Blog

General Information about injuries, treatment and rehabilitation.

Efficacy of Strength Training on Fatigue and Performance in Patients with Multiple Sclerosis: A Systematic Review

Abstract

Background: Multiple sclerosis is a chronic debilitating condition, which can cause muscle weakness and fatigue. Exercise has often been thought of as contraindicated in Multiple Sclerosis (MS) sufferers. It is only recently been documented that there may actually be benefits to partaking in physical exercise. Objective: To determine the effect strength training has on fatigue and performance in patients with MS. Methods: A systematic review of the literature was conducted. Results: The review found positive evidence for the implementation of strength training to improve function and fatigue in patients with MS. Conclusion: Strong evidence exists for the use of exercise to treat MS symptoms, specific protocols and additional research looking at more disabling forms of MS are necessary to ensure the patient receives the best management.

Key Words: Multiple Sclerosis, Strength Training, Fatigue, and Resistance Training.

Efficacy of Strength Training on Fatigue in patients with Multiple Sclerosis SIS Site

Management of the Injured Tendon: Difficulties in Diagnosis and Treatment

Abstract

Background: Tendon injury is a painful and often debilitating affliction, which commonly presents to the sports medicine professional. Researchers have often struggled to determine the most appropriate way to manage this condition. Despite the plethora of literature on management strategies, there appears to be little stemming from sound scientific evidence. Objective: The aim of this is to identify studies that demonstrate a greater understanding of the pathophysiology of tendon injury and evaluate the most effective management strategies for this difficult condition. Methods: A systematic review of the literature was conducted. Results: The current review found support for the early use of corticosteroid injections, despite long term detrimental effects. The review also demonstrated exercise therapy designed to stretch and strengthen will be more effective in the long term. Conclusion: Individuals with tendinopathy should perform a regular strengthening and flexibility regime as early as possible. Patients with pain limiting daily activities may benefit from corticosteroids injections, to allow them to perform activities with reduced pain.

Management of the injured Tendon

Lumbar Sprain and Strain

What is it?

Muscular or ligamentous injuries to the lumbar spine can cause significant pain and or disability in the individual which could lead to pain in the legs. Understanding the extent of tissue damage depends on the grade to which damage has occurred.

Grade 1: can take approximately 7days to 4 weeks for full recovery

  • Simple sprain/strain with minimal dysfunction
  • Minimal fibre damage
  • Minimal loss of function and pain
  • Reduced range of motion

Grade 2: can take approximately 2 weeks to 1 year for full recovery

  • Moderate sprain/strain, partial tear
  • Moderate fibre damage, approximately half of fibres may be torn
  • Loss of function and significant pain
  • Typically as a result of sports injury, trauma or faulty lifting movements

Grade 3: may take 8 weeks to over a year to recover

  • Significant damage, complete rupture
  • Severe fibre damage
  • Significant function loss and pain
  • May need to consider surgical consultation

Sprains are classed as ligament injuries which are typically painful during active and passive range of motion, and generally exhibit little to no pain during muscle contraction. In strains muscles are usually painful during active range of motion and muscle contraction, passive range of motion is typically not painful unless stretching to end of range.

Causes

  • Direct trauma as a result of injury following a fall, impact during sport or car accident
  • Overuse: repetitive movements and sustained postures can weaken structures in the spine leading to possible tissue damage.
  • Postural: poor working postures can also cause structural imbalances which can lead to weaknesses which when performing daily or sporting activities may increase risk of injury.
  • Sudden unguarded movement: bending down to pick something up without using knees and core can increase the pressure on the spine, increasing the risk of spinal injury.
  • Muscle imbalance can predispose muscle/ligament injury due to poor movement patterns.
  • Previous injury can leave weakness in the area if correct rehabilitation protocols were not adopted.
  • Poor core musculature

Signs and symptoms

  • Pain in the lumbar spine with possible referred pain into the legs, pain can be unilateral or bilateral. Muscle spasm may be present as part of the bodies protective mechanisms. Pain may be a dull ache with sharp pain during movement.
  • Reduced mobility: stiffness in the lumbar spine as well as hip stiffness may be present.
  • Guarded movements: movement may be restricted, especially turning, twisting, getting into and out if a chair. Guarded movements typically occur due to pain, however these altered movement patterns can increase risk of muscle imbalance and further injury.
  • Local swelling
  • Tenderness on palpation

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce further stress on the lumbar spine. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from ice application (15mins every 2 hours) and some non-steroidal anti-inflammatory medication (NSAIDS). Once initial inflammation has subsided heat may be more beneficial to facilitate movement.
  • Initiation of flexibility and strengthening programmes for the core musculature as soon as the initial pain has subsided and movement is no longer guarded.
  • Hydrotherapy may be an option in the early stages to facilitate correct movement patterns without too much impact on the joints of the spine.

What can Sports Injury Scotland Do?

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with lumbar spine sprains and strains, increasing the mobility at the joints and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a safe return to activity. Postural education will help individuals with reducing the likelihood of recurrence. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Rotator Cuff Strain

What is It?

A rotator cuff strain is a sudden traumatic injury to one or a combination of the supraspinatus, infraspinatus, teres minor and subscapularis muscles and or tendons. prior history of impingement syndrome may be present, and can often be difficult to diagnose. injury to the rotator cuff musculature, typically follows a traumatic incident, which is usually a good way to differentiate between tendinopathy.

to determine the extent of muscle injury a grading system exists to assist in guiding the rehabilitation process:

  • Grade 1: Minimal fibre damage, slight strength loss, minimal pain and a reduction in the range of motion
  • Grade 2: Partial tear with moderate fibre damage, increased strength loss, the tear is often palpable.
  • Grade 3: Complete rupture, possibility of surgical management, individuals may have a complete loss of strength with marked dysfunction including the arm drop sign.

Causes

  • Unaccustomed overuse of the muscle/tendon unit following extended periods of home improvements (gardening, painting), sporting activity (Tournaments with multiple rounds), weight training.
  • A single violent blow to the shoulder, particularly in the mechanisms of abduction, external rotation and extension (pulling the arm back to throw) and or adduction, internal rotation or flexion (Empty can).
  • lifting or pulling something with significant weight.
  • Falling onto and outstretched hand
  • If you have suffered a previous impingement syndrome without adequate recovery.

Signs and Symptoms

An individual may experience immediate pain at the time of the injury, depending on the severity of the injury the individual may be able to continue the activity only for the pain to come back once activity has ceased. A popping or tearing sensation may be felt at the time of the injury. There will be associated pain and weakness felt in the shoulder with possible swelling and bruising.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the shoulder joint and rotator cuff musculature. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain and inflamation is present you may benefit from ice application and some non-steroidal anti-inflammatory medication (NSAIDS). initial immobilization of the shoulder joint may be necessary in grades 2 and 3.
  • Initiation of flexibility and strengthening programs for the shoulder muscles with particular focus on the rotator cuff muscles, focusing on building stability in the joint before looking at strength.
  • Evaluating any training errors, correct technique and checking use of appropriate equipment. posture education for desk based workers limit the risk of further weakness through faulty head and neck alignment.

*** Assessment of muscle damage by a qualified professional is essential to determine the extent of the injury and evaluate the best course of treatment, therapists at sports injury scotland will be able to evaluate your injury and guide you as to the best method of progression ***

What can Sports Injury Scotland do??

Correct diagnosis of a muscle injury will ensure the individual gains the most appropriate treatment strategy for their injury. management of a muscle injury will vary depending on the amount of tissue damage and also the individuals daily activities. Sports massage and mobilizations have been found to be an effective method of reducing the pain associated with rotator cuff tears, increasing the mobility at the joints and improving the muscles strength and flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure adequate recovery. Postural re education is essential to ensure correct movement patterns in the future. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Lateral Elbow Tendinopathy (Tennis Elbow)

What is it?

Lateral elbow tendinopathy is the most common cause of elbow pain, 7 times more than medial. Pain on the lateral aspect of the elbow, typically known as tennis elbow, has an insidious onset with early presentations of pain only posing a problem with aggravating activity. despite the term tennis elbow, research has suggested that 95% of individuals presenting with lateral elbow pain have never actually played tennis. The condition typically affects the extensor muscle group at the elbow (Extensor carpi radialis brevis, extensor digitorum and extensor carpi ulnaris), commonly due to repeated overload of the tendons without adequate recovery.

Causes

  • Overuse: a sudden change in training levels and/or loads can have a detrimental impact on the muscle. as well as training overuse, occupational stresses can place additional loads on the flexor musculature.
  • Change in training technique or equipment: in tennis a change or racquet, grip size, playing with a wet ball all has implications on the elbow joint.
  • Changes in work duties: additional typing or writing can increase the stress applied to the lateral tendon group.
  • Neck and thoracic dysfunction: previous or current neck and/or thoracic pain can refer pain into the elbow region.
  • Poor grip strength: poor strength and flexibility in the arm can predispose an individual to lateral elbow pain.

Signs and Symptoms

Individuals usually experience pain on the outside of the elbow, which in the early stages is only symptomatic following aggravating activity, which subsides following cessation of activity. When the issue is ignored the pain is felt in other times of daily life, and in severe cases the pain may keep the individual awake, have difficulty picking up normal items such as a mug, carrying shopping bags and certain movements may be an issue. performing daily activities i.e. work tasks, especially if there is a lot of computer work can become difficult. There may be associated neck and upper back pain, which may cause neural distribution symptoms.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the elbow joint and wrist extensor musculature. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain and inflammation is present you may benefit from ice application and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programs for the elbow muscular with particular focus on the extensor muscles, while incorporating flexor, supinator and pronator strength, training not only isometric strength but also looking at the control of movement under load. Focus on building stability in the joint before looking at strength.
  • In patients with associated neck and thoracic pain, mobilizations have been found to be an effective treatment strategy.
  • Evaluating any training errors, correct technique and checking use of appropriate equipment. posture education for desk based workers limit the risk of further weakness through faulty head and neck alignment.

*** Assessment of tendinopathies by a qualified professional is essential to determine the extent of the injury and evaluate the best course of treatment, therapists at sports injury scotland will be able to evaluate your injury and guide you as to the best method of progression ***

What can Sports Injury Scotland do??

Correct diagnosis of a tendinopathy will ensure the individual gains the most appropriate treatment strategy for their injury. management of tendinopathies will vary depending on the level of pain and dysfunction and also the individuals daily activities. Sports massage and mobilizations have been found to be an effective method of reducing the pain associated with lateral elbow tendinopathies, increasing the mobility at the joints and improving the muscles strength and flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure adequate recovery. Postural re education and technique evaluation is essential to ensure correct movement patterns in the future. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Cervicogenic Headache

What is it?

A cervicogenic headache is head pain which originates from the cervical spine. A complex musculoskeletal syndrome thought to be caused by abnormalities in the joints, muscles, fascia and nerves. Research suggests that this type of headache often goes untreated due to its often intermittent nature.

Causes

  • Prior neck trauma: any previous injury to the head or neck may predispose an individual to this type of headache, for example whiplash type injury as a result of a car accident. Improper management following these injuries could result in long term movement compensation patterns which could lead to chronic headaches.
  • Movement compensations: sustained postures associated with sitting at a computer for extended periods, playing computer games for extended periods, improper desk set up leading to forward head postures which increases the stresses on the joints ligaments and muscles leading to over activity. Repetitive movements of the head and neck can also lead to head pain, especially in jobs requiring excessive cervical extension (eg. painters)
  • Cervical joint dysfunction: joint stiffness and muscle weakness as a result of faulty movement patterns at work or in daily life. Imbalances can be developed over a long period causing weaknesses and poor muscular endurance in the cervical flexors and extensors.
  • Stress and tension due to work or home life can increase the tension on the neck and back musculature, which can increase the risk of sustaining headaches.

Signs and Symptoms

Diffuse dull ache which is typically located in the neck and occiput region, however in more chronic pain further referral into the forehead can occur. Pain experienced is usually unilateral (single side) and typically of gradual onset. A reduction in neck and shoulder range of motion is usually apparent. Individuals typically wake with a headache which can ease once up only to return later in the day. In the more chronic patient pain in the shoulder and arm may be apparent, however it doesn’t follow a typical distribution pattern.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the cervical spine. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from heat application and some non-steroidal anti-inflammatory medication (NSAIDS). It may be beneficial (when appropriate) to lie down when you are suffering from a headache, this will allow the cervical muscles time to relax.
  • Initiation of flexibility and strengthening programmes for the cervical flexors and extensors
  • Correcting any posture issues, ensure your desk set up is unique to you to avoid any unnecessary postures.

What can Sports Injury Scotland do?

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with Cervicogenic headaches, increasing the mobility at the joints and improving the muscles strength and flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure adequate recovery. Postural re education is essential to ensure correct movement patterns in the future. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Is Self Administered Proprioceptive Neuromuscular Facilitation (PNF) Stretching superior to Static Stretching at increasing Range of Motion and Flexibility?

An important component to overall fitness is good flexibility, which is the ability to move and bend joints through a full range of motion (ROM). Adequate flexibility allows minimal stress to be applied to joints, allowing them to function more efficiently. Research has documented many benefits to improved flexibility including a reduced risk of injury, performance improvements and improved coordination and stability. Many methods of stretching exist, however choosing the most appropriate is often challenging. Two common methods of improving ROM is by static stretching (taking the body into a position and holding for a prescribed timeframe) and PNF (Where a muscle is taken to end range and held, with intermittent isometric contractions, also known as hold-relax). PNF has always been thought of as time consuming due to the need of a partner to perform the exercises, however recently it has been suggested that self administered PNF may yield the same improvements as partner assisted PNF. A recent study by Wicke et al (2014) compared self administered PNF to static stretching to evaluate the effects on ROM and flexibility. The study included 19 healthy college aged individuals. Pre measurements of hip ROM (Gonniometer) and hip, back and shoulder flexibility (sit and reach test) were taken and retested post intervention. The participants were split into 2 groups (group 1: static stretching – 2x40sec holds and Group 2: PNF – 2x40sec holds with intermittent contractions) both groups stretched the hamstring muscle and completed 2xweekly for a period of 6 weeks. following the 6 weeks individuals had a 1 week break before switching protocols for another 6 weeks. The study found improvements in overall flexibility in both groups, however only the PNF group had significant improvements in hip ROM. the results of this study suggest that self PNF may be used in place of static stretching due to not requiring a partner. The study results, while interesting the individuals were under direct instruction with regard to protocol, therefore it may be difficult for an inexperienced individual to develop this technique, and as static stretching did improve overall flexibility levels, this method should not be overlooked. The study also utilised hamstring in the PNF group, inclusion of other muscles need to be examined before further conclusions can be made.

Wicke, J., Gainey, K. and Figueroa, M. (2014). A comparison of self administered proprioceptive neuromuscular facilitation to static stretching on range of motion and flexibility. Journal of Strength and Conditioning Research, 28(1), 168-172.

Can the inclusion of a plyometric training program improve performance in middle to long distance runners?

The importance for runners to achieve their personal best, whether this be in a quicker time or longer duration, how they get there has always led to much debate between runners, coaches and health professionals. The inclusion of strength training programs has been met with much resistance in the running community, with many runners fearing it will make them “too bulky” or it will “slow them down” with regard to maximal strength training where mass and strength are the main goal, this may be the case, however there are many ways to incorporate strength training into a schedule to actually enhance performance. A recent study by Ramirez-Campillo et al (2014) evaluated the effects of a 6-week plyometric training program on competitive middle to long distance runners. Participants were split into two groups (Group 1: Plyometric group performed 30mins 2x week of plyometric training alongside their normal training regime, and group 2: a control who continued training as normal). Prior to commencement of the 6 week intervention all individuals performed 4 athletic tests and were encouraged to perform all out. the plyometric group were then instructed on the plyometric drills. the groups were then retested at the end of the 6 weeks. The study found a significant improvement in performance in the plyometric group compared to the control (3x) in all 4 performance tests. the results of the Ramirez-Campillo et al (2014) study demonstrated that including as little as 60 mins of explosive strength training per week (i.e plyometrics) will have a positive impact on running performance without taking anything away from overall training intensity and frequency. the results of this study support the inclusion of a plyometric based intervention alongside a running schedule to improve performance, it is important to seek professional advice before beginning any form of strength training to ensure proper form, reducing the risk of injury.

Ramirez-Campillo, R., Alvarez, C., Henriquez-Olguin, C., Baez, E. B., Martinez, C., Andrade, D. C. and Izquierdo, M. (2014). Effects of plyometric training on endurance and explosive strength performance in competitive middle and long distance runners. Journal of strength and conditioning research, 28(1), 97-104

Foam Rolling during the warm up: an added benefit or waste of workout time?

Over the last decade self myofascial release has become a popular modality to relieve muscle soreness following exercise. Recently it has begun to appear in the warm up, with individuals postulating the potential benefits following the restoration of the normal length tension relationships. Despite the increase in popularity there appears to be a lack of clinical evidence to support the claims. A recent study by Healey et al (2014) evaluated the effects of myofascial release with foam rolling on performance, using healthy recreationally active (Exercises 3-5x week) college individuals. Participants were split into 2 groups (group 1: foam rolling for 30 secs each muscle group, and group 2: planking for the same time as the foam rolling group). Following warm up individuals performed 5 athletic tests and commented on levels of muscle soreness and fatigue. The study found no significant differences between both groups with respect to the 5 athletic tests, there was no improvement in performance found in either test group. with regard to levels of fatigue the foam rolling group noted significantly lower levels than the planking group. ultimately individuals are looking for the most effective way to improve performance, with regard to foam rolling it was not found to be of any additional benefit to performance, however if the individual is suffering from muscle soreness and fatigue the addition of foam rolling may give them a psychological edge, allowing them to perform a little longer during the session.

Healey, K. C., Hatfield, D. L., Blanpied, P., Dorfman, L. R. and Riebe, D. (2014). The effects of myofascial release with foam rolling on performance. Journal of Strength and Conditioning Research, 28(1), 61-68

Back and Core Stretching

Lower Back Stretch

Stretching should form an integral part of any training regime. Research suggests the best time to stretch is after exercise, making sure the muscles are warm. stretching a cold muscle can lead to potential muscle damage.

Attached is some stretches focusing on the main muscles of the Back and Core.

Back Stretching Program