We use many approaches to support you
- deep tissue massage
No single approach works for everyone, and we tailor our treatment methods to your individual needs based on the results of your examination. We use a combination of traditional massage (including Effleurage and kneading), as well as cross-fiber, inhibition, friction and facilitated stretching. In addition to these massage approaches, we use physiotherapy and osteopathy techniques like static and contract-relax stretching, gentle harmonic joint-rocking, and short lever joint-freeing techniques to improve the mobility of your body’s tissues.
Of particular interest to athletes is the use of sports tape. We use tape to perform 3 goals, firstly to promote drainage, secondly to reduce sensitivity, (although if like Alex you have hairy legs then the removal of the tape is painful) and as a means of drawing further attention to the injured area.
Ultrasound is borrowed from physiotherapy and uses mechanical energy in vibrations of either 1000000 or 3000000 a second, or 1 or 3 MHz. These frequencies cannot even be heard by a bat, however, they oscillate protein-rich tissues like bones, ligament, tendon, and fascia.
How We Treat
We look at you from head-to-toe, considering your posture, shape of your feet and ankles, the alignment and congruency of your knee joints, the position and asymmetry of your pelvic bones, the three dimensional curvature of your spine, relative balance between the front and back compartments of your body, the impact that your ribs, diaphragm and secondary muscles of breathing have on your posture, the way your body copes with straightening and flexing itself, the position of your sacrum and occiput to name but a few.
For example, runners with an underactive Glute Max muscle can recruit other muscles which can support Glute Max in its role in straightening the body, i.e. spinal extensors, Hamstrings and quads which then can predispose them to one of the helper muscles taking over the lead role potentially leading to pain and overuse.
Exercise as Therapy
How we exercise has a profound impact on our body. For instance, running burns significant calories is weight bearing and leaves runners feeling well. Running is extremely repetitive, exposes the body to significant compressive forces and mainly contracts muscles.
Heavy weight-training builds lean metabolically active muscle, increases bone density and over-time will change the weight lifter’s shape. However heavy weight training tends to work mainly on the surface and aesthetic muscles (although squatting and lunging movements clearly work core stability). Squatting and deadlifting can place significant stresses on the lower back.
Weightlifting movements tend to be done using both body sides of the body together (i.e. bench press) but this training does not reflect how we live our lives and move, i.e. activities like walking, driving, and computer-use are single-sided, (when using your laptop you tend to use only one arm to operate
your mouse, not both together). Thus weight-lifting methods should reflect this living functional need. How many weightlifters do you see doing dumbbell presses or regularly use cables in their training? Include lifting movements that also incorporate single sided movements, like external shoulder cable pulls, while balancing on the opposite foot. This exercise combines weightlifting and core stability, that in turn reduces the need to lift as much weight that reduces the repetitive contractile stresses on the muscles and tendons.
These pros and cons need to be considered and where possible adjustments to training methods built into training routines. All runners know that after the race, warm-downs and muscle lengthening exercises are essential, but how many runners routinely stretch properly after running? How many yogis do cardiovascular workouts to train their heart?
Static stretching is useful for increasing the range of over-active or shortened muscles, like the Iliopsoas or Levator Scapulae. Here we initially lengthen the target muscle which will initially feel overactive and tight, but with patience will release after 30 seconds to 2 minutes of the held stretch. This mechanism is Autogenic Inhibition where the Golgi Tendon Organ detects too much muscle activation and sends an inhibitory signal to lower the tone of the muscle. (The muscle gets turned down!) These Golgi Tendon Organs detect too much muscle activity and switch some of the activity off in order that the tendon is kept safe. Imagine trying to bench press too much weight, and with repeated lifts eventually, your Pec becomes so tired and over active that the tendon attachment of Pec starts to be pulled off the bone! Rather the GTO steps in and lowers the muscle tone. In static stretching, we place the muscle at the end of the muscles comfortable range of motion and wait for the muscle activity to trigger the GTO, thereby seemingly relaxing the muscle.
For example, the Levator Scapulae which starts at the top medial side of the shoulder blade and attaches to the upper four transverse processes in the neck. This muscle can give pain and trigger points (TrPs) that are often misunderstood as Traps pain. To stretch Levator Scapulae gently side bend away from the pain, turn and look down to the opposite pocket. Hold until you feel the give. Pain is a warning to stop.
Static stretching will as described lengthened muscles held in a contracted or shortened position. Where you don’t feel a response from the target muscle we should consider what else the muscle is doing to help the body, is the muscle supporting a problem elsewhere.
Ultra Sound (US)
Is a modern main-stream medical therapy where sound waves are directed towards the injured tissue, normally either 1 or 3 million tiny vibrations per second. The NHS use this technology to image patients to look for illness or see unborn infants. Sound waves reach up to 5cm and vibrate the bodies’ cells, which agitates the cell’s molecules creating heat. Heat vasodilates arteries local to the injured area and more fresh blood enters the area. The 1 million sound vibrations per second create local stress in the body which subtly changes the polarity of your tissues, creating a Piezo Electric charge, that signals to the body that damage has occurred and in response to this the body sends Fibroclast eater cells to gobble up the damage cells or foreign bodies, and then the Fibroblast cells emerge to build new tissues.
Ultrasound needs to be applied according to the chronicity, where you have a recent injury we would increase the interval between the sound waves as this type of response will not benefit from a constant sound wave. Old injuries require a stronger sound wave, the body has adapted to the injury and in-a-sense needs more energy to facilitate change.
How much ultrasound should we use? Rule-of-thumb is to spend one minute on each part of the injury covered by the chrome head of the applicator. So where we treat an area in the shoulder about the size of a tennis ball we should spend about 4 minutes as the chrome head of the ultrasound applicator is 4 times smaller than the area.
Unless a fracture is present, the client cannot feel the sound waves, and as such only feels the gentle pressure of the chrome applicator. This then is useful where hands-on treatments are excessively painful or where you have pain near to the joint.
We may recommend holistic exercise like yoga or Pilates with the main aim of learning and be practicing lumbopelvic stability. That said these exercises have numerous and laudable benefits other than the stability of your lower back and pelvis. Yoga and Pilates seek to integrate and activate inhibited muscles of the whole body. Many so-called bad-backs are as a result of muscular inactivity followed by the body adapting around the problem. Pilates will isolate and integrate the inactive muscles making the body and brain relearn how to perform movements correctly.
Recently a healthy debate rages over whether strengthening specifically the core muscles is worthwhile? Using MRI we can see that in people with back pain the Multifidus muscle actually shrinks from underuse and ultimately fat invests the muscle. Later after core exercises the floor based work specifically targets neural drive or nerve energy at the inactive muscles and stimulates them to work. Of course, not everyone with back pain has shrunk muscles or that everyone with shrunk muscles gets back pain, however sometimes these factors contribute to pain.
An area of exercise less discussed is the role of Proprioception, our sense of where we are, particularly useful if we cannot see, we know where the bed leg is and can avoid toe stubbing by using proprioception. Yoga and Pilates use balancing to increase the complexity of our sensory brains. The larger this area of your brain the greater control you will enjoy.
Treatments That Can Benefit Your Symptoms:
Massage – A traditional yet powerful method of affecting the fluid balance and tone of your painful muscles and tendons.
Ischemic Inhibition – A proven method that works in one of two ways: it briefly restricts your blood supply and stimulates your body’s healing mechanism, or discourages your motor nerves from firing so frequently.
PNF/MET – Here your own strength is used to relax and lengthen tight muscles. After a short phase of muscular contraction, there is a window of opportunity where the therapist can passively lengthen your tight or contracted muscle. This contraction-relaxation does not occur naturally in day-to-day living.
Articulation – Your joints are gently moved to stimulate the absorption of synovial fluid which feeds your restricted or damaged joints. If your joints are not moving properly then they will suffer from reduced nutrition.
Manipulations/HVTs – These techniques are direct joint adjustments that allow the muscles around your spine or joint to relax, thereby allowing a proper supply of blood to enter the joint. These high-speed, low-distance thrusts often create a pop or a crack that is completely normal and considered healthy when used appropriately. Often considered to be the main therapeutic tool of chiropractors, these are effective methods but are all the more effective when combined with articulation and massage.
Deep Tissue Massage – Directed at specific muscles, tendons and connective tissues which are then treated with greater pressure directed below the superficial tissue layers. Deep tissue work is often done slowly, where tissues are allowed to give rather than be massaged over.
Soft Tissue Release (STR)- The technique involves applying precise force during a specific stretch performed in multiple planes of movement. The aim is to appeal to the autonomic nervous system in a way that leads to a spontaneous release of the injured muscle, thus regaining the original resting length of that muscle. The result: fast and permanent reorganization of scar tissue, the targeted muscle(s) return to the proper resting length, muscle imbalances are corrected, associated pain is decreased or eliminated altogether, and muscle performance is improved. Results are often obtained quickly and permanently.
Ultrasound (US)– Much healthy debate rages regarding this method of affecting tissues. In 2012 the Journal BMC Musculoskeletal Disorders published good quality research in a paper entitled The Effect of Continous Ultrasound on Chronic Non-Specific Low Back Pain (NSCLBP). In this research paper, 50 patients were randomized into two groups. The first group received therapeutic ultrasound (US) and exercise whereas the second group unknowingly received a placebo ultrasound plus exercise. After the intervention was administered three appropriate outcomes measures were used to compare the two groups. Measures were taken before and after the ultrasound and after one month. Results: Both groups experienced significant improvements in function, the range of motion and pain. The group which received the therapeutic ultrasound recorded significantly greater improvements in function and range of motion.
Many conditions can benefit from conservative physical therapy but can occasionally require the involvement of your GP. Conditions such as osteoporotic compression, meniscus tears in knees and acute intervertebral disc lesions can result in a referral to your GP. Many conditions can mimic back and extremity pain and must be ruled out prior to commencing your treatment.