Sports Injuries
03.18.09
Torn Muscles
Where muscle fibres are torn the damaged tissues ‘leak’ histamine and this chemical draws fluid to it then slightly thickens it to stop it moving and stabilise the fluid in the area. This is the typical puffy oedema one sees round a twisted ankle, this is a pretty effective splint supporting the damaged tissues. At the same time the remaining undamaged muscle fibres in the area go into spasm again to protect the damaged tissues and prevent us from overloading them and thus further damaging them.So as a Therapist the first thing we do is drain the fluid and remove the spasm. This encourages the flow of fluids in the damaged tissues and allows them to heal faster. However since the patient is in less pain and being highly motivated to do their job they may ignore gentle advice to take it easy for a while. So we must be firm, the patient must not do further damage by heavy or prolonged use.
Contrast bathing will then speed the healing, but only speed it not reduce the pain. Again the patient needs to realise all of this, so direct them to these pages.
Once you have it Contrast Bathing [Q.V.] and the application of anti-inflammatories are going to be helpful but remember you also need to See Your Therapist, preferably me.
Tennis & Golfer’s Elbow , Carpal Tunnel Syndrome , Repetitive Strain Injury , Frozen Shoulder, , Plantarfascitis , Tendinitis,
Groin Strains, Pulled Hamstrings.
All of these are basically different combinations of the conditions listed below in different joints or areas of the body, all include to varying degrees inflammation and all are painful. Though they are recognised ‘conditions’ most of them can have totally different causes producing the symptoms which give them their name and since the cause may be totally different in two people with the same ‘condition’ so the treatment may need to be very different though it may share elements where both causes have produced the same symptoms, e.g. inflammation.
For what a patient can do about Sports Injuries go to Sports Injury Treatment. Ganglion , Tenovaginitis , Bursitis , Tenoperiositis , Tendinitis , Knee Problems .
Often these injuries occur at the same time as each other so after a particularly nasty accident a groin strain and hamstring injury with a broken bone and massive tendon and muscle damage. The patient may only be told of the broken bone.
A sprained ankle and the patient is told ‘torn ligaments’, when there are several torn ligaments possibly with some cartilage damage suspected, a small chip in a bone and massive tendon and muscle damage.
In the arm frozen shoulder, R.S.I. and carpal tunnel will cause pain in the affected forearm, often this is in both since, as pain develops in one arm, we start to use the other hand for those jobs which hurt and so develop a similar problem in both arms at once. They can cause stiffness, pain, pins & needles, numbness, swelling in the forearm, the shoulder and the neck. In the hand a loss strength and of dexterity are common symptoms. In severe cases the hand may at times develop black patches and the pain is often so severe that the patient cannot sleep. For all these conditions rest from the actions that are causing the problem is imperative.
When they occur in the leg the names change to Sprained ankle, Plantarfasciaitis, Baker’s Cyst, Groin strain, Hamstring injury, etc: however they show similar symptoms.
All of these can be and most are caused by subluxation of a joint. That is to say the bones are misaligned either having slipped or twisted out of their correct alignment which causes a joint capsule entrapment and that provokes a muscle spasm and sometimes damage to the joint or the bone as well as the capsule. In combination and singly these all cause inflammation, and that will not subside permanently until all the other problems have been rectified. But the inflammation itself prevents the body rectifying the other problems which is why a therpaist is needed.
Musculo / Skeletal / Lymphatic Therapy is a safe, gentle and almost painless Advanced Massage Technique to release these tissues and so long as there has been no irreparable damage to the tissues they will normally heal and require no further treatment, thus relieving the symptoms. ARTHRITIS
Osteoarthritis is often the result of capsule entrapment wearing away the bone.
When a badly worn joint has associated capsule entrapment it is usually put down to entrapment happening subsequent to wear, not as the cause. However the soft tissue of the joint capsule wears away the bone. If you have difficulty with the idea of soft tissues wearing less rapidly than hard ones think of that ring on your finger. Any Jeweller will tell you that the ring will wear away from the inside but you know the finger wll not suffer any wear from the ring after fifty years; the ring though will become so thin in that time that it will need resetting.
Musculo / Skeletal / Lymphatic Therapy using mobilisation, a gentle Advanced Massage Technique releases the entrapment and, if caught in time, allows the body to heal itself.
Ganglion
This is caused by an inflammation in the tendon sheath which sticks the sheath to the tendon and then on a larger movement the tendon turns the sheath slightly inside out. Since the inside then does not have the support of the retinaculum it bulges. So it looks like a fluid filled little sack under the skin on the back of the hand or on top of the foot.
The folk lore cure of hitting it with a bible works by bursting the lining of the sheath. Obviously not a clever idea. The best method is to remove the inflammation and hope that the sheath lining will return inside the sheath. Of itself this condition is not serious even if it persists but it is an indication that the internal lining of the tendon sheath is inflamed and so can be an early warning of Tenovaginitis.
If treated within a day or two it is usually possible to reduce this by returning the lining inside the sheath.
Tenovaginitis
Tendons sometimes pass beneath sheets of fascia called retinaculum at the wrist and ankle where the direction of movement of the contracting muscle is altered. To prevent chaffing here they pass through a specially adapted tube of fascia called tendon sheath. These sheaths are lubricated by synovial fluid.
Inflammation of a tendon sheath. Often becomes long -term.
During the early phase there will be pain and sometimes crepitus (a kind of jerking of the movements of the joint) during and after exercise with swelling.
If it becomes long term initial pain disappears during the warm up; but impaired function; swelling and sometimes calcification (bone formation within the damaged tissues) can result. Rest is imperative. This is a serious condition.
Treatment in the acute phase is RICE and then contrast bathing, followed by gradual stretching as the inflammation goes. In long term conditions it is best to break down scar tissue if possible.
On top of the foot consider tight shoe laces and methods of easing this. Under the foot, heel lifts may help or full orthotics.
At the wrist the most common cause is repetitive small movements, occasional larger ones should help relieve some of the symptoms.
Determining the cause and removing that are much the best way of dealing with these problems however that is often nigh on impossible.
This condition needs correct treatment from the early stages and should be taken very seriously.
Bursitis
Bursae occur round a joint where there is a chance of wear between bones and soft tissues which would be damaged by that wear. The bursae are simply small fluid filled sacks that allow movement between adjacent tissues without friction. Overuse especially under pressure can cause an inflammation on the inside of the sac, Bursitis.
Inflamed bursae tend to have specific names. Baker’s Cyst, Housemaid’s Knee, Carpet-layer’s Knee, Student’s Elbow.
Much the most common cause of Bursitis is friction. This causes the bursae to become inflamed and swell Symptoms are as for all inflammations, but if the bursae only is involved it may be localised. Bursitis gets worse with use.
Treatment is RICE. but here the compression is more important, and clearly must be within pain barriers. Then contrast bathing.
Other causes of bursitis are tendons being inflamed over them and the condition spreading to the bursae.
Sceptic bursitis is when infection has found its way into the bursae, if this is suspected go straight to a Doctor.
Tenoperiositis
Inflammation of the tendon bone junction.
This is slow to heal since the area involved does not have a good supply of blood. Under ideal circumstances six to eight weeks, but often the injury will be aggravated long before that time has elapsed.
Common sites for this are the elbow, Golfer’s/Tennis elbow; the heel at the attachment of both the Achilles tendon and the plantar fascia; the knee where the tendon attaches above and below the patella; the groin where the adductor longus attaches to the pubic bone.
Treatment is initially RICE but after the first 48 hours I consider contrast bathing to be better than ice and some recommend heat.
This problem often leads to a small part of the bone becoming detached and since damaged bone grows to try to re-attach itself a spur formation grows, with runners this on the Achilles tendon interferes with the heel of the running shoe and the shoe inflames the spur. Another vicious circle and trying to get a runner to take a long enough break from their sport to allow the required healing means that this condition commonly becomes a long term problem.
Tendinitis
Inflammation of a tendon. Often becomes long-term. As above taking the require rest from activity is often almost impossible.
Treatment is RICE and thencontrast bathing.
Whiplash, Migraines & Headaches
These are difficult, because by far the most common cause of migraines that I see is a whiplash injury to the neck, often many years old.
95% of the British live with their heads thrust un-naturally and unhealthily forward from the ripe old age of 15.
That can’t be right can it?
Try people watching on a street corner, preferably with a nice unholistic cup of caffeine to hand. I think you’ll find it is.
All the under 10’s walk by with their ear over their shoulder / hip / knee / ankle, poised and balanced, aren’t they just beautiful. At 15 along come Exams and suddenly the head moves forward, off balance as we thrust forward into life and responsibility, determined to ‘Get there’..
So from 15 to 75, 60 years, C1 is held in a position as though we were constantly looking up trying to correct this thrusting neck position.
Here all I have done is isolate the head and neck photographically and move it back into its correct position for balance, [i.e. good posture].
As you can see with the neck straight and the head in its correct position over the torso, the top of the neck and head meet at an appalling angle and effectively the patient and most of us, walk round with our head in a position that is constantly looking up at the sky; this, because of the shape of the joints, is an insecure position and means that the skull is more likely to move out of alignment on the atlas.
Also quite clearly it is rounding the upper back and transferring the weight of the head into the chest at an appalling angle.
That is even more apparent in these ‘before and afters’ where I taught the patient’s to move their head back into a balanced position and they have corrected their load bearing posture automatically, the shoulders are lifted and the upper back is no longer overloaded and rounded.
Which for the gentleman means the weight of his head is over his torso not in front of his chest.
The young Lady has another most interesting problem which is more apparent with her head forward [the before] in these pictures and that is that her upper spine is flattened where she came off a horse and landed on her back. If you compare her spine to that of the other lady or the gentleman you can clearly see this problem.
If you want to know more about this and why it matters go to Flattening of the Upper Spine
Going back to our subject of whiplash, modern cars have fantastically efficient brakes and if applied suddenly they are now powerful enough to cause a violent enough movement of the head to an unprepared passenger to cause a whiplash.
I suspect this combination of poor posture and effective but vicious brakes can cause whiplash not only to a passenger who is not expecting it but even to a driver who is and definitely a surprisingly small bump will cause it to the driver. For these reasons the major problem after traffic accidents is whiplash.
Generally this goes unsuspected for years so is the underlying cause of many and many a migraine and repeating headaches; as well as causing neck, shoulder and arm pain.
Why aren’t you told all this at the Hospital? A very good question, but is immediately after an accident the time to correct your posture?
My own view is that this is something our gym teachers ought to be trained to do.
Oh dear. I feel a headache coming on.
Fortunately it takes no more than twenty minutes to correct and can be done safely and painlessly using gentle massage techniques. MUSKELYM being the method of choice for its simplicity, gentleness and effectiveness.
So increasingly caused by traffic accidents whiplash uncorrected often (not always) causes headaches and migraines. Basically the bottom of the skull is pretty flat with a couple of lumps on it and the first vertebra is a bar with a couple of dimples in it. Whiplash occurs when the lumps come out of their dimples.
As you can see here [ click the picture to enlarge] this is likely to interfere with the flow of blood to and from the brain by kinking the soft walled tubes that carry the blood to or from the hind part of the brain, a bit like kinking a hose. In a hose the water pressure behind the kink goes up enormously and beyond it drops to next to nothing.
Fortunately these tubes feed into and form a loop from one side to the other so in the majority of cases when one side is kinked the other is still functioning and takes up the difference.
However if the arteries are kinked then an empty headed ‘swimming around’ feeling is induced through a lowering of the presasure and if the veins are blocked then a ‘pressure’ headache is induced.
Musculo / Skeletal / Lymphatic Therapy uses safe, gentle Advanced Massage Techniques to correct the subluxation and that usually allows the body to heal itself.
This is done generally by the therapist holding the head still while the Patient tries to turn their head. Since the head cannot turn the muscles turn the vertebra correcting the alignment.
However one could never assume this to be the cause until one has established the subluxation of the cervical vertebrae and the Atlas in particular.
To do this takes training and reducing this problem safely without recourse to manipulation is a skill not easily acquired. Even if one achieves this not all patients will have their problem resolved. Some migraine sufferers do not have a whiplash injury, whilst others have but this is not the only cause of their problem, so resolving it may well not solve their problem and yet others have a whiplash, but this does not even contribute to the problem. You can also see from this diagram that the artery and vein taking blood to and from the back of the brain both pass through holes in the wings of the vertebrae and so any misalignment in them will probably have a deleterious effect, a bit like stepping on a hose.
In my experience reducing a whiplash injury resolves the problem entirely for only 70% of sufferers. As with so much in this work we have to settle for less than we would like.
What can a patient do for themselves? In this case the complexity of the problems means that the only help is from a professional therapist and Osteopathy I would suggest is going to be the method of choice for those who can not get to me. Repetitive Strain Injury & Carpal Tunnel Syndrome
Unfortunately these two conditions are extremely common for Massage therapists to develop (up to 80% in some studies) and that fact is an absolute condemnation of the teaching and examining of Massage therapists. To compound which a brilliant massage technique was developed by an internationally renowned therapist to enable Masseurs with this problem to continue working despite it.
These problems are largely due to bad posture and working practices.
To correct these problems subluxation of the joints at the wrist and sometimes the elbow needs to be reduced and thereafter contrast bathing and rest are advisable.
For what a patient can do about Sports Injuries go to Sports Injury Treatment. Ganglion , Tenovaginitis , Bursitis , Tenoperiositis , Tendinitis , Knee Problems .
Often these injuries occur at the same time as each other so after a particularly nasty accident a groin strain and hamstring injury with a broken bone and massive tendon and muscle damage. The patient may only be told of the broken bone.
A sprained ankle and the patient is told ‘torn ligaments’, when there are several torn ligaments possibly with some cartilage damage suspected, a small chip in a bone and massive tendon and muscle damage.
In the arm frozen shoulder, R.S.I. and carpal tunnel will cause pain in the affected forearm, often this is in both since, as pain develops in one arm, we start to use the other hand for those jobs which hurt and so develop a similar problem in both arms at once. They can cause stiffness, pain, pins & needles, numbness, swelling in the forearm, the shoulder and the neck. In the hand a loss strength and of dexterity are common symptoms. In severe cases the hand may at times develop black patches and the pain is often so severe that the patient cannot sleep. For all these conditions rest from the actions that are causing the problem is imperative.
When they occur in the leg the names change to Sprained ankle, Plantarfasciaitis, Baker’s Cyst, Groin strain, Hamstring injury, etc: however they show similar symptoms.
All of these can be and most are caused by subluxation of a joint. That is to say the bones are misaligned either having slipped or twisted out of their correct alignment which causes a joint capsule entrapment and that provokes a muscle spasm and sometimes damage to the joint or the bone as well as the capsule. In combination and singly these all cause inflammation, and that will not subside permanently until all the other problems have been rectified. But the inflammation itself prevents the body rectifying the other problems which is why a therpaist is needed.Musculo / Skeletal / Lymphatic Therapy is a safe, gentle and almost painless Advanced Massage Technique to release these tissues and so long as there has been no irreparable damage to the tissues they will normally heal and require no further treatment, thus relieving the symptoms. ARTHRITIS
Osteoarthritis is often the result of capsule entrapment wearing away the bone.
When a badly worn joint has associated capsule entrapment it is usually put down to entrapment happening subsequent to wear, not as the cause. However the soft tissue of the joint capsule wears away the bone. If you have difficulty with the idea of soft tissues wearing less rapidly than hard ones think of that ring on your finger. Any Jeweller will tell you that the ring will wear away from the inside but you know the finger wll not suffer any wear from the ring after fifty years; the ring though will become so thin in that time that it will need resetting.
Musculo / Skeletal / Lymphatic Therapy using mobilisation, a gentle Advanced Massage Technique releases the entrapment and, if caught in time, allows the body to heal itself.
Ganglion
This is caused by an inflammation in the tendon sheath which sticks the sheath to the tendon and then on a larger movement the tendon turns the sheath slightly inside out. Since the inside then does not have the support of the retinaculum it bulges. So it looks like a fluid filled little sack under the skin on the back of the hand or on top of the foot.
The folk lore cure of hitting it with a bible works by bursting the lining of the sheath. Obviously not a clever idea. The best method is to remove the inflammation and hope that the sheath lining will return inside the sheath. Of itself this condition is not serious even if it persists but it is an indication that the internal lining of the tendon sheath is inflamed and so can be an early warning of Tenovaginitis.
If treated within a day or two it is usually possible to reduce this by returning the lining inside the sheath.
Tenovaginitis
Tendons sometimes pass beneath sheets of fascia called retinaculum at the wrist and ankle where the direction of movement of the contracting muscle is altered. To prevent chaffing here they pass through a specially adapted tube of fascia called tendon sheath. These sheaths are lubricated by synovial fluid.
Inflammation of a tendon sheath. Often becomes long -term.
During the early phase there will be pain and sometimes crepitus (a kind of jerking of the movements of the joint) during and after exercise with swelling.
If it becomes long term initial pain disappears during the warm up; but impaired function; swelling and sometimes calcification (bone formation within the damaged tissues) can result. Rest is imperative. This is a serious condition.
Treatment in the acute phase is RICE and then contrast bathing, followed by gradual stretching as the inflammation goes. In long term conditions it is best to break down scar tissue if possible.
On top of the foot consider tight shoe laces and methods of easing this. Under the foot, heel lifts may help or full orthotics.
At the wrist the most common cause is repetitive small movements, occasional larger ones should help relieve some of the symptoms.
Determining the cause and removing that are much the best way of dealing with these problems however that is often nigh on impossible.
This condition needs correct treatment from the early stages and should be taken very seriously.
Bursitis
Bursae occur round a joint where there is a chance of wear between bones and soft tissues which would be damaged by that wear. The bursae are simply small fluid filled sacks that allow movement between adjacent tissues without friction. Overuse especially under pressure can cause an inflammation on the inside of the sac, Bursitis.
Inflamed bursae tend to have specific names. Baker’s Cyst, Housemaid’s Knee, Carpet-layer’s Knee, Student’s Elbow.
Much the most common cause of Bursitis is friction. This causes the bursae to become inflamed and swell Symptoms are as for all inflammations, but if the bursae only is involved it may be localised. Bursitis gets worse with use.
Treatment is RICE. but here the compression is more important, and clearly must be within pain barriers. Then contrast bathing.
Other causes of bursitis are tendons being inflamed over them and the condition spreading to the bursae.
Sceptic bursitis is when infection has found its way into the bursae, if this is suspected go straight to a Doctor.
Tenoperiositis
Inflammation of the tendon bone junction.
This is slow to heal since the area involved does not have a good supply of blood. Under ideal circumstances six to eight weeks, but often the injury will be aggravated long before that time has elapsed.
Common sites for this are the elbow, Golfer’s/Tennis elbow; the heel at the attachment of both the Achilles tendon and the plantar fascia; the knee where the tendon attaches above and below the patella; the groin where the adductor longus attaches to the pubic bone.
Treatment is initially RICE but after the first 48 hours I consider contrast bathing to be better than ice and some recommend heat.
This problem often leads to a small part of the bone becoming detached and since damaged bone grows to try to re-attach itself a spur formation grows, with runners this on the Achilles tendon interferes with the heel of the running shoe and the shoe inflames the spur. Another vicious circle and trying to get a runner to take a long enough break from their sport to allow the required healing means that this condition commonly becomes a long term problem.
Tendinitis
Inflammation of a tendon. Often becomes long-term. As above taking the require rest from activity is often almost impossible.
Treatment is RICE and thencontrast bathing.
Whiplash, Migraines & Headaches
These are difficult, because by far the most common cause of migraines that I see is a whiplash injury to the neck, often many years old.
95% of the British live with their heads thrust un-naturally and unhealthily forward from the ripe old age of 15.
That can’t be right can it?
Try people watching on a street corner, preferably with a nice unholistic cup of caffeine to hand. I think you’ll find it is.
All the under 10’s walk by with their ear over their shoulder / hip / knee / ankle, poised and balanced, aren’t they just beautiful. At 15 along come Exams and suddenly the head moves forward, off balance as we thrust forward into life and responsibility, determined to ‘Get there’..
So from 15 to 75, 60 years, C1 is held in a position as though we were constantly looking up trying to correct this thrusting neck position.
Here all I have done is isolate the head and neck photographically and move it back into its correct position for balance, [i.e. good posture].
As you can see with the neck straight and the head in its correct position over the torso, the top of the neck and head meet at an appalling angle and effectively the patient and most of us, walk round with our head in a position that is constantly looking up at the sky; this, because of the shape of the joints, is an insecure position and means that the skull is more likely to move out of alignment on the atlas.
Also quite clearly it is rounding the upper back and transferring the weight of the head into the chest at an appalling angle.
That is even more apparent in these ‘before and afters’ where I taught the patient’s to move their head back into a balanced position and they have corrected their load bearing posture automatically, the shoulders are lifted and the upper back is no longer overloaded and rounded.
Which for the gentleman means the weight of his head is over his torso not in front of his chest.
The young Lady has another most interesting problem which is more apparent with her head forward [the before] in these pictures and that is that her upper spine is flattened where she came off a horse and landed on her back. If you compare her spine to that of the other lady or the gentleman you can clearly see this problem.
If you want to know more about this and why it matters go to Flattening of the Upper Spine
Going back to our subject of whiplash, modern cars have fantastically efficient brakes and if applied suddenly they are now powerful enough to cause a violent enough movement of the head to an unprepared passenger to cause a whiplash.
I suspect this combination of poor posture and effective but vicious brakes can cause whiplash not only to a passenger who is not expecting it but even to a driver who is and definitely a surprisingly small bump will cause it to the driver. For these reasons the major problem after traffic accidents is whiplash.
Generally this goes unsuspected for years so is the underlying cause of many and many a migraine and repeating headaches; as well as causing neck, shoulder and arm pain.
Why aren’t you told all this at the Hospital? A very good question, but is immediately after an accident the time to correct your posture?
My own view is that this is something our gym teachers ought to be trained to do.
Oh dear. I feel a headache coming on.
Fortunately it takes no more than twenty minutes to correct and can be done safely and painlessly using gentle massage techniques. MUSKELYM being the method of choice for its simplicity, gentleness and effectiveness.
So increasingly caused by traffic accidents whiplash uncorrected often (not always) causes headaches and migraines. Basically the bottom of the skull is pretty flat with a couple of lumps on it and the first vertebra is a bar with a couple of dimples in it. Whiplash occurs when the lumps come out of their dimples.
As you can see here [ click the picture to enlarge] this is likely to interfere with the flow of blood to and from the brain by kinking the soft walled tubes that carry the blood to or from the hind part of the brain, a bit like kinking a hose. In a hose the water pressure behind the kink goes up enormously and beyond it drops to next to nothing.
Fortunately these tubes feed into and form a loop from one side to the other so in the majority of cases when one side is kinked the other is still functioning and takes up the difference.
However if the arteries are kinked then an empty headed ‘swimming around’ feeling is induced through a lowering of the presasure and if the veins are blocked then a ‘pressure’ headache is induced.
Musculo / Skeletal / Lymphatic Therapy uses safe, gentle Advanced Massage Techniques to correct the subluxation and that usually allows the body to heal itself.
This is done generally by the therapist holding the head still while the Patient tries to turn their head. Since the head cannot turn the muscles turn the vertebra correcting the alignment.
However one could never assume this to be the cause until one has established the subluxation of the cervical vertebrae and the Atlas in particular.
To do this takes training and reducing this problem safely without recourse to manipulation is a skill not easily acquired. Even if one achieves this not all patients will have their problem resolved. Some migraine sufferers do not have a whiplash injury, whilst others have but this is not the only cause of their problem, so resolving it may well not solve their problem and yet others have a whiplash, but this does not even contribute to the problem. You can also see from this diagram that the artery and vein taking blood to and from the back of the brain both pass through holes in the wings of the vertebrae and so any misalignment in them will probably have a deleterious effect, a bit like stepping on a hose.
In my experience reducing a whiplash injury resolves the problem entirely for only 70% of sufferers. As with so much in this work we have to settle for less than we would like.
What can a patient do for themselves? In this case the complexity of the problems means that the only help is from a professional therapist and Osteopathy I would suggest is going to be the method of choice for those who can not get to me. Repetitive Strain Injury & Carpal Tunnel Syndrome
Unfortunately these two conditions are extremely common for Massage therapists to develop (up to 80% in some studies) and that fact is an absolute condemnation of the teaching and examining of Massage therapists. To compound which a brilliant massage technique was developed by an internationally renowned therapist to enable Masseurs with this problem to continue working despite it.
These problems are largely due to bad posture and working practices.
To correct these problems subluxation of the joints at the wrist and sometimes the elbow needs to be reduced and thereafter contrast bathing and rest are advisable.