Monday, 22 December 2014

PFP Event

This popped up on my Twitter feed the other day. I was wondering about going, but haven't decided yet. Given the number of people who complain about knee pain, it might be 3 hours well spent!

Here's a link to the Eventbrite booking page for the seminar.

Friday, 14 November 2014

ITB Pain

Came across this article on ITB Pain, its sources and solutions.

I remember having a difference of opinion with a few folk when I was doing my PT course about whether you could stretch the ITB or not. I'm glad to say I argued the case for not and this article agrees with me!

The article looks at friction and compression as the potential sources of ITB pain and favours compression arguing that it's simply not possible for friction to be the culprit. Sadly there's no discussion of adhesion as a possible factor and I wonder if that's because it's not considered to be significant. Anyway, it's worth a read.

Friday, 24 October 2014

Radial Nerve entrapment

I haven't read the article in detail yet, but this popped up via LinekdIn and looked rather interesting. I've noticed one or two clients complain of suffering what initially sounds like either lateral or medial epicondylitis but may in fact turn out to be nerve entrapment given the symptoms. So this article is particularly useful with that in mind.

Worth a scan.

Thursday, 16 October 2014

Dynamic calf stretches

I've seen this video before but had completely forgotten about it until it popped up on a Twitter feed again. By now we all know there is general agreement that dynamic stretching is the better way to stretch pre-exercise or activity. Doing this most major muscles is fairly easy, but I've always struggled to figure out a really good way to stretch those pesky gastroc and soleus muscles.

James Dunne's blog and website are well worth a visit!

Thursday, 25 September 2014

A few things I'm learning as a local club therapist

I'm beginning to settle into my role as club therapist with the rugby team, although it's still proving to be a quite a steep learning curve. For many of the players it's their first experience of having someone around to help in this way and because I'm not a physio or even a sports therapist, just a humble sports massage therapist, there's much for me to learn and limits to my knowledge. I'm very grateful for the time I spent as a student at both Thurrock RFC and working at the daily Telegraph. Those two adventures helped build both skills and confidence.

So what are some of the things I've learnt? (both serious and funny).

Well, there's the simple fact that you can never have enough tape when it comes to looking after a rugby team. give them a roll of zinc oxide, EAB or even electrical tape and it will disappear in a flash! Some of it is for support some of it can appear more cosmetic than essential! We get through at least 4 rolls of EAB just doing the lifting blocks for the line out jumpers. Oh, and I've been experimenting with how to prolong the life of the blocks we use.

I'm guessing at a professional level they use them once and discard them because tape gets stuck to them and tears lumps off when you try to remove it. They're only 50p each, but at our level that would add £100 to the season's costs. My first solution was to wrap the blocks in cling film, which works quite well. It stops the tape sticking to the blocks and makes them reusable. I then tried wrapping them in electrical tape. This also works, but the blocks become quite stiff and less easy to shape around the leg. My next experiment is the try Z/O tape.

The next thing I've learnt is that no matter how organised your bag might be, you can never find the thing you want when you're looking for it under pressure! I've tried to make sure I know where all the things are in my pitch-side bag, but it's not that easy. Over time I'll probably find a way of sorting things in the bag so it's more obvious where to look, but one import an thing is to put stuff back in the same place. So, for example, my scissors are always in the same pocket. That is until someone takes them out to cut something and doesn't put them back where I do. When things go quite, I sometimes check through the bag to remind myself where things are. The other thing I've done is buy some ziplock bags to separate items out. For example, I have one with nasal sponges in, and one with swabs. It keeps them clean and separated. I also have one for odds and ends of tape.

As the therapist and pitch-side first aider I've learnt to carry a few other items with me too. Spare boot laces, a pen, a small torch (which I need to get next time I'm in the supermarket). I also carry a variety of sports straps for ankles and wrists. As a small club the budget for supplies isn't big, so some of the players buy their own tape. Because I get a discount, I often offer to get stuff for them and pass on my discount.

Ice is important! I've got instant ice-packs, and I've got Physicool bandages too (Physicool is a great product and worth a closer look for anyone who uses ice.) I take a cool box with me. At home matches I go to the bar for ice, but for away matches I stick a bag of ice from Tescos in. It only costs £1 and makes 5 or 6 smaller bags that can often be refrozen after the match when we get home.

Last on my list of things to take with me is a small camping stool. Most of the grounds we go to don't have a bench, so if I want to sit down at all I need something with me.

I've also learnt to filter the language and accept the ribbing that comes with the job. I'm waiting for the day I run onto the pitch and fall over. I suspect that will get one of the biggest cheers. This isn't a judgement. As anyone who knows me, you'll understand the challenge as a Christian such an environment can be, but it's great fun. The only problem is that some of the jokes are really funny but not repeatable in any context in which I usually find myself!

Tuesday, 2 September 2014

Bags, bags, bags!

How much kit do you carry around with you? Be honest now, it's probably more than you need, I know it is for me. Having recently taken on the role of club therapist for local rugby club I've found myself looking at bags, specifically pitch-side bags, to carry all the first aid and other stuff around. There are a lot of bags out there to do this job, but I've got three I've been using for a variety of things.

First up is the pitch-side bag from Physique. This is a great bag. I inherited this one at the club and I've been using for a couple of weeks. The shoulder strap has gone missing, but that's not too important.

The bag itself is just the right size (42 x 28 x 25cm) for everything I seem to need to carry, especially when we're off to an away match and I have to leave the cupboard behind! There are front and rear side pockets, one with an internal mesh pocket and dividers in the main compartment. Unlike the other bags, these dividers are fixed and simply fold out to create separate spaces. There are also two handy mesh pockets on the outside for a bottle and a spray.

This one has been through at least one season given the dirt it's accumulated, but it's still okay and all the zips work.

Next up is a similar bag from Physioroom. This bag is similar in size (45cm x 26cm x 27cm) to the Physique bag but lacks the external mesh pockets. Inside it has all sorts of pockets and holders to keep you organised. I haven't tested this in the field as they say, but it's certainly seems to be well made and I use it to keep my personal stash of first aid supplies. The main compartment can be divided using two velcro panels, giving some organisation but not as much as the other bag.

The third bag comes from Firstaid4sport. At 45cm x 25cm x 31cm it's by far the largest of the bags, which is both a plus and a minus depending upon what you put in it! It's also bright orange (as you may have noticed!)

I like this bag for a variety of reasons. First the size. As a First Aid bag I think it might be a bit big (there is a smaller version that measures 41cm x 27cm x 23cm-a little smaller than the other two above), but for carrying my massage stuff this is a great bag.

The central compartment can be divided using two velcro partitions and there is a very useful zip pocket on the end of the bag as well as both the front and the back. Additional to these compartments are a couple of velcro fastening pockets on the front and back.On the opposite end to the pocket is a mesh pocket for a water bottle or spray.

The side pockets have the usual internal mesh pockets and zipped compartments that you find in a field bag.

The colour is the most obvious and in some ways useful distinctive characteristic of the bag. It's certainly unlikely to get missed amongst a pile of rucksacks and holdalls.

Out of the three, the Physique bag is certainly robust and a good size with those handy external mesh pockets. If you don't need or want the mesh pockets, then the Physioroom bag offers great value for money at the moment (as of Sept '14 it's on a promotional price under £20!) If you're looking for a more compact touchline bag then have a look at Firstaid4sport's touchline bag.

You can buy any of these bags empty or fully equipped as a first aid bag. But beware, the contents are similar yet with some very clear differences. It would take too long to analyse the contents, but again I think Physique probably just has the edge over the others for value and range. Whichever you choose you will probably need to supplement the supplied contents, so check carefully what you get and think about what you need.

If you just want a bag for you're own stuff, I'd definitely consider the bright orange offering.

Wednesday, 13 August 2014

New Role

Last night I started my new role working with a local rugby club. We're not talking high flying professional stuff here, just a local club made of folk who love rugby and love playing. One thing this means is that there's no money, so I'm not about to make my fortune here, but I get the opportunity to broaden my skills and build connections. And I love rugby too, so it's not a big hardship to give up some time and effort working with them.

My role is to look after the players, primarily the first team, and to provide pitch-side assistance on match days. I set up my "clinic" on one of the training nights and assess and treat within the scope of my knowledge and practice. Already I've sent a couple of players off to see their GP's to get a proper medical assessment of their injuries.

It is really important to me to be professional about what I do. There might not be a lot of money involved, but that is no reason to do a poor job and what's more my reputation is on the line. If at the end of the season I've done a good job, then that bodes well for the future. The fact that the pay isn't going to cause me any great problems with the tax man is neither here nor there. There are other things to take into account. The opportunity to advertise for free at the club for one, and the possibility of getting involved with the other sports clubs that run on the same site. There's a cricket club and football and there are some tennis courts that are being brought back into service!

As far as the players are concerned, they see me as the club physio. I know that's not what I am, I'm a sports and remedial massage therapist, but they don't make that distinction. It's up to me to stay inside my professional boundaries, to know my limits and refer on without worrying about what people might think.

As a group, they seem great. There's the usual banter and colourful language of a dressing room.

I suspect that many a small, local sports club is the same position of needing some support but not having the funds. Volunteering your time or working for expenses is one way of helping them and helping yourself.

Monday, 21 July 2014

First Aid Training

My knees ache and my brain is exhausted. I've been on another First Aid Course!!

I know many of us end up on FA training because our certification or professional body require us to do it. Every three years we dutifully attend a one day EFAW or similar course to satisfy those requirements and tick another box. But what about the skills you are learning? FA shouldn't just be about ticking a box and moving on to the next checkbox. I found that out a couple of years ago when I came across and apparently unconscious non-breathing casualty on a train. It's then that you realise how important the FA training you did is. I could almost hear my trainer's voice in my head saying, "Asses the situation, consider personal safety/cross contamination, alert response, airway..." as I tried to stay calm, control the situation and look after the casualty.

So, although I hate the idea of role playing, I see real value in doing high quality FA training. Because I've recently been asked to get involved with a small local rugby club, and because that will involve pitch-side first aid, I decided to do a specific pitch-side course. Over the weekend I spent two days going through all the basic stuff again and then extend that into pitch-side scenarios.

It's my third FA course in two years and my second with ReactFirst. It began with a requirement of my Sports Massage course followed by the need to do a different course for the LTA and then this weekend doing the pitch-side course.

The major difference between the EFAW (Emergency First Aid at Work) course and the sports specific courses lies in the extra material covered. Even the one-day course offered a more in-depth exploration of injuries and how to handle them than the EFAW course that I attend was able to cover. EFAW is a really good qualification to do, but if you are involved in a sporting environment then I's strongly urge you to consider a sports specific course. Like me, you may end up needing to do both because of regulatory requirements, but it might just be worth the extra investment.

The ReactFirst courses I've attended have been physically, emotionally and mentally draining. In truth, they've been tough. But you wouldn't really want sail through FA training without being put under some pressure because when it comes to the real thing, every FA situation is stressful.

The learning process is quite simple. Build a reliable, repeatable and systematic approach to dealing with a casualty and keep doing until it's fixed in your brain. As you progressively add elements to the process you keep practising. When you make an error, you go back to the start and do it again until you can get from finding the casualty to handing them over to the ambulance without a mistake. That probably sounds demanding and it is, but it's worth the effort because it helps embed the process in your head.

But there's fun too, just in case you are tempted to think it's like sitting your exams all over again! We laugh a lot, once we've got used to it! By the middle of the day folk are walking into the training room, stretching wide their arms and announcing, "I'm assessing the situation!"

On the two-day course we spent the afternoon of the second outside with different pitch-side scenarios. Casualties were no longer neatly arranged on their backs unresponsive but had a range of injuries from a casualty entangles in the nets of a goal to a clash of heads with casualties bleeding, fainting and generally passing out around you! Hectic, challenging and stressful? Definitely! Useful, thought-provoking and confidence building? Absolutely!

So, if your looking for First Aid training that will inspire you, motivate you, teach you, equip you and ultimately give you the confidence to take control of a casualty while professional help comes, then check out FirstReact's courses. They are among the best, if not the best FA courses available.

If you're involved in sports, working with sports people or involved in outdoor activities, FirstReact have a course for you. Check out their website and read some of the testimonials, then book yourself on a course!

Tuesday, 8 July 2014

Niel Asher Technique

After listening the the talk and chatting to folk on the Niel Asher stand at the COPA Show the other week, I decided to go ahead and do the access course for this technique. For those who don't know, it's a massage based routine to relieve frozen shoulder (adhesive capsulitis).

I'n not about to describe the process, but in it's simplest form it's about trigger points and following a set routine that apparently works. I haven't put it to the test yet, although I am treating a tennis player who has problems with his dominant arm and lack full ROM in that shoulder (as I understand it, frozen shoulder typically occurs in the non-dominant shoulder). However, I thought applying NAT might help and so we are experimenting with a series of treatments. Practice for me and hopefully improved ROM for him!

Monday, 30 June 2014

Omni Massage Roller

Omni Massage Roller
There are lots of self-help massage products around from foam rollers to spikey balls. There are home-made solutions too from tennis balls taped together to bits of drain pipe used in place of a roller! The latter doesn't bear thinking about for me but some people who like pain seem to enjoy rolling around on them.

As a therapist I know that not everyone wants to spend a lot of money on paying someone to treat them, so knowing about what devices for self-massage are out there and how to get the best out of them seems to be a good idea to me. That way I know what my clients are trying to do and I can advise them appropriately.

The Omni Massage Roller consists of a solid ball that rolls freely inside a cup. There is a hole in the cup through which you can pour massage lotion to aid the glide of the roller. There's a band around the cup for a sound grip.

Because the contact area between the ball and the soft tissue is quite small, it's quite easy to overdo the pressure. Having said that, used well it can be very precise. That it turn suggest to me that you need to know what you're trying to do with it to get the best out of it.

The advantage of the roller over a simple ball is the ease with which you can move it around compared to lying on a tennis ball for example. Of course the downside is that creating pressure can be difficult and even potentially bad for you if you're trying to apply leverage through your arm, shoulder and wrist.

I paid £8.99 for one from FirstAid4Sport, but they are also available from the likes of Amazon.

COPA Show, Conferences and CPD

It's been a busy few weeks what with one thing and another. I went to the COPA Practice show again this year. Much the same as year as far as I could tell. Some very expensive equipment on show alongside some high-tech stuff too. Beyond that there was enough to make the day worthwhile.

As a result of the show I decided to investigate the Niel Asher Technique for frozen shoulders. I've got a guinea-pig to volunteer for treatment, and will see how it goes.

One interesting piece of kit I saw was called the bodyblock. It's a useful looking support tool with a wide range of applications. The surface is wipe clean and the block is soft enough to give under pressure but not so soft that it collapses.

You can get them direct from the website,

If you buy stuff from Physique, they are planning to trial stock them in the very near future, or so I'm reliably informed!

Having signed up for the NAT (Niel Asher) cod, I downloaded the files, did the reading and watched the videos. The basic reasoning behind the technique is that frozen shoulder arises from an inflammatory response in the tendon of the long head of the bicep, to put it simply. It's certainly interesting and I'm looking forward to see how it works in practice.

Lastly I went to the SMA Conference on Saturday. A really useful and interesting day. Met a few people I knew and a lot of people I didn't! The venue was good and the talks interesting and informative. In the end I was glad I went.

It looks like I may be working with a local rugby club for the upcoming season. This will be at training and pitchside. I've booked myself on a two-day pitchside first aid course, and while daunting,  it will be good to expand my knowledge and experi

Friday, 11 April 2014

Modified Thomas Test

I have to confess that I don't use the Thomas Test as much as maybe I should given how useful it can be. I think that's because when we were introduced to it there was so much information going into my brain that I react rather negatively to it! Well I'm over that now and it's about time I reminded myself about how to do this simple test.

This video is interesting because it extends the Thomas Test but it also reminds you of how important it is to get the pelvis in the correct position in order to make a proper assessment. It's also interesting to hear what John has to say about psoas, testing adductors and abductors and how you can use the Thomas Test position to stretch and do STR.

He also talks about testing ITB if you're interested!

 John has got a new book coming out soon about the glutes called: The Vital Glutes: Connecting the Gait Cycle to Pain and Dysfunction. It's available to pre-order from his website.

Monday, 31 March 2014

Could that pain in the groin be a hernia?

Some of the stuff I get through my RSS feeds and Twitter feeds is way above my level of experience or training, but it's useful and interesting to read around the subject matter. It's keeps me thinking and learning and I believe helps me become a better therapist within my own sphere of expertise and training.

The latest post I've found useful comes from The Sports Physiotherapist, and concerns groin pain. I've had one or two clients who have complained about pain in the groin when doing a hamstring stretch. Something that seemed counter intuitive at first considering the hip flexors aren't being stretched. But I've learnt that the hip is more complicated than that!

What I've rarely thought about is the link between groin pain and the possibility of a hernia. Such clinical diagnoses are beyond my training, but it's certain something I ought to bear in mind when treating clients, particularly those who play a significant amount of sport.

You can read the original article here. It's not just about diagnosis, there's also information about management too.

Wednesday, 26 February 2014

The problem with glutes!

Some days the title of an email just makes you smile. Checking through my spam reports I came across a great email this morning that simply asked a question: Are weak buttocks ruining your training? I suggested to Anne that she might like to see if she could work that one into conversation at work later in the day!

Of course the email was raising an important point and wasn't sent out with this title just to amuse me. In its context it's a perfectly appropriate question. It's hardly news to most of us that many people have issues with their glutes, often around firing patterns. I remember being fascinated one morning when someone ran past me as I walked along the Thames Embankment and I watched as their left gluteus maximus didn't appear to be engaging at all. It just sort of flopped about, appearing to do very little. Quite what was going on I don't know and didn't think it polite to ask!

If you wonder how much your gluteal muscles are engaging then you could try a simple test. Find a slope and just walk up it  normally. Then clench your buttocks and walk up. Did you notice any change in power? If you did, then it might just be that when you walk or run your glutes might not be firing properly. With practice you can retrain your muscles to fire at the right time without having to hold them "on" as it were. It can make a real difference because active glutes allow the hamstrings to focus on their job rather than compensating for the inactivity elsewhere.

The article to which the email points was actually all about a training programme and quotes one sports physiotherapist who says:

"So many athletes with running overuse injuries of the lower limb present with poor gluteus medius function that I have come to the view that the strength and function of this muscle is probably the most important active component in the achievement of a biomechanically efficient running technique."
The more I read about hips the more fascinated I am by their seeming significance to so many aspects of our health and movement. Not surprising really given their strategic role and position between upper and lower body. When you first learn origins, insertions and actions, you don't really take the time to consider what that means in complex movements. The more I read and try to understand the mechanics of movement, the more one has to see muscles in groups, working together. So, for example, gluteus medius may primarily abduct the hip and the posterior fibres extend and laterally rotate whilst the anterior fibres do the opposite, but what does it do when you run or walk? How does it stabilise the pelvis during a complex movement?

The more I think about it, the more important it seems to become to me that if I want to be a good therapist, even and excellent one, then understanding movement patterns, compensations and their relationship to injury and rehab is also very important.

And as to my buttocks and hips, well maybe if I paid a bit more attention to having healthy hips, a few other things might sort themselves out on their own!

Tuesday, 25 February 2014

Musculoskeletal problems and the workplace

There's an interesting article on the business pages of the BBC website about musculoskeletal issues and work. Apparently:

Almost 31 million days of work were lost last year due to back, neck and muscle problems, according to the Office for National Statistics (ONS).

That's a not insignificant number.  It seems obvious then that there's a place for soft tissue therapy in the workplace, but how do you go about convincing business that it pays to have onsite therapy available? I don't know the answer to that, but I know from my time as a student working at a large media company that members of staff seemed to value having us available.

Of course we can't help everyone, but I do wonder whether, if we could somehow get more involved in the work place, then maybe we could address some of the muscular problems that might be affecting some workers as part of the bigger picture of well-being for all staff.

Thursday, 20 February 2014

Tight Calves?

No, not money pinching young cattle, but those bits between your ankle and your knee that give you jip when they get stiff and tight. Typically the way we stretch our calf muscles is to lean into a wall or fixed object, flexing the ankle with our leg nice and straight. A good, simple, static stretch, but with limits.

Firstly, it only really targets one of the major calf muscles, the gastrocnemius (that's the big one you can feel at the back and, when well defined, shows up as two large bellies of muscle either side of the back of the calf). You can stretch the deeper soleus muscle by making the same flexing movement but  with your knee bent. This switches the gastroc off, allowing to target the other muscle. The second disadvantage is that it's not necessarily the best way to to stretch pre-exercise. Recent research points to dynamic stretching as the better pattern for pre-exercise stretching. In fact some suggest that static stretching before exercise is positively bad for you and actually increases the risk of injury.

So, how can you stretch your calf muscles dynamically and target both the superficial and deep muscles efficiently?

Heres a link to a short blog post at Kinetic Revolution that shares a video to do just that. According to the video/post this routine can help with some shin splint issues and issues with both the achilles (calcaneal) tendon and plantar fascia (that's the soft tissue under the foot).

Tuesday, 18 February 2014

Don't forget TFL!

A couple of weeks go my back got a little stiff and sore. Nothing unusual in that, I've suffered two significant back injuries in the past and at 6'3" I'm on the tall side on usual! Anyway, when my lower back gets tight I usually get down on the floor and do a series of stretches.

I work systematically through the hamstrings, quads, gluteus and piriformis. That usually does the job, but not every time and not this time. The one muscle that I often forget, and I'm not sure why, is TFL. Perhaps it's because I haven't yet found an easy way to stretch it on my own, although I've seen a few possible ways of doing it.

My solution was to get out one of the spikey massage balls I bought a while ago. Lying on my side, I placed the ball under my side and into TFL. Carefully I moved up and down and round in small circles over the ball. It's quite difficult to control the depth, but after a while I found it relatively easy to support myself enough to control it.

You could probably do a similar thing with a tennis ball or even the two tennis balls taped together tool I made. For me it solved by lower back pain and freed up my back considerably.

If you're going to try this on yourself and aren't sure where TFL is located, the easiest way to find it is probably to lie on your back and find the bony bit of your pelvis that sticks out on the side. TFL starts just behind that bump on the outside and runs down to the outside of your thigh. If you put your fingers on your thigh up near your hip and then turn your foot inwards you should feel a muscle tighten under your fingers. That's TFL.

Monday, 13 January 2014


Last week I ventured into the world of education, not as a student, but as a teacher! Back in the autumn I was approached by a local college about doing some workshops for their dance students. They wanted me to talk about anatomy and physiology, nutrition, exercise and anything else I could think of that fitted with their curriculum. I, in turn, came up with a long, long list of possible topics and tried to work it into a 2.5 hour workshop.

In then end I had way too much stuff, but I expected that. Although I've been involved in preparing and delivering talks for many years, this was somewhat different and I could tell from the outline I prepared that we were simply not going to be able to get through it all in the time we had. But that was okay because the last thing I wanted to do was run out of stuff to do.

Overall i think the day went okay. Certainly from my perspective I was quite pleased with the atmosphere we created and how we managed to collaborate. Yes I'd do things differently next time. Mostly working out where to focus attention, but with enough room to explore the topics in ways that supported the student's learning objectives.

I thought I might struggle to build rapport with the students, but they were great. I tried to make the workshop as interactive as I could, and that helped.

So what's next? Well. hopefully, I might get to go back in at some point and revisit some themes and maybe do some stuff with next year's students. You never know, maybe I'll get other opportunities to similar projects. It certainly helps me to keep some of the things I've learnt fresh as I learn how to deliver them to a group. Mind you, I might need some training on how to use an interactive white board!