MANAGEMENT OF TENDINOPATHIES WITH ULTRASOUND TISSUE CHARACTERISATION (UTC)

Just received a really nice little article written by Jarrod Antflick and good friend and colleague Chris Myers!

They have been working with UTC and tendinopathies over the last eighteen months or so and have some really good data and thoughts on rehab now.

You can download the article for FREE at: https://zl199.infusionsoft.com/app/page/1eca04acb357e34b1aed433ba63cd590

achilles

 

This newer imaging technique should really make you think about the way you load tendinopathies from now on…

Looking at rehab specifically, the authors highlight a few key points:

Consider the irritability of the tendon when designing a loading programme. 3 x 15 reps eccentric loading is not always the solution!

Consider adding in moderate and heavy isometric exercises.

Don’t forget Soleus strengthening!

Be cautious loading into end-of-range with irritable tendon  or if you suspect the plantaris involvement.

Make sure you download a copy for the full read!

For more info and to book in for UTC, you can contact Chris directly: chris@complete-physio.co.uk

Cheers guys!

Emerson

Rolling, rolling, rolling… why are we foam rolling?

Keep rolling, rolling, rolling…

They are in every box, gym, yoga studio, and sports club in all shapes and sizes, textures and densities! I get a lot of questions about foam rollers!

How often? How hard? How long? Before or after exercise? Which muscles?

Chris Beardsley, a well-known sports science writer, wrote an informative article in 2013 looking at some of the evidence around foam rolling: http://www.strengthandconditioningresearch.com/2013/10/01/foam-rolling/

The article is well worth a read! It got me thinking so here is my take on things…

What tissues are we actually affecting?

Fascia – mainly. Fascia is an uninterrupted viscoelastic tissue, which forms a functional 3-dimensional collagen matrix. Basically, fascia surrounds and penetrates every structure in the body, head to toe. It is an innervated, continuous, functional organ of stability and motion. And it is tough!

What is foam rolling?

Foam rolling is a form of self-myofascial release. What is myofascial release? That is another well-debated subject! It has been suggested that applying pressures to tissues can:

1) Rehydrate tissues

2) Reduce pain (a neural response?)

3) Improve vascular function

4) Release trigger points and break up adhesions

5) Reduce the effects of DOMS (Delayed Onset Muscle Soreness

6) Improve tissue range of motion (ROM).

What is the evidence?

There is limited, good quality evidence; however, Chris Beardsley has summarised the findings so far:

1. Foam rolling may reduce arterial stiffness, improve arterial function and improve vascular endothelial function – therefore potentially increase blood flow.

2. Foam rolling may have no detrimental effects on athletic performance pre-workout – therefore no effect.

3. Foam rolling may increase joint ROM while not impeding the production of muscular force or rate of force development – pre workout mobility could increase range. It is at least as effective as static stretching however does not reduce performance which static stretching has been shown to do (http://journals.lww.com/nsca-jscr/Abstract/publishahead/Differential_effects_of_30_s_vs__60_s_static.97324.aspx)

4. Foam rolling does not acutely affect counter-movement, squat or depth jump performance. A dynamic warm-up is better.

5. There is mixed evidence on whether foam rolling increases flexibility long term.

6. Foam rolling reduces muscle soreness. A more recent study concluded that the reduced feeling of fatigue may allow participants to extend acute workout time and volume, which can lead to chronic performance enhancements (http://journals.lww.com/nsca-jscr/Abstract/2014/01000/The_Effects_of_Myofascial_Release_With_Foam.8.aspx).

When should you foam roll?

 

Based on the evidence and also clinical experience these are the recommendations:

 

–       Foam roll myofascial structures to increase joint ROM pre-workout. Be specific – work on the areas that you have problems with and be specific to the exercise you are about to perform. Don’t replace a dynamic warm-up – supplement it.

 

–       Use foam rolling post-workout for quicker short-term recovery.

 

–       Regular use may help longer-term recovery and sustained performance.

 

–       Make it functional – get into end of range or dynamic positions to mimic what you are going to exercise.

 

–       It doesn’t work for everything – use other tools and types of mobility drills too!

 

How should I foam roll?

 

I work on trigger points. These have been well mapped out by Travell and Simon’s (http://www.triggerpoints.net/). Find a ‘tender’ or ‘tight’ spot, and then apply pressure with the roller for up to 20 seconds. IF it has started to ease, stay on it for another ten seconds then release. 30 seconds maximum – you don’t want an ischemic response, which will just be painful and may actually start to damage the tissue. Try to work through a few specific trigger points along the structure you are working on. Spend 60-90 seconds rolling out the area, then move on! This shouldn’t take you more than five minutes to be effective – even when looking at a large area like the lateral thigh / Illiotibial band (ITB).

Vastus_Lasterallis

I also really like it for thoracic extension – more of a joint mobilisation. Great pre-Olympic lifting and for any overhead movements where extension is key:

Other resources:

 

https://www.youtube.com/channel/UCnnB4zDBqZHhQ4uLTAX8eYA

http://catalysttrainingsystems.ca/2013/11/youre-not-stretching-what-you-think-youre-stretching-part-i/

http://catalysttrainingsystems.ca/2013/11/fascia-part-2/

 

Not a bad video demonstrating basic positions for foam rolling:

 

So there you have it! As always, if you have any questions please feel free to grab me or contact me!

 

Emerson

07903247247

emerson@xphysio.com

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Return of the King! Ledley’s testimonial May 12th at White Hart Lane…

I thought I should write a few words about a very special day for one of my best mates!

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Ledley King is publicly acknowledged as one of the most naturally gifted defenders that England has ever produced and is probably of the few players to have dedicated his career to one club, Tottenham Hotspurs. He had a great football career which was unfortunately hampered by numerous injuries. Despite these Ledley played 323 times for Spurs and represented England 21 times. He also still holds the record for the fastest goal scored in a premiership match at just ten seconds against Bradford in 2000!

As a Physio and close friend who spoke to Ledley a lot about injuries, rehab and training I can say that I doubt there are many professional football players or athletes that could manage such a consistently high standard carrying injuries week-in-week-out.  It was common knowledge that Led didn’t train with the team during the week and was wrapped up in cotton wool. Some weeks he would barely kick a football but be ready to play when needed. You wouldn’t know it when he controlled a ball instantly, knocked an effortless cross field ball or marshaled a £50m centre forward all game. Not today Robben…

Few people outside of football know that he had a severely restricted range of movement in his knee. He couldn’t fully straighten it and had blocked flexion at around 100 degrees – crazy to think that despite this every single England manager wanted him in their squad.

“I don’t like defenders who hold the shirts of other players. The only defender here who doesn’t do that and sometimes still gets the ball off my feet easily is Ledley King. He is the only guy who doesn’t hold players. He will get the ball off you without you even noticing. For me, that is a good defender. He plays without any contact yet is somehow still strong and gets the ball without doing any fouls.”

Thierry Henry.

“He is like a magnet for the ball, a thoroughbred of a defender and the best centre-half in the country.”

Jamie Redknapp.

“Without doubt, King is one of the best central defenders in England.”

Fabio Capello.

“He is the best central defender I have ever seen.”

Martin Jol.

“He is an absolute freak.”

Harry Redknapp.

Anyway… hope to see you down at his testamonial game on May 12th at White Hart Lane where the current first team will play a ‘legends’ team including Ginola, Sherwood, Sheringham and Crouchy!

http://www.tottenhamhotspur.com/news/king-of-the-lane-040414/

Tickets are priced as follows:

Adults – £20.00

Seniors (65+) – £10.00

Junior (U16) – £5.00

Family Package (Two Adults and Two Juniors) – Available in all areas at £40.00

Hospitality packages are also available for the game.

Do you need a MARATHON MOT?

January is nearly up and it seems like everyone is up and running… literally!

So if you have already entered or considering a distance event this year then prevention is better than cure!
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To discuss or to make a booking with us at Angel, Shoreditch or Dalston clinics please contact:

emerson@xphysio / 07903247247

Inspirational stuff this weekend at the battle of London!

Battle of London, BOL14

Managed to get down to the BOL at the Copperbox on the Olympic site yesterday to shout at Coach Geoff who was representing our CrossFit Hackney box! Geoff was looking good going in to masters day two in 10th place but was scuppered by a nasty ankle injury!

Nnnaaaooo!

Great effort though!

Anyway it was a great event and there were some proper athletes competing! Nice to chat to some old faces and some new ones.

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Check out the final leader boards and event info at: http://battleoflondon.com/

Maybe next year for me 😉