How to Ease your Neck Pain….Right Now!

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Ease your neck pain nowNeck pain is a common problem in today’s society, something which I am seeing a lot more of and most frequently in those who sit at a desk or computer day after day. In these cases, the pain they are experiencing is not brought on by an accident, old injury, extreme or repetitive movement. Instead, it is brought on by very little movement!

Sitting still at a desk all day, staring at a computer often results in a postural position which is less than ideal for the neck. The typical pattern I see is rounded shoulders and a chin poke – meaning the chin juts out towards the screen, rather than the head being positioned directly over the neck – the ideal position. Having the head in this forward position places additional strain on the muscles of the neck, front and back, which act as guy ropes to support the head. It is this increased muscle tension which causes the majority of pain in this population, which can develop into headaches and tingling or numb sensations into the arms and hands.

Whilst what you really need is a thorough assessment from a qualified injury professional and an ergonomic assessment of your workspace, there are a few things you can do right now, yourself, to ease your pain in the short-term. Here are my top tips for easing neck pain NOW!:

Move!
The most important thing you can do when neck pain starts to set in is to move!  Get up from your desk and move around. Go for a walk around the building; nip to the loo; make a cup of tea – anything to get you away from your desk for 10 minutes.Whilst you are up, or if you can’t leave your desk, do some gentle neck range of motion exercises to try to ease muscle tension. Start by looking up, down and over each shoulder a couple of times. Then try a few full head circles, starting right ear to right shoulder, looking down, then left ear to left shoulder, then up and then back to the start. Do this in both directions. Make sure you move at least once an hour.

Stretch
In addition to the movements listed above, specific neck stretches will further help to ease your pain. Start with a neck flexion stretch (chin to chest), then a lateral flexion stretch (bottom image) and a SCM stretch (top image). All of these muscle groups are often tight in neck pain sufferers. Hold each stretch for 20 seconds and repeat them all twice.

Sternocleidomastoid stretch


Posture
Consider your current position. Without moving, think about how your head, neck and shoulders are positioned. Then do something to correct yourself! Pull your shoulders back and make sure you are sat upright. Tuck your chin in and down and bring your head back, directly over your neck.  Try to keep the back of your head in light contact with the headrest on your chair if you have one. If you don’t – change your chair!

Trigger Point Therapy
Active trigger points are often the source of local and referred pain in the neck, shoulder and down the arms. These trigger points develop due to repeated muscle tension. They are easy to distinguish as dense ‘lumps’ within the muscle belly which are acutely tender when pressure is applied to them. They are commonly found in the upper fibres of Trapezius – between the neck and shoulder joint.Trigger point therapy (TPT) is a form of treatment used by massage therapists to help de-activate these trigger points and therefore reduce the pain they are causing. TPT can be applied to the Trapz yourself and is pretty easy to do.To target trigger points in the right Trapz, use the thumb and/or index finger of the left hand to feel around the area for tender lumps or ‘knots’ in the muscle. When you find one, apply as much pressure as you can comfortably bear, without tensing up. Hold this pressure for 10 seconds. In this time the discomfort usually fades considerably. In this case you can then increase pressure and hold for another 10 seconds. Repeat this process for all trigger points found on the right and then do the same on the left, with the right hand.

Warmth
Warmth is great for easing muscle tension and pain. Keep a small microwaveable wheat pack at work (or a small hot water bottle or similar) and apply it to your neck and shoulders when they are aching. Warm muscles also stretch better so you will get double the benefit when stretching after 10-15 minutes of warmth!

So there you have it! Whilst these are not long-term solutions to your neck, upper back and shoulder pain and we highly recommend a trip to an injury specialist, as well as an ergonomic assessment and home exercise regime, they can certainly help to ease your pain and allow you to get through the day in a little more comfort!

3 Controversies of Achilles Tendinopathies

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achilles tendinopathy

Overuse Achilles injuries are common in runners and sports which involve running, but also those who enjoy hill walking and even sometimes those who are less active. There are many controversies surrounding the causes and treatment of this group of injuries, generally referred to as Achilles tendinopathies. This is largely down to conflicting and unclear research findings, as well as differing perspectives when it comes to the best treatment approach.

Here are 3 of the biggest controversies surrounding the Achilles tendon and overuse injuries.

1. The Achilles tendon has a poor blood supply

The achilles is frequently described as having a ‘poor blood supply’ and this is often quoted as the reason why these injuries can take so long to recover. Whilst it is a fact that a poor blood supply would not only delay healing but may also contribute to injury development, there is controversy surrounding just how poor that blood supply is.
It is established that the achilles tendon is supplied by the Posterial Tibial and Peroneal arteries. A study published in 1994 by Aström and Westlin found that the blood flow throughout the tendon was uniform other than being significantly lower at the calcaneal insertion. But further studies by Chen et al in 2009 and Ahmed et al in 1998 contradict these findings. Chen found that the mid-portion of the tendon was significantly less vascular than the proximal and distal portions, whereas Ahmed’s study found the entire tendon to have a low blood supply throughout its length. Both Chen and Ahmeds studies used a relatively low number of cadaver specimens, whereas Aström and Westlin used 40 healthy volunteers.
The importance of this point is that blood supply is known to decrease with age. Therefore cadaver tendons are likely to display a lower vascularisation than those of live, healthy volunteers.

2. Tendinopathies: Inflammatory or non-inflammatory?

Prior to the 1990’s it was believed that Achilles overuse injuries were inflammatory in nature and were referred to as tendinitis to reflect this. Over the last 20 years there has been a shift away from this thinking, following studies which found no inflammatory cells in symptomatic tendons.
However, recent research using more advanced immunohistochemistry analysis has demonstrated the presence of inflammatory cells in both established cases of tendinopathy and the early overload response phase. These findings are backed up by the fact that anti-inflammatory treatment methods such as NSAID’s and steroid injections are shown to have some benefits, even if only short-term in easing pain and swelling in the tendon.
The authors of ‘Tendons – Time to Revisit Inflammation’ are not advocating a switch back to the previous ‘tendinitis’ model and believe that mechanical overload is still the primary cause of overuse achilles injury, but also that this overload may initiate an inflammatory response.

3. Do micro-tears contribute to development?

Overuse tendon injuries are caused by overloading the tendon. This has been thought to be a tensile load which causes micro-tears within the tendon structure. However, micro-tears are now thought to be unlikely as throughout the running cycle, the tendon remains within the elastic region of tendon strain. It is above this level of strain that micro-tears occur.
Tendons are also designed to withstand tensile loads and more recent research shows pathological changes which suggest that the tendon response could be down to compressive loading rather than tensile loading.
In addition, it is well documented that the tendinopathic area of a tendon is located on its deep surface. This does not fit with the tensile load theory as there is less elongation of fibres in this region compared to the superficial surface.

There is new research being undertaken all the time surrounding Achilles tendinopathies, which is attempting to clarify the cause and development of these conditions, as well as the best possible treatment methods. The above points demonstrate the need for this continued research as certain areas which were thought to be understood are now being questioned again in the light of new research techniques and results.

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The Latest on “Shin Splints”

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Shin splints - or Medial Tibial Stress Syndrome

‘Shin Splints’ is an outdated term which is now believed to cover many forms of anterior shin pain. What most people perceive to be ‘shin splints’ should actually be termed Medial Tibial Stress Syndrome (MTSS).

This condition typically presents with pain on the inside border of the Tibia which intensifies at the start of exercise but may ease as running continues in the early stages. Pain generally eases with rest and there are no neurological symptoms. MTSS accounts for approximately 13-17% of running injuries, with only Plantar Fasciitis occurring more frequently. MTSS is 10 times more common in females during basic running training than their male counterparts.

As the name suggests, MTSS is a condition caused by increased bone stress. Even healthy bone contains microcracks, but microcracks under continued overloading will develop into macrocracks, resulting in pain and the potential to develop into Tibial stress fractures if ignored.

How is the Tibia Overloaded?

Our bones are strongest at withstanding compression forces, weaker in tension forces and weakest of all in resisting shearing forces. When we run, all three directions of force are applied to the bone.

Tension Force

When running, the combination of the foot hitting the ground on the outside of the heel and the more medial compression loading force from the Femur onto the Tibia causes a bending force on the bone. The lateral Tibia is subjected to a compression force which as discussed is withstood well, but the medial Tibia undergoes a tension force which can result in bone stress.

There are two reasons why some people are more prone to this condition than others:

  • Those whose Tibia has a narrow diaphyseal width are more prone to bone bending forces
  • Those who overpronate

Overpronation places additional strain on the medial Tibia border due to increased tension in the facial and muscle attachments including the Tibialis Posterior, Soleus and Flexor Digitorum Longus. This ‘pulling force’ increases tensile bone stress on the medial aspect.

Shearing Force

Shearing forces are the hardest on the bone.  These are produced as overpronation at the foot causes an internal rotation force on the Tibia. An external force is placed on the Tibia from above due to external femoral rotation which is made worse by weak hip rotators. This causes a shearing, or twisting force on the Tibia bone.

Treatment

This latest view on MTSS development has some impact on the way the condition should be treated. Treatment should be approached using the following four aims:

  • Strengthen the Tibial cortex and aid recovery
  • Reduce Tensile Tibial bone stress
  • Reduce Shearing Tibial bone stress
  • Reduce vertical loading rate

Strengthen the Tibial Cortex

Bones strengthen in response to stress. But it has to be the right kind of stress and in the right doses. As MTSS is down to too much of the wrong stresses it is vital that the causes which have predisposed the individual to tension and shearing stresses on the Tibial are corrected before commencing a graded running program. So, in the meantime, rest is recommended, from running and walking if this also causes pain.

Graded running programs are designed to gradually overload the bone to strengthen it. Here is an example: Graded training program for MTSS

Reduce Bone Stresses

In order to reduce the stress on the Tibia, overpronation must be corrected. It is not simply enough to look at the patient’s feet and determine if they have a ‘good arch’ or not. Even those with a ‘high arch’ can be heavy overpronators! In order to address this properly, gait analysis should be performed using video technology to slow down the running cycle and highlight excess motion at the subtalar joint.

For those found to overpronate, both orthotics and footwear should be addressed. Either stability or motion control shoes should be worn and orthotics inserted in addition, when necessary. Placing orthotics into neutral shoes will be next to useless as the insert will simply ‘sink’ into the cushioning of the shoe.

Overpronation can be further reduced by increasing the range of dorsiflexion available at the ankle. The Gastrocnemius and Soleus muscles are responsible for plantarflexion and so if tight or shortened can reduce the range of dorsiflexion. In order to compensate for this, the foot overpronates further to bring the bodyweight over the stance foot. Stretching exercises and sports massage therapy are ideal for doing this.

Along the same rehabilitation exercise lines, strengthening the lateral rotators of the hip can also help reduce shearing forces on the Tibia. Exercises such as the Clam are ideal.

Whilst it may be a difficult conversation to have, patients who are overweight are more prone to MTSS as the pronation force = mass x acceleration. Higher body mass results in increased pronation.

Reduce Vertical Loading Rate

Finally, the runner, therapist and coaches etc should work together to try to reduce the Vertical Loading Rate (VLR) of the running pattern. What this means is how quickly vertical load is applied during impact. A higher loading rate has been linked to an increased injury risk in runners.

There are a few ways in which this can be achieved but a lot of research is still underway to determine the best ways of doing this. Some will argue for a change in technique to favour forefoot running and others would go as far as recommending barefoot running. Whilst landing on the forefoot rather than the heel does seem to reduce vertical loading rate, it is not clear at the moment the effect that this has on pronation. And so by trying to fix one problem, are we increasing another?

The most effective ways of reducing the VLR, without potentially causing other problems are to:

  • Reduce fatigue
    Fatigue is responsible for a decrease in running efficiency and technique, as well as increases in lower limb muscle tension and so bone stress. Fatigue can be reduced using fitness training (cross-training) and correction of training errors.
  • Running form coaching
    Working with a running coach can help to improve your running form and make it more efficient, thus reducing energy costs and fatigue.

Conclusion

Researchers and experts in the field of running injuries now believe true ‘shin splints’ to be a result of bone stress to the medial Tibia. With repeated running, the Tibia becomes overloaded, which over stresses the bone. These stresses are caused by excess tension and shearing forces on the Tibia.

Treatment should aim to reduce these forces with rest; footwear or orthotic changes; increases in ankle flexibility and hip rotator strength; weight loss; increased fitness; improved running form and a graded running program to increase cortical bone strength.