Myofascial Release – an effective treatment for back pain for the sports person, athlete and performer
Osteoporosis – How to Prevent, Treat and Reverse it
Seven ways to promote your practice online
Myofascial Release – an effective treatment for back pain for the sports person, athlete and performer
The 2014 Commonwealth Games have come and gone and I have just finished my last shift at the athletes village Polyclinic providing massage and soft tissue therapy for the athletes for both pre and post competition.
Despite the range of sports involved from table tennis to hockey and from powerlifting to javelin, the most common area of the body that the athletes wanted treatment for was their low back and the backs of their legs.
Its very different working with athletes to those suffering chronic pain and yet both present with tight and stiff joints and muscles, but for very different reasons.
Athletes have trained hard and long and have well developed muscle tone and resilience, yet they can still have pain and dysfunction due to injury or from overuse. People suffering chronic pain can have pain from an injury as well as misuse, disuse and abuse of their body.
Athletes will try and train through the pain often creating more problems, whilst chronic pain clients give up very easily allowing their body to become chronically under toned which in turn creates its own myriad of symptoms.
Even though these two categories of people are very different, they can both be effectively treated with soft tissue and myofascial approaches.
Back pain can be anything from a twinge for a 24 to 48 hour period to a chronic condition over a number of months and even years. In many cases a visit to the GP will result in a referral to the local physiotherapy department with the label of ‘mechanical back pain’, anti-inflammatory medication and perhaps a referral to the pain clinic to ‘discuss’ the pain. In many cases rest and medication makes a huge difference but there are a growing number of the population that seek alternative treatments due to ongoing pain, loss of function and dissatisfaction with the traditional process.
It is reported that back pain is the second most occurring musculoskeletal condition in the UK that causes patients to seek medical attention from their GP, around 7 million visits per year with a cost to the NHS of just under £500 million (backpainexpert.co.uk).
Back pain is common across the population but for the sports person, athlete or performer, unless treated successfully, back pain can produce vulnerability; stiffness and guarding that will affect stability, function and ultimately performance.
Performers who sit or stand to play instruments or who play a more static acting role suffer due to prolonged periods without movement in isometric contraction in order to support their posture.
Sports people, athletes and dancers create pressure on certain muscle groups producing a repetitive strain and in many cases also without adequate warm up, cool down and stretch routine.
These people are prone to mechanical back issues and even intervertebral disc issues, nerve entrapment, functional scoliosis, tension and general myofascial pain syndromes.
Muscle mechanics
Postural muscles demand more oxygen to provide sustainability of bodily functions whilst phasic muscles prefer burning glucose for fuel. When tension, trauma and poor body mechanics reduce the amount of oxygen to the postural muscles they fatigue and the gravitational load shifts to the phasic musculature. Phasic muscles have a greater number of fast twitch fibres and do not respond well to prolonged overloading and begin to shift the load back to the already exhausted postural muscles. The fascial network around the muscles is then recruited to support creating a splinting effect cascading an insidious ‘creep’ throughout the entire network affecting every other cell in the body. Injured muscle cells break down causing a release of calcium and histamines. Calcium normally reacts with adenosine triphosphate (ATP) to produce muscle contraction promoting energy, however in already constricted tissue this combination further creates painful contraction and muscular spasm.
It is important with the sports person, athlete and performer to establish the mechanism of injury, ask them to show you how the pain occurred as well as the position(s) they adopt in their activity. It is also important to get an idea of the position they sleep in, what other activities they do as well as describing their regular routine for preparation of their activity. YouTube can be a valuable resource for viewing files of the activity to assess body mechanics.
The soft tissue and myofascial treatment
If we think of the fascial compartments and connections through the body plus the mechanical loading of the musculoskeletal structure within gravity, it is important that we remove the loading from the front of the body to alleviate the strain pattern on the back of the body. You can start by looking at the positioning of the psoas muscle as it attaches between the lumbar spine and the lesser trochanter. When this muscle is tight, it will pull the lumbar spine anterior creating a lordosis. Plus, a tight psoas will often create a side bend or hip hike at the lumbar spine as psoas laterally flexes the spine along with quadratus lumborum.
Even though I have mentioned these muscles, we must always remember that it is never simply one muscle, but numerous soft tissue structures (fascia, tendon, ligament and muscle), which are contributing to force transmission as well as working to provide both stability and mobility.
Due to the positioning of the lumbar spine it is never a good idea to initially lie someone prone and put pressure through his or her low back, this exaggerates the lumbar lordosis and can exacerbate pain. It is always better to start and treat the front of the body and work around the hip flexor area as well as treating the lateral low back areas as the lumbar fascia can become very tight and solid.
One of the models which we can use to understand pain and muscle imbalance is from the work of Vladamir Janda who was a Czech neurologist and physiatrist who specialised in the pathology and treatment of chronic musculoskeletal pain. Janda’s model is simply called upper cross and lower cross syndrome, where he views muscle imbalances from the front and back of the body where some are tight and facilitated and others (usually the antagonist) are weak and inhibited. Janda suggests that in lower crossed syndrome, the following muscles are tight and facilitated:
• iliopsoas
• rectus femoris
• TFL
• adductors
• erector spinae
• gastrocnemius and soleus
In comparison he suggests that the following muscles would be weak and inhibited:
• rectus abdominis
• oblique’s
• gluteus maximus
• gluteus medius
• hamstrings
This muscle imbalance often results in an anterior pelvic tilt and an increased lumbar lordosis (an exaggerated lumbar curve). The hips would be forced into slight flexion and the knees forced to lock into hyperextension, all creating pain and dysfunction.
If we start on the front and treat iliopsoas and the quadriceps muscle groups bilaterally, including their associated fascia, that will create a release of tension that pulls the low back forward. Treat everything on the front first before positioning the client on their side and treat their back musculature and fascial connections on each side. Follow this by laying the client prone and treat their legs, buttocks and back.
It is important to remember that muscles cannot function alone and that they are only a length of tissue within a far greater 3D fascial network. We must not blinker ourselves to focusing on any one part of the soft tissue network but instead feel and treat globally as the fascial web supports each muscle and fascia’s tension levels can overpower a newly treated muscle making your work useless. If the fascial compartment around a muscle is tight and that compartment is part of the whole body fascial network, then that particular muscle will struggle to perform what it is being asked to do. Very often, fascia, which is restricted and tight, will create an abnormal pull through its structures, which will affect muscle, and joint function anywhere along that line of pull. Therefore, whilst we can use Vladamir Janda’s approach, and many other models of soft tissue dysfunction, we must also be very aware that every muscle is supported, protected and encased in fascia and unlike muscle, fascia is one complete continuum throughout the body
Unlike muscle, the fascial network does not respond to firm pressure but instead enjoys both sustained gentle pressure as well as oscillatory approaches, compression and tangential sheer, all of which can be performed through the skilled touch of myofascial release.
As research increases into the fascial network we are learning more, almost everyday, which allows us to refine our touch and offer ideas and scope to enhance our treatments.
MFR UK has been delivering workshops for healthcare professionals for over 10 years and we dedicate ourselves to providing comprehensive and practice led hands-on workshops based on our own extensive myofascial training and clinical practice experience.
We offer an Advanced Clinical Diploma in Integrated Myofascial Therapy including workshops on fascial assessment, the integration of neuromuscular approaches and trigger point therapy, a variety of fascial techniques
and also myofascial rehabilitation, all of which can be immediately incorporated into your therapeutic practice.
Our workshops are accredited with the Federation of Holistic Therapists and the Sports Therapy Organisation.
Ruth Duncan, senior lecturer and director of MFR UK also presented the opening lecture for the very successful British Fascia Symposium, which was held in Windsor earlier this year.
Ruth is also the author of ‘A Hands on Guide to Myofascial Release’ published by Human Kinetics and is available from MFR UK via our website and will also be for sale on the MFR UK stand at camexpo.
Myofascial Release UK
www.myofascialrelease.co.uk
Email – info@myofascialrelease.co.uk
Tel – 0845 602 6274
Osteoporosis – How to Prevent, Treat and Reverse it
Osteoporosis is a major public health problem. Osteoporosis affects many more women than men – striking 1 in 2 women over the age of 50. And osteoporosis isn’t just a matter of brittle bones. It can kill. In fact it is a bigger female killer than ovarian, cervical and womb cancers combined.
But the biggest problem is that osteoporosis is so often a ‘silent disease’, bone loss happens gradually over time, without any symptoms. Osteoporosis, at the moment, remains woefully unrecognised and yet it is preventable and treatable.
What is Osteoporosis?
The word osteoporosis literally means ‘porous bones’ that is bone filled with tiny holes. Bones change constantly – being broken down and rebuilt. However, problems arise when the rate of renewal does not keep up with the rate of breakdown, the result being bone loss. When this continues over a period of years, osteoporosis occurs.
While osteoporosis is often thought of as an older woman’s disease, it can strike at any time; by about the age of 25 a woman should have acquired 98% of her bone mass. The bone density stabilises in her 30-40s and then starts to decline, with a more rapid decline around the menopause.
The biggest concern is for the next generation of girls, where many will not even reach their peak bone mass by the age of 25, because of lifestyle factors such as smoking, lack of exercise, poor diet (e.g. high intake of soft drinks) and controlling their weight because of media pressure to be stick thin.
Risk Factors
If a woman answers ‘yes’ to any of these below, then she should be tested for osteoporosis, as her risk can be higher:
• Does she have a family history of osteoporosis?
• Has she dieted in the past or suffered from bulimia or anorexia?
• Ever had irregular menstrual cycles?
• Is she post-menopausal?
• Has she taken steroids, heparin, anticonvulsants, diuretcis or long-term laxatives or antacids?
• Has she suffered from digestive problems such as Crohn’s, or Coeliac’s?
• Did she have a premature menopause before the age of 40?
• Is she or was she a smoker?
• Is she inactive?
Testing for Osteoporosis
These are the tests most commonly used to assess bone health.
1. DEXA Scan
A DEXA scan (Dual Energy X-ray Absorptiometry) is a machine that uses two X-ray energy beams simultaneously to measure bone density. It is the gold standard for accessing bone density.
2. Quantitative Ultrasound Scan (QUS)
In a QUS, sound waves are passed through the heel (calcaneus) bone which, like the hip and spine, is rich in trabecular bone. Research has shown that the QUS scans can predict those patients who subsequently go on to have a fracture as well as DEXA scans (Stewart A et al, 2006, Long term fracture prediction by DXA and QUS: a 10 year prospective study, J Bone Miner Res, 21, 413-18).
3. Bone Turnover
Another way of assessing bone health is to measure biochemical markers in urine that show the rate of bone resorption. Research has shown that in postmenopausal women osteoporosis levels of bone resorption markers above the upper limit of the range are associated with an increased risk of hip, vertebral and nonvertebral fractures, independent of bone mineral density (Ganero P, 2008, Biomarkers for osteoporosis management: utility in diagnosis, fracture risk prediction and therapy monitoring, Mol Diagn Ther, 12, 3, 157-70).
Markers of bone turnover can also be used to predict the rate of bone loss in post-menopausal women and also be used to assess the risk of fractures. Research suggests that markers of bone turnover appear even more strongly associated with fracture risk than bone mineral density. (Eastell R, Hannon RA, 2008, Biomarkers of bone health and osteoporosis risk, Proc Nutr Soc, 67, 2 157-62).
Nutrition and Osteoporosis
Scientists have looked at women and the incidence of hip fractures in different countries. The highest rate of hip fractures is found in Western countries that consume high amounts of animal protein per day. The lowest incidence occurs in Asian and African populations in which animal protein intakes are much lower (Frassetto LA et al, 2000, Worldwide incidence of hip fractures in elderly women: relation to consumption of animal and vegetable foods, J Gerontol A Biol Sci Med Sci, 55, 10, M585-92).
The skeleton acts like a buffer and the more acidic the diet becomes the more calcium is used to neutralise that acid and the reverse is true by making the body more alkaline. The power of fruit and vegetables to keep bones healthy is enormous and one study described fruit and vegetables as ‘the unexpected natural answer to the question of osteoporosis prevention’ (Lanham-New SA, 2006, Fruit and vegetables: the unexpected natural answer to the question of osteoporosis prevention? Am J Clin Nutr, 83, 6, 1254-1255).
Research has shown that higher intakes of animal protein are associated with lower bone density whereas higher vegetable protein is linked with better bone density (Weikert C et al, 2005, The relation between dietary protein, calcium and bone health in women: results from the EPIC-Potsdam cohort, Ann Nutr Metab, 49, 5, 312-8) and a seven year study on older women showed that those who consumed a high animal protein diet had more bone loss and a greater risk of hip fractures than women with a lower animal protein intake (Sellmeyer DE et al, 2001, A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group. Am J Clin Nutr, 73, 1, 118-22).
The irony is that cheese is one of the most acidic foods a person can eat and they can actually be losing more calcium from their bones than the amount of calcium they get from the cheese (milk and yogurt are more neutral). (Remer T and Manz F, 1995, Potential renal acid load of foods and its influence on urine pH, J Am Diet Assoc, 95, 791-97)
What a woman drinks also has to be taken into account as caffeine can decrease bone density, increase the risk of hip fractures and increase calcium loss (Tsuang YH et al, 2006, Direct effects of caffeine on osteoblastic cells metabolism: the possible causal effect of caffeine on the formation of osteoporosis., J Orthop Surg Res, 1:7) and soft fizzy drinks will also cause a leeching effect of calcium from the bones.
Phosphorus acid is added to soft fizzy drinks to give it a tangy taste and higher levels of phosphorus in the blood tells the body to release calcium from the bone to balance out the phosphorus. Recent research has shown that drinking just four colas a week is associated with lower bone density (Tucker KL et al, 2006, Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study, 84, 4, 936-42).
Alcohol also contributes to osteoporosis because it acts as a diuretic, leaching out valuable minerals such as calcium and magnesium. This increases bone loss and the incidence of fractures (Hansen SA et al, 2000, Association of fractures with caffeine and alcohol in postmenopausal women: the Iowa Women’s Health Study, Public Health Nutr, 3, 253-261)
Supplements and Osteoporosis
The first nutrient that comes to mind is calcium. But many other nutrients are equally crucial for healthy bones.
Calcium – is essential for bone health and not only improves bone density but also reduces the risk of fractures (Shea B et al, 2004, Calcium supplementation on bone loss in postmenopausal women, Cochrane Database Syst Rev, 1, CD004526).
Magnesium – helps to metabolise calcium and converts vitamin D to the active form necessary to ensure that calcium is efficiently absorbed. It is thought that magnesium deficiencies may contribute to the development of osteoporosis (Nielsen FH, 2010, Magnesium, inflammation, and obesity in chronic disease, Nutr Rev, 68,6, 333-40.)
Vitamin D – In the digestive system, vitamin D is responsible for calcium absorption – it transports calcium across the wall of the intestines and helps to move both calcium and phosphorus into bones. It reduces the risk of fracture. (Papadimitropoulous E et al, 2002, Meta-analyses of therapies for postmenopausal osteoporosis. VIII: Meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women, Endocr Rev, 23,4, 560-90.)
Vitamin C – this vitamin is vitally important in the manufacture of collagen, which is important for bone health as it makes up 90% of the bone matrix. Research has shown that those older people who have higher total or supplemental intake of vitamin C have fewer hip fractures than people with the lowest intakes (Sahni S et al, 2009, Protective effect of total and supplemental vitamin C intake on the risk of hip fracture – 17 year follow up from the Framingham Osteoporosis Study, Osteoporosis In, 20, 11, 1853-61).
Probiotics -these beneficial bacteria help to improve calcium absorption within the gut (Elia M and Cummings JH, 2007, Physiological aspects of energy metabolism and gastrointestinal effects of carbohydrates, Eur J Clin Nutri, 61, Suppl 1, 40-74).
Exercise
When it comes to bones and exercise, it is definitely a case of ‘use it or lose it’. The skeleton is constantly fighting against gravity, and it is that fight that helps to maintain bone density. So it is important for prevention of osteoporosis to do weight bearing exercises like walking, dancing, jogging, stair climbing, skipping, tennis and badminton. The important thing is for the woman to find an exercise that she enjoys.
Much of the osteoporosis research is focused on preventing falls so any exercise that promotes co-ordination or balance is especially helpful. (Hourigan SR et al, 2008, Positive effects of exercise on falls and fracture risk in osteopenic women, Osteoporosis, 19, 7, 1077-86). Preventing falls is really important as a person gets older.
Osteoporosis is a preventable illness that requires a multi-disciplinary approach looking at lifestyle issues such as exercise, diet and supplements.
‘Osteoporosis, once thought to be a natural part of ageing among women, is no longer considered age or gender-dependent. It is largely preventable due to the remarkable progress in the scientific understanding of its causes, diagnosis and treatment. Optimisation of bone health is a process that must occur throughout the lifespan in both males and females.’
(The National Institutes of Health Consensus Development Conference Statement on Osteoporosis Prevention, Diagnosis and Therapy, March 2000)
Dr Marilyn Glenville PhD is the UK’s leading nutritionist specialising in women’s health. She is the former President of the Forum for Food and Health at the Royal Society of Medicine and a patron of the Daisy Network, a charity for premature menopause. Dr Glenville is the author of a number of internationally best selling books including ‘Osteoporosis – how to prevent, treat and reverse it’, ‘Natural Solutions to the Menopause’, ‘The Natural Health Bible for Women’. Dr Glenville runs a number of clinics in Harley Street, Tunbridge Wells and Ireland. For more in depth information look on Marilyn’s website www.marilynglenville.com. She can be contacted on 0870 5329244 or by email: health@marilynglenville.com.
Dr Glenville is one of the Keynote Speakers at camexpo 2014 speaking on Saturday 4 November at 10.30am on Osteoporosis and on Sunday 5 November at 2.00pm on Fertility and Miscarriage.
Seven ways to promote your practice online
In this article, Geoff Simons from The Private Practice Hub gives us his six top tips for promoting a private practice using online marketing.
‘Online marketing’ is a term used to describe a whole range of activities that you could use to promote your practice. Just some of these activities include directory registration, email marketing, pay-per-click, Search Engine Optimisation (SEO), and social media.
It can be tempting to try several, in a scattergun fashion, spending a lot of money in the process. Yet in reality, many online marketing activities are free, and there’s absolutely no need to do everything at once.
Here are some suggestions to help you get started.
Your private practice website
You probably already have a website. But is it doing its job? Too often, clients will visit a private practice website and leave without getting in touch. Have a look at the tips in this blog post, and if possible, have your own site in front of you while reading it.
Once you have a great website, you need to make sure it can be found…
Online directories
Make sure your business is listed with free, relevant online directories. Start with Google Maps: go to http://maps.google.com and choose ‘Put your business on Google Maps’. You should also add your details onto the UK Therapy Hub (www.uktherapyhub.co.uk) and check whether your professional body has an online database. We’ve collated a list of other online directories here.
Social media
Many therapists are wary about using Twitter, Facebook or even LinkedIn. However, when you approach it correctly, social media is a useful way to connect with fellow practitioners and publicise your services. You’ll find advice about social media here.
Email marketing
Good email marketing is NOT spam. It is one of the most effective and affordable ways to promote your private practice and generate referrals. It can be as simple as letting previous clients know about a new treatment. Or, you could encourage prospective clients to sign up for a mailing list, so that you can send out a regular newsletter. We provide some more advice here.
Get to grips with SEO
Social Media Optimisation (SEO) is the process of making your website easier to find by prospective clients. In short, ‘getting it to page one of Google’. SEO is a daunting prospect, mainly because it’s a mystery to many of us. However, you can enhance your website’s SEO with a few quick and easy keyword improvements. Have a look at our suggestions.
Get blogging
Blogging is a great way to demonstrate your knowledge and expertise. Writing posts takes time, and building a readership can be a slow process, yet, when you combine it with social media, it’s a powerful way of drawing prospective clients to your website.
I hope you find this advice useful for your own practice – good luck! There are lots of articles on the Private Practice Hub about marketing, finance, admin and more, plus we’d love you to read and comment on our blog. It’s completely free to become a member!