Christmas Injuries

Christmas is Coming the Goose is Getting Fat and Physiotherapy Clinics get full with Christmas Injuries!  Whenever we discuss this with people they always laugh but be assured you that this can be no laughing matter - especially over the Christmas period when you have a house full of people and fun to be had.  So, the four main complaints that we see most years through the Christmas period are injuries from:

• Putting Up The Christmas Tree  

• Wrapping Presents

• Christmas Card Writing

• Cooking The Turkey

Putting Up The Christmas Tree:

If you take a step back this really shouldn't surprise anyone.  The man handling of a 6 FT + tree either into a car or onto a roof rack then into the house is clearly a tricky manoeuvre.  However, with a bit of teamwork the exercise can be easier. 

The injuries we tend to see related to Christmas trees are low back strains and shoulder injuries.  If your back or shoulders are hurting before you even head to the garden centre please consider postponing the visit, or taking a helpful friend.  The height of the tree makes the stress on the body quite high so sharing the load between two people will help dramatically Also if possible, put the tree (wrapped in an old sheet to save your car) inside the car so that you don't have to lift the tree above shoulder height, which significantly increases the load on the shoulders and upper back / neck.

Wrapping Presents:

Why do people still wrap presents sat on the floor?  Those of us with young children have probably all been found hiding in the bedroom sat on the floor desperately trying to wrap presents without small eyes seeing.  However, irrespective of how carefully you sit, you will be loading the hips, knees and lower back sitting on the floor for a prolonged period, especially whilst leaning forward to wrap the gifts.  We see patients most years that have sat wrapping presents on the floor only to be in pain for days after. The pain is often felt when you get up rather than at the time. So our advice is to send the children out to play and set up a wrapping station at the kitchen table.  

Christmas Card Writing:

Now, I must say that this is getting less and less as people send significantly less cards due to the digital age.  However, there are still a large number of people who send many cards and spend hours writing them. The main injuries we see are shoulder / neck aches and elbow pain.

The shoulder and neck aches are due to the static holding of the shoulder muscles whilst you write  The muscles around the shoulder are strong and able to work for prolonged times but they do fatigue and make you ache.  We have all felt the need to rub our shoulders and neck after a period of concentration or work. So, take breaks and try to limit the card writing to 20 minutes at a time.  The elbow pain can be from overuse of the muscles that extend the wrist and hold it in a position suitable for writing - this is inherently “tennis elbow.” Tennis elbow can occur when there is irritation where the tendons attach on the outside of the elbow.  Using a larger diameter pen to reduce tension and over gripping in combination with frequent rests can help.

Cooking the Turkey:

This is the injury Physiotherapists dread to hear about the most, as it happens on Christmas Day when the Physiotherapy clinics are shut and everyone wants to have a lovely time.  A turkey is heavy and, if you add to that the roast potatoes, a tray with the turkey in is very heavy. The majority of the injuries occur whilst lifting the hot loaded baking tray out of the oven and cause injury to the lower back - often the discs.  This is an especially precarious task if you have a low oven and you are bending over with the heavy tray outstretched in front of you.

There is no easy way to avoid the lifting but if you have a “weak” back please delegate the activity or ask someone to share the load with you. Also, use your knees to bend and engage the core to support the spine.  If you are plagued by a “weak” back you would be wise to address the problem with core strengthening or Pilates. Victoria at ThamesPhysio would be very happy to help you address these problems.

The above information is for your interest and information, if you have any specific concerns or aches and pains that you would like to get sorted out Victoria at ThamesPhysio would be very happy to address any individual needs.

Warm Up For Hockey

So why warm up?

The warm up is often a hurried exercises of a quick jog and a few stretches but the warm up is a very important part of the  pre-match preparation. A warm up has two main aims:

Prepare the body to play - and thus prevent injuries

Prepare the mind to play - and enhance your game.

The main benefits of a good effective warm up are:

1. Muscles that are warm are able to contract more effectively creating more force.  They are also able to relax more easily. All areas of your game will obviously be improved when your muscles are functioning at their optimum.

2. Joint range of movement is improved after a warm up so stiffness and restriction will be reduced.  This will not only help to prevent stresses and strains but also improve your dynamic movement.

3. Warm up causes vasodilation which enhances the carriage of vital oxygen to the active muscles.

4. The nervous system is primed following a warm up - so is ready for the activity about to happen.

As you can see from the above points a warm up is critical for injury prevention and sporting excellence.

So what should you do?

The basic principle of a warm up is to:

1. Get everything generally warmed up - especially on a cold morning in January!

2. Start slowly with slower stretches progressing to dynamic work increasing intensity and speed.

3. Strength activation exercises.

4. Game specific activities.

1. Get warmed up:

10 minutes of brisk walking progressing quickly to light jogging should be enough to get the body ready to exercise. 

2.Stretches and dynamic stretching

Research (Page, 2012) shows that for athletes involved in running sports, such as hockey and football, dynamic stretching may be the best method of stretching. Whilst for those involved in sports requiring flexibility such as gymnastics and dance, static stretching may be more beneficial.  Therefore the stretches suggested below are dynamic. However it is important to start these stretches slowly and build up the range.

Standing on the spot:

• Hip Swinging - Swing the leg forward and back  and side to side. X 20 each movement 

• Knee bends and heel raises - Bend the knees and them raise heels, lower the heels and bend the knees with arm reaches. x20

• Knee lifts and hamstring curls - Lift each knee to chest. Then bend each knee to bring the foot to bottom. x20 each

• Roll down  and reaches - Rest hands on the thighs and nod the head and roll the spine down to reach the toes - if you feel tension in the back allow the knees to bend slightly. Uncurl as you roll up and reach for the sky. Try to move vertebra by vertebra.  x5

• Hip Swivels - Rotate the hips in both directions. x10 each direction

• Cross body arm reaches -Take the right arm across the body to the left - palm up, repeat with the left arm. Then repeat with the palm down. X 10 each movement.

• Trunk twist - Cross the arms across the body, keep the hips facing the front and rotate the trunk to the right and left. x10

See the below videos to help with the above exercises.

Start to build movement:

• “A” skips - Skip forwards knees to chest.

• “B” Skips - Skip forwards extending the knee.

• Back Skips - Skip / Jog backwards. 

• Skater skips - Hop onto 1 leg at an angle in front and to the side of you., then hop to the other leg.

• Hamstring curl skips - Move forwards bringing alternate foot to the bottom.

• Carioca -  Run sideways alternating one foot in front and one behind. Ensure to turn around halfway to lead with the opposite side.

I suggest doing each exercises for half the width of the pitch and repeating x 2 - 3

See the below videos to help with the above exercises.

3. Muscular activation.

Hockey requires a high level of asymmetric muscle work and a common finding in my practice with hockey players is tight hamstrings (back of the thigh) and weak glueals (Buttock muscles).

We have addressed the hamstring tightness with the dynamic stretches but activation of the gluteal muscles will improve stability and help stabilize the core.

• 1 leg dips - stand on 1 leg ensure the hips are level and bend one knee - keeping the knee cap over the second toe, ensure to “squeeze” the buttock on the stance leg. x 20 each leg.

If you can invest in some theraband, this can really help wake up the gluteal muscles.

• Crab walking -  Tie the band around the ankle. Position the feet in turn out and keeping knee cap over the second toe walk right and the left. - 1 minute.

• Squat to lateral lift - Tie the band just above the knees, feet hip width apart.  Squat and push the bottom backwards. Stand tall and lift the right leg to the side. Repeat squat and leg lift to the left. X20 reps.

4. Game specific:

Now is the time to start to gear up for hockey. Stick and ball work in a small area - ¼ for  5 mins. Progress to ½ pitch for 5 mins and then to position specific drills - corners passes etc. 10 mins.

You should now be all set for a great game!

The above programme is given as a suggested warm up for those with no specific concerns and does not take into account any previous injuries.  You should not feel any pain with any of the above exercise and should seek advice from a doctor or professional if you have any symptoms or concerns.  

Victoria at ThamesPhysio would be very happy to guide you through a warm up for hockey or address any individual needs.

Reference:

P. Page: “Current concepts in muscle stretching for exercise and rehabilitation”.

Int J Sports Phys Ther. 2012 Feb; 7(1): 109–119.

"Cartilage Tear" in the Knee

This is a common presentation  to a physiotherapy clinic. I hope that the information below will clarify some of the confusing points.

What is the Mensicus - “The Cartilage?”

The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint - the medial and the lateral menisci.  They assist in shock absorption. The knee also has articular cartilage that lines the surface of the joint and should not be confused with the menisci.

What are the types of tears: Degenerative and Traumatic

Degenerative tears are as a result of overuse and may or may not be attributable to a specific evident.  They most commonly present between the ages of 40 - 60 years Until fairly recently, an arthroscopy with meniscal debridement was often performed for these types of injuries to smooth out the tears.  However, recent evidence shows that very many people have resolution of symptoms with physiotherapy and exercises. If however, symptoms persist an arthroscopy may still be needed. It should be noted that an arthroscopy is not always a quick fix and the improvement of thigh muscle and buttock muscle (quadriceps, hamstrings and gluteal muscles) control through exercise should be done prior to surgery, to either avoid surgery altogether or ensure a good recovery. 

Traumatic tears are, as the name suggests, usually as a result of a specific injury.  They are often described by the shape and position of the tear. They often result in locking and giving way.

These tears usually need a surgical repair and will require a period of joint protection and rehabilitation to ensure a good outcome.

What are the symptoms and how is the problem identified?

Pain is usually the overriding symptoms and may range from acute severe pain to a dull ache.  With the more significant tears you may also experience true locking or giving way. True locking is when the knee becomes completely stuck and cannot be moved.  This usually require urgent attention as the knee is not functional. Giving way usually occurs whilst weight bearing and rotating or changing direction. Again this does require attention as further giving way can extend the tear.

A physiotherapist can identify the presence of a tear through a thorough subjective history taking and a physical examination where they will use specific tests to identify a tear.  If there is concern about the extent of a tear or a need for surgery the physiotherapist may refer you for an MRI. An X Ray would not identify a meniscal tear.

What would physiotherapy involve for a meniscal tear?

Following an assessment your treatment will be planned to treat the various problems that may exist but could include:

• Joint mobilisation for restoration of full range of movement .

• Soft tissue massage for reduction of swelling and movement improvement.

• Acupuncture, Ultrasound and Interferential for reduction of inflammation and pain control.

• Exercises for strength, balance and range of movement.

If you feel you would like to discuss your knee problems or have an assessment, please do be in touch with Victoria at ThamesPhysio Ltd.

How Much Activity Should I Be Getting?

The UK chief medical officers have today released new guidelines on physical activity based on the latest research.  (Published 7th September 2019). The guidelines are summarised into age groups.

Children and Young People (5 to 18 years)

• Children should participate in at  least 60 minutes per day of moderate to vigorous exercise every day.

• Children should develop and maintain muscle tone and strength.

• Chldren should minimise sedentary pastimes and intersperse inactivity with physical activity.

Adults (19 to 64 years)

• For good physical and mental health, adults should aim to be physically active every day.

• Adults should participate in activities to develop or maintain strength in the major muscle groups. Muscle strengthening activities should be done on at least two days a week.

• Each week, adults should accumulate at least 150 minutes of moderate intensity activity (such as brisk walking or cycling); or 75 minutes of vigorous intensity activity (such as running); or an even shorter duration of very vigorous intensity activity (such as sprinting or stair climbing); or a combination of moderate, vigorous and very vigorous intensity activity.

• Adults should aim to minimise sedentary lifestyles.

Older Adults (65 years and over)

• Older adults should participate in daily physical activity.

• Older adults should maintain or improve their physical function by undertaking activities aimed at improving or maintaining muscle strength, balance and flexibility on at least two days a week. 

• Each week older adults should aim to accumulate 150 minutes of moderate intensity aerobic activity, building up gradually from current levels. Those who are already regularly active can achieve these benefits through 75 minutes of vigorous intensity activity, or a combination of moderate and vigorous activity, to achieve greater benefits. 

• Weight-bearing activities should be included to maintain bone health.

• Older adults should aim to minimise sedentary lifestyles, or at least with standing, as this has distinct health benefits for older people. 

If you are finding that aches, pains or stiffness are preventing you from achieving the goals set out above please do contact Victoria at ThamesPhysio for an assessment to see if we can address these problems and get you back on the road to full fitness.