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.)
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.
Ask anyone involved in any kind of sport or exercise if they stretch and you’re likely to hear one of 2 answers: “Yes, religiously” or “No, not as much as I should!”
So what should we be doing and when should we be doing it? Well, in this blog we’ll have a look at when to stretch, along with some examples of stretching for different muscle groups at different times (and while we’re at it, we’ll define the various kinds of stretch too).
Types of stretching
Static stretching is just what it says on the tin – stretching and holding in one position (see our “models” on the left). Usually the hold is for a standard 20 or 30 seconds, but some people like to hold a static stretch using breaths as a measure (e.g. 5 inhales and exhales for one stretch).
Dynamic stretching is stretching while moving. This is a gentle “swing” through your full range of motion, but without pushing too hard at the end of the stretch. For example jogging forward kicking your heels up to your bottom is a good dynamic quad stretch that doesn’t push the muscle beyond its natural range.
Ballistic stretching is holding a muscle at its maximum length and “bouncing” it to try to increase that length. It is almost never recommended, as it can actually cause muscles to tighten or even tear as they are over-stretched. Imagine trying to touch your toes and consistently jerking you fingers closer to the floor each time. Your hamstrings would very likely complain with this movement!
When is best?
Now we’ve covered stretching terms, but when should we carry out each different type of stretching?
Traditionally, people stretched statically before any kind of exercise, but this has been shown to do more harm than good. Herda and colleagues conducted a study on men in their 20s using methods to measure hamstring strength after different kinds of stretching. They found that the muscles could generate more power after dynamic stretching than following static stretching.
Another study by Wallmann and colleagues in 2012 looked at stretching the hip flexors (iliopsoas muscle) before a sprint, and how much difference this made to the performance of healthy recreational runners. Without stretching, the subjects ran the fastest. The next fastest runs were after the dynamic stretching, and the slowest runs were after static stretching. So it seems that not stretching at all before an activity could be best – but the key part is the warm-up and it’s important to note that in this study, the runners all had a warm-up first.
When Samson and his colleagues looked at different warm-ups and different types of stretching, they found that an activity-specific warm-up improved sprint times more than a general warm-up. They also found that static stretching increased the range of movement in the subjects better than dynamic stretching (but didn’t improve speed).
So in short, static stretching before exercise can actually worsen performance in sports that require explosive movements like sprinting (and can actually decrease your muscle power by around 3%), and dynamic stretching has been shown to be not quite as detrimental but can still negatively affect performance.
None of this looks particularly encouraging for stretching pre-exercise at all, does it?
Here’s where the warm-up comes in.
Don’t be confused – even dynamic stretching does not equal a warm-up as such.
The best warm-ups consist of an activity-specific and aerobic exercise to get your blood pumping and start your body moving in the way your intended exercise program is designed. Your muscles, nerves and other soft tissues need blood (and its nutrients and oxygen) in order to work, and a warm-up will help deliver these slowly at first, then more efficiently so that you can reach your maximum performance during your workout. Warming up also lubricates your joints, and reduces the risk of your muscles becoming prematurely fatigued.
So for instance a sprinter might do a warm-up of walking, lunges, jogging and then running before finally engaging in sprinting. A footballer might do some jogging followed by some mid-height kicks or mid-paced direction changes with some ball work to warm them up for a game.
So should we stretch after a warm-up? Well, you could do, but the point of the warm-up is to get your blood pumping so your body is ready for exercise. If you have to stop in order to stretch, your heart rate will slow again, defeating the purpose. You could do a second warm-up before exercising but not all of us have the time for that!
Does stretching have any use at all?
Yes indeed! This might seem like an anti-stretching article, but stretching can have fantastic benefits. Right after you cool down (again, doing the same sorts of activity-specific movements as in your warm-up), you should stretch. This should help your soft tissues get rid of the waste products built up during exercise, as well as return your physiological responses (metabolic, heart and breathing rates etc) to normal. Stretching probably doesn’t prevent injury as such, nor will it prevent a loss of power that generally follows on the next 2-3 days after a good workout, but it can have an effect on improving your muscle soreness on the days following your workout (especially in your abdomen and back), which can be a huge drawback to exercise. Plus it’s a nice relaxing way to finish a session.
If you want to improve your flexibility in general, you could take part in a yoga class (and don’t be fooled by its laid-back reputation – depending on the teacher and the type of yoga, it can be pretty hard work!) Pilates is also an excellent way of improving your joint range of motion, your muscle suppleness and flexibility in a low-impact way. But make sure before you do any static stretching that you don’t intend on running any personal best sprints straight after!
As with starting any form of exercise, particularly if you are entirely new to it, seek advice from a registered health professional before you begin. If you’d like to ask us a question, or book in for one of our prehabilitation appointments, please call us on 0141 2372 721 or browse our website for more information www.firstclassphysio.co.uk.
When you hear the word physiotherapy, what do you think of? A football match and the person running on with the bag to aid the stricken drama que… sorry, the injured player? The athletes at the Olympics and their fancy coloured tape? Or do you have personal experience of working with a physiotherapist, and know us more for working with people with disabilities, working with sportsmen and -women to improve their fitness or helping injured people learn to walk again?
Many of you lovely blog-readers will know, or know of, a physiotherapist, but not know much about what sorts of skills they have or how you could benefit from them. That’s where this blog comes in!
Here are a few ‘did you know’ items about the physiotherapists at First Class Physiotherapy:
- We use movement, exercise, education and advice along with our own manual skills and banks of knowledge to help people manage their pain and other symptoms and prevent disease
- We can promote recovery from an injury to help you get back to full function (and back to work) as soon as possible
- We understand that injury or pain affects you as a person and we design a treatment program around what you expect, what is realistic and what is most beneficial for you
- We promote health not only through physical treatment but also advice on how to lose weight and give up smoking (amongst many other things!)
- We can help you stay relaxed as well as preventing injury by offering sports massage, Swedish massage and hot stones massage (all together now, aaaaaahh)
- We offer a mobile service to your workplace or home so that you don’t have to take extra time out of your day to visit the clinic
- We can help you access physiotherapy through an insurer so that you don’t have to pay up front
A typical patient we may see will have back pain (much like 60-80% of the population at some point in their lifetime) and will be wondering whether or not to see their GP. That’s an excellent start, and will help you find the right pain medication if that is the route you’d like to take. The GP might then refer you on to a physiotherapist, and through the NHS in the Glasgow area, you could wait up to 6 months for an appointment. Hmm, that’s quite a long time to be stuck with a sore back… Happily, your back pain will most likely have resolved by then.
Instead of waiting to find out if your pain does become chronic (in other words, if it lasts longer than 3 months), you could self-refer to see a physiotherapist.
That’s where First Class Physiotherapy comes in! We’re here to offer you an appointment – even before you see your GP – within 48 hours of you first contacting us. Even if it’s just for advice or reassurance, if you are concerned about a pain, stiffness or weakness contact us today, and put yourself on the road to recovery. Then you’ll have first hand experience of what a physiotherapist really does when she’s not nursing the drama queens!
At a networking event last week, I was asked if we see many patients with whiplash. I replied that we do, and it’s one of the most common problems we treat in the clinic. Here is some information about how whiplash is caused and what you can do if you are suffering from WAD.
Whiplash (or to give it its Sunday name: Whiplash Associated Disorder) can be a very debilitating disorder, but on a brighter note, is usually short-lived. The name “whiplash” refers to the mechanism of injury rather than the injury itself. Most of us associate it with car accidents, but in fact it is quite common for whiplash to be seen after contact sports injuries or falls – anything where the body is travelling at speed in one direction and then is suddenly stopped or rapidly thrown in the other direction, “whipping” the head as it goes.
This all sounds very painful.
The symptoms usually include inflammation (redness, heat, swelling, immobility and, yes indeed, pain) and bruising to the soft tissues and joints in the spine. These might include the cervical (neck) muscles, intervertebral discs and joints, the vertebrae (bones) themselves, nerves, ligaments and tendons. You might also feel stiffness in your neck, and muscle spasms around your neck, shoulders and into your arms.
Still more bad news to come, but don’t worry, it gets happier soon…
You may also feel some stranger symptoms such as pins and needles, numbness or altered sensation in your arms and hands, along with dizziness or headaches. And it is not unusual for any of these symptoms to appear hours or even days after the accident or fall.
Ok, now for some reassurance.
Although you may be experiencing some or all of these symptoms, it is important to remember that no serious damage has been caused. It is most likely that these symptoms are caused by the neck not moving properly, and not by any permanent or serious damage.
The symptoms may persist but the body has a natural ability to repair and restore itself. Bear in mind these tips for things that you can do to help speed up this process.
Your GP may already have prescribed you painkillers and anti-inflammatories (such as ibuprofen) and these can help you manage your pain in the first few weeks. You might also find that using an ice pack or heat pack can help alleviate some of the worst symptoms. One more thing: whiplash symptoms are generally worsened by tension so keeping your stress levels to a minimum and trying to relax your muscles can really help (contact us to ask about a relaxing massage!).
We physiotherapists do love to nag about posture, but seriously: maintaining good posture while sitting, driving and standing will support their muscles in their optimal position. If you sit at a desk or spend long periods in one position, try not to slouch and do take regular breaks. Performing gentle movements of your neck and shoulders will also help stop you from stiffening up.
It’s really important to keep your head supported when you’re sleeping – in other words, do not sleep without a pillow! Depending on your size and your sleeping position, the number of pillows you require will vary but remembering that your head should remain in line with the rest of your body will help you choose the right pillow set-up. If you sleep on your back, one pillow should support you, and if you sleep on your side, two pillows is usually right. The thickness and firmness of your pillows will also have an effect.
Keep moving. It is important not to let your muscles stiffen up any more than they already have. The earlier you get things moving, the sooner the symptoms will settle. Try not to avoid too many activities (such as washing your hair, walking the dog) as early return to these can be helpful. Prolonged inactivity slows down recovery and may cause symptoms to worsen.
Some activities may involve pain but this is rarely harmful.
So, here are some simple exercises you can do to help alleviate your whiplash symptoms.
Neck Retractions Sitting or standing in an upright position, pull your chin in as shown. Your head should not tip forwards or backwards, but should stay in a neutral position. You should feel a stretch up the back of your neck. Repeat 10 times.
Side flexion Bend your head to one side, bringing your ear down towards your shoulder. You should feel a stretch on the opposite side of your neck. Hold for 5 seconds, the repeat on the other side.
Rotation Turn your head to look over your shoulder. You should feel a stretch in the opposite side of your neck. Hold for 5 seconds, then repeat to the other side.
Each of these exercises is meant to be undertaken after you have sought medical advice, and along with physiotherapy treatment. If you are suffering from whiplash, contact us now on 01412372721 to book an appointment or to take advantage of one of our free 15 minute consultations.
A couple of weeks ago we posted a blog about posture and we had some feedback about backs in general, and questions about back pain in particular. So we thought we’d write another wee note about the demon that is back pain…
Why oh why are you afflicted with back pain and everyone else is fine? Don’t worry, you’re not alone by any means: two thirds of us will suffer back pain at some point in our lives.
But why is back pain so common? What causes it? And how the heck do you get rid of it?!
Let’s start with a wee bit of background (no pun intended…)
First we need to know what makes up the back so we can get an idea of which structures are causing the problem. The spine is made up of 33 bones or vertebrae, separated into the cervical spine (at neck level), thoracic spine (where your ribs attach), lumbar spine (in your lower back) along with the sacrum and coccyx (tailbone) which are fused together.
The vertebrae are narrow and smaller at the top of your spine (below left), growing thicker and wider towards the bottom of your spine, where they bear more weight (below right). The spinal cord passes through the middle of these vertebrae so that it is protected by the bone on each side.
In between each vertebra lies a disc. The intervertebral disc (to give it its Sunday name) is made up of a fibrous outer layer, and a jelly-like interior. The disc has lots of nerves supplying it, which means that it is very sensitive to pain.
Each part of your body is supplied by nerves which detect sensations and pass these to your brain to make sense of, and also carry messages from your brain, e.g. to muscles to make them work. At each level of the spinal cord, spinal nerves “peel off” and split into lots of smaller nerves which in turn supply all the different parts in your body, like “electric wires”.
At the sides of the vertebrae, there are nicely formed spaces called foramen for the spinal nerves to pass through, so each segment (vertebra, disc and foramen with nerve passing through it) looks a little like this:
Ooft. Hands up if you’re still with us! Not long to go now…
Each of the vertebrae are attached to one another by a number of ligaments (tough cord-like structures) and the whole of the spinal column is controlled by muscles, which are the only structures that you can voluntarily shorten (or contract). This is important.
Well, we’ve covered the basics of what makes up your back. If any of the above structures (bone, ligament, disc, muscle etc) are damaged, it is liable to become painful, therefore you move it less, therefore it stiffens up and becomes weak. If the foramen (the spaces through which the nerves travel) narrow down, then the nerves can become compressed, leading to aches, pains and sometimes tingling or numbness.
You need the muscles, the only contractile thing in your spine, to keep you moving, and reduce the stiffness, which will in turn help reduce your pain. Quite often the damaged structure heals, but the stiffness in the rest of your back remains a problem.
Your back loves movement! The more movement there is between all the little joints and for all the bits and pieces in your spine, the better you’ll feel. Not least because you’re able to sit comfortably, as well as do all those other things you need your back to move for: walking, reaching, vaccuuming, hugging, putting your shoes on, pulling a jumper over your head, cycling, picking up the shopping, twisting to see what’s behind you…
Here are some simple exercises that you can do a couple of times a day to help get your back moving. They won’t take long, and all you need is a wee space to stretch out into.
Warning: Disclaimer coming up! Remember that the exercises are not a substitute for a professional opinion. Be sensible and seek individual advice from your doctor or physiotherapist if your back pain is severe or lasts longer than a few days or if you have other symptoms like weakness, numbness or pins and needles.
These exercises move your lower back into flexion (bending forwards), extension (bending backwards) and rotation. Each of them can be part of a program to help you maintain your flexibility and movement, as well as strengthening your core to support your spine. This will help ease your pain and most importantly, stop it recurring.
You can also ask your GP or pharmacist about medications such as painkillers or anti-inflammatories which can help settle back pain and let you get back to your normal activities.
Remember being told to “SIT UP STRAIGHT!!” by your mother? (“Brush your hair!” and “Blow your nose!” also featured heavily in my childhood, but we’ll just cover the former here).
When you were a wee thing in the assembly hall at school, it was so easy to sit with your arms and legs crossed for – what seemed like – hours upon end without having cramp, and still being able to walk afterwards.
As we get older, and our concentration spans lengthen (in theory anyway), we find ourselves sitting for longer periods of time. We don’t feel the need to jump up and down the aisles in the supermarket, or challenge ourselves to stay standing for the whole train journey. Instead, we tend to assume a sitting posture in the morning which we alter only a few times in our day.
Think about it: most of us will travel in to work by vehicle (sitting down), then work at our desk (sitting down), eat (sitting down), go home and watch the television (sitting down).
Are you seeing a pattern here?
The spine loves movement, and your joints will thank you for changes in positioning by not stiffening up. But if you have to sit for long periods of time, make sure you follow these tips for a healthier, more comfortable position:
1 Keep your feet flat on the floor
If you’re of a smaller stature, use a footrest and make sure your feet are well supported on a flat surface. Play about with seat height (actually, play about with all the little levers on your seat. You might surprise yourself by how different you feel after even a small change in position).
2 Make sure your thighs are supported
For tall people, whose feet reach the floor no problem but their knees are knocking on the underside of the desk, this is essential. Make sure your seat is deep enough from front to back to support the whole length of your thighs. The bigger your base of support (i.e. the area where your bodyweight is resting on a surface), the better.
3 Keep your back upright and supported
The reason we don’t say “keep your back straight” is because that’s misleading: your spine has a natural “S” shaped curve to it, and it’s this curve that you want to maintain, rather than a striving for a “flat” back.
4 Have the top of your monitor at eye level
This will prevent your neck from being strained. Bit of a tricky one with a laptop, but if you can support the screen (even on a very un-fancy box) and use a keyboard at the right height (see number 5) you’ll feel much better for it.
5 Make sure your forearms are supported
See number 2! Again, making sure more of the weight of your upper body is supported on the desk means that your shoulders and neck won’t have to take the strain of holding your arms up (we’re not all The Incredible Hulk with ginormous arms but every little helps!)
6 Move frequently
A-ha! The key here is movement. Even a small change in position can remove stresses from certain areas. The idea is to move every 20 minutes, even if it’s to stand up and walk to the window and back, or just to do a wee dance. You might look silly but you’ll be walking tall at home time.