What to Expect from Soft Tissue Therapy

Soft Tissue Therapy

Before attending your first Soft Tissue Therapy session it is important to think about the following questions. These are important questions that therapists should ask you before you commence treatment. It gives the opportunity for both parties to gain an understanding of exactly what the client would like to achieve, what the therapist believes is possible, and what will have to happen in order to achieve this.

At Central Sports Massage we will ask you:
– What is the reason for your visit?
– What result are you looking to achieve?
– When are you looking to achieve the desired goal by?

From this information we can then advise on:
– Whether we feel that we can help with your issue.
– What treatment approach we believe will be most effective.
– How realistic your desired result is:
– Can such a result be achieved in the desired time scale
– Is the end result achievable through soft tissue therapy
– Create awareness of need for ‘homework’ if results are to be realistic

 

Sports Massage Consultation

 

What soft tissue therapy / sports massage is not:

In the majority of cases, especially those involving chronic/persistent pain, soft tissue therapy is not a 1 stop solution. Pain is a complex mechanism and it can take a lot more than 1 hour on the massage table to correct one’s problem. The first session should offer the client a good level of pain relief and increased mobility; this provides a great window of opportunity to continue the good work with effective exercises at home – guided by the therapist.

Without this, those positive effects will gradually begin to fade.

Soft tissue therapy should be thought of as a course of treatment that also requires the client to follow instructions from their therapist to work on their issue at home also.

In some cases, 1 soft tissue therapy sessions involving quality sports massage may be all that is required to completely resolve one’s pain symptoms. But the majority of client visits involve persistent pain, which may take more of a change in lifestyle habits than just 1 short session.

It is the role of the therapist to communicate this information. A person seeking treatment, of course, cannot be expected to know the ins and outs of what is attainable….the therapist should. It is important for the success of the treatment that the client’s expectations are managed and that they understand what treatment will entail, how long it may take, and what they will have to do in order to achieve their goal.

By having this initial conversation at the very beginning, both client and therapist will have an understanding of each other and the treatment plan that will follow. As a client, having that information upfront allows you to fully understand what the therapist’s aims are, and the confidence in the treatment plan to know that you may not walk out of that first session like a complete new person, but that with the right dedication to the end result, you will have the best possible chance of achieving it!

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British Athletics – u20 European Championships

European Championships

I have recently returned from a week-long trip to Grosseto, Italy for the u20 European Athletics Championships, where I was working as the soft tissue therapist as part of the medical team with British Athletics. The medical team consisted of myself as the soft tissue therapist / sports massage therapist, an osteopath, a physiotherapist and team doctor.

This was a great opportunity to work at a major championships and to gain great insight into the world of athletics. The trip consisted of very long, but rewarding days. With over 50 athletes at the event there was plenty of sports massage required and athletes were queuing ready for there pre event/post event soft tissue therapy.  I was presented with a whole range of issues throughout the week and I was lucky to work alongside a fantastic group of professionals.

The championships were very successful for Team GB. The 19 medals secured equalled the highest ever number of medals won by Team GB in any u20 European Championships.

I hope to gain more experience working with British Athletics over the coming year – and I sound like an athlete myself now when I say ‘I am now focussed on trying to get to Tokyo 2020 Olympic Games’!

squad

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Yorkshire 100km

Event Sports Massage

Finish line!
Sports Massage is in sight!

Last weekend I traveled up to Darley, North Yorkshire to help out at the Yorkshire 100km 24 hour walk. The event was in order to raise money for Blind Veterans UK & Guide Dogs UK charities. The challenge, as the name suggests, was to complete the 100km route in 24 hours. This was a long slog. It also meant an early rise for me in order to get to the finish line in time for people to start returning back! Despite the sleepy eyes, the sight of the beautiful morning sun shining across the Yorkshire Dales had me in good spirits and raring to get involved!

Upon arrival, I relieved Terry (the night shift sports massage therapist, who started his shift at 2am!) from his duties and set up alongside another two therapists (one physiotherapist & one sports therapist). One of the great parts of getting out and working at events is that it provides the chance to meet likeminded professionals and can also learn a great deal from the experience – this weekend’s physio had not one, but two PhDs….so ample knowledge to share!!

The conditions, whilst delightful for me, were not ideal for those in the field! With temperatures rising to 29 degrees, this 24 hour ordeal was not a ‘walk in the park’! Understandably there were quite a large number of participants that were not able to finish the route. And those that did were understandably fatigued!

Although the role of the sports massage therapist at the end of an event like this is purely about kick starting the recovery process and just providing a gentle massage, the effect that the 15 minutes sessions had on the participants, both physically & mentally, was great!

It was a pleasure to help everyone out after what was a great display of endurance by all involved, and I will not hesitate to return next year!

Hiking for Sports Massage

A huge endurance event!

 

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Running Series: The Most Common Injuries – Plantar Fasciitis (4 of 5)

Plantar Fascia Sports Massage

Next on the list of the Central Sports Massage blog series on common running injuries is Plantar Fasciitis. This is a condition that regularly brings frustrated runners through the door in our clinic looking for answers! This blog post aims to introduce people to the condition, what it is, why we get it & what can be done!

What is it?

Plantar Fasciitis is an issue that is common with runners. Around 10% of runners are affected by this condition (Chandler TJ, Kibler WB. A biomechanical approach to the prevention, treatment and rehabilitation of plantar fasciitis. Sports Med. 1993;15. PubMed #8100639.).

To understand the condition, let’s first have a look at what the Plantar Fascia (PF) is. The plantar fascia (or plantar aponeurosis) is a thick band of connective tissue that runs along the sole of the foot. It travels from the toes across to the heel of the foot. Functionally, the plantar fascia plays many roles in human biomechanics. It helps to create the ‘heel raise’ when walking, it stabilises the arch of the foot, and also provides shock absorption when the foot strikes the ground.

Plantar Fasciitis is the name of the condition when the PF becomes inflamed and/or suffers degeneration. The ‘itis’ at the end of the name means ‘inflammation’, however the tissue is rarely inflamed (maybe a little at first, but not for long). Instead, the plantar fascia generally shows signs of collagen degeneration.

It is a kind of repetitive strain injury. Pain often presents itself in the arch or heel of the foot and morning foot pain is a classic symptom of plantar fasciitis.

“Recent basic science research suggests little or no inflammation is present in these conditions.” (Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466(7):1539–1554.)

How can it be prevented?

There is no easy answer as to why plantar fasciitis occurs, but due to the degeneration nature of the condition it is important to ensure that training and load exposure is maintained at a progressive rate and that adequate strength is maintained.

Tight calves are often diagnosed as a reason for developing plantar fasciitis, and although my sports massage clients with plantar fasciitis do often present with tight calves, there is no real evidence, that I have read, that links it as being the cause.

Similarly, over pronation is often muted as the reason for developing plantar fasciitis. Again, it may play a part, but so too may over supination. There are so many factors that are likely to be simultaneously having an effect that it may be far too simple to confidently claim it as the cause.

It is important to keep our muscles and tissues in great condition with restriction free range of movement – even tight shoulders could have an impact on the plantar fascia. If the arm swing of a runner is affected by shoulder restrictions this will alter the body movement and affect the foot strike, this in turn will place a different stress on the plantar fascia and could have a negative effect.

During the ‘push off’ phase of running, runners exposed their plantar fascia to up to 7 times their body weight. A muscle in the foot called the Flexor Digitorum Brevis (FDB) tenses during this period and acts to disperse pressure from the stressed plantar fascia. This relationship is greatly reduced when the FDB is weak, meaning that that the FDB is not as efficient in sharing the load. This suggests that adequate strength in the FDB may be important to prevent developing this condition.

Soft Tissue Therapy

Flexor Digitorum Brevis (middle 4 bands of muscle)

What to do if you have it?

Soft tissue therapy has been shown to have a positive effect on the outcome of short term heel pain. Trigger point techniques, a technique that is commonly utilised in sports massage sessions, were employed alongside a conventional self-stretching protocol and produced superior results to the group that performed stretches alone (Renan-Ordine R, Alburquerque-Sendin F, Rodrigues De Souza D, et al. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011;41:43).

Soft Tissue Therapy Planter Fasciitis

Self Release for Plantar Fasciitis

Sports massage/soft tissue therapy can be very effective at bringing about short term pain relief for this condition. However, it is important that these positive effects are capitalised on by carrying out relevant rehab/strength training. Self soft tissue release of the plantar fascia can be done using a tennis ball under the foot, which can be followed up with stretching for the PF/Achilles/calf muscles.

Soft Tissue Therapy

Calf Stretch for Plantar Fasciitis

Regular strengthening of the intrinsic foot muscles, achilles and calves, along with a good general strength program that is completed 1 to 2 times per week will be important to create the changes that will alleviate, and keep the condition away.

Soft Tissue Therapy Plantar Fasciitis

FDB exercise for Plantar Fasciitis

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Central Sports Massage: Running Series – The Most Common Injuries (3 of 5)

Iliotibial Band Pain

This week in Part 3 of the Central Sports Massage: Running Injuries blog series, I will take a look at Iliotibial Band Syndrome.

The Iliotibial Band (ITB) is a thick, fibrous length of connective tissue, or fasica. It has proximal attachments at the iliac crest, and the tendons of the tensor fascia lata and gluteus maximus. The tissue spans down the lateral side of the thigh to its distal attachment at the lateral epicondyle of the tibia. As the ITB is made up of fascial tissue, its attachment points are not just at the proximal and distal locations – it is firmly anchored along the entire lateral length of the femur.

The relationship of the iliotibial band with the tensor fascia lata means that it assists in the muscle’s function of abduction, medial rotation and flexion of the hip. Its relationship with the gluteus maximus means that it may have a role in the extension of the hip also. The length of the ITB crosses both the hip and knee joints which give the ITB a stabilising role whilst walking, standing, running, cycling etc.
 

What is Iliotibial Band Syndrome (ITBS):

Iliotibial Band Syndrome is a condition that is most prevalent in long distance runners (approx. 1 in 20 long distance runners (Sutker AN, Barber FA, Jackson DW, Pagliano JW. Iliotibial band syndrome in distance runners. Sports Med. 1985;2(6):447–451.). To a lesser extent cyclists are also prone to suffering the condition. It is largely due to the high repetition, overloading nature of the activities.

ITBS is often confused with Patello-femoral Pain Syndrome, but the two conditions actually have very different symptoms.

ITBS has three key identifying features:
1. Pain is located on the lateral side of the knee
2. Pain is located at, of just above, the prominent bump of bone (lateral epicondyle)
3. There is a well-defined pain location; it is not a vague pain.

Any knee pain that does not fit the criteria above will not be ITBS.

Any pain in the hip or the lateral thigh, similarly, will not be ITBS.

Historically, ITBS has been treated like a tendonitis condition and has been thought to be caused by the band flicking over the lateral epicondyle causing a friction and irritation of the tissue. Research has shown that the IT band is actually firmly anchored at the lateral knee and the mechanics of knee flexion mean that it does not move back and forth over the lateral epicondyle. This research suggests that ITBS is actually caused by increased compression on the underlying fat and loose connective tissue, and is related to impaired function on hip musculature (Fairclough J, Hayashi K, Toumi H, et alIs iliotibial band syndrome really a friction syndrome? Journal of Science & Medicine in Sport. 2007 Apr;10(2):74–76).

 
How can it be prevented?

Prevention is better than the cure!

As with a lot of sports injuries, ensuring that we have enough rest and recovery scheduled into our training program is vitally important. As I have linked in previous blog posts, runners who schedule two days of rest into their weekly schedule have been shown to experience a greatly reduced chance of injury occurrence.

Along with rest days, training load is extremely important. Whether overall volume or intensity of training runs, increases in training must be structured and raised progressively.

Another thing that has been mentioned already in this blog series on running injuries is the implementation of strength training. Whether running specific strength drills, or just general lower body/core conditioning work, strength training will help guard against iliotibial band issues. The benefits are universal and will help increase tissue tolerance to guard against many common running injuries, whilst it may also give you speed and power benefits to help drive you times down!
 

What to do if you have it:

Whilst there is no stone wall approach to rehabbing ITBS there are approaches that can help facilitate recovery.

Depending on the severity of the condition, ITBS may clear up just by giving it some rest. It may also clear up by a combination of rest, ice, and stretching – although these approaches have been shown to be fairly obsolete!

Two common approaches which have been shown to be ineffective in their approach are stretching and foam rolling the IT band. Studies have been down which have shown that it takes over 1000 pounds of pressure to physically stretch the IT band. Similarly, that makes it quite futile to attack the tissue with a foam roller.

However, that is not to say that stretching and foam rolling may not have some impact on the surrounding tissues, or on reduction of pain…they just do not physically affect the ITB in the direct structural way that they are targeted.

A much better approach would be to address the musculature related to the IT band. Sports massage/soft tissue therapy work targeting trigger points in the tensor fascia lata and the glutes is likely to have more of a success and can be very useful when utilised correctly. Self-release work into these same areas can be achieved at home by using a tennis ball/cricket ball.

 

Iliotibial Band Syndrome foam rolling

Foam Rolling the TFL for Iliotibial Band Syndrome refielf

 

Once the pain symptoms have settled a little, progressive introduction to strength training will help to increase the load tolerance of the tissues. Exercises targeting the gluteal region, such as: side lying straight leg raises, clams, hip thrusts, resistance band side steps can all help by increasing the control and the load tolerance of the hip region. Some studies have shown a risk of injury reduction rate of 1/3 when strength training has been incorporated into a training program.

Exercise for Iliotibial Band Syndrome

Straight Leg Raise exercise for Iliotibial Band Syndrome

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Running Series – The Most Common Injuries (2 of 5)

achilles tendinopathy

Last week I began a Central Sports Massage blog series on 5 of the most common running injuries. Last week we looked at hamstring strains. Today we are going to move down the body and turn our attention to the Achilles.

This week is Achilles Tendinopathy.

Many of you will be more familiar with the term ‘Achilles tendonitis’. The word Tendinitis means Inflammation of the Tendon. However, more recent studies (notably by Jill Cook) have shown that in many cases there is barely any inflammation present and the issue is caused by degeneration of the tendon due to overuse. The term ‘Tendinopathy’ is a broad term that encompasses painful conditions in/around tendons in response to overuse.

Pain may be experienced in a couple of places. Symptoms experienced in the main body of the tendon may suggest that the tendon has not been able to tolerate the load placed upon it i.e. too much running – whether a sharp increase of mileage or too many intervals – for the tendon to recover from. Another location where symptoms may present is at the insertion of the tendon to the heel of the foot. This is often caused by compressive overload on the tendon. This overload occurs when the foot pushes off the floor in dorsiflexion. At this point the tendon is being heavily loaded and there is a strong force at the insertion of the heel. If there has been an increase in the amount of hill running, this could well be a cause.

How it can be prevented?

Training should always be progressive. The best way to avoid suffering Achilles tendinopathy is to give our body enough time to recover and adapt. Avoid any significant increases in overall volume or intensity of runs. By allowing our body to recover, we can adapt and will be able to tolerate the increase of volume and intensity that our training program is building.

One trait that I experience a lot with the runners I see is the will to keep on running….and not stop running! The key message here regarding injury is that some REST is BEST! Many studies have shown that those who incorporate 2 rest days per week into their program have a large % decrease of picking up an injury. I have included the link to a study below that show that those who do have 2 days rest a week reduced their risk of injury by a factor of 5.

https://www.ncbi.nlm.nih.gov/pubmed/24445548

Incorporating strength training into a training program is another key way to help prevent developing an Achilles tendinopathy. Performing any variety of heel raises will help to increase the load tolerance of the soft tissue. The soleus muscle takes up a lot of the force during the running gait and so incorporating bent knee/seated raises that target the soleus may be beneficial.
What to do if you have it?

If you feel symptoms of Achilles tendinopathy developing it is important to cease doing the activity that has aggravated it. Allowing 48 hours between each training session may be enough in mild cases to allow training to maintain whilst undergoing the rehab process.

A key point to remember with Achilles tendinopathies is that the initial pain can be quick to subside. This can make it tempting to resume full training. However, even though pain may subside the healing process is still taking place and the tissue is not at full strength. By returning to full training too early, the chance of recurrence can increase by up to 70%.

Isometric exercises are useful for increasing the tissue strength and load tolerance. Isometrics work by holding a contraction against force without the tissue lengthening or shortening. They are particularly useful early on, as the stress on the tendon is less due to the static nature of the exercise.

Examples of isometric exercises for the Achilles tendon are: simply standing off the edge of a stair and holding that position, using a resistance band (as displayed in the image), or as rehab progresses and the load placed upon the tendon is increased, they can be performed using a leg extension machine placing the foot over the plate.

achilles isometric

Towards the later stages of rehab we would look to increase the load placed on the tendon by adding weight, and by incorporating eccentric strength work. Eccentric contractions are when the tissue lengthens. A whole body of research has shown this type of exercise to be an important factor in the rehab of Achilles tendinopathies.

http://journals.lww.com/ajpmr/Abstract/2013/01000/Effect_of_Eccentric_Strengthening_on_Pain,_Muscle.8.aspx

Soft tissue therapy can be an effective tool to use in the recovery & prevention of Achilles tendinopathy. General sports massage techniques can help with pain reduction. This effect may be short term, but it can give the athlete a window of opportunity to perform a good rehab session/complete some training without experiencing pain.

More specific soft tissue therapy techniques can be used to really target the Achilles. Isometrics can be incorporated into a session along with muscle energy techniques which will help work on tissue load and range of movement. More functional techniques can be used to work on the tissue whilst mimicking training specific movements.

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Running Series – The Most Common Injuries (1 of 5)

What-is-Maximalist-Running-LPF

Running is an extremely accessible sport. It requires minimal equipment: You can run from your door, there are an abundance of running clubs which are often free to attend, and with running being a fundamental requirement for the vast majority of sports it is often an integral part of peoples fitness regime.

Despite the simplistic nature of running, as a sporting activity it has one of the highest injury rates. Statistics reporting higher than 70% of runners picking up an injury each year. This may in part be due to the accessible nature of running. It is very easy to just lace up your trainers and hit the road. Factors that may not always be considered sufficiently enough when a person takes up running are volume, intensity & also technique/skill.

As a species we are designed to run, however it is still a demanding task. Our training load is what puts us at most risk of injury and should be considered carefully when planning running activity.

Today I will take a look at: Hamstring Strains

What causes a hamstrings strain?

Injuries to soft tissues account for up to 30% of all injuries in sport. The most common muscle to suffer a strain is the hamstring group. The Hamstrings are made up of the Semitendinosus, Semimembranosus and the Biceps Femoris. The primary function of the hamstrings are to flex the knee and to extend the hip.

About 70% of injuries relating to the hamstrings occur in the biceps femoris, which is the lateral of the 3 muscles. Injury most commonly happens in the forward leg swing phase of running, during high speed activity. In this phase, the body must decelerate to prepare for the foot to connect with the ground. During that movement the hamstrings have to lengthen as the hip flexes, whilst contracting as the knee extends. Injury often occurs at the musculotendinous junction of the long head of the biceps femoris.

How can it be prevented?

The best form of defence is to bulletproof our body to prevent it happening in the first place!
To reduce the chance of suffering a hamstring strain it is important to increase strength capacity of the tissues. The stronger we can develop, the more resilient they will become to the load placed upon them. When incorporating strength training into a running regime, the program will be most successful when using exercises that relate to the specific demands of the sport that you are training for.

Two great exercises are listed below:

Nordic Hamstring Curls: Nordics are great at building strength through the same movement pattern where most strains occur. This allows us to increase our strength capacity in this motion to reduce the chance of overloading.
Nordics
https://www.youtube.com/watch?v=qPRZcNx_C0A

Single Leg Romanian Dead Lifts (RDLs): Single leg RDLs not only allow us to develop strength in the tissue that also focuses on the eccentric (muscle lengthening phase), but they also help develop our control and co-ordination in the movement around our hips.
RDL
https://www.youtube.com/watch?v=lnrRKga6rZc

Once an injury has occurred then a process must begin of: Initial rest (first 72 hours) — gentle mobilisation — gradual progressive strength training — sport specific drills — return to play.

Soft tissue therapy/sports massage can be a very useful tool throughout this process. From the early stage of rehab light sports massage can be used to stimulate area of injury. As the recovery progresses soft tissue work can be used to promote tissue mobilisation as it heals and deeper massage work may help to promote the healing of the damaged tissue and reinforce the minimisation of scar tissue.

Aims of treatment can be: promote the healing process — increase/maintain range of movement — help muscle activation — help pain relief.

At Central Sports Massage we may utilise a variety of modalities (sports massage, mobilisations, instrument assisted soft tissue mobilisation, dry needling, taping)  depending on what we find clinically relevant to helping you recover.

Next up I will take I look at anterior knee pain!

Alex

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Dry Needling

Last weekend I attended a CPD course in Dry Needling/Medical Acupuncture at Norris Health Clinic in Congleton, Cheshire. The course was taken by Dr Chris Norris, a leading medical author and physiotherapist. It was aimed at professionals who practice physiotherapy, soft tissue therapy, sports massage, osteopathy.

I found the weekend to be extremely engaging! There was a lot of in depth theory…but all very interesting so it was no means a drag – if anything, I will just struggle to contain all of the info in my modest brain!! Along with the theory, there was even more hands on practical work, and with a nice small group we had plenty of tuition and attention.

A Great weekend!

100th needle of the day!

100th needle of the day!

I am now looking forward to utilising all of the techniques learned back in clinic within my soft tissue therapy practice and bringing another modality in to help provide the best service I can to my clients.

What is Dry Needling and how could it help you?

Dry needling is a popular technique that is widely used in sports medicine and physiotherapy and is now becoming a popular tool in soft tissue therapy and sports massage sessions. It involved the use of very thin filament needles that are inserted into areas of myofascial trigger points.

Trigger points are hyper-irritable points within the musculature than are identified by tight bands of tissue or sensitive nodules, ‘knots’.

Trigger points can become ‘active’, whereby they become painful and can also radiate pain in predictable patterns.
One of the goals of dry needling is to achieve a local twitch response in the area of insertion, which can help to release muscle tension and pain.

The technique can be useful for a range of neuromusculoskeletal conditions, such as chronic pain issues, back & neck pain, tennis elbow, tendinopathies, sciatica, muscle spasms, to name a few.

Dry Needling3

I will be making full use of this new skill set within my sessions – Soft Tissue Therapy is much more than just sports massage…

Alex

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Sever’s Disease: Current Evidence-Based Treatments in Pediatric Injuries

http://www.medbridgeeducation.com/blog/2017/01/severs-disease-current-evidence-based-treatments/?medium=social

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No, your pelvis is not out of place

No, your pelvis is not out of place…

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