Category Archives: Head2Toe News

Head2Toe Physio Run Reigate 2015

Head2Toe Physio Run Reigate

We did it.  Head2Toe Physio Run Reigate!

After some serious badgering from our patients, we finally caved in and decided to Run Reigate 2015. In normal circumstances we’re the ones giving advice to our patients but this time around we wanted to prove that we could walk the walk and were up for the challenge.

8 of us were running for Head2Toe Physio, although a combination of the mist and the seriously large crowds on Sunday morning meant we managed to lose 2 before the photo! (Sorry Shona and Fiona).

The event set in the market town of Reigate started cold and misty and finished in bright sunshine. Along the way we took in some beautiful country lanes and countryside. The locals were out in support offering a great mix of noisy support and jelly babies. It was nice to see loads of my patients along the way and even more of them running too.

I’m happy to say that we all made it back in one piece and most of us may well be back for another go next year.

World Reflexology Day Special Offer

Reflexology

World Reflexology Week 21 – 27 September 2015.

Amanda Collins works at our Dorking and Leatherhead clinics. Book now to get your £10 off your first Reflexology Treatment.

Call Amanda now on 07971 002323 or email Amanda@RestoringBalance.org.uk

Potential benefits of reflexology are:

•feelings of deep relaxation
•improves mood
•increased energy levels
•the release of endorphins, the body’s feel good hormones
•improved circulation
•more efficient removal of impurities and toxins
•aids sleep
•helps relieve tension
•a sense that the whole body is in better balance

Reflexology can help treatment people with the following conditions:


•stress & anxiety
•stress related illnesses
•neck & shoulder tension
•back pain
•pain relief
•fibromyalgia
•ME & chronic fatigue syndrome
•asthma
•digestive disorders, IBS & constipation
•headaches / migraines
•sinus problems
•insomnia

NEW Crawley Massage Therapist Caroline Telfer

Crawley Sports Massage

We welcome CAROLINE TELFER to our Crawley Massage team.

At Head2Toe Physio clinics we know that what our Physiotherapists do best is ‘Physiotherapy’. We wanted to offer our patients high quality sports massage to complement our Physiotherapy and set about appointing dedicated Sports massage therapists. At Head2Toe Physio Clinic Crawley, our new Sports massage therapist is Caroline Telfer.

Caroline retrained as a massage therapist in 2012 after a successful corporate career.

Her interest and subsequent career choice stemmed from her personal experience of the effectiveness of sports massage therapy to manage muscular pain, sports injuries and enable optimum training.
During her time as a student at NLSSM she developed an extensive tool box of both foundational and advanced massage techniques which she has expanded through an annual program of continued professional development (a minimum of 40 hours per year).
Hands on skills and a natural talent for problem solving have enabled her to excel at assessment and evaluation of her clients, as well as their treatment.
A lifelong cyclist both on and off road and a keen masters swimmer; Caroline’s experience of participating in these sports has informed the treatment of the many swimmers and cyclist she has met in her clinic and through an extensive event work programme. She brings her passion and knowledge of these sports into her work, and working relationships.
Caroline finds that the satisfaction that comes with delivering a treatment plan that allows a client to realise their goals is highly motivating. She says ‘’My work whether it is with a sports team, in a clinic setting or at major events provides a unique buzz and set of challenges; a mix that means it is always interesting. But by far the best and most enjoyable aspect of my work is seeing the smile on the client’s face as they get off the couch, move with ease and realise they are no longer in pain’’.

If you or anyone you know would benefit from a massage whether it be for stress relief or a sports massage pre or post sport contact us now.

Crawley Yoga – Got Back Pain – try Yoga?

Crawley Yoga

Why have we got Yoga at Head2Toe Physio?

One of the reasons we were so keen to get Crawley Yoga into Head2Toe Physio, is that it often forms a perfect next stage for our patients following their Physiotherapy. Whether we are treating patients for Low Back Pain, Neck Pain, Repetitive Strain Injuries or Sports Injuries, Yoga targets so many of the areas people need to improve to stay pain free or reduce their pain levels further in the long term.

We have classes aimed at those who are starting exercise for the first time in a long time, and classes for those who think they are ready to push themselves a bit further!

At Head2Toe Physio Crawley we work closely with Debs our Yoga instructor to make sure classes are safe for our patients, and where needed help adapt poses for some.

Is Yoga going to be good for me?

Well you won’t know if you don’t try will you? We have taster sessions for those who want to try it before committing too much and If you would like to talk to Debs or any of the Physiotherapists about it before booking on a course, please contact us.

There is definitely evidence that Yoga does a lot of people a lot of good:

The US based National Center for Complementary and Integrative Health have carried out a number of studies which suggest that carefully selected poses may act to decrease pain, and increase function, in those patients with Low Back Pain (LBP). In addition there is evidence that Yoga may contribute to lowering blood pressure, heart rate, anxiety and depression in those patients with Chronic LBP.

In this country, a 2012 study published in Spine Journal carried out a randomised controlled multicentre trial into the effects of Yoga in chronic LBP. Whilst acknowledging that Yoga has been shown to be an effective intervention in chronic or recurrent LBP, this study aimed to investigate its cost effectiveness.

The authors concluded that on the basis of their study, 12 weekly Yoga classes were shown to be more cost effective than usual medical care from a GP, in patients with recurrent or chronic LBP.

It was interesting to note that just as I was about to write this blog post, the Chartered Society of Physiotherapy published a piece on the 13th July with the title “Yoga works for Rehab”. A Physiotherapist in Wigan has been using Yoga for 3 years to treat NHS patients with LBP and points out that Yoga meets all the criteria of the National Institute of Clinical; Excellence guidance that LBP patients should be treated with movement instruction, muscle strengthening, postural control and stretching.

Is it safe?

Whilst their are many types of Yoga, in the US and UK the most common form of Yoga is Hatha Yoga. It emphasises posture, breathing exercises and meditation. There are many types of Hatha Yoga although most tend to be low impact and deemed safe for individuals when carried out under the guidance of a well-trained instructor.

The rate of injury or side effects is low although some people who are pregnant or have conditions like glaucoma, sciatica or high blood pressure should make Debs aware in case poses need to be adapted for them.

Click here for more information on Yoga

If you or anyone you know would be interested in booking our Yoga classes or trying one of our taster sessions please click here.

 

Ling-Hsiang, C et al, A Pragmatic Multicentered Randomized Controlled Trial of Yoga for Chronic Low Back Pain: Economic Evaluation, Spine, 2012; 37(18):1593-1601.

Oken BS, et al. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Alternative Therapies in Health and Medicine. 2006;12(1):40–47.

Raub, JA. Psychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. The Journal of Alternative and Complementary Medicine. 2002;8(6):797–812.

Tilbrook HE, Cox H, Hewitt CE, et al. Yoga for chronic low back pain: a randomized trial. Annals of Internal Medicine. 2011;155(9):569–578.

Crawley Yoga Classes at Head2Toe Physio

Crawley Yoga

Crawley Yoga Classes

We are starting two new Yoga classes at Head2Toe Physio Crawley, Gentle Yoga Fusion and Dynamic Yoga Fusion.

Gentle yoga Fusion

Gentle Yoga Fusion leaves out many of the arm pumping push-ups (chaturanga) and focuses on an easy flow pattern with higher emphasis on hip openers and bends, twists and balancing postures.

This practise is a great balance for a very busy lifestyle.

It creates flexibility, strength, balance and alignments.

Power Yoga Fusion

Doing a series of Yoga Poses while synchronizing one’s breathing patterns to each movement is power Yoga, resulting in actions with perfect unity and grace.

The name Power Yoga says it all. It is one of the several types of Yoga that has the same potential of emulating a rigorous full-body workout and promotes mental stability and concentration.

Breath is so important when doing yoga and within this class the Ouja breath will be used to expand the heart rate.

This yoga will burn calories and leave you feeling that you have worked out. There will be a Savasana (relaxation) ending.

 

Click here for more information on Yoga

If you or anyone you know would be interested in booking our Yoga classes or trying one of our taster sessions please click here.

25% off Crawley Massage in July

Crawley Massage Duncan leaflet prices crop

New Massage therapist at Crawley Head2Toe

We welcome Duncan Stephenson to our Crawley Massage team.

At Head2Toe Physio clinics we know that what our Physiotherapists do best is ‘Physiotherapy’. We wanted to offer our patients high quality sports massage to complement our Physiotherapy and set about appointing dedicated Sports massage therapists. At Head2Toe Physio Clinic Crawley, our Sports massage therapist is Duncan Stephenson.

Duncan’s massage career was born out of a passion for sport and ensuring his body remained at its peak of performance. He is a member of East Grinstead Triathlon Club, and has done triathlons ranging from Sprint, Olympic and 70.3 through to Ironman. In the last couple of years he has concentrated on ultra running with many 30, 35 and 40 mile runs, a 50 and a 100 mile running race being his longest to date. He is even a qualified Triathlon Level 1 Coaching.

“What excited me most was being able to use my understanding of the sport and its impact on the body to help other athletes achieve their full potential.  Triathlons place huge demands on the body, demands I have experienced first hand so I know just how important it is to ensure the correct care and attention is given to the body of an athlete in between competitions and training”.

If you or anyone you know would benefit from a massage whether it be for stress relief or a sports massage pre or post sport contact us now.

Crawley Physio Clinic moves to Amazing new location!

Crawley Physio Clinic

Crawley Physio clinic moves to amazing new premises!

Well we have finally done it. Mel, Gareth and the rest of the Crawley team are moving. From our rather humble clinic at the end of the old high street in Crawley, we are moving just 5 minutes walk to Gleneagles Court.

We started our clinic in Crawley 6 years ago and in that time we have seen (and helped) literally thousands of patients.

Why move?

We had simply outgrown the space.

Our new clinic has loads more space. Five times more space in fact. The space was formerly used by Baker Tilly Accountants. It was open plan and after getting council approved change of use , we had the perfect blank canvas to design the space to suit us and our patients.

 

One week ago and under construction

Crawley Physio Clinic Crawley Physio Clinic

We have ground floor and first floor clinic rooms. A small gym area and lots of parking!

The space we have has allowed us to go out and start recruiting the best health professionals around. Our aim is to maintain our current high standards of Physiotherapy provision, whilst adding other complementary disciplines.

We have already recruited Duncan Stephenson, a local, well known and excellent Sports Massage Therapist. He will be a valued asset and great first addition to the team.

In addition to Sports Massage, we hope to unveil our new Sports Medicine Doctor soon. He is currently the sports doctor for a Premiership Football Club and with any luck will be starting to run clinics in the coming months.

We hope to add biomechanical Podiatry for gait analysis, Clinical Pilates and much more. One thing is certain. We have the opportunity to create a place of excellence for the local area and will take our time to find the right people in order to do so.

Watch this space for news on additions to the team…..

P.S. Special Thanks to Mr Taylor for fitting our amazing new kitchen area!

Crawley Physio Clinic

Swimmers Shoulder- How to fix it

Swimmers Shoulder

How to avoid and fix Swimmers Shoulder

Swimmers shoulder is a common complaint we see at Head2Toe Physio Clinics. As more and more people get into swimming and in particular long distance swimming, the numbers of people complaining of swimming related shoulder pain increases as well.

Swimmers shoulder is a term used to describe a whole array of shoulder problems. One thing they have in common is that they are typically overuse injuries. Symptoms can be neck pain, shoulder pain and pain referring down the arm.

The shoulder is a very mobile joint and depends more on stability from muscles and ligaments surrounding the joint than for example the hip joint, which gets more of its stability from the bony socket itself. A number of things can place too much strain on the soft tissues around the shoulder, including fatigue, weakness, tightness, hypermobility and overtraining.

For those of you who train at a swimming club or have a swimming coach, technique issues will no doubt be picked up early. For those less fortunate, especially those starting to swim, poor technique is one of the most common and obvious causes of swimmers shoulder.

In the early stages after suffering swimmers shoulder, you should follow normal acute injury management. With time, your injured tissues will start to heal and the goal at this stage is to restore normal range of movement as soon as possible. There is evidence at this stage that physiotherapy assisted treatment will improve your range of movement more quickly. Your Head2toe Physiotherapist will use massage, mobilisations and specific stretches to improve your range as quickly as possible.

As well as restoring your shoulder range of movement, we will ensure that you have good posture and that your neck, shoulder blade and upper back are moving well too. It is important at this stage to make sure that you gain good scapular control and your Physiotherapist will give you scapular stabilisation exercises to help with this.

Good posture can be hard to maintain, especially in this day and age when so many of us spend all day in a car or sat in front of a computer. We may also give you some basic stretches and upper / middle back strengthening exercises to address any postural issues. Once you have good range of movement and scapular control, you will be given rotator cuff strengthening exercises to get these shoulder muscles back up to full strength.

The final phase is getting you back to swimming and working on technique issues. We often work with swimming teachers and coaches at this stage to ensure that you have a sensible, graded return to swimming. Your coaches will help you iron out any technique issues but below are a number of key issues specific to front crawl that we have put together with the help from some of our best local swimming coaches.

Here are some key points to help you avoid getting swimmers shoulder and how to try and fix it if you have it!

  1. Have a high elbow when reaching into the pull phase
  2. Avoid crossing the middle of your body when pulling through the water
  3. Really work on rotating the body when alternating arm strokes so more work goes through the trunk than the shoulders
  4. Breathe on both sides

If you or anyone you know is suffering from shoulder pain and would like to have a physiotherapy assessment for suitability of physiotherapy treatment, contact us here.

Barefoot running or stick to the trainers?

barefoot running

The bare foot running question

More frequently than ever I get asked by patients about bare foot running and minimalist shoes. They have often read in a running magazine, have been told by a friend or with increasing frequency been told by a health professional or gym instructor that running barefoot (or at least running in minimalist footwear that is said to mimic barefoot running) might be a good idea.

So what are Barefoot or Minimalist shoes?

Barefoot shoes are designed to give an experience as close to running barefoot as possible, without actually running barefoot. They are designed to fit like a sock and often have individual ‘pockets’ for your toes. The soles are very thin and just enough to protect from debris on the road. Minimalist shoes are somewhere in between running in a barefoot shoe and a normal cushioned trainer. The soles are slightly thicker and give marginally more protection from the road surface. They don’t often have the individual toe pockets or pods and because the soles are a bit thicker, they heels aren’t completely flat.

The Theory

The basic theory goes that humans evolved over years to walk and run barefoot, therefore the addition of trainers with heavily cushioned soles has led to a change in running gait which may have increased the chance of leg and foot injury in runners.

It follows that running barefoot or wearing barefoot or minimalist footwear returns us to a more ‘natural’ style of running thereby reducing injury and improving economy of running style. The counter argument is that in fact there is plenty of evidence that humans have been wearing footwear for at least 50,000 years and that by now we should have adapted to wearing something on our feet.

It is certainly true that there has been a big increase in endurance running since the 1970’s and that this coincided with the use of more heavily cushioned trainers. Larger and softer cushioned heels were produced in an effort to reduce forces going through the lower limb and foot. It was thought that these forces increased the likelihood of injuries like stress fractures.

Interestingly the evidence fails to support this and incidence of running injury has not altered much at all. This is something fans of barefoot running have seized upon, although they often fail to acknowledge that the types of runners who run these days are very different from those who used to run at the start of the running craze in the 1970’s.

Put simply, in those days running was more likely to be done by fit, healthy individuals, whilst these days more people run and those who do are often….well how can I put it nicely…..larger, less athletic and possibly without any prior history of training.

Positive barefoot theories abound and in an effort to create better footwear technology or possibly just to cash in on the developing trends in running footwear, many well recognised brands of trainer manufacturer have now been producing barefoot and minimalist running footwear to add to their normal cushioned footwear range. A win-win situation for them!

So what is supposed to happen when you run barefoot or wear minimalist footwear? Brands of barefoot and minimalist footwear now include Vivobarefoot, Vibram Five Fingers, Merrel Barefoot, ZEMgear, New Balance Minimum, Nike Free and the list is growing.

Some Research

Barefoot running is supposed to encourage you to run on your forefoot compared to cushioned trainers which encourage a heel strike. Does it happen? Well, probably not in everyone. In a study of habitually barefoot runners by Hatal et al, running at their preferred running speed, 72% landed on their heels. The number landing on their mid foot did increase as their running speed increased, but 40% still landed on their heels.

In a study of runners normally wearing trainers, Lieberman et al, found that 83% of runners continued to land on their heel when they changed to barefoot running. If the aim is simply to reduce forces through the feet and legs, those runners who land on their heels whether barefoot or not, would be better off wearing cushioned trainers.

Is Barefoot Running a skill that can be learnt?

Well, we don’t know because the research isn’t out there. What we do know is that just running in minimalist footwear doesn’t necessarily mean running style changes.

Lieberman et al, showed that after 6 weeks running in minimalist shoes designed to imitate barefoot running, 50% of heel strike runners had shifted to a more fore foot running pattern. 50% therefore hadn’t and presumably those runners were more at risk of injury from increased forces through the leg as a result of not wearing cushioning.

It may be that given more time or some basic training, those runners could have changed their foot strike as well. It doesn’t necessarily follow though. Goss et al, found that runners often cannot report their foot-strike patterns accurately. What the runners thought they were doing didn’t necessarily match what they were doing. Only 41% got their self assessment of foot strike correct!

 

So should I or shouldn’t I?

What is true is that despite a lack of good research in this area, popularity of barefoot running remains a very current trend.

There is some research that suggests runners who switch from cushioned trainers to minimalist shoes and continue to heel strike may be at increased risk of heel or calcaneal fracture, whilst those who transition to fore foot striking may be at increased risk of metatarsal fractures.

The effect on the Achilles tendon with forefoot running is conflicting. Landing on your forefoot increases the work required of the Achilles tendon and may be argued to increase risk of Achilles tendon injury; it may also alter biomechanical factors like foot pronation and reduce the risk of injury at the Achilles.

Even more confusing is that Physiotherapists often use eccentric loading programs to treat Achilles injury, so maybe the increase in this work with forefoot running may strengthen the Achilles tendon.

Forefoot running has been said to reduce the eccentric forces through the knee and might be beneficial to patients with patellofemoral pain (a pain affecting the front of the knee). On the other hand it should be noted that whilst a possible risk factor amongst many, there is no actual evidence that wearing minimalist or barefoot trainers and forefoot running will reduce your knee pain.

All of this conflicting advice and evidence brings us to the same frustrating place we often end up at. Put simply, we don’t have enough evidence that changing your trainers will help or hinder you. In fact for every patient who sings the praises of barefoot running, there is another cursing the day they ever made the change.
My advice to all is that ‘if it ain’t broke, don’t try and fix it’. If you’re getting along just fine with the type of trainers you have and the running style God (or evolution) gave you, then stick with what works!
There are so many factors that could affect the outcome of a change it is always best to get assessed by a good Physiotherapist or Biomechanical Podiatrist.

If you or anyone you know is suffering from low back pain and would like to have a physiotherapy assessment for suitability of physiotherapy treatment, contact us here.

Goss DL, Lewek M, Yu B, Ware WB, Teyhen DS, Gross MT, Lower Extremity Biomechanics and Self-Reported Foot-Strike Patterns Among Runners in Traditional and Minimalist Shoes, Journal of Athletic Training, 2015,  Feb 19. Hatala, K G, Dingwall, H L, Wunderlich, R E, PLoS ONE, 2013, 8:e52548 Lieberman, D E, What we can learn about barefoot running, Exerc Sport Sci Rev, 2012, 40: 63-72.

Review – Cycling and Low Back Pain

cycling and low back pain

 

Why does cycling give me low back pain?

Head2Toe Physio clinics work from Dorking, Leatherhead and Redhill in Surrey and Crawley in West Sussex. I see patients at our Dorking and Leatherhead branches.

I get asked two main cycling related questions. Firstly, “why are there so many bl**dy cyclists on the road round here?”

Well it’s obvious if anyone asks the first question, they aren’t a cyclist. This conversation normally goes down the usual route (pardon the pun) of cyclists not paying road tax, riding two abreast, not allowing gaps for cars in between the long packs of bikes that ride along narrow country lanes, not stopping at traffic lights and so on. Once I’ve allowed the rant to burn out, the questioner is normally far more responsive to any positive observations I might make about cycling.

Having said that, I am not a cyclist myself. I seem to spend a fair portion of my working week either working on cyclists with back pain, groin pain or pain down the side of their leg (often ITB – iliotibial band syndrome). Perhaps more worrying and one of the reasons I’m too wimpy to get on the road on a bike, are the number who come in having been knocked off by cars or unseated by potholes and bad weather conditions. Suffice to say these reasons are enough to find me jogging and not cycling.

For those brave souls who do get out on the road multiple times a week, their most common question is usually “What it is with cycling and low back pain? Why does cycling give me low back pain?”.

Cycling is a sport that I recommend frequently. Your feet are fixed which takes co ordination out of the mix and means technique is less important than in many sports. You can even select the gear that suits the surface and gradient that you’re on to reduce the forces required to keep the cranks spinning. A lot of the injuries I see have reduced the patients ability to weight bear and cycling is a good way to keep fit without actually fully weight bearing through your legs.

So why do so many people get back pain?

Well one of the first things that cyclists now check is their bike set up. Thankfully many of the shops specialising in bikes around the area are more than able to check your set up and alignment. However, despite seeking advice for bike set up, people still complain of low back pain.

A study of professional road cyclists reported that 94% of cyclists had encountered an overuse injury and that 58% of them had experienced low back pain in the last 12 months. 41% of them had felt the pain disabling enough to have sought medical advice for it. All the cyclists in the study above had access to national coaches and superb facilities so I would have to assume that bike set up had been checked thoroughly.

What we do know is that when you pedal to the point where your legs (hamstrings and calf muscles) are fatigued, the effect on your back is one of making you flex and bend over the bike more in your lumbar spine. So firstly your legs get tired and then your posture on the bike gets worse. The muscles that hold your low back straighter (the extensors) get tired and you bend over more to compensate.

As well as slouching forward more, have you ever cycled (or driven) behind someone who seems to have lots of side to side tilt of their pelvis when they pedal? Its possible that they have poor lateral hip and pelvic control. You need your hips stabilised by muscles like quadratus lumborum and your oblique abdominals when pedalling and its possible that theirs are weak or fatigued or both.

These are just a few faults among many which we check for in an assessment of a cyclist coming into our clinics with low back pain.

If you or anyone you know is suffering from low back pain and would like to have a physiotherapy assessment for suitability of physiotherapy treatment, contact us here.

Comparing lower lumbar kinematics in cyclists with low back pain versus asymptomatic controls, Van Hoof et al, Manual therapy, 2012, 17,4.