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, bodyblock.co.uk.

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

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.

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.

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!

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.

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).

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.