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Information Sheets
Pilates Information Sheet
Developed by physiotherapists, the Clinical Pilates programme pioneered the link between recent spinal stability research and the original work of Joseph Pilates. Core stabilization training and muscle efficiency are key factors that have been identified by researchers and addressed by the Clinical Pilates approach. Athletes too are now focusing on muscle control work. The result is a body that works more efficiently. For more details see www.clinicalpilates.com/about/ or ask our Chartered Physiotherapists. Our group classes are designed to incorporate the principles of Clinical Pilates into your ongoing physical healthcare.
Advice for Cartilage Injuries
What is Cartilage?
Cartilage is a tough flexible tissue that covers the surface of bone in your joints.
Cartilage helps to reduce friction and damage to the bone. It also acts as a cushion and a shock absorber for the joints.
Advice for Disc Injury
What is a Disc?
The spine is made up of many bones called vertebrae. These are roughly circular and between each vertebra is a disc. The discs are made of strong rubber-like tissue which allows the spine to move and acts as a shock absorber between vertebrae.
Joint Hypermobility and Joint Hypermobility Syndrome
Ergonomics – Work space and sitting posture
The International Ergonomics Association (IEA) has defined ergonomics as the application of scientific information concerning objects, systems and environment for human use. With more and more people visiting doctor’s clinics and physiotherapy clinics each year with neck, shoulder and back pain. It has been found that a key contributing factor in neck, shoulder and back pain is ones posture in work. The amount of hours that people spend in front of a computer screen, hunched over a tablet or smart phone screen has increased tenfold in recent years. This advance in technology has given rise to an increase in neck, shoulder and back pain complaints all over the world. Sitting or standing in front of a computer screen in a poor postural position for prolonged periods of time can put people at risk of muscle pain, muscle tightness, general joint stiffness, developing eye problems as a result of staring at a computer screen and circulation problems.
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Female Pelvic Anatomy Floor Video
Male Pelvic Floor Anatomy Video
Foam Rolling Video
Main Library
Chronic pain
Chronic pain in patients with hypermobility
Joint hypermobility syndrome (JHS) is a ‘connective tissue disorder with hypermobility in which musculoskeletal symptoms occur in the absence of systemic rheumatologic disease’ (Simpson 2005). JHS occurs in 4 to 13% of the general population (Seckin et. al. 2005). Women have greater joint laxity than men and up to 5% of healthy women have symptomatic joint hypermobility compared to 0.6% of men (Engelbert et. al. 2004). The Brighton Criteria and is a valid tool that can be used clinically and for research to identify the condition (Simmonds & Keer 2011) (Appendix 1).
Foot, Ankle & Calf
Achilles Tendon Advice
My Achilles tendon has swollen up, how should I manage it?
Swelling in the Achilles tendon is caused by overuse or trauma. Constant stress placed on the Achilles tendon causes irritation, inflammation and pain.
Calf Muscle Advice
I have torn my calf muscle, what should I do to help it get better?
Your calf muscle (on the back of the lower leg), is made up of two muscles: the gastrocnemius and the soleus. The gastrocnemius is the larger calf muscle, and forms the visible bulge under the skin. This muscle has two parts or "heads," which together create its diamond shape.
Calcaneal Stress Reaction
Stress reactions and fractures of the calcaneus are a frequently unrecognized source of heel pain. In some cases they can continue to go unrecognized because the symptoms of calcaneal stress fractures sometimes improve with treatments aimed at plantar fasciitis. Calcaneal stress fractures can occur in any population of adults and even children and are common among active people, such as athletes, sports enthusiasts, and military personnel.
Peroneal Tendon Dislocation
Peroneal tendon dislocations are rare and are commonly misdiagnosed as lateral ankle sprains. It accounts for less than 1% of acute ankle injuries (1). They generally occur when the superior peroneal retinaculum is torn with allows the dislocation of the peroneus brevis and longus tendons from the retromalleolar groove. (1). Peroneal tendon dislocation is commonly linked with longitudinal splits in the peroneus brevis tendon and lateral ankle instability (4).
Shin Splints
I suffer from shin splints, what should I do?
Shin splints refer to pain in the shins - the front lower legs. It is an inflammatory condition of the front part of the shin bone. The pain is brought on by activity, more commonly in sports that involve running, with shin splints being reported to account for 12% to 18% of all running injuries (1).
Hip, Groin & Hamstring
Groin Pain & Osteitus Pubis
What is Osteitis pubis?
Osteitis Pubis is the inflammation of the pubic symphysis which is the midline joint where the two bones of the pelvis meet. The pubic symphysis is a cartilaginous joint with very little movement. The most amount of movement at this joint results from shear forces produced at the joint.
Hamstring Literature Review
Injury to the hamstring origin usually occurs when sudden forcible contraction of the hamstring muscles against resistance causes excessive eccentric overload, as in sporting activities such as gymnastics and sprinting (Gidwani and Bircher, 2007).
Hip Pains
Anterior Hip Pain
Although athletic injuries about the hip and groin occur less commonly than injuries in the extremities, they can result in extensive rehabilitation time. Thus, an accurate diagnosis and well-organized treatment plan are critical. Anterior Hip pain (pain located at the front of the hip) is the most common type of hip pain and may be caused by several different types of pathology.
Exercise Induced Iliac Artery Endofibrosis in Cyclists
Epidemiology
Elite athletes, predominantly professional cyclists, can develop arterial flow restriction in one or both legs during exercise. Deformation or progressive stenosis of the iliac artery may reduce blood flow to the lower limb and adversely affect performance (Peach, 2012). The ischemic symptoms are caused by endofibrosis and/or kinking of the external iliac artery (Vink et al., 2008). Iliac artery endofibrosis is a rare cause of arterial stenosis most often found in highly functioning and competitive athletes, commonly cyclists.
Meralgia Paraesthetica
Meralgia paraesthetica is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve that extends from the thigh to the spinal column. This chronic neurological disorder involves a single nerve—the lateral cutaneous nerve of the thigh.
Knee
APTA press release
Study finds physical therapy just as effective as surgery in patients with a torn meniscus and arthritis of the knee.
Knee Pain Advice
The front of my knee is painful every time I run. How do I stop it getting sore?
The most common running injury to get is pain in the front of the knee (patella-femoral joint). The pain is a result of placing too much stress on this joint. The pain comes from inflammation or damage to one or a combination of the following: joint, tendons, muscles, cartilage, fat pad or bone.
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Osgood-Schlatter Disease
Osgood-Schlatter disease is common in active adolescents. Repeated traction of the quadriceps muscles on the tibial tuberosity and abnormal quadriceps tightness can lead to repetitive microtrauma or a traction apophysitis of the proximal tibial tuberosity (1)(2). This may lead to an enlargement of the tibial tubercle with repetitive stress on the bone. Onset may be caused by the relative imbalance of strengthening quadriceps muscles compared with the growing bone (3). The disease is associated with growth spurts and can occur bilaterally in approximately 30% of cases (1). Local pain, tenderness, and swelling around the tibial tuberosity and the site of patellar tendon insertion are the main symptoms that a patient presents with (2). Knee pain generally stops at the end of the growth.
Popliteal Pain
The popliteus assists in flexing the leg upon the thigh; when the leg is flexed, it will rotate the tibia inward.
It is especially called into action at the beginning of the act of bending the knee, in as much as it produces the slight inward rotation of the tibia, which is essential in the early stage of this movement.
When the knee is in full extension; the femur slightly medially rotates on the tibia to lock the knee joint in place. Popliteus is often referred to as the "Key" to unlocking the knee since it begins knee flexion by laterally rotating the femur on the tibia.
Surgery Vs Physical Therapy
Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain.
Lower Back
Lower Back Pain Advice
My lower back gets sore when I go for long runs, what do you think is causing it?
Running is a high-impact repetitive activity where your legs absorb the impact of your feet on the ground and do their best to transfer this energy evenly to the upper body. However, sometimes this transfer is not smooth and can cause lower back pain. Common causes for pain in the lower back include overuse (running for too long or too often), weakness in the core or hip muscles, poor back or hip flexibility, incorrect body mechanics and imbalances in muscles in the body.
Spinal Stenosis: Literature Review
Aetiology
Spinal stenosis is a narrowing of the spinal canal. Eventually, this narrowing can press upon surrounding tissues and nerves, causing pain and other symptoms (Weinstein et al. 2010). Spinal stenosis occurs most commonly in either the lumbar or cervical region of the spine.
Information Sheets
Advice for Cartilage Injuries
What is Cartilage?
Cartilage is a tough flexible tissue that covers the surface of bone in your joints.
Cartilage helps to reduce friction and damage to the bone. It also acts as a cushion and a shock absorber for the joints.
Advice for Disc Injury
What is a Disc?
The spine is made up of many bones called vertebrae. These are roughly circular and between each vertebra is a disc. The discs are made of strong rubber-like tissue which allows the spine to move and acts as a shock absorber between vertebrae.
Chronic Pain and Hypermobility
Joint hypermobility syndrome (JHS) is a ‘connective tissue disorder with hypermobility in which musculoskeletal symptoms occur in the absence of systemic rheumatologic disease’ (Simpson 2005). JHS occurs in 4 to 13% of the general population (Seckin et. al. 2005). Women have greater joint laxity than men and up to 5% of healthy women have symptomatic joint hypermobility compared to 0.6% of men (Engelbert et. al. 2004). The Brighton Criteria and is a valid tool that can be used clinically and for research to identify the condition (Simmonds & Keer 2011) (Appendix 1).
Running Advice
Sports Massage Advice
Muscle soreness after exercise can often be attributed to Delayed Onset Muscle Syndrome (more commonly known as DOMS). This is the body’s reaction to strenuous exercise or exercises our body is not accustomed to. It is recognised as a dull soreness in the muscles which begins within 24 hours of the offending exercise session and peaks within 24-72 hours before gradually dissipating over the next -7 days. The most recent evidence puts this pain down to microtrauma (small tearing) within the muscle fibres of the muscle being exercised.
Shoulder
ACJ Injuries and Osteoarthritis
Management of acromioclavicular injury depends on the degree and direction of displacement of the clavicle. Using the Rockwood’s classification of ACJ dislocation Grade I and II dislocations are best treated conservatively (Hootman, 2004). Grade V and VI are generally thought to be best treated operatively (Rolf et al, 2008). A review of the literature done by Smith et al (2011) has shown that there is there is a lack of clarity regarding the optimal treatment approach for Grade III and IV. Their research did show that non- operative management had poorer aesthetic outcome but less sick leave than operative management (Smith et al 2011). When ACJ reconstruction is considered post trauma, results were better the sooner the operation was performed. Delayed reconstruction had worse functional outcomes, higher complication rates and higher patient dissatisfaction (Smith et al 2011).
Management of Upper Limb Lymphedema
Lymphedema after cancer is a condition in which excess fluid collects in tissue, causing swelling as a result of removal of lymph nodes and vessels during surgery or radiotherapy (Langbecker et al. 2008). In patients with chronic lymphedema, large amounts of subcutaneous adipose tissue may form. Although incompletely understood, this adipocyte proliferation may explain why conservative treatment may not completely reduce the swelling and return the affected area to its usual dimensions (MEP, 2006). In the UK, a large-scale prevalence study found that 28% of women who were treated for breast cancer and were still surviving had lympedema (Mortimer et al. 1996).
Women's Health
Physiotherapy and Women's Health
Reasons to Exercise during Pregnancy
Reasons Being active and doing exercise is important for everyone and this is no difference during pregnancy. Of course there are some potential risks resulting from maternal exercise, however, the benefits appear to outweigh the risks. These risks can be minimized by doing appropriate exercises that have been prescribed for you by a trained professional. Exercise such as swimming, biking, and walking are not associated with reported problems.