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Have You Been ‘Hamstrung’? A Hamstring Injury Help Guide

‘Hamstrung’ – a figurative verbal expression from the noun hamstring (the muscle and tendon on the back of the thigh), originating in the 1500’s where soldiers would slay their enemy across the back of their thighs rendering them disabled, crippled, lame, or useless.

If you have ever strained or torn a hamstring muscle (albeit in a less violent manner!), you probably felt the same.

Hamstring injuries are the most significant injury in football, rugby, running (more commonly sprinting), basketball, and baseball.

Apart from being debilitating at the time of injury, hamstring injuries can be frustratingly slow to heal. Often taking an average of 3-4 weeks to recover, even up to 6 months to return to full sporting ability.

What’s worse is that there is a 20 to 50% chance that you will re-injure your hamstring in the same season! Hamstring injuries can be strains that are a pulled or torn muscle, or an overuse injury called hamstring tendinopathy.

The hamstring is a powerful group of three muscles that run down the back of your thigh from your buttocks to just below your knee. They work over two joints, both bending (flexing) the knee and extending (straightening) the hip.

The hamstrings work throughout each stride, but are especially active when you are bending the knee and extending the hip at the same time, for example when going up hills or powering to the finish in a run.

Often injuries to the hamstrings happen with sudden changes in running direction, sudden acceleration, explosive speed, or when trying to contract the muscle whilst it is being stretched, for example a football player with an outstretched leg, attempting a high kick all at the same time.

Risks

Social athletes or sportspersons of any level are at risk of straining their hamstrings. However, people who sit for long periods of time during work or at home are also at risk of injury. They most likely have weak and tight hamstrings, due to the static nature of their day, and shortened position of the hamstring whilst sitting.

Whether this is you, the office worker who is convinced to play a quick friendly game with mates after work; or get roped into the parents 100m dash at the school sports day; or a weekend warrior; ‘tearing’ your hamstring (or at least injure the tendons) can happen.

Hamstring tendinopathy is an overuse or overloading of the hamstring muscle tendon attachments either at the knee or on the ischial tuberosity (sitting bone) deep in your buttocks. This may come about from an increase in training load, for example more hill running, increased speed work, unaccustomed deep lunges, yoga or deadlifts. Tendons have poor blood flow that makes healing and recovery slow, especially without physical therapy.

When the hamstrings contract, the quadriceps muscles relax. And vice-versa. It’s a not-so-delicate game of tug-of-war. When they are out of sync, injury can happen that can extend beyond the muscle groups themselves. Several factors, often in play at the same time, can cause a strained hamstring, however many of these factors are modifiable, suggesting one can prevent a hamstring injury to a certain degree.

Strength imbalances, muscle fitness and endurance, warming up, underlying back problems, technique, conditioning of the muscle to acceleration and deceleration – these risk factors can all be addressed. Sadly, a previous hamstring injury and age are two risk factors that can’t be altered. Increasing age increases injury risk. It’s something to be aware of and possibly take extra caution to prevent a hamstring injury!

Symptoms

Your symptoms may vary depending on how severely you strain your hamstring or injure the tendons.

They may include:

  • Pain behind the leg and into the buttock immediately at the time of injury or afterwards, with difficulty running or walking.
  • Muscle spasm and tightness in the muscle, swelling, bruising (which can spread down into the calf area) and tenderness.
  • Associated pain in the buttocks and back. If the tendons are involved there may be pain on, or just below the sitting bone (ischial tuberosity).
  • Chronic stiffness in the back of the legs aggravated by sitting and driving, deep lunges and hamstring stretches.
  • Sharp, stabbing pain even an audible popping or snapping sensation when the injury occurred.
  • With a complete tear, you may feel a ‘ball’ of muscle in the back of your thigh.

Management

Treatment and rehabilitation

  • As soon as you can follow R.I.C.E. protocol for a few days. That is, rest, ice (up to 15 minutes at a time), compression and elevation, and then go and see an Osteopath or Sports Therapist after about 2-3 days. You may want to rest the leg and use a crutch to reduce loading on your injured leg.

Once this acute phase has passed treatment can progress to:

  • Physical therapy, which helps to promote healing and ensure minimum scar tissue formation. This will include massage, and soft tissue mobilisation to release the surrounding structures of the hamstrings as well as addressing underlying back or hip issues. Ultrasound may also be used to help promote healing.
  • If you have tendinopathy arising from below the buttock sit as little as possible, use a cushion under your buttock to relieve pressure on the tendons attached to the sitting bone.
  • Correcting muscle strength and flexibility imbalances. Including strengthening the pelvis and core including the gluteus (buttock) muscles as they work with the hamstrings.
  • Strengthening exercises such as squats, deadlifts and stretches to improve eccentric strength of the hamstring.
  • Correction of sports technique and functional problems including leg length discrepancy or flat feet – a podiatrist will be able to advise whether orthotics would help.

Training

Complete rest may be advised depending on the severity of the injury. Otherwise reduce the intensity and volume of training. Avoiding speed and hill work and find a comfortable walking/running pace and distance that doesn’t cause pain, and stick with that 3 times a weeks with a rest day in between.

Walk/run on softer surfaces like grass. Gradually build up training load and intensity – be patient! Compression tights during or after running or sports can aid blood flow and recovery.

Also worth considering:

  • Cross-train in sports that don’t place a heavy demand on the hamstrings e.g. upper body strength training, easy lap swimming, low resistance stationary cycling or cross trainer
  • Observe the 10% rule: Do not increase exercise intensity, frequency or duration more than 10% a week.
  • Regular massage may form part of a prevention strategy, keeping the hamstring muscle flexible and aiding in muscle recovery.

For optimal recovery and prevention of a recurrent hamstring injury it is essential you work through a treatment and rehabilitation program with your Osteopath or Sports therapist.

 Debbie Crumpton

 

 

Have You Been ...

Marathon Training – Are you eating and drinking the right things?

Marathon Food & Drink

The Virgin London marathon approaches –  Are you eating the right things as part of  your Marathon training?

No doubt you have been sweating, aching, even wondering why you inflicting such punishment upon yourself?

And have you answered the question – ‘have I optimised my chances of success with the best preparation?’

 

 

Marathon runners cannot be immune to the endless nutrition and hydration messages that abound in the endurance sports arena. There are endless webpages and products advising you what to do – to the point that confusion reigns.

In fact there is no simple answer to any of this because everybody is an individual and there is no one size fits all approach. They point is that you must use your training activities to experiment with what’s out there and find the best approach for you.

But the basic message is simple:-

  • You need to understand energy metabolism – carbohydrate, fat and even protein can be used as energy fuels – but you really don’t want to use your protein deposits which are after all the muscles you need for running. So how do you plan to avoid ‘consuming your own muscle’?
  • What is the best approach for you with respect to carb loading? in fact what are the approaches to carb loading – and do you know which one suits you?
  • How can you best prepare your energy reserves during the days before the event?
  • And what is the best approach to hydration? Water? Sports drinks? Hypertonic, hypotonic or isotonic? Should they contain glucose? Should they contain carbohydrate polymers and if so in what proportions? Should they contain electrolytes – and at what concentration? We all sweat at different rates which has an impact on the need (or not) for electrolyte replacement.

These are all important questions which individuals need to answer and experiment with to find the best individual approach. There are some really good websites populated with advice by evidence-based scientists – and there are some really bad websites populated with advice from people who think they know best. I have seen some real rubbish out there – advice about consuming huge amounts of protein which is a complete waste of time. Advice about consuming massive doses of vitamin C – which could have terrible effects on your stomach.

So make sure that wherever you are getting your advice from – it is reliable – which means it comes from evidence-based practice rather than popular myth.

If you would like help with finding such information and applying it to your own needs, or would like to understand more about the science behind performance then please contact Sue Force at The Mill Clinic, sue.force@themillclinic.co.uk or 07490 413983

At The Mill Clinic we can treat injuries, help preparation and/or aid recovery, we can advise individuals, and we can advise teams on the appropriate nutrition, we can also point you in the direction of evidence-based sources of advice.

Sue Force

Marathon Traini ...

Corn Treatment and Prevention

Blond lady covered by blanket in the bed room suffering from Corns

Suffering from Corns on the feet

Corns are a common foot complaint treated by Podiatrists; nearly 50% of us will have suffered from them. Common home treatments include using corn plasters, however I have seen corn plasters cause more problems than they helped!

Podiatrists treat corns by removing the layers of skin and you should get faster relief. So before you are tempted to use the corn plasters keep on reading to find out more, including how to prevent them.

Corns: What are they?

Corns can be described as areas of the skin that have thickened to the point of becoming painful and irritating. They are often layers and layers of skin that have become compacted, dry and rough.

To form a corn the skin thickens initially to protect itself but reaches a point where it cannot continue to grow outwards, as there is either body weight or high pressure from the shoe, which causes the thickened skin to develop a deeper plug forming a corn.

Most people believe that corns have roots and if the root of the corn were removed then the corn would never return. This is of course not the case – corns do not have roots!

What causes them?

Corns are caused by abnormal pressure and friction known as mechanical stress. Your foot shape can make you more susceptible, because if the bones of the foot are misaligned and excessive pressure is exerted over a particular area, it can result in severe hard skin and corn formation. This is frequently seen on high, and low, arched feet.

Painful High Heel Shoes

Footwear is also an important factor in causing corns. Tight fitting pointed shoes that cause the toes to pinch together and rub against the toe box of the shoe. Particularly if you wear high-heeled pointed shoes, they change the alignment of the foot and generate excessive forces through the balls of the feet.

Wearing shoes and sandals without socks can also cause friction on your feet.

Corns can also occur if you have enlarged Bony prominences such as bunions or structural toe deformities such as hammer toes or claw toes, which become prone to increased pressure.

Treating Corns

A qualified podiatrist can advise on the main reason why the corns have occurred and treat by removing corns painlessly and safely. If the cause of the corn is removed, i.e. shoe pressure or the feet realigned by Orthotic Therapy, then it may be possible to eradicate the corns permanently.

Self-treating with corn plasters

Corn plasters tend to be used by patients as a quick cheap way of pain relief with the belief that the corn will be gone permanently.

Corn plasters use acid to remove the corn and have traditionally been regarded as a temporary solution, with a visit to the podiatrist for gentle removal with a scalpel as the most effective.

I personally don’t recommend using corn plasters as I have seen all too often they cause more problems than help. Medicated corn plasters contain a caustic acid (salicylic acid) that causes tissue destruction by dissolving keratin (protein that makes up skin and corns) and can result in severe inflammation, sepsis and ulceration developing on the corn site. Corn plasters often can slip from the area of the corn (due to sweaty feet after a long day) to healthy skin and tissue and consequently burn off healthy skin.

If you are diabetic it is particularly important not to use corn plasters, but you should consult with your podiatrist regarding the treatment of corns. This is because most people do not realise that the medication they are taking can affect their circulation, and that the restrictions mentioned on the medicated corn plaster containers actually refer to them. Nevertheless, corn plasters can be obtained freely from chemists, and even specialist Foot Shops, without receiving any or very little advice.

A patient has kindly allowed me to show you what can happen when using corn plasters. She suffered with a corn between her toes, so she put on a corn plaster as best as she could. As you can see the corn plaster had shifted and caused tissue burning and damage. (The white area) To the left of the white area is where the original corn is seen. The patient had the corn plaster on for approximately 2 days, at which point she booked in to see me complaining that the toe was very sore and painful and was unable to wear shoes due to the pain. The patient was treated with sterile wound dressings to promote healing and the corn was removed. The patient in this case made a full recovery and conservative care treatment was the best option.

Corn Plaster Problem

Ways to Prevent Corns

There are many ways to prevent painful corns such as wearing:
– Well fitting shoes that are not tight around your foot and offer support and comfort
– Flat or low heeled shoes that prevent excessive forces being transferred to the balls of the feet
– Good fitting socks
– Using a moisturising foot cream daily to keep the skin soft and elastic
– Checking footwear for foreign bodies such as dirt and fine grit
– Orthotics can also be an option particularly if the cause is the inherent shape of your foot, they are fitted by a podiatrist and help balance the foot pressures, lower friction and lower chances of getting corns, so reducing pain overall and providing better foot function.

Atty Jhita, Podiatrist

 

Corn Treatment ...

Last April I ran my first full Marathon in London – here are my tips for novice Marathon runners

By Nicki Goodman, Sports Massage Therapist at The Mill Clinic

It wasn’t until I had a client in today who isn’t a regular runner for me to remember what it was to realise the enormity of the challenge it is to be a novice marathon runner. I remembered after the initial joy of getting in the London Marathon, then the rising panic of how on earth I was ever going to do it!

There is so much advice out there regarding how fast to run, what pace to run at, interval training, but when you are not a regular runner, that can all seem like jargon and isn’t easily understood.

So we sat down and started right at the beginning…..

Novice Runners

Shoes

Having the right trainers is vital. Making sure they fit correctly and are the right ‘gait’ for your running style. Having your gait tracked is when you go on a treadmill and someone watches you to see if you run neutral (your foot doesn’t twist in or outwards). If not they can give you insoles or different trainers to stop your foot rolling inwards (pronating) or outwards (supinating). This ensures that all the body is running in the correct positioning and not putting too much strain on the ankles, knees and hips.

Training Programme

Once you have the correct trainers its now about finding the right training programme to suit you. There is no point picking a programme that has you running 5 times a week if this isn’t going to fit into your lifestyle. You must be running about at least 3 times a week and the pace doesn’t matter or the distance to begin with it’s all about time out on your legs. It’s also a mental thing too. Knowing that you can run!!! There are some good free Apps that you can use to help get you started as well.

Once the first 3-4 weeks is under your belt now is the time to start marking the miles off. It’s really good to change speeds when you run. This is good to do on the shorter runs. This is called interval training. The speed work gives the body extra ability to accelerate up and down gradients and it’s also there to help with endurance. Increasing the speed up and down on the shorter miles will help with the distance when you are clocking up the 20-22 milers.

Stretching

Stretching is always a thing that I get asked about loads when people start running or upping the miles. Everyone seems to underestimate stretching. It should be a vital part of marathon training. The muscles are being worked so hard when running, and when we run lactic acid can build up in the muscles. Stretching helps to eliminate this and makes the muscles run freer. Freer muscles makes running easier and faster and stops the aches and pains after running and is the biggest prevention to injury. Stretching should be done only after running once the muscles are warm. You don’t stretch cold muscles. If you feel stiff and the need to stretch before a run then warm the muscles up first, run for 5 – 10 minutes and then stop and stretch and then start again. But stretching must take place at the end of the run. Stretch all the body, calf’s hamstrings, quadriceps and the upper back as sometimes our shoulders get tight when running for long distances.

Runner stretching

The most important thing is to enjoy your running as it takes up such a big part of your life for 4 months and at a time of year when the weather and darkness can make it seem like an even harder challenge. Although I personally love to run in the rain!

I know it’s easy to say at this stage but you will have a good happy marathon, but only if you have put in the training.

Nicki Goodman Sports Massage Therapist

Good luck!

Last April I ra ...

Why have I got back pain? I haven’t lifted anything heavy!

Mrs Drew (not her real name) came to see me with back pain but she couldn’t understand why she had it, as she was always active, and she hadn’t lifted anything heavy or from an awkward position recently. Yesterday she found it difficult to get out of bed and so decided to see me her local Osteopath.

Simply reaching for the remote control, or loading the dishwasher can bring on back pain or a muscle spasm. In fact I rarely see patients who come to see me with back pain as a direct result of lifting something heavy.

The only consistent reason for getting back pain is life – It happens!

Our backs take on life’s stresses and strains; we all get a degree of wear and tear especially as we get older, and the back can get progressively stiffer without us realising.

Lets face it, it’s hard to avoid. We sit at a desk or drive for long periods, we have manual jobs, accidents, do sports, DIY, have children…. the list is endless. Sometimes (although much less likely) the source of the back pain is genetic or due to a medical condition.

Most people will have back pain at some point in their lives. Full recovery varies from person to person; it can take days or weeks.

The majority of back pain we will all suffer at some stage is mechanical back pain with a pulled muscle or strained ligaments sometimes irritating the local nerves.

What are the symptoms?

  • Pain or ache.
  • Muscle spasm. If you are really unlucky the muscles may go into spasm and may be momentarily stuck half way between the washing machine and the sink! Try not to panic! Breathe deeply and find a safe confortable position.
  • Pain that is felt anywhere from buttock to the big toe and sometimes numbness and tingling in legs and feet. This is called sciatica and is caused by irritation of the sciatic nerve.

What can be done to help? 

Stay active: There is good evidence that gentle activity speeds up recovery and prevents the pain from getting persistent. The back likes movement so it is good to return to normal activities as soon as you are able. However, don’t try to beat the pain with an activity that makes it worse. Instead, adjust what you are doing or change position for while to see if that helps. Strike a balance between rest and activity taking breaks and acknowledging that things may take longer to do.

Cold Pack: A cold pack (or frozen peas wrapped in a tea towel) can provide short-term pain relief. Apply on the sore area for up to 15 minutes, every few hours, or more often but the area must warm up in between sessions with gentle movements.

Medication: Talk to your GP or pharmacy about painkillers or anti-inflammatories. Do take them as prescribed. Don’t wait for the pain to get out of control before taking them as they may help you regain your movements more comfortably.

Osteopathy: If your back pain is affecting your activity and is persisting, or you need some help in relaxing and improving the flexibility of the muscles and managing the pain see a physical therapist such as an Osteopath. Osteopaths can provide a variety of treatments to enhance recovery, help you understand your problem, and give advice on how you can prevent back problems returning in the future.

Getting moving  

Gradually increase physical activities progressively, start with some walking and simple stretching exercises which will help restore movement and prevent back stiffness.

Activity is helpful too much rest is not! Getting stiff muscles and joints moving is often uncomfortable to start with but becomes easier as you regain flexibility. However, any activity should not cause pain that lingers.

As well as walking, stretching (including Yoga or Pilates) and swimming are good whole body activities that will get you moving. When the back pain calms down don’t stop the exercise make them part of your normal day to help prevent further back problems at a later date. Little and often is much better than a couple of hours one day at the weekend. 

Simple backstretches:

Here are some simple backstretches to start you off. Perform each exercise gently and slowly, only moving as far as feels confortable. Practice each exercise 2 or 3 times a day. Increase the intensity gradually.

Chair Stretch

Sit on a firm seat chair, lean forward with your elbows on your knees, count to 10, and then sit up do this 3 times. Open your knees and now go down again on your elbows then reach to the floor between your knees, hold for a count of 10 come up to sitting position by tensing your stomach muscles, repeat another 3 times.

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Lying Stretches – Lying on your back with knees bent:

  • Knee Hug – Bring (hug) your knees in towards your chest keeping the knees apart. Hold for a count of 10 and repeat 5 times. If very painful do one leg at a time then do both legs together.

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  • Rotations – Keeping your knees bent gently roll your knees to one side getting as close to the floor as possible hold for count of 10. With the hand closest to the knee try to push it further to the floor, the opposite arm is stretched out along the floor as far as possible. Repeat on the other side. Do this 2 more times each side.

Back Rotation

 

The following symptoms are very rare, but if you do suddenly develop any of them you should consult your doctor straightaway.

  • Difficulty passing or controlling urine.
  • Numbness around your back passage or genitals
  • Numbness, pins and needles or weakness in both legs (not just one).
  • Unsteadiness on your feet.

If symptoms are not improving within a week or two, you should consider seeing our Osteopaths Debbie Crumpton or Shelley Machin for advice and treatment. Call today 01322 864499, or book online.

Why have I got ...

Diabetes – Why is foot care so important

Diabetic Foot Check

Atty our podiatrist at The Mill Clinic explains why looking after your feet is so important when you have Diabetes, and provides tips on how to care for them.

Over time, diabetes can cause you to lose feeling in your feet. Diabetes also can lower the amount of blood flow in your feet. Numbness and less blood flow in the feet can lead to foot problems.

When you lose feeling in your feet you may not realise when you have cuts and sores and the reduced blood flow to the feet will significantly slow the healing process.

Foot care is very important for all people with diabetes, but even more so if you have:

• pain or loss of feeling in your feet (numbness, tingling)

• changes in the shape of your feet or toes

• sores, cuts, or ulcers on your feet that do not heal

If you take care of your feet every day, you can lower your chances of losing a toe, foot, or leg. Managing your blood sugar can also help keep your feet healthy.

It’s important to see your Diabetic nurse and Podiatrist regularly.

 1. Check your feet every day.

 

Check your feet for cuts, sores, red spots, swelling, and infected toenails. You may have foot problems, but feel no pain in your feet.

Check your feet each evening when you take off your shoes.

If you have trouble bending over to see your feet, use a mirror to help.

2. Wash your feet every day.

Wash your feet in warm, not hot, water. Do not soak your feet because your skin will get dry.

3. Keep the skin soft and smooth.

Rub a thin coat of lotion, cream on the tops and bottoms of your feet. Do not put lotion or cream between your toes because this might cause an infection.

4. If you can see, reach, and feel your feet, trim your toenails regularly.

If you cannot see, reach or feel your feet or have thick yellowed or ingrowing toenails come and see me (Atty).

5. Wear shoes and socks or tights at all times.

Do not walk barefoot when indoors or outside. It is easy to step on something and hurt your feet. You may not feel any pain and not know that you hurt yourself.

Make sure you wear socks, or tights with your shoes to keep from getting blisters and sores. Choose clean, lightly padded socks that fit well. Socks that have no seams are best.

Check inside your shoes before you put them on. Make sure the lining is smooth and that there are no objects in your shoes.

Wear shoes that fit well and protect your feet.

6. Keep the blood flowing to your feet.

Put your feet up when you are sitting.

Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to help blood flow in your feet and legs.

Do not cross your legs for long periods of time.

Do not wear tight socks, elastic, or rubber bands around your legs.

Be More Active!

If you have any questions or need an appointment call 01322 864499

Diabetes – ...
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