Hawkes Physiotherapy Blog

The body is complicated and just because pain is felt in a particular area doesn't actually mean that this is where the pain is coming from. Firstly you don't have to have neck pain for it to be coming from your neck: "Cervical radiculopathy may or may not be associated with neck pain (Caridi et a 2011)." For example Golfer's elbow: In a study by Lee & Robinson (2010) they had fifty-five patients that were diagnosed with medial epicondylitis (Golfer's elbow). Of these, 44 had C6 and C7 radiculopathy whereas, 11 presented with just C6 radiculopathy. What this means is that either the Radiculopathy was mimicking the Golfer's elbow or it created a neurological weakness thereby causing the Golfer's elbow to develop. Bottom line is that you need to treat the neck and if you just treat the elbow you are barking up the wrong tree! It's the same problem with Tennis elbow too: This study  indicates that lateral epicondylitis symptoms...

Today it is still common place for Tennis elbow to get stuck with a steroid injection. Just the other day I saw somebody who'd had several done and each time the effect was shorter and shorter. My head was in my hands. Why? Firstly, Tennis elbow is a Tendinopathy which essentially means it is a pathology of the tendon. The reason that they call it this, is because Tendinitis basically means inflammation of tendon and the current thoughts are that it is not an inflammatory problem: Stanton (2012) describes Lateral epicondylitis (Tennis elbow) as tendinosis of the origin of Extensor Carpi Radialis Brevis (ECRB) tendon & is not an inflammatory process. The fact is that Corticosteroids are mainly used to reduce inflammation and suppress the immune system according to the NHS website. So at best for this type of condition they would be barking up the wrong tree and ineffective. Not to mention that inflammation is needed to heal the tendon so taking it away doesn'...

Simply question: Will a brace or support help me? Well depending on who you speak, to you will hear yes and no but what is the real truth? Yes: Elastic bandaging can assist proprioceptive function of knee and ankle joint (Fousekis et al 2016). Patellofemoral braces appear to be effective for preventing anterior knee pain (Yeung et al 2011). Significant reduction in ankle sprains in people allocated external ankle supports: semi-rigid orthosis or air-cast brace (Quinn et al 1997). A brace may be helpful in managing immediate symptoms related to lateral epicondylalgia (tennis elbow) (Bisset et al 2014). No: Our systematic review found no conclusive evidence about the effectiveness of braces in medial knee osteoarthritis (Mine et al 2016). 15% of ankle sprain patients who used an ankle brace re-sprained, compared with 27% who did neuromuscular training (Janssen et al 2014). So not a simple answer then! No change there then!!! Simple answer is that it dep...

The human body is adaptable in both a negative and positive way. In the past, rest was prescribed for injury but was it the the right thing to do? Short answer: Probably not. Why? I feel better when I rest so that's good, right? Not necessarily. Think about it. Do your muscles get stronger with rest? Do your bones get stronger? Do your tendons?  Do you get fitter? No! In fact the opposite occurs. So that can't be good can it? Muller et al (1970 found that after 8 days of resting, muscle strength reduced by 2-6%. Most injuries are caused by cumulative overload to a structure, which basically means they are loaded beyond their physical strength. So taking this on board does rest work? No, because the tissue that is injured will actually get weaker, which of course, causes more of the same problem that actually caused the injury in the first place. A great example is the Achilles tendon. Here you have a structure that on average takes between 6-8 time...

As usual I am always trying to find a new subject to write on, and this week, I have been inspired to write about injury in dancers due to the fact that, recently, I have had quite a lot of dancers come into clinic.  So what are the common injuries experienced by dancers then? Well, the injuries that I have seen in clinic recently are knee injuries, Achilles issues and back problems but is this a true reflection of dancers as a whole? As a whole this is the general view: Minor injury in professional ballet, modern, and theatrical dancers is 74% according to Chmelar et al (1987). Chronic injuries in professional ballet and modern dancers was 48% according to Bowling (1989). Musculoskeletal pain that lasted for at least 1 year in Swedish professional ballet dancers was reported to be about 95% according to Ramel and Moritz (1994) and (1998). They also found that 90% of those followed up 6 years later reported recurrent pain (Ramel and Moritz 1999). ...

Now you must of heard this saying before and of course it is absolutely bang on! So hands up who went to their Physio injury free with the intention of trying to prevent injury? What, nobody? Exactly! ...but what about the phrase? Don't you agree that prevention is better than cure? Oh you do! So practice what you preach. Here is why: Let's take an example such as Plantar Fasciitis or CPHP (Pain under your heel). What causes this problem is different in each individual and so the person needs to be assessed for these issues to get rid of the problem. However getting rid of the causes before you get a problem means that the chances are that you don't get it in the first place. Wouldn't that be great! So what are examples of causes of Plantar Fasciitis: Running? 4.5 to 10% of all running athletes will develop it and this is mostly in distance runners, hence why it is sometimes called jogger’s heel (Lopes AD et al 2012), (Singh et al 2008). I...

I thought that I would write this blog article to clear a few things up about what some patients are told by some therapists.  The common thing that I hear from patients is that the therapist felt the discs were out, or were calcified and then performed a technique and go on to say that they are back in after the technique. Now I don't know where to start with this because it's just not possible based on normal human anatomy. The thing that perpetuates the myth is that whatever technique is used it can bring about symptom improvement, which I don't dispute at all. However, the statement about what it has done and why it has done it are so far off base it's crazy! So answering the first question: Can you palpate a disc? I'll let the pictures illustrate the answer below: The first problem is the depth. Look below at how deep into the body that disc is! It is not far off half way to your middle. So even if all the stuff in the way was soft and gooey and yo...

Now, with this question, it is impossible to give a straight answer! Sorry!! The reasons are many! For example there is no such thing as an average injury, in an average person, with average environmental conditions etc. Even within the same tissue types in the same person the tissues can heal very differently. So I would advise caution reading too much into the following article, but people ask “how long” all the time so I have done this as a little evidence based guide but don’t worry if you aren’t matching up to what times are suggested below! Muscle Healing: The common feeling is muscle takes between 3-6 weeks but what does the research say? Hamstring injuries: If you can walk painlessly within 1 day then you are likely to get better within 3 weeks but if it takes longer than 1 day to walk painlessly then it will take longer than 3 weeks to recover back to sport (Guillodo et al 2011). Bone Healing: Most people say that bone heals in around 6 weeks...

What are the expectation of patients? It sounds obvious but patients expect to be shown respect by their therapist, they expect to feel trust in them, for them to be punctual and compliant and take an active role in rehabilitation. However, the most important patient expectations were for symptomatic relief, self-management strategies and "hands on" treatment. In fact the nature of the treatment provided by physiotherapists was ranked as the most important (Potter et al 2003). What is the effect of patient expectation on the success of treatment? Positive expectation = Positive outcome: Linde et al (2007) found a significant association between better improvement and higher outcome expectations with placebo treatments. & Metcalfe & Moffett (2013) performed a study on 285 patients referred a peripheral joint problem and they found that higher expectations were related to greater change in functional disability and health status, and a...

For a long time we were always told to tell the patients to not flex their hip past 90 degrees, cross their leg past the mid line or twist their leg. The reason for this was due to the increased risk of dislocation but is this really true? Well considering the emphasis and importance placed on these precautions, it may seem that they are unfounded! Now it is actually true that one of the most common complications after a total hip replacement is a dislocation, the prevalence is reported to be 19% of total hip replacements (Smith T & Sackley 2016). The problem is that if you are restricting movement for a while then you may create issues with flexibility and function. So if we didn’t restrict the patients then they can just get on with their rehab unimpeded. The other issue is the cost. For example Occupational therapists have to raise toilet seat and chairs etc. at home for the patient so that they aren’t putting their hip into these positions.   So what does ...

As you know being injured means that you lose all the conditioning that you worked so hard for in the first place....FRUSTRATING! MUSCLE STRENGTH DECREASES BY 2-6% FOR THE FIRST 8 DAYS OF IMMOBILISATION (Muller,1970). So what can you do to help minimise this effect? Well, here is what the research says: What to avoid? Rest! It used to be R.I.C.E. or P.R.I.C.E. or P.R.I.C.E.M. but rest doesn't help recovery. The more recent accronym is: P.O.L.I.C.E which stands for: Protect, Optimal Loading, Ice, Compression, Elevation. It's obvious that rest will accelerate deconditioning but it also affects healing too. Malliaras et al (2013) found that tendons heal quicker when progressively loaded as opposed to rested. Anti-inflammatory drugs! The jury is out on this! Remember inflammation is the only thing that heals you so you really need it! The question is that in the first 72 hours do some things over inflame and inhibit you unnecessarily, well ...

Now as you may know I have been writing blog articles and producing CPD training videos for a while now but I am interested to find out what my readers and viewers want to me write about or do a video on next. I would be happy to produce something to cover what you want or need. So tell me what you want, what you really really want: So let me know! Either comment here on the blog or comment on here: Hawkes Physiotherapy E Course CPD YouTube channel or here: Facebook or here: Twitter or here:  Google + Looking forward to hear from you soon!

It's incredible the amount of people who are very quick to tell me that they have a high pain threshold but do they really? Do they know what the pain threshold even is? I suspect they don't. So what is pain threshold anyway? Mosby (2009) states the following: "The point at which a stimulus, usually one associated with pressure or temperature, activates pain receptors and produces a sensation of pain. Individuals with low pain thresholds experience pain much sooner and faster than those with higher thresholds; individuals' reactions to stimulation of pain receptors vary." Put simply, it is when there is enough stimulus to make the pain nerve fire. So the threshold required for an action potential at a synapse in a C fibre neurone. So what patients are referring to then is their pain tolerance. This is defined as: "the highest intensity of painful stimulation that a tested subject is able to tolerate." ( Farlex 2012). So the que...

Incredibly I get asked this question quite a bit. It is easy to assume that people know what physio is and what it can help.  So firstly the definition of Physiotherapy is: "The treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery." (Oxford dictionary definition) So pretty broad then! But even the Oxford dictionary isn't completely accurate! It doesn't mention about the prevention of injury for example. So what does the Chartered Society of Physiotherapy (CSP) say? "Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. They maintain health for people of all ages, helping patients to manage pain and prevent disease. The profession helps to encourage development and facilitate recovery, enabling people to stay in work while helping them to remain independent for as...

Here is a FREE CPD video, which highlights the research behind this mobilisation technique along with showing you how to perform the technique correctly on a real person and on a spinal model. There is a full reference list at the end if you would like to read more into things. Keep posted for more free CPD videos to improve your evidence based practice. If you want to have a look at the CPD channel there is lots of free and paid subscription content so check it out: Hawkes Physiotherapy E Course CPD channel

That's right, I have become a Jockey! Only Joking, I have been writing a presenting CPD courses for Sub 4 health. The first of which was in April with another due in June. Currently the course is on Muscle strength and range testing and the first one went great. I had fun and got some really good feedback. Below are some Photos from the course: (I think someone is behind you! Scary!) The plan going forwards is to research and write courses on many other subjects. So keep tuned for news of new subject matter in the future! Here is the website to have a look at: http://www.biomechanicsacademy.com/