Plantar fasciitis is a common cause of heel pain, and can be incredibly painful. Our patients typically present with pain under the heel which radiates along the underside of the foot. Quite often, the pain is worst when getting out of bed in the morning. You may also have pain when trying to stretch up. The pain is caused by tiny microtears, scarring and a breakdown of collagen where the plantar fascia attaches on to the heel bone.
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.
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.
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.
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?
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?
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.
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!
Kinesiology tape has become massively popular over the past few years, gracing the torsos of Olympic athletes and sportspeople around the world- and whilst there are conflicting messages coming from the research around it, the tape appears to show promise for a range of issues. A recent review showed that there was moderate evidence to support the use of tape to reduce pain, so let’s look at how tape can help.
Properties of kinesiology tape
100% cotton, latex free tape
Medical grade acrylic adhesive which is heat sensitive allowing the tape to stick to the skin
The thickness, weight and elasticity of the tape is approximately that of skin, so most people can tolerate the tape without issue
Allows for free movement and does not restrict movement like other tapes may
The elastic properties provide support and reduce muscle fatigue
Where some tapes are stretched out to maximum capacity before being applied, kinesiology tape is less effective when fully stretched out- in fact, mastering the art of how much stretch to apply is one of the main skills to learn when using tape.
The risks of using tape are minimal, and whilst the research surrounding tape is still in its infancy, we can use it safely in clinic knowing that we’re not causing any harm and are instead likely to see great results which will help contribute further to the use of kinesiology taping.
How taping works to reduce pain
When taping for pain, inflammation, swelling or oedema, we use a technique called “space correction”. This does what it says on the tin- creates more space directly above an area of pain, inflammation, swelling or fluid build up, which helps decrease pressure by lifting the skin away from the fascia.
This has a number of effects:
Decreased pressure alleviates the irritation on chemical receptors in the underlying structures, thus decreasing pain
Increased circulation may occur in the area, allowing for increased removal of cells or fluids that can build up during the inflammatory process
Stimulating mechanoreceptors (sensory receptors in our skin that pick up pressure or distortion) can help decrease pain
The initial benefits are reducing inflammation and pain, but there are thought to be neurological benefits
too- when the tape is placed over tight muscles, it appears to reduce their response to being stretched, helping to make them feel less sore and painful. When applied over weak or injured tissues, the feedback these tissues send to the brain is altered and improved, which can help the body to stabilise the area. This is how we can then move on to use the tape for fascial correction.
In some cases, as with ankle inversion injuries (rolling over on the ankle), there is an imminent risk of further injury as the ligaments in the muscle have been stretched out and therefore aren’t able to stabilise the joint as effectively as usual. In this case, the patient’s initial injury was over 7 days ago so we have used a fan application to encourage lymphatic flow but also applied a light-stretch support around the lateral part of the foot to help stablise the injured ligaments.
Lymphatic fan taping helps to reduce fluid build-up by directing lymph fluid towards a less-congested lymphatic pathway and lymph nodes. We use the anchor of the tape to indicate where we want the lymph to flow, much like directing traffic! Whilst this is an advanced taping technique and one that would be applied by your practitioner, it demonstrates the myriad uses of kinesiology taping perfectly and shows how effective it can be in helping reduce inflammation and aid recovery at a cellular level.
Take home notes:
There isn’t a barrage of research to support the use of kinesiology tape, the papers that are available show positive and encouraging results. Every new treatment modality has to start somewhere, after all!
(Think of Louis Pasteur testing out his Rabies vaccine on a 9 year old. Sounds nuts now, but that’s where most great ideas starts from- somebody going “I wonder if….?”)
Much like any treatment, there will be an element of placebo involved, but studies like this and this have shown that the effects of kinesiology tape can’t be reproduced by placebo taping.
Simply put, the mechanisms and understanding behind how and why kinesiology tape works are grounded in scientific thinking and understanding. It’s a safe, low risk, effective way to help your body towards recovery, and whilst it’s no replacement for treatment, rehabilitation and injury management, it helps to put some of the power of recovery back into your hands.
NB: Whilst tape can be applied by anyone, it is important to have the issue diagnosed by an appropriately qualified healthcare or medical professional prior to using kinesiotape or allowing someone else to apply it. As with any form of treatment, you want to ensure the treatment is appropriate for the issue and eliminate any other underlying issues which may mean taping is inappropriate.
Tennis is without doubt one of the most popular summer sports around- both social and an effective form of exercise (plus, if tennis means Wimbledon that also means strawberries and Pimms- can’t go wrong there!)
As a recreational activity, tennis players do subject their bodies to stresses through ballistic movements and repetitive motions. Whilst these often occur at specific parts of the body (tennis elbow, we’re thinking of you here) these can be the catalyst for more widespread challenges, because dysfunction in one joint can impact significantly on others.
The most common injury we tend to associate with tennis is, of course, tennis elbow (read about that here), but the ankle, hip, lower back and shoulder are also susceptible to injury, be it tendon injuries, plantar fasciitis or muscle tears. Stress fractures (caused by repetitive loading of the upper extremity) are also widely reported, and there are even rare vascular injuries reported, likely due to the compression of the large vessels in the armpit whilst serving.
Tennis is physically demanding with lots of sprinting, flexion, rotation, extension and lateral bending of the spine and related joints, and so a certain level of fitness is critical to help withstand the repetitive stop-start movements, bending, twisting and rotation. When we see a tennis player in clinic we also have to consider the dominant side of the person, as these repetitive motions can lead to one-sided disorders. In fact, when looking at a tennis player it is often easy to spot
whether they are left- or right-handed simply by looking at muscle tone and size!
Let’s talk technical tennis!
The ankle is often injured in tennis due to shearing forces that occur at the subtalar joints. The plant-pivot action often seen in tennis players causes translational distortions throughout the rest of the body, not to mention repetitive shock absorption, and in turn these lead to dysfunction both locally and in more widespread joints and tissues due to compensatory changes. For example- repetitive shear forces through the ankle can cause altered gait biomechanics, which in turn can compromise the stability of the pelvis and the lower back, leaving the player with not only an ankle injury, but also potentially other problems in his pelvis, hips or lower back.
We’ve all seen a tennis player serve- the racket moves over the head and behind the body whilst the spine flexes laterally and hyperextends- the trunk must then be brought into very rapid flexion to smash the ball, whilst very high velocity rotation causes a corkscrewing motion through the spine, transferring force and torque (twisting) into the spinal segments. The tennis serve places more load and stress on the spinal structures than any other stroke in tennis, and these shearing forces can lead the lower back susceptible to injury. Think of Andy Murray and his microdiscectomy surgery on his lower back in 2013- the large forces transmitted through the lumbar spine can cause intermittent lower back pain that can eventually lead to retiring from the game.
In addition to ankle and lower back problems, the shoulder also has to work hard during the serve to stabilise the glenohumeral joint when it is extended, preparing to serve. This relies almost completely on the rotator cuff muscles, who not only have to stabilise the shoulder but also cope with the added issue of the tennis racket- which further increases the distance from the shoulder to the moment of impact in the centre of the racket. When the rotator cuff muscles are weak, there is excessive “play” in the movement of the joint in the shoulder socket, causing irritation in the surrounding tissues.
[clickToTweet tweet=”Only ≈ 20% of #energy needed to serve a #tennis ball comes from shoulder- the rest is from hip, trunk & core strength” quote=”Only around 20% of the energy needed to serve a tennis ball comes from the shoulder- the rest is from hip, trunk and core strength.”]
So how do we avoid injuries?
Cold muscles are more prone to injury so always take time to warm up and stretch before any game.
Proper muscle strengthening and conditioning will help minimise the reduce of most injuries. Shoulder injuries are usually due to poor conditioning and poor strength of the rotator cuff muscles so these should be appropriately stabilised.
Pay particular attention to technical components such as grip size and proper technique can help reduce the likelihood of developing tennis elbow.
Appropriate footwear is critical to preventing stress fractures (which often occur in the leg or the foot) in addition to supporting the arches of the foot and ankle.
Focus on technique- the need to hyperextend through the lumbar spine when serving can be reduced by bending your knees and lifting your heels, which allows your upper body weight to be more evenly balanced.
Introducing specific core stability exercises will enable tennis players to achieve better balance and proprioceptive abilities (proprioception is the body’s ability to sense movement within joints and understand their position in space without having to look!) With this, players are better able to stabilise their body through the extreme ranges of motion it undergoes during tennis.
[clickToTweet tweet=”Remember that #tennis isn’t exercise. It’s a #sport. You have to exercise in order to play the sport!” quote=”Remember that tennis isn’t exercise. It’s a sport. You have to exercise in order to play the sport!”]
Pluim, B.M., Staal, J.B., Windler, G.E., Jayanathi, N. (2006) Tennis injuries: Occurrence, aetiology and prevention. British Journal of Sports Medicine. 40(5) 415-423
Pluim, B.M., Drew, M.K. (2016) It’s not the destination, it’s the ‘road to load’ that matters: a tennis injury prevention perspective. British Journal of Sports Medicine. 50. 641-642
Sell, K., Hainline, B., Yorio, M., Kovacs, M. (2014) Injury trend analysis from the US OPen Tennis Championships between 1994 and 2009. British Journal of Sports Medicine. 48. 546-551
We’re delighted to announce that our St George’s Day Charity Dog Walk has helped raise £398.35 for local charity Hounds for Heroes.
Our principle chiropractor Philippa comments, ‘Coming from a military family, it has always been important for me to give back to the military community. The event was a great success, and we are now planning for next year’s adventures. It was fun for all the family, and we all enjoyed the beautiful scenery of Chichester Harbour accompanied by a slice of cake baked by Emsworth Cookery School and a bottle of refreshing locally sourced water from South Downs Water who both kindly sponsored the event.’
Hounds for Heroes provide specially trained assistance dogs to injured and disabled men and women of both the UK Armed Forces and UK Emergency Services. Through this provision, Hounds for Heroes aim to provide help and practical support leading to an enhanced quality of life. Allen Parton, founder of Hounds for Heroes, comments, ‘This money will assist us in our aims of placing assistance dogs with injured veterans and emergency service personnel, Acorn Health’s event and support really does send such a positive message to those serving Queen and Country that folk at home really do care about them. Every single penny received makes such a huge impact on and difference to our work. We have a great organisation, staffed by serving members of the armed forces, which in itself is fairly humbling, but we couldn’t do it without others help as well.’
Allen continues, ‘It is a thrilling time for us at the Training Centre as we have just had two new recruits join Squadron 4 so the sound of puppy paws running round the centre re-enforces our aim to improve and enhance the quality of our partner’s lives.’
Emsworth’s St George’s Day weekend of events was supported by The Emsworth Business Association, Havant Borough Council, Acorn Creative Ltd, South Downs Water, and Emsworth Cookery School.
Living and working in Emsworth and Langstone, you’ll know that sailing is an inherent part of our community here (so much so, we’ve included some photos taken by Philippa of our lovely harbour!) As such, it’s not uncommon for us to be treating professional or recreational sailors in clinic, and whether you compete professionally or just enjoy a turn about the Solent, sailing poses as much a risk of injury as with any sport.Sailors often compete in extremely difficult conditions, battling high winds and rough seas, and as such the risk of injury during sailing is 8.6 per 1000 hours sailing when training, and 2.2/1000 otherwise. In a study on the 2003 America’s Cup, researchers found that the upper limb was the most commonly injured body segment (40%), followed by the spine and neck (30%), and the most common injuries were joint/ligament sprains (27%) and tendinopathies (20%). (1)
Who is at risk of injury?
Mastmen are at greatest risk of acute injuries, helmsmen most commonly injury the upper-limb through steering, whilst grinders and bowmen are at the greatest risk of injury from repetitive strains. High repetition activities such as hiking, pumping, grinding and sterring are major causes of overuse injury, even in the most experienced of sailors. Windsurfers are also frequently admitted to hospital suffering from chronic lower back injuries as a result of “pumping” the sail.
It’s not just the professionals who are at risk of injury, as novice and recreational sailors commonly encounter acute injuries such as contusions or abrasions after colliding with the boom or other equipment whilst performing manoeuvres. (1) Not only that, but there are other perils to consider: tripping over ropes, winches and cleats; being swept overboard or falling down open hatches!
How and why do sailing injuries occur?
[clickToTweet tweet=”What are the main contributors to #sailing #injuries? Find out here! #Chiropractic” quote=”The main contributors to sailing injuries are: Heavy weather (23%), tacking (17%), jibing (13%), sail change (12%) and alcohol (7%)”]
Injuries may result from a lack of general fitness, overuse, overtraining, or macrotraumatic accidents.
Lack of warming up, stretching, and cooling down may also increase the risk of injury.
Muscles are placed at high risk when performing explosive, powerful moves, such as those frequently required when sailing.
Shoulder and arm injuries are common through constant handling of the mainsheet, and the sudden, strong movements in hiking may lead to back and knee problems. (Remember Sir Ben Ainslie’s back injury? This was caused by repetitive, high strain hiking out!)
Inadequate leg strength and poor hiking technique are thought to predispose the knee to injury.
Boats can be difficult to navigate around and result in crew members having to adopt awkward positions, often resulting in rotating, hyperextending, locking, or twisting of joints.
Postural problems are common in the majority of the population, and these inherent issues can lend themselves to musculoskeletal problems.
Poor fitness training may exacerbate common muscular imbalances associated with changing forces on opposing muscle groups while sailing.
If ignored, it is easy for these issues to progress into a chronic problem, the possible severity of which could impact on your participation and enjoyment in the sport.
So what can be done about it? Five simple steps to avoiding sailing injuries!
A robust exercise regime is crucial, which should focus on all aspects of physical fitness in order to ensure that your body can cope with the demands of sailing.
– Cardiovascular training
– Strength training (Competitive sailors should undergo regular health screening with specific strengthening of high-risk muscle groups, synergists and stabilizers. )
– Flexibility training
– Core stability training
– For more advice on bespoke rehabilitation plans, please email us at firstname.lastname@example.org or visit our Langstone clinic.
Research has shown that aerobic training and fitness is directly related to an improved reaction speed to wind shifts, as well as enhanced endurance, decision making, and concentration, particularly in the later stages of races. Mental and physical recovery is faster for those who are physically fit. Suggested types of aerobic exercise that are most appropriate for sailors are rowing, cycling, swimming, stair climbing, or running.(3)/li>
Regular checkups can help ensure joint movement and function is maintained, as well as provide an opportunity for assessment of joint strength and function. Not only will this help reduce the risk of developing injuries, but it can also speed up recovery should you become injured.
Technical skill and expertise is important– if your technique needs improvement, seek out advice and informed coaching to help minimise the risk of developing an injury as a result of poor technique.
Taking frequent breaks and changing positions during long periods of sailing. This will help prevent postural stresses and strains from occurring and is a healthy spinal habit we all should follow.
Whilst we have focused on musculoskeletal injuries, there are a number of other safety measures to take into consideration. Above all, always wear a life jacket when sailing. In the UK, there were 35 sailing or water-sport related deaths at sea in 2014 alone. Safety at sea should always be taken seriously.
1. Neville, V., Folland, J.P. (2009) The epidemiology and aetiology of injuries in sailing. Sports Medicine. 39(2) 129-145.
2. Nathanson, Mello, Baird “Sailing Injuries and Illness – Results of an Internet-based survey” Wild Env Med 2010
3. Allen, J.B., De Jong, M.R. (2006) Sailing and sports medicine: A literature review. British Journal of Sports Medicine. 40(7) 587-593.