I’ve been using kinesiotape/RockTape for nearly a year now and I’ve always felt that CrossFit was particularly well-suited to the benefits that the tape offer, from improving muscle mobility to tissue recovery to posture correction, so I was extremely pleased to treat a CrossFit-ter recently for a shoulder issue.
After a full assessment and treatment of an early case of should impingement, we did some taping. As the pain was worst on overhead presses, the aim was to reduce compression through the upper fibres of trapezius and levator scapula, whilst improving the fascial movement in the upper limb. Results were great:
It worked really well. Especially on Friday it felt it’s supporting the right posture and pulling my shoulders back. It also sticked really well still after working out and showering, only the endings came off a bit.
Firstly I’m extremely proud to announce that our little boy turned one year old on Monday and we celebrated with a three-day party, setting a rather dangerous precedent for the future! We all had a great time though and having the opportunity to celebrate with friends and family was fantastic. He’s growing up to be quite the young gentleman!
In other news, I’m now an osteopath! Found out on Tuesday that I’ve passed all my exams and coursework and am officially graduated from Oxford Brookes University with a First Class BSc(Hons) in Osteopathy!! Just waiting for my registration from GOsC to come through and then I can start practicing.
With that in mind there will be a few changes ahead but more on that later 😉
Ankylosis Spondylitis (AS) is probably the most well-known seronegative spondyloarthropathy and is certainly one of the most recognisable, with its characteristic “question mark” posture and reduced mobility in the spine.
It commonly affects men more than women and begins in late teenage years or early twenties, often beginning as a dull ache or stiffness in the lower back and sacro-iliac joints, worst on waking. It is a chronically inflammatory condition and Without treatment can steadily progress up the spine, fusing vertebral segments and causing chronic postural adaptations.
In clinic, alongside thorough case history taking, we typically have two specific tests for AS. Both measure movement in the body, one focussed on the lumbar spine and the other, the rib cage. Using a standard measuring tape we can assess:
lumbar spine flexion – should be >5cm (see video below)
rib expansion – should be >3cm
Once diagnosed, the BASDAI index can be used to measure progression and development of the disease.
We’ve just completed 2 of our last 3 exams and there’s always one question which throws a lot of people – this year, that question was: “which nerves innervate the sole of the foot?”. We spend a lot of time thinking about the spinal nerves that innervate the foot but relatively little time considering the peripheral nerves themselves. These are just as important though, especially when assessing nerve damage from local injury or systemic disease such as diabetes.
One of the most common tests that I use to assess low back pain is the Straight Leg Raise, also know as the SLR or Lasegue Test. The patient lies on their back in a comfortable position and the examiner lifts the straight leg up, noting if or when it causes any symptoms into the lower back or back of the legs. These symptoms could be low back pain, muscle tightness in the legs, shooting/electric pain down the leg or a ‘pins & needles’ sensation. If pain is illicited, the leg is lowered slightly and then neck flexion and/or ankle dorsiflexion added. The leg can also be taken across the body to identify whether the sciatic nerve is implicated or it is just hamstring tightness.
As the nerve is stretched, tension first happens in the greater sciatic foramen, then over the ala of the sacrum and then the intervertebral foramen.
A device called a goniometer is used to measure the angle where the symptoms begin, which can help diagnose what the causes could be. Personally, I have an app on my iPhone which does the same job!
Interpreting the results
Shooting pain down the leg, pins & needles and/or numbness indicates involvement of neurological structures including the sciatic nerve (L4-S3) but doesn’t identify exactly where or how. Magee (1992) suggests:
pain that increases with neck flexion and/or dorsiflexion indicates stretching of the dura mater of the spinal cord
pain that does not increase with neck flexion indicates a lesion in the hamstring area, lumbosacral area (LSJ) or sacroliliac joint (SIJ)
35-70 degrees is most likely to present as nerve root stretch across posterior IV disc
nerve root stretching finishes around 70 degrees so pain after 70 degrees is likely to be LSJ or SIJ
80-90 degrees of flexion is considered normal
pain primarily in the back = central lesion
pain in lower back and posterior leg = intermediate lesion
posterior leg pain primarily = lateral lesion
References
Magee (1992) Orthopaedic Physical Assessment, 2nd Ed. Philadelphia: W B Saunders Company. p267-269
“I was suffering quite a bit when I first went to see Rich. Nine months previously I had undergone a spinal de-compression operation to relieve the pain of chronic sciatica. Unfortunately, the operation failed and I was faced with a nine month wait before I could see my consultant again.
After my first session with Rich I was relatively pain free and this has remained fairly consistent until today, eight sessions on. Rich is a professional: he is methodical, logical, skilled and caring. I feel that I am in good hands.“
Came across this very nice infographic on the web today, talking about how dangerous it is to be sat at a desk/at home/in front of the TV for hours on end – scary stuff!
Firstly, a very Happy New Year to all my readers and followers! I hope that everyone had a fun and relaxing Christmas and New Year – I don’t know about you, but it feels like it was a long time ago already!
New Opening Hours
Due to increasing demand, I’m going to be offering an extra block of appointments on Fridays, from 3rd February onwards. I’ll be opening early in the morning and running through to lunchtime, meaning that I’ll be available:
As the festive season approaches, what better gift to give than a Sports Massage Voucher!
Vouchers are available for individual aapointments at £35 each. You can pay online via Paypal and I’ll send out a voucher in the post, so that you can treat that special someone. Vouchers are valid for 12 months.
August 13, 2012 | Posted by Rich 
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