The core

Following the question of one of my patien's "what is the core" I looked for the best way to describe it and this is what I came up with The core The Core is an integrated functional unit consisting of the Lumbo-Pelvic-Hip Complex, the Thoracic and Cervical Spine. It is a Muscular Corset that lends integrity and  support to the body. The Core is the center of the body, the thickest part of the body. The Core is where all movement is modulated. It is more than “six pack abs”. The core works as an integrated functional unit that accelerates, decelerates, and dynamically stabilizes the body during movement. All movement is relayed through the core. The core is in effect a swivel joint between the hips and the shoulders which: 1) Allows the entire body to accelerate the limbs 2) Allows the entire body to decelerate the limbs 3) Allows the entire body to support a limb. So strengthening the core is a complicated multidimensional process that requires good understanding of biomechanics and normal movement.

Patient testimony

PI suffered with chronic lower back pain for over 6 years, caused by the effects of 2 prolapsed discs (old sports injury).  Over the years I've been treated by other Physiotherapists, but none have offered me the level of help and support that Nick has. It's a shame I never met him sooner!  Nick actively listened to my concerns and prescribed a highly effective treatment plan, significantly reducing the amount of pain I suffered with. Prior to receiving treatment from Nick, I could only sit for a maximum for 15 minutes as back-pain forced me to stand up in agony!!    I can honestly say, I'm now able to sit comfortably for over 2 hours. My quality of life has improved significantly and I've returned to the sports I love, with the confidence I once had. Big thanks for your superb help Nick, I'm well and truly back on the road to recovery.  David McEwen.

Hamstring Injuries in Football

A few days ago I was interviewed by Talksport Radio regarding two injured Tottenham Hotspur players. One of the questions of the presenters was why are there so many hamstring injuries in football, specially to the faster players and is there anyway from the physiotherapy to prevent it. My answer to that is yes we can definately do something to reduce the incidence and the severity of it but firstly we need to understand the mechanisms of hamstring failure in elite football. When running the hamstring muscle acts as a decelerator of the leg so when the athlete is faster there will be more load on the muscle to slow the person down. If the load on the muscle is more than the muscle's capabilities that can lead to muscle failure. Looking at football as a sport specially this time of the year there's more matches going on following winter cancellations, more cup games and peaking towards the end of the season. More games means more playing time, more running, more sprinting and potential muscle failure. Another factor is that due to the increase game time there's less time for quality football training as well as strength and condition work. More games means more travelling to games and back and therefore more prolonged sitting postures that will affect the low back the pelvis and the lower limbs. As you can see apart from the pure sprinting there's many other factors that can expose the hamstring muscles to potential injuries. That should also include previous injuries on the hamstring themselves or other parts of the body that directly or indirectly load the hamstring muscles.The hamstring is part of a muscle groups that perform different functions at different body positions. The positions of other body parts such as the hip, the pelvis, the low back, the knee etc will affect the load that the hamstring muscle will be able to take.It has been thought that if an athlete injures a muscle then the muscle must be weak and needs strengthening. In my experience athletes in particular do not have weak muscles. They tend to have poor muscle balance and motor control. That means that the timing of muscle activity or the sequence of muscle recruitment is not normal. That will expose the muscle to overlaoding and potential failure. In theory if we make that particular muscle stronger and stronger it will be able to sustain higher loads and last longer. Unfortunately that theory is not correct. It is known that isolated muscle training has not got a functional carry over and although it increases muscle mass it does not necessarily make the muscle stronger to sustain a sporting activity. It has also been shown that extensive strenching of a non-injured muscle will increase it's length, however it increases the risk of injury as it reduces the element of active stiffness that is essential when performing a functional activity. So we as physiotherapists we have to screen the athletes regularly and perform functional tests to identify muscle imbalance or motor control problems. Once we do that we should implement the appropriate strength and condition programmes to overcome those deficiencies. In doing that we need to have a sound understanding of normal body movement and be able to adapt that to a specific sport. We also need to be specific to the player demands. Field position, body size and shape, posture, fitness, previous injuries,minutes on the pitch, style of play are all factors that need to be considered when designing a strength and condition programme for an athlete. The overall management should include other professionals such as the coach/manager, sports scientins, club doctor, strength and condition coach, nutritionist and more importantly the player. Good planning and understanding among those parties will reduce hamstring injuries to a minimum, have more players fit, and good selection problems for the manager.

Neck Pain

Neck Pain Neck pain is the second most common complain that patients present to physiotherapy departments with, after back pain. The neck is the upper region of the spine called the cervical spine. It is composed of 7 vertebrae separated by discs and supported by ligaments and muscles. The cervical spine can be subdivided into 3 regions. The upper cervical spine vertebrae C0-C2, the middle cervical spine C3-C6, and the lower cervical spine C6-T2. The T1 and T2 vertebrae are part of the thoracic spine anatomy but they function as one unit with the rest of the low cervical spine. Those 3 sections of the cervical spine can function as a unit of independent from each other.  The upper cervical spine contributes 50% of the neck rotation and more than 60% of the overall headaches. Any dysfunction around that area can cause significant amount of pain and discomfort. Dysfunction around this area is commonly associated with poor postural control, sustained postures and lack of movement. In more severe traumatic cases with ligament damage dizziness and blackouts can also be present. The upper cervical spine can also refer pain down the arm as well as fascial and jaw pain. The middle part of the cervical spine is where most of the flexion and extension of the neck occurs as well as about 30-40% of rotation.  The lower cervical spine contributes to flexion and extension of the neck as well as the upper trunk. Common pathologies: Whiplash Arthrogenic pain (arthritis) Neurogenic pain Stiffness/muscle spasms Disc prolapse Headaches Referred pain Peripheral sensitisation Cervical instability VBI Treatments at PPC: Up to date evidence based  Identify cause of the pain Identify contributing factors Education regarding condition/management/cure Manual therapy: latest up to date techniques Acupuncture Manipulation Soft tissue treatment Postural control Cognitive functional rehabilitation Strength & conditioning to maintain

Quality over quantity

Yesterday I saw again Fearghus Ó Conchúir a dancer/choreographer that I've been looking after for a while following a knee arthroscopy and partial meniscectomy. Fearghus had a progressively worsening knee problem that eventually stopped him dancing. He was successfully operated and returned back to his full function following several months of rehabilitation. His rehabilitation consisted of close kinetic chain (CKC) exercises, such as leg press, squats, step-ups etc and progressed to very functional exercises relative to his dancing routines. Once Fearghus was back to dancing I kept seeing him every few weeks and he would tell me what activities he would struggle with and we'll find exercises or ways to stop the pain. That led to advising on exercises from the thorax down to the toes, which shows the influence of all the body parts on the knee function. We worked on his hip control, pelvic control, low/upper lumbar control and they all had a positive influence on the function of the knee. The purpose of yesterdays visit was that Fearghus started experiencing some symptoms on his knee again. That followed a period of not doing a lot of his "rehabilitation" exercises, dancing a lot more, and travelling. When we went through again the exercises Fearghus himself saw that the quality of his exercising dropped and he was now abnormally loading his patellofemoral joint in certain positions. It was easy enough to correct it as he done all this before. By the end of the session he was able to do everything without any problems. What I'm trying to emphasise is that there's no "rehabilitation" exercises or "normal" exercises. There's EXERCISES the normal way the body moves and functions relevant to the activities that the individual is doing. The other point is that the quality that the exercises are performed is far more important than the volume of the exercises. If the quality is poor then the loading patterns of the joints change and that can lead to dysfunctions and eventualy pain.

Always good to hear

Dear Nick, I've written this recommendation of your work to share with other LinkedIn users. Details of the Recommendation: "I visited Nick to resolve an issue with my knee which had been ongoing since childhood. I was previously informed by the NHS that my knee could only be fixed with surgery. However, after attending sessions with Nick I began to see fast results within weeks of treatment. He is highly professional and knowledgeable in his field of work with a lively personality. He motivated me so that I can achieve results and also provided practical exercises that I could try at home. Nick helped to boost my self confidence and realise my potential which I am thankful to him for. I would highly recommend Nick to anyone for physiotherapy and wish him all the best."

I'm back

Its been so long since I was on my blog last. It's probably down to my organisation skills rather than anything else. If anything there's been so much to update about. Still very busy working at Premier Physiotherapy Centre in Chadwell Heath that has now expanded to a new Centre in Brentwood Essex. We still treating all the ususal conditions with a lot more advanced education, equipment in state of the art facilities. I'm planning to use this blog to educate people about common problems that the physiotherapists deal with and hopefully provide some background and advice of how to deal with those problems. I'll try to use examples from my current caseload and aiming this to be informative for clinical and non-clinical followers.
I'll update again soon.