Tag: joint

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Stretching won’t make your muscles stretchy

Stretching doesn’t work the way we think it does. At all. If you’ve ever spent your time gritting your teeth, pulling your arms or legs or (eek) neck into weird and wonderful positions to feel that pull, before noticing that a few hours later they’re back to where they were before, you’ll know that stretching doesn’t make your muscles stretchy. To understand why stretching isn’t the key to flexibility, we first have to understand a bit more about how and why our muscles stretch in the first place.

All humans have a reflex in our nervous system called the myotatic reflex. Believe it or not- you’ve probably had this tested without even knowing it. It’s the one we activate when we use a reflex hammer to hit just below your knee which makes your leg jump, or the one just above the elbow which does the same to your arm.

stretch muscle reflex stretchy injury knee pain relief chiropractic chiropractor education blog physiotherapy physiotherapist health rehabilitation painful sports injury training fitness emsworth chichester hampshire sussex
The C6/7 reflex

This reflex is the body’s pre-programmed response to a stretch stimulus in the muscle. When the muscle is stretched (as in when hit by the reflex hammer), an impulse is sent to the spinal cord to contract that muscle (and relax the muscle that works in opposition to it), causing the limb being tested to jump. These reflexes are what are called “monosynaptic” as there is only one junction for any signal to pass through before the body sends a response (the message going in->junction->message coming back happens in the spinal cord, bypassing the brain to make sure the response happens quickly) Think how rapidly your knee jumps when it’s hit by the reflex hammer- it’s usually just 1-2 milliseconds before the body responds.

We use these tests in clinic to check the integrity of your spinal cord and the peripheral nervous system, and they can be vital in helping us identify neuromuscular conditions. But that’s not what we’re talking about today. You might be wondering what purpose these reflexes have? Well, one of their most important functions is to prevent us from tearing our muscles/tendons/ligaments. Let’s look at the patella reflex to demonstrate this:

The patellar tendon is tapped just below the knee, which puts a rapid stretch into the tendon which attaches to your quadriceps muscle (the muscle in the front of your thigh). Muscle spindles (sensory receptors that pick up changes in the length of the muscle) pick up on this rapid increase in the length of the muscle, and very quickly send a message to contract your quadriceps in order to stop the muscle or tendon from over-stretching and causing damage. What happens when your quadricep contracts? Your lower leg comes flying up! If it doesn’t, it could indicate an underlying condition or disease affecting your muscles and nerves (which is why we always test them in clinic!)

What else do reflexes do? Well, they also stop us from falling over all the time. Stand up for a second. Now lean over. As far over to one side as you can go. What happens? The muscles on the opposite side to the lean become stretched, and that reflex is activated again, telling those muscles to contract in order to correct your posture and stop you toppling over. Now, this is a more obvious demonstration of how reflexes maintain our posture, and these postural corrections are generally carried out subconsciously (so we don’t spend all day feeling like we’re going to fall over!) It’s one of those things that we notice more when it stops working.

So what do reflexes have to do with stretching my tight muscles?

When we activate stretch receptors in the muscle, the message the body receives is to contract that muscle to prevent overstretch. So the usual static stretching that we do (for example when we bring our foot up behind us and grab on to it to stretch our quadriceps) puts our conscious and subconscious brain into war against each other. You’re consciously grabbing that foot to pull that muscle into a stretched position, and your stretch reflex (the subconscious brain) is automatically kicking in (as reflexes do) saying “No!” and tries to stop you from over-stretching and causing yourself an injury. What do we tend to do in this situation? Most people say “oooh that’s tight!” and promptly pull harder… Static stretching has actually been shown to decrease strength and athletic performance, while failing to reduce risk of injury to any significant degree.

Why does stretching feel so good then?

There are a few reasons why stretching might make you feel like you’re getting somewhere.

One: If you continually statically stretch your muscles, you can cause that stretch reflex to become less active. This can mean the muscles do lengthen, but only for a little while. Give it an hour or two for that reflex to go back to normal and the muscles will tighten back up again. This can cause problems for athletes- static stretching means the muscle is unable to contract properly because those muscle spindles aren’t functioning right. There’s plenty of research out there to show that static stretching before exercise can reduce your muscle strength, power, performance and joint stability.

Two: The more we stretch, the better we’re able to tolerate the sensation of “pulling” in our muscles. Yep, we’ve all said it “Ooooh, that’s a good stretch!” That temporary lengthening and release does feel good, but not for long.

Three: Pull a muscle or tendon enough, and you’ll begin to stretch your ligaments. Ligaments can, over time, then become stretched out to the point where they’re unable to function properly, resulting in joints that move too much, and are unstable. When ligaments get to this point, they might never regain their original length and strength.

stretch muscle reflex stretchy injury knee pain relief chiropractic chiropractor education blog physiotherapy physiotherapist health rehabilitation painful sports injury training fitness emsworth chichester hampshire sussex stretching
Someone tell him to stop…

Stretching- Will it get you out of pain?

In a nutshell, no. The nervous system rules the road. It’s totally in charge of everything that we do. If you’ve had treatment with me, you’ve probably heard me talk about the reasons why the brain can cause our joints to stiffen and feel like they’re “locked up”. It’s your brain’s way of stabilising an area that it perceives to be at risk of injury (whether that perception is founded in fact or fiction!) So on a very fundamental level, if your brain still perceives there’s an issue in that area, no amount of pulling on your muscles is going to change that. Equally,if the muscle is tight and sore because there’s a joint somewhere that’s misbehaving and preventing the muscle from functioning as it should, then stretching isn’t going to do much for that problem.

stretch muscle reflex stretchy injury knee pain relief chiropractic chiropractor education blog physiotherapy physiotherapist health rehabilitation painful sports injury training fitness emsworth chichester hampshire sussex stretching

The process that tells us how tense our muscles should be at rest (known as “resting muscle tone”) is called the alpha-gamma feedback loop and it’s a lot more intelligent than we give it credit for when we’re yanking on our body to get it to stretch. In order to reset an over-enthusiastic resting muscle tone, we need slow, controlled movement which provides vital sensory feedback, allowing this system to reset itself. This makes it fairly clear that pulling our muscles into, or beyond, their stretch capacity does little other than provide a temporary increase in muscle length which then rebounds when those muscle spindles reset, giving you little more than temporary relief from pain and probably serving to prolong your discomfort by making your muscles tighter overall.

So how do we make muscles stretchy without stretching?

First we have to look at what’s causing the muscle tension in the first place. Let’s look at the hip joint as an example. It’s got anywhere between 170 to 200 degrees of flexion and 40-60 degrees of extension, so is well over the 180 degrees needed to do the splits. So aside from structural changes in the hip joint, is mainly restriction in the soft tissues that stops most of us from being able to pop the splits whenever we fancy. No amount of stretching or “bouncing” into the splits is going to get you there- for whatever reason, the muscles you need to do the splits are activating way before their supposed maximum load and your brain is telling those muscle spindles to stop before you hurt yourself.

We have to stop thinking that we can teach our muscles anything. Our muscles don’t call the shots- our brain does. If a muscle gets tight, it’s because the brain is telling it to contract. So if stretching isn’t the answer, what is?

  1. Chiropractic care to correct the cause of the problem- We find, assess, diagnose and treat the underlying reason for the muscle tension. If you don’t know why they’re tight, how can you possibly get them better?
  2. Foam rolling. It’s not just rolling about on the floor (although that helps!) Foam rolling activates a different receptor in the muscle (called the Golgi Tendon Organs) which sit at the junction between your muscles and tendons. When we foam roller correctly, we stimulate these GTO’s which encourage the muscle spindle activity to calm down, helping to decrease muscle tension, reduce pain and improve function.
  3. Functional movement. Simply put, warm up based on movements you actually do in real life. How often do you actually grab your neck and pull it into a weird angle in real life? Not often. If you’re a runner, instead of doing straddle-stretches or the good old foot-behind-your-bum-and-pull stretch for the quads, try lunges, high knees and skipping instead to replicate the movement you’re going to do.

So there you have it. Stretching tight muscle tissue will only make it tighter. Find and correct the reason for the tension and enjoy super-supple muscles instead!

Marathon Ready Workshops

This year we have hosted two popular running workshops with a twist on our popular “Running without pain” workshop concentrating on marathon training, injury prevention and recovery and increasing your training load.

Thank you to The Run Company for letting us take over your shop for those evenings!

There are some big races in every runner’s diary at this time of year, including the largest local marathon taking place in June and international races coming up in the Autumn. Nothing’s more disappointing than picking up an injury just a few days before the big event, so in this workshop, we took our guests through the top prevention steps everyone needs to know to prevent injury, helping you spend more time on the road and less in rehab.

We covered everything from overtraining to optimum performance tips as well as advice on the all-important recovery period, and an opportunity to speak to Philippa, Acorn Healths principle Chiropractor, one-on-one after the event for any specific questions or advice.

We had an Ultra-marathoner and a Tough Mudder runner who had specific questions on nutrition and keeping up their energy levels. We also talked to a few ladies who are looking to improve their stride to reduce expelling unnecessary energy, and a 10K runner interested in injury prevention. We also had a lady interested in increasing her walking to running without causing serious injury and a gentleman looking for information on running winter marathons.

Our events are never a dull affair, and all are encouraged to get involved and ask questions throughout the talk. We left the first event thinking about stocking up on jaffa cakes and jelly beans and the last one thinking about taking a nap! If you are interested in coming to one of our events please subscribe to Facebook events here or sign up to our newsletters here.

Book in for your pre-race MOT appointment here so we can get those backs mobilised, ribs moving freely to increase your lung expansion and thus your muscle moment and improve your hip flexion and extension for a better stride.

Your body is an intricate machine and just like any machine, things can go wrong from time to time. If you are in pain, it’s your body’s way of telling you that something isn’t right. Listen to it.

You may also be interested in:

Marathon Ready Resource

Understanding Pain Resource

Running without Pain Resource

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor

The Acorn Health PROMs: A Case Study

We’re not talking about the BBC PROMS, or in fact anything to do with music. We’re talking about Patient Reported Outcome Measures (PROMs), and they’re far more exciting than the BBC version (in our humble opinion).

Patient Reported Outcome Measures are the tools with which healthcare practitioners and clinicians can better understand the impact illnesses or conditions and treatment are having on our patients’ daily lives.  At Acorn Health, we utilise Care Response, a system which gathers the data for us and is supported by the Royal College of Chiropractors.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Why is it we often wait to get help for something until the pain becomes so intense we can’t do what we want to do?

We don’t collect PROMs purely for our own benefit, it’s also for yours. We want to understand how your pain or problem is affecting your daily life- are you able to wash and dress yourself without pain? Is it stopping you from having a social life? Is it preventing you from working?  Not only that, but we want to know how you feel about your pain. Are you worried it’s never going to get any better? Perhaps you’re scared about whether being physically active is going to make it better or worse and had to duck out of that golf game you had lined up.  These are all very common concerns (so don’t worry if you’re having them- we all do!) and by understanding what your concerns are and how your pain is affecting you, we can provide a more accurate and more appropriate course of treatment for you.  The responses to these questions will also indicate to us whether you are at a low, medium, or high risk of the problem becoming chronic (lasting for a long time) and this can mean that we need to provide you with very specific advice and information in order to prevent this happening- and yes, it can be done!

PROMs are starting to sound really good, aren’t they?

PROMs health chiropractic pregnancy baby childbirth paediatricsAnother fantastic thing about PROMs is that they can tell us whether the treatment plan we have together decided upon is having the effect we want or not.  Often, when pain decreases it can be difficult to remember just how bad it was (Remember that saying about giving birth? If we remembered how bad childbirth was we’d never have more than one child!) That being said, PROMs give us a way to determine your response to treatment based on your original responses to the questionnaire.

The story of patient X: Utilising PROMs in clinical practice

So how do we put PROMs to use in clinical practice, and how do they help inform our decision making and improve the care we provide our patients? We’ve got a case study here to explain it.

A bit of background- this Patient (let’s call them Patient X… sounds all mysterious and technical doesn’t it!) Anyway, Patient X had sustained a lower back injury in a road traffic accident more than a decade ago and had suffered with recurring episodes of lower back pain which, as seen by the chart below, were having a significant impact on their ADL’s (activities of daily living- things like washing, doing housework and sleeping) as well as their social life (going out to see friends, going to the gym, playing sports), the pain was a 6/10 and it was also making them anxious, depressed, having quite a severe impact on their working day and they had very little ability to cope with, control or reduce the pain themselves.  All in all, not a very pleasant situation to find yourself in, but these results are fairly common in the patients we see in clinic. So much so, in fact, that Philippa takes a special clinical interest in chronic pain management– but that’s a story for another time.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor
Patient X’s initial responses

The questions on the initial form are part of a validated assessment tool called the Bournemouth Questionnaire, and the answers are scaled on a 0 – 10 linear scale, 0 being “the pain has no interference” and 10 being variations of responses such as “completely unable to carry on” or “extremely anxious/extremely depressed.”  As you can see, this patient was also at medium risk of chronicity due to some concerns they had about their back pain and what it meant for them, as they were worrying about it a lot of the time and felt that it was never going to improve.

We normally complete an outcome questionnaire after 2 weeks but in this particular case it was after 4, and Patient X completed this questionnaire which asked how their pain has changed, and also assesses the impact this pain is having on their lives at that time.  This is where we get a bit geeky and excited- bear with us while we explain why.

Yes, as you can see below, Patient X’s pain level had increased at the time they completed the outcome questionnaire because (by their own report) the “Sciatic nerve in left leg has been irritated since last weekend” after spending a weekend doing a lot of heavy work in the garden…. they knew it wasn’t the best idea (!) However, despite the fact that they’d been doing quite hard physical work and had a slight flare-up as a result, they still reported they were “much improved” as a result of treatment, and their Bournemouth Questionnaire (the one that tells us how the pain is impacting on your day-to-day life) had reduced from 52/100 to 34/100 (which is computed as a 34.62% improvement!)

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor
Patient X’s outcome at 1 month

How is it possible that the pain could actually have increased, but Patient X felt better? Well, as we do with all our patients, we had a lengthy chat with Patient X about their pain, and how it was impacting them, and how they could manage it more effectively, as well as what we could do to help.  Studies have shown that in some specific cases, a pain management course is actually more helpful than physical treatment, so we always include pain management as part of our treatment programmes. The more control you have over your pain, the less pain you feel. So through understanding pain and knowing what’s going on, what the cause was (in this case a mechanical issue with how a joint in the lower back was moving) what it isn’t (lower back pain is very rarely serious) and what to do about it (treatment and active self-management), Patient X felt less pain as they were less threatened by it, understood what was going on, were less concerned by the pain and able to move more normally without fear of pain.

After speaking to Patient X to establish what they felt had changed, the overall message was “I know what’s happening now, and I know what to do about it.” Woohoo!  This is why it’s absolutely critical that we convey the right messages to you and help you to understand your pain.  As practitioners, we also know that pain in itself is a really unreliable indicator of the severity of the underlying issue.  To use our favourite analogy- think how painful a papercut can be despite the fact it’s a fairly minor injury. Pain in itself is just a symptom and studies have shown it does not relate to the severity of the underlying problem- in fact, some studies show that pain related fear is more disabling than the pain itself!

To understand more about pain and what causes pain, this should be your next bit of reading: Understanding Pain.

Let’s get back to Patient X, who today completed their final outcome assessment.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Patient X’s outcome at discharge

As you can see, the pain has dropped now to a 3/10. Those sections where Patient X reported were a 9/10 (ability to complete ADL’s and impact on social life) have dropped to a 3/10 and 2/10 respectively, impact on work was initially 7/10 and is now 0/10, anxiety and depression are both down from 7/10 to 1/10, and ability to cope with, control and reduce the pain was initially a 7/10 and is now a mere 2/10!

Whilst plenty of naysayers might say “Sure, but they’re not pain free and their Bournemouth Questionnaire isn’t zero.” If you had an illness or disease that lasted several years, would you take a few pills and expect it to be cured? No.  Realistically, you’d hope that it would be better, as it is for this patient.  Recovery takes time and is something that cannot be rushed. If you recall, Patient X’s problem had started over a decade ago, so we’re delighted that two months later the pain has improved this significantly. Not only that, but Patient X reports feeling “much improved” as well so we know they’re happy with how they’ve progressed- which gives us all sorts of warm fuzzy feelings. Hooray for job satisfaction!

So what happens now? At this stage, we’ll see a lot less of Patient X as they are formally discharged from care. The pain is now PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthyso minimal and intermittent that after discussing it with them, they’re happy to manage it themselves at home with stretches, exercises and lifestyle modifications (such as taking regular breaks from sitting whilst at work).  We’ll check up on them in a few months to review their exercises, identify if there are any issues that have crept back on and this also gives us an opportunity to discuss their progress with them and if they have any further concerns.  Of course, we’re always at the end of a phone or email, Facebook, Google+ or Twitter if they (or you) want to get in touch in the meantime!

We never guarantee 100% cure as nothing in medicine can. No pill, no operation, no treatment. There are no guarantees. What we do say at Acorn Health is that we will always give you the very best treatment and care, in accordance with the latest research guidelines and current evidence base.  We can also say (thanks to another fancy PROMs questionnaire) that we have 100% satisfaction rates from every patient we’ve seen since we opened back in 2014, and that makes us very happy indeed.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Acorn Health Outcome Satisfaction Results

So there’s a little overview and case study into how PROMs are put into use in clinical practice, and why we utilise them! If you’d like to know more, or would like to get in touch to book your own appointment, you can contact us using the form below.

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PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor

Christmas Giveaway 2015

Christmas Giveaway

Introducing our Christmas giveaway! Win one of our Back Pain Packs worth a whopping £40.00!

Christmas Giveaway 2015

To be entered into the prize draw, simply comment on the Facebook Post with the answer to the following question, like our Facebook page and share the post so others can join in!

The question is: What award did Acorn Health win in March 2015?

You could win the following prize, which includes:
– One foam roller for releasing tight muscles, mobilising joints and improving flexibility.

– 1m medium resistance Theraband for stretching, strengthening and rehabilitating muscles.

– “Knobbler” hand-held massager for deep tissue massage on tight, knotty muscles.

Biofreeze pain relieving gel which uses cold therapy to give fast, topical pain relief.

Hot/Cold Pack: Cool in freezer to use as a cold pack and reduce swelling, or heat in the microwave to use as a hot pack and increase circulation to an injured area.

For full terms and conditions, please click here.

The winner will be selected at random on Wednesday 16th December at 11AM!
Best of luck from the Acorn Team

Sports Tape Workshop

The uses and benefits of kinesiology tape are overwhelming! At Acorn Health, we have utilised it for issues such as sports injury, post-operative rehabilitation and severe bruising and to help ease postural strains when pregnant. 

Whether you’re training for your first marathon, getting ready for your next game, reaching a personal fitness goal, or just trying to get through the day, you already know that nothing slows you down faster than pain and injury.

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Sports tape is lightweight, comfortable to wear, and can be used for hundreds of common injuries such as lower back pain, knee pain, shin splints, carpal tunnel syndrome and tennis elbow, to name a few.

It also provides 24 hour relief per application, and each application can last up to 4 days through sweat, strain and humidity, and can even be worn in water thanks to the specially designed adhesive.

Book your appointment here.

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Acorn Health Ltd © 2014- 2020

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Contact Info

01243 379693
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Acorn Health Limited © 2014 - 2020

Website Created by WebHolism