Slings and Chains

There's been a lot of talk over the last few years about fascia. We've had symposia about it and there seems to be some interesting research taking place. We no longer see it as just a layer of tissue but as something more significant than that. It seems quite logical when you think about it that this cling-film like material that is wrapped around muscles and bones and that blends together to form something of a network throughout the body, should actually be playing a role in the complex systems of movement and posture.

Now, I'm no expert, so I'll leave the technical stuff to someone else, but as a therapist I'm fascinated by the relationships that exist through this fascial net, as I am about the non-isolated relationships between muscles. When we learn our basic anatomy it's usually done muscle by muscle as if they work in isolation. But we soon realise that this is not the case. Very quickly we discover agonist and antagonist as one relationship, then we begin to learn about co-contraction, eccentric and concentric contractions, synergists and stabilisers. Next we might start to think about movement patterns. Not just getting up from a seated position or taking a walk but about what happens when we kick a ball or hit a tennis serve.

These patterns are a series of complex interactions as muscles contract to produce movement at a joint or to stabilise a joint during movement. Suddenly our origins, insertions and actions of isolated muscles simply won't do the job of informing our understanding of these patterns.

Of course, from a therapy point-of-view, it's only when these patterns breakdown and cause an injury or a limitation that we tend to get involved. It's then that we start the detective work of trying to figure out what's going on and what we might be able to do to help fix it. I've never bought into the slightly "mystical" approach that I've seen some therapist apply. Personally I prefer to think a little more logically and dare one say scientifically about what I'm doing. For me there's nothing mysterious about a pain in the shoulder starting from the ankle on the opposite side when you understand a little more about how muscles interact and how fascia responds. It makes logical sense.

This is where myofascial slings are helpful as are muscle chains. Muscle chains got mentioned to me the other day and I'd not heard the term before, so I decided to do a quick bit of research. There's a lot more to be read, but at it's most basic a muscle chain simply traces the relationship between muscles and they cross joints or share attachment site. For example, think about the relationship between tibialis anterior and latissimus dorsi on the opposite side. TA shares and attachment site with peroneus longus, which in turn shares a site with bicep femoris. Follow this hamstring muscle and you'll find a connection with GMax via the sacrotuberous ligament. GMax and LD share an attachment via the thoracolumbar fascia. You could trace gastroc in a similar way. In fact, when a client comes to me complaining of tight hamstrings, I often check gastroc first with a simple test. Usually, even if the hamstrings are tight, there's tightness in the calf too. Where the client first feels this in a forward bend can be a clue as to where the primary problem might lie.

So, if you're just starting out in therapy remember to think about muscles in relationships and in movement patterns and not just in isolation, and maybe try to find a subtle way to get your gym bunny clients to understand that too!

The new muscle on the block

So, last year as I recall we were told about a new ligament in the knee and now we find out there's a new muscle in the quadriceps! They've given it the name tensor VI, or TVI. It lies between VL and VI and apparently the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella.

According to the abstract I read (you can find it here) this new extensor was found in all the lower limbs investigated. What caught my eye was the insertion on the medial aspect of the patella. Thinking out loud I wondered whether further research would point to the influence this newly discovered extensor might have on patella tracking. I don't know, and it would obviously depend on how that medial attachment relates to the patella tension and the quadriceps in general. That's something for the clinicians and sports science folk to play with!

It is quite amazing that with all the anatomy studies that have been done that we're still finding new stuff, but I guess we're more complex that we probably imagine.

Tennis Anatomy

I decided to read this book for two reasons. I'm both a therapist and a tennis player, so the book appealed to both aspects of my thinking. The book has value to both, but maybe not as much for the therapist as for the player.

As a therapist, the value of the book lies in the detailed analysis of which muscles are at work in the full range of tennis shots. Knowing where to focus your attention when working with any sports person can be a challenge, and of course it differ from sport to sport. As well as tennis players I get to treat a range of sports people from runners to rugby players.

The books provides a general introduction to how a tennis player moves and how they adapt to different surfaces and also how different styles of playing influence the way muscles are used. There's also a useful section at the end of the book on movement patterns that could be used to provide the basis for rehabilitation exercises, and a chapter covering common tennis injuries and stretches. The chapters in-between look at specific areas of the body (shoulders, wrists, core, etc). Chapter 8 is focussed on rotational strengthening.

Each chapter looks at the anatomy of the area, how it is used in tennis and then offers a series of exercises related to strengthening that area.

The reface makes the aim of the book very clear:

This book is written for serious competitive and recreational tennis players... In this book, we highlight the different muscles groups involved in each of the strokes and show you how to best train those specific muscle groups as part of a comprehensive approach to tennis-specific training.

The book certainly delivers on that level! From a therapy perspective, the book's value lies in increasing one's understanding of the mechanics of tennis. How you apply that knowledge is up to you!

My verdict: Not really a therapy book, but a useful read if you're dealing with racket sports.

An Alternative Way to HIT

Came across this article via Facebook of all places! Amazing what slips through amid the pictures of angry looking cats and banal so-called "Only for geniuses" rubbish.

It's about a study done in Denmark looking at high intensity interval training that developed into a different routine. The researchers suggest a 30-20-10 approach where you do low intensity for 30 seconds, moderate for 20 and all out for 10 before resting and repeating. They call it 10-20-30, probably because that is easy to say and it scans nicely.

The results are interesting too, although there is a minor warning about injuries in the test group. Using runners the results showed an improvement in 5k times and a lowering of blood pressure plus other positive health markers. Interval training does improve endurance, so some of these affects are not a direct rest of the specific intervals used, but rather the impact of interval training in general.

The upside of the programme might lie in its simplicity. Some interval programmes can get quite complicated, so anything that makes it easy to do and easy to repeat is a good thing. If it makes it fun then all the better.

COPA 2015

So I trundled off the the ExCel again yesterday for the annual COPA Practice Show. It's a range of exhibitors and talks aimed primarily at Chiropractors, Physio's and Osteo's. There's stuff there for other maul therapists and soft tissue specialist too.

This year there was a lot more exercise equipment on display and a few stands about nutrition. There were companies with software for handling client appointments, designing exercise and rehab programmes and assorted orthopaedic aids and supports.

I had a good chat to one or two interesting folk and came away with an array of leaflets, booklets, samples and even a t-shirt this year! I didn't have too much time this year, so I wasn't able to take in any of the talks and seminars.

In the next few days I'll sort through all the stuff I picked up and decide what is worth following up at this time and what can go straight in the bin. I found some interesting looking CPD courses that might be useful, and there are some that I didn't visit but remember them from previous years and was reminded that they too might be worth a look. Often the courses run at weekends, or so it seems, and when you're involved in a sport at weekends it makes these courses difficult to fit into a schedule of fixtures. I have the same problem with my tennis coaching qualifications where the courses are almost exclusively weekends, just when I'm busy on the touchline!

Agility training

Ok, so not very therapy orientated, but I'm not just a therapist!

An interesting agility drill for rugby. I think it might be good for tennis players and other racket sports too.

I have another drill I picked up from a tennis website that uses two cones around which you shuffle in a figure of eight. With this drill you always face forwards so you have to use small side-steps as well as forward and backward movements.

I sometimes do it using the tramlines as a guide during a warm up routine. This rugby drill could be done using the baseline and service line. Although I might adapt it if I thought running backwards on a hard court was dangerous!

Are all athletes healthy?

There was an interesting little piece in The Times today (May 18th 2015) about the incidence of heart issues in elite athletes. The headline was a bit alarming, suggesting that thousands of athletes are at risk of a serious heart problem. When you get into the statistics a study of Italian Olympic aspiring athletes found around 7% had some sort of heart problem that was potentially life limiting. Taking the figures another way, it has been suggested that had screening been used to stop participation, a large number of athletes might well have been prevented from taking part.

Now this is serious stuff. Who can forget the scenes a few years ago in the Premier League when Fabrice Muamba collapsed and the recent news of the death of a footballer in Europe and a rugby player here in the UK. So any move to increase both awareness of conditions and applying a rigorous testing process for high level athletes in any sport is a bit of a no-brainer. The big question is at what point do you actively intervene and stop someone playing or taking part?

As a club therapist at a fairly low level of competitive rugby (we just got promoted to tier 7 if I've got my league structure correct), I wonder what we can do to help our players be as aware as possible of their health. Even a very simple screening process including body fat% and blood pressure might be a worthwhile procedure.

The thing is, we might well do a fitness test at the start of pre-season training and measure it again as the season progresses, but being fit does not presume being healthy. The two can even be mutually exclusive.

The article in the paper is a timely reminder that we should take health in sport just as seriously as we should be taking it in everyday life. Personally my hope is to be as fit and as healthy as I possibly can be for as long as I can be.