. If the injection works and you become pain and symptom free then you are likely a good candidate for surgery provided the physio work hasn’t been successful. 

Your rotator cuff is made up of four muscles and they are there to stabilise your shoulder. They sit as the name suggests as a cuff around the shoulder joint. The muscles work in harmony to keep everything stable, if one gets injured, they can all become a little unhappy. The most likely injured and easiest to tear is the supraspinatus muscle. This is because it sits underneath your collar bone and is the smallest of the rotator cuff muscles. However, not all tears need to be surgically repaired. It depends on the size of the tear, if the symptoms have lasted up to 12 months, there is significant loss of function and weakness or the tear was recent and acute.

There are a couple of critical things for you to do and do not do post rotator cuff tear repair surgery.

DO:

 Listen to the post operation physio exercises and follow them

 Take your pain medication as instructed (don’t be a hero)

 Talk to someone if something is worrying you or you’d like to double check the exercises

DON’T:

 Panic – post surgery there will be lots of people around to help you out, just ask if you need something or you’re unsure

 Deviate from the plan you’ve been given. Yes, it is true to say that some people heal faster than others and that different surgeries can be more or less traumatic BUT stick with the physio exercises you have been given and trust the physio to give you the correct exercises

 Take your arm out of the brace until instructed.

Once you are in the physios hands and have been given the go ahead for free movement, work on getting your range back as soon as you can. This will make life a lot easier as time goes on. The next thing to work on is strength and control.

Your rehab will be completely tailored to you and your specific surgery. Be aware that post surgery you wont be able to lift your arm out to the side and you wont be able to externally rotate (if you place your hand on your tummy and tried to take it away from your tummy with your elbow in your side) This movement will be limited so your arm is straight in front of you.

Once you have got your movement back, its time to start the strengthening exercises. This is so that the muscles surround the shoulders build back up and lead to better functionality. Strength will need to be built up both linearly and in awkward positioning so to test the shoulder and again, create better functionality as life doesn’t happen linearly!

To give you an idea of sling use age timings, it will be in a sling for between 4 and 6 weeks. This gives the graft time to repair and will mean you can cause damage to it. During this time you can do gentle passive movements (using your other arm to assist) If you area sports person, it can take between 4 and 6 months before you will be able to start to be integrated back into sporting activities. Again, this will need to be slow and steady to allow the body to relearn what it has to do to accommodate the sport.

The take away: listen to the instructions, they will give you the best chance of success with your repair and enabling full functional movements.

Balance – Are you losing yours?

What can you do about it?

Where to start?

As we get older, sometimes balance can become impaired. Injuries can also affect balance as can neurological conditions.

Within the elderly population, losing balance and having falls can get more and more common. This can lead to hospital omissions and sometimes even broken bones which is obviously less than desirable!

So what to do about this… There is a large body of research out in the scientific community around balance and the elderly and one that sticks out is the OTAGO balance programme that was developed in New Zealand and has been shown to have a great effect in

improving balance in the elderly. In the sporting community, ankle sprains make up a high proportion of injury. With these types of

injuries comes a disruption in proprioception which in turn can lead to balance problems and reinjury of the same injury!

Some balance injuries can occur from other conditions such as inner ear infections, labyrinthitis, strokes and in the older population balance issues can occur from UTI’s.

Some simple balance exercises that you can follow are:

“quiet standing” – for all of these exercises, hold for 30 seconds before trying the next stage, also stand close to a kitchen surface or back of chair just in case you lose balance.

-Feet shoulder width apart with eyes open

-Feet together with eyes open

-One foot infront of the other with eyes open – switch to the other way round (one will be easier than the other)

-Eyes closed

-Feet shoulder width apart

-Feet together

-One foot infront of the other – switch to the other way round

Now try walking heel of front foot touching toes of back foot for a few steps:

-Single leg stance eyes open

-Single leg stance eyes closed

For all you ankle injuries out there! Now try standing on a squishy cushion with double legs and then move to single leg stance. The try hopping vertically upwards then long hops and then side to side hops. Take this slowly as you wont be able to complete all of these in one session.

Strength is another important aspect to balance, so having strong legs and core will help you balance in all sorts of situations. So completing things like:

-Glute bridges or mini squats

-Long lever glute bridges or wide base mini squats

-Banded leg extension or static quad raises

-Calf raises