A lot of people ask us about acupuncture. Not only the obvious things like: Does it hurt? How big are the needles? But also, How does it work? And, Will it help my sciatica/mood/tight muscles?
Sensible questions all round! Here, we try to provide some (mostly sensible) answers. Watch out for the science (anyone else remember Jennifer Aniston in the L’Oreal advert?) Let’s start at the beginning.
What is Acupuncture?
It’s the insertion of very thin needles into specific points on the skin. Part of Chinese medicine that’s been around for over 2000 years, it has been used commonly in Western societies since the 1970s. Physiotherapists use acupuncture for many different purposes, but the main ones are: to relieve pain, to reduce muscle tension, and to promote the body’s own healing processes as an accompaniment to other treatments such as manual therapy and relaxation teachniques.
*Science bit* By creating a very small and controlled amount of “sterile trauma” with the needle, acupuncture stimulates the body to produce endorphins (happy/pain-relieving hormones) and their receptors (which means not only do you have more hormone to create an effect, you also have a greater catchment area to “feel” that effect), as well as serotonin (stress-busters). The needle also stimulates A? nerve fibres. This produces another chemical which blocks the C fibres – the nerve endings for PAIN – from accepting input. Long story short: you swap the pain sensation for something more like a tingling or a heaviness, or a nice relaxed feeling instead.
Does it Hurt?
Well, not any more than you might expect from a very small needle (each one is about the width of a human hair). And quite often, a whole lot less than you’d expect. It depends what area we’re working on. Some parts of the body have more concentrated nerve endings per unit area, and these will natually be more sensitive (your hands and feet, for example). Some have fewer nerve endings (thighs, back etc). If there is a lot of muscle tension in the area, you can get a very strong sensation but conversely, you may not feel the needle at all.
So What Will I Feel?
Alongside the tingling or warm, heavy feeling, you may feel a little sleepy or even giggly (this one more common in men in my experience). Some people feel a little light-headed, and there can be side-effects that aren’t as much fun, like nausea or fainting. Usually the treatment won’t feel unpleasant at all, but if you don’t wish to proceed at any time, we’ll take the needles out immediately.
Where Will the Needles Be Put?
This will depend on what your symptoms are and where you feel them. Because of the way the channels are lined up in your body and along your limbs (think of them kind of like a long train track with lots of stations along it), you wouldn’t necessarily have to have the needles exactly where your pain is to still get a good effect. There are some points that are usually used in conjunction with others (called “formula” points), for instance the “4 gates”, which are points in both hands and both feet and help relieve pain. And there are points away from the spine, as well as closer to the spine on those “tracks” or Meridians, which will help send those messages along the appropriate nerve fibres to give you relief where you need it.
Are the Needles Sterile?
Yes, every one is individually packed and disposed of in our sharps boxes after a single use. Each needle also comes in its own plastic guide tube so your physiotherapist will not touch the part inserted into your skin.
How Many Sessions Will I Need?
Most conditions are treated with good effect in fewer than 6 appointments, but you might feel better after only one or 2 sessions. It will generally be clear after 2-3 sessions if the acupuncture is of benefit.
I Have (select an option) Epilepsy/a Pacemaker/Man-Flu, Can I Still Have Acupuncture?
Well, unfortunately no is the answer for some conditions like unstable heart conditions or over infected or broken skin, or for women in their first trimester of pregnancy. For people with diabetes, hepatitis, high/low blood pressure or a history of metal allergies, blood disorders or cancer, we’ll help you decide with more in-depth questions whether it’s best to proceed with acupuncture or not. We’ll also work with you to make sure that any treatments given are the current best practice for your specific condition, and in many cases, this doesn’t include acupuncture (man-flu included.)
Any time by sending us an email (firstname.lastname@example.org), giving us a phone (0141 2372 721) or popping in to see us. We offer a free 15 minute consultation, where you can tell us what ails you and we’ll let you know if physiotherapy would be advised (and if acupuncture is an option, how we suggest proceeding.)
Ah, beautiful day, isn’t it? And what lovely scenery/pavement in Glasgow. Do watch that kerb tho… Oh. Are you ok? Just going to walk it off? No? No.
That looks sore, and it’s starting to swell already. Oh dear.
Sound familiar? One of our previous blogs (here) covers the anatomy and first aid for twisted or sprained ankles (and defines what damage has actually been done), but here we’re going to go through what a physiotherapist will do.
First of all, you’ll have carried out your PRICE first aid (of course): protect, rest, ice, compress and elevate for the first 48 hours or so. You’ve got some lovely sensible shoes on and you’ve made your physiotherapy appointment, good stuff.
So what are we going to do?
Well, first, we’ll have a look at you. Really, we’re checking for bruising, swelling, obvious limps or even more obvious sobbing etc (tissues will be available).We’ll have a look at the position of your foot (both sides) and ankle, as some people’s natural foot positions make them more susceptible to injuries.
Then we’ll look at you standing, to see if you can weight bear on your affected side. If you can, we might ask you to stand on one leg (I know, a lot of people struggle with this at the best of times, but we’ll look at both sides for a comparison.) If you’re able, we’ll also have a look at your balance with your eyes closed to test something called proprioception, which is your body’s own balance correcting mechanism when you don’t have visual input.
Active Range of Movement
Next, we want to know how much you’re able to move your ankle yourself (in other words: are you muscles and joints still working ok, or is pain or stiffness limiting movement?) NB It’s ok to take your normal painkillers or anti-inflammatories before your physio appointment – we’ll still be able to tell how sore you are! We’ll take a look at your other joints as well, as a sore ankle can affect all sorts of movement and cause you to tighten in your hamstrings, or give you an achy lower back for example.
Passive Range of Movement
We’ll be gentle, we promise. This is to see how far your joint will move without relying on your own muscles. We’ll also do specific ligament stress tests. To put it simply, a ligament’s job is to hold bones together, and if you’ve ruptured a ligament completely, the bones will move like they shouldn’t. This calls for a plaster cast I’m afraid.
This is where your joints move by gliding or sliding, rather than your conscious flexing and extending. We can test this in lots of different ways, most of which shouldn’t be too painful.
Now let’s see if your muscles are working at all or if they’ve been inhibited by your injury or pain. We’ll test all your ankle movements, both sides, and probably have a quick look further up the chain too.
Sounds fun. Quite often we see lots of swelling and oedema, and sometimes (if we’re really lucky) pitting oedema. That’s where your thumb mark stays put after you’ve pressed the swollen part. Physiotherapists know the anatomy underneath the skin and we’ll palpate the area to feel for anything untoward (like a “dent” where a ligament should be intact, or for areas of heat.)
Ok, by now you’re probably feeling a little poked and prodded, but that’s the general assessment over with. Now onto treatments. There is a vast range of modalities available, and our physiotherapists will find out what suits you best (for instance, ultrasound won’t be used if you already have metalwork around your ankle) and what will work for your particular injury. Here are a few:
exercise – sounds obvious (we are physios after all), but you’d be amazed at how small, regular (easy!) movements of your toes, foot and ankle can improve the swelling. We’ll teach you appropriate stretches (especially for the calf) to help regain your flexibility. Then we’d progress your exercises to build strength and improve your balance and proprioception, to help you avoid future injuries like this
massage – veeeerrryy gentle at first, don’t worry, and we won’t be massaging within the first 72 hours of your injury, as this may increase the blood flow, and therefore the swelling. After that though, massage can help shift any excess fluid which has gathered at your ankle through gravity, returning it to your lymph vessels for drainage
acupuncture – brilliant for helping ease pain, but also good with encouraging healing on older injuries (so swelling that’s been hanging around a while)
ultrasound – (other electrotherapies are available) This is a pain free, swelling-reducing, scar tissue-organising treatment that takes just a few minutes (and no, unfortunately you won’t be able to see your ankle on a screen)
taping – different tapes for different dates (sorry). Kinesiotape is wonderful for helping reduce swelling and bruising appearance, and can help those inhibited muscles get back into action. More restrictive zinc oxide taping, or elastic adhesive tape can be used for your return to sport, but we prefer a strengthening program rather than relying on tape for restricting excess movement for a too-early return
advice and education – sounds obvious to us, but we can give you lots of information to help you better understand what’s going on in your body, so that you can do more of the right things and fewer of the wrong things
Pretty soon, you’ll be back out enjoying the nice weather (pavements), pain free and maybe even in heels.
If you’d like to speak to a physiotherapist, or make an appointment please call us on 0141 2372 721 or book online at www.tm2online.co.uk/firstclassphysio
What is foam rolling?
Foam rolling is used more and more as a tool which allows self myofascial release. In other words it is being used as an aid for self-massage to release muscle tightness (trigger points) and to target the damaged fascia of the muscle.
So what is the fascia?
Fascia covers and protects your tissues, tendons, bones, ligaments, organs and, last but not least your muscles. Its main role is to prevent injuries by resisting internal and external forces that are placed on these structures. Its structure enables it to contract and relax; making it perfect for stabilisation, mobilisation and flexibility of your joints.
When a muscle is over exerted the fascia can be left with areas of scarring and rigidity (trigger points). This in turn can create tension in surrounding structures, which can produce pain, known as trigger points; this has a knock on effect throughout the body. Additionally it can reduce blood flow to particular areas, causing further damage and reduced healing times.
Okay, but how can foam rolling help?
Through applying pressure to specific trigger points, you are able to aid in the muscles recovery and assist in returning them to normal function. It can release these areas of damaged/ hardened tissue; in turn restoring blood flow and letting the muscles return to their ordinary strength and flexibility.
It can help your muscles go back to being elastic, healthy, and quick to respond when required. Finally, rolling your muscles can increase the flexibility, mobility and stability of your joints; leaving you less prone to injuries (yippee!).
Foam rolling or stretching?
Well, the simple answer is …BOTH!
Studies have found that the greatest results in flexibility and mobility, and decreased occurrence of injuries are shown when foam rolling and dynamic stretching are combined (C.Goad et al, 2014). The benefits of stretching alone before exercising is a grey area, with reports it lowers performance and energy.
So when should I use the foam roller?
As mentioned above, the foam roller is a great way to warm up a muscle prior to exercising; it also works well for increasing muscular recovery.
After a big workout or run, we can often feel quite sluggish and those ‘few stairs’ seems to bear more of resemblance to Mount Everest. This is called DOMS (delayed onset of muscle soreness) and the peak of this pain is normally 48 hours post exercise (hence the ‘delayed’ part). One of the most popular uses of the foam roll is to decrease the incidence and the severity of the DOMS experience; allowing athletes to return to training and normal muscle functioning earlier.
Foam rolling with First Class Physiotherapy
As Physiotherapists we have seen the benefits of incorporating foam rolling into our patient’s home exercise / running programmes; so much so that we have introduced a class which is suitable for all individuals no matter your previous rolling experience.
As a runner I personally do not know what I did before rolling; my patients and current class would tell you that I am a big fan of the ‘game changer’ – the foam roller.
Classes run on Wednesday evenings from 5.15pm and can be booked by phone or email.
If you have any further questions or would like to give it a go, please do not hesitate to contact us.
Best ‘Foam party’ you will attend.
We’ve all had them. Whether it’s a calf in the second half of a football match, your fingers after writing or typing all day or toes in the middle of the night (just me?), cramp is something we’ve all experienced. But what causes it? What’s the best way to get rid of it, and how can you avoid it?
What IS cramp?
When we talk about cramp, we are generally referring to the sensation of our muscles tightening up involuntarily, leaving us temporarily paralysed and usually in a lot of pain. Cramp can come on for several reasons and is usually harmless (apart from the excruciating pain, obviously), but it can indicate underlying pathology.
One of the most common areas to cramp is the calf muscle, and 75% of these cramps occur at night time. Many people suffer from this for no apparent reason (this is known as an idiopathic condition), but some people have cramps as a result of a pre-existing condition such as pregnancy, diabetes or liver disease. You might cramp more often if you’ve been exercising excessively during the day, or if you are on certain medications e.g. for high cholesterol or high blood pressure (statins or diuretics).
Some cramps last only a few seconds and happen occasionally, but they can last up to 10 minutes and occur more frequently. If the latter is the case with you, or you are experiencing swelling or numbness along with the cramps, it’s worth visiting your GP.
What causes cramps?
Dehydration is thought to be one of the most common causes, and although we may think we are drinking enough in a day, we could always take on board that extra glass or two.
A deficiency in salt is also a popular theory for cramping, however this doesn’t necessarily mean you should laden up your chips tonight just in case! Potassium (a mineral which can be found in bananas, spinach, mushrooms, raisins and oranges amongst other foods) is an important missing factor in many people’s diets, and eating a little more each day can reduce cramping.
Fatigue is another common reason for cramp. If you have been doing more exercise than usual during the day, or if the weather has been particularly warm (as it was this lovely summer), it’s natural that your body will sweat more and therefore be losing more water and salts than usual.
As we age, our tendons (attaching muscles to bones) naturally shorten, pulling more on the muscles causing them to tighten, which may be one reason people over 60 experience cramp more often.
To prevent cramps…
There is no guaranteed way of preventing cramps (unless you listen to my Granny, whose cure involving nettle leaves and tuna fish is a sure-fire winner…) but there are ways of reducing the severity and frequency. Try to include some moderate exercise into every day, especially targetted stretching of the affected muscles (i.e. a few calf stretches before bedtime). Walking, taking a flight of stairs here and there, even a few extra stretches when on a break from your desk – but do remember that unusually heavy exercise (relatively) may increase the occurrence.
To combat the dehydration issue, spread your fluid intake throughout the day – having a bottle of water at your desk to sip is a good tip, as is having a glass of water after every time you visit the toilet (not from the toilet I hasten to add). Lots of people don’t like to drink too much before bedtime, so the best advice is to drink as much water as possible throughout the day before dinnertime.
If your cramps are worse at night, make sure your ankles are relaxed when you sleep (in other words, don’t sleep with your toes pointed). Your sheets should also be kept quite loose, to allow your muscles to move.
For those with persistent cramping, your GP might prescribe you medication, but the main methods of preventing cramps (as above) should be exhausted first. If your leg cramps occur during pregnancy, especially in the last trimester, you should find these ease once you’ve had your baby.
What should I do when I get cramp?
Ah, the all important part. With any luck, you’re probably already doing some of the right things to help ease cramp when it does occur, but here is a quick rundown of how to help.
First and foremost, try to get the cramping muscles into a stretch (see the picture opposite for a calf stretch). Some people find a standing stretch easier, others ask for help and have someone else flex their ankles for them while they lie on their backs. Having someone assist you is often easier for hamstring (back of the thigh) cramps.
Massage the tight muscles gently to try to release the cramp. Once the cramp has shifted, you might be left with a fatigued and sore muscle which can be massaged properly to help return normal sensation and function.
Use warm water to try to ease the pain and tightness if you can.
If you are concerned about the cramps you’re having, it is worthwhile making an appointment to see your GP. If you’d like to book a physiotherapy appointment, or even book a massage, please get in touch by calling us on 0141 2372 721, or emailing email@example.com.
We’ve all been there. That horrible moment when you miss a step and fall awkwardly off the kerb, or are tackled from the side with your foot planted (usually on the sports field, but not necessarily), feeling that awful snap in your ankle. High heeled shoes and icy weather have a lot to answer for too. Now we can’t go attributing twisted ankles to wearing high heels all of the time, but certain footwear – and certain activities – do seem to cause more problems than others.
The most common injury reported with a “twisted ankle” is a sprain to the lateral ligaments of the ankle (the ones on the outside as opposed to the inside [medial]). Normally the symptoms will include swelling, pain, bruising, heat and redness, along with stiffness over a period of time.
One of the big differences between ligaments (which hold bones together) and muscles is that muscles are contractile, meaning that you can actively and purposefully shorten them. By over-working a muscle, you may strain it (note that’s “strain” with a “t”). Ligaments are generally stiffer (thankfully, otherwise our bones would be wobbling all over the place), but when we stretch them too far, we can sprain them (with a “p”).
The ankle joint is fraught with long names for all the little joints in between the smaller bones and for the ligaments between those bones, so there will be some hefty vocabulary to swallow here, but don’t worry – I’ll keep it as plain and simple as possible. So, the leg bone’s connected to the ankle bone…
Only joking! Let’s start with a diagram of the bones of the foot. The ones we’ll be concentrating on are the tibia and fibula (which make up the lower leg), the talus and the calcanous (heel). The other bones in the foot are important for movement, but not strictly involved at the ankle joint.
The ankle joint itself is formed by the tibia (the shin bone), the fibula (the smaller lower leg bone) and the talus. It is a hinge joint, meaning it moves up and down (dorsiflexion and plantarflexion) but not side to side – these movements are prevented by the strong medial and lateral ligaments, the medial being stronger than the lateral (which is one reason we tend to injure the lateral ones more often).
The lateral ligament is actually split into 3 parts (see the diagram below): the anterior and posterior talofibular ligaments and the calcaneofibular ligament. The most commonly injured part is the anterior talofibular ligament.
There are 3 types of ligament sprain, each varying in intensity.
Grade I sprains are those with very little damage. You’ll see some local swelling and feel a moderate amount of pain, particularly if you twist whilst standing on the injured ankle. However, this should ease off fairly quickly following the advice below.
A grade II sprain involves damage to more of the fibres of the ligaments, therefore the swelling will be more pronounced and will appear much more quickly than in a grade I. You’ll be in more pain (sorry about that), and may find it difficult to weight-bear on the injured foot. The good news is that the joint itself remains relatively stable, and the ligaments are still able to hold the bones in place.
The most severe sprain is a grade III. This is a complete rupture of the ligament, meaning that the bones at the ankle joint will lose some of their stability. There will be a lot of swelling and, unfortunately, a fair amount of pain too.
The best way to determine how severe your ankle sprain is, is to have your GP or physiotherapist assess the injury.
Ok, so we’ve covered how a healthy ankle joint is made up, what sort of things cause injury, and the different severities of injury you may have.
So what do you do with a twisted ankle?
The main aims of treatment will be to reduce the pain and swelling in your ankle and to help the tissue healing begin. There are lots of things you can do to facilitate this by using the PRICE mnemonic.
P is for Protect. This means be aware of your injury and protect your ankle by further damage e.g. by using crutches, or by keeping the weight off of the injured side as much as possible. (In other words, come off of the pitch and wear sensible shoes for the time being.)
R is for Rest. When an injury is sustained to a ligament, some of the small blood vessels supplying the tissue will break. This starves small parts of the tissue of oxygen and nutrients, meaning that the tissue necroses or dies. It is important to rest as much as possible to limit the amount of oxygen required and therefore limit how much of the tissue dies. Larger injuries may require total rest as your body may be in shock. Smaller injuries will require rest of the affected ankle, but otherwise allow you to continue activity. As your healing continues, the periods of rest will be reduced.
I is for Ice. Making the affected area cold will reduce the swelling in the area and lower the metabolism of the tissues – in short this means the tissues need less oxygen, and so the rate of tissue death slows. This is all good for recovery. If you’ve had an injury, the best thing to do is use ice or an ice pack, wrap it in a moist tea towel or use a barrier between the ice and skin (very important to avoid ice burns) and place that over the painful area for 15 minutes every 2 hours or so throughout the first 2 days.
C is for Compression. You’ll be well aware by now that ankle injuries tend to swell. By using a simple elastic bandage such as tubigrip, you can provide a uniform compression around the foot, ankle and lower leg to reduce the accumulation and spread of the swelling, which is very common in this type of injury partly due to gravity allowing fluid to pool at the foot.
E is for Elevation. A-ha, you were waiting for this. I’m not one to encourage you to put your feet up… except in this case. Normally the shifting of fluid from the legs is aided by the pumping of the calf muscles, but when you are restricted to rest, the excess fluid from the injury tends to gather around the ankle. Using a stool to place your foot on, this will encourage rest and protection, as well as help drain the excess fluid back up the leg and towards the heart. And hopefully help bring you sympathy and cups of tea too.
Grade I sprains can be treated solely with the PRICE first aid, however grades II and III strains will likely need some form of support such as taping, or a cast or splint, and some solid advice on how to deal with the injury, particularly in the early stages of recovery.
Once the swelling has started to ease slightly (generally after the first day or 2 for grade I sprains) you can begin some gentle exercises to help your ankle regain normal movement. Your physiotherapist can help you by designing a specific programme for you which will help you recover from injury and return to your normal activities as soon as possible, as well as helping you avoid future ankle sprains (even if you really MUST wear those high heels…)
Give us a call on 0141 2372 721 to ask for some advice about your injury, or to book an appointment with one of our qualified physiotherapists.