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.

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.

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!

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!

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.

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.

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!