Advice on treating acute injuries – the R.I.C.E protocol

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Injuries, like a sprained muscle, strained tendon, torn or damaged ligaments need immediate first aid treatment to help increase speed of recovery and reduce the risk of potential complications.

R.I.C.E. is an acronym for Rest, Ice, Compression and Elevation.

Injuries are frequently accompanied by pain, bruising, swelling, bleeding and inflammation. These are all natural responses of the body as a result of injury and are part of the healing process. By applying the four elements of the RICE protocol you can help to reduce pain or swelling and help to speed up recovery by aiding the healing process.

REST: stop the activity which caused the injury, and anything else that may further increase pain or exacerbate the injury. You may need to see a doctor or other medical professional – it is important to follow their guidelines as to when you may be able to resume activities.

ICE: applying ice to the injury site and immediate surrounding area has the benefit of reducing bleeding, swelling and pain. It is important to apply ice as soon as possible after the injury has happened.

How is Ice applied?

As a guide use cold packs indirectly (wrapped in a clean dry cloth to prevent skin burning) for 20 minutes every 2 hours, for the first 1 to 3 days. Crushed ice in a plastic bag (or a bag of frozen vegetables) works best as you can mould the bag around the injury site. 

 

Do not apply ice directly to the skin as it can cause ‘ice burns’. If your skin is sensitive to ice or you have circulation problems you may need to adjust the duration/frequency of ice application. Please use your own judgement as you know your body best. It is better to apply ice for a shorter duration and more often if you find the cold excessively painful. Remember though, it is ice, so it will be cold!

You may have heard that heat should be applied to an injury but this is not the case in acute injuries, which is usually during the first 1-3 days following injury. Heat can increase the level of bleeding and therefore cause an increase in swelling and pain. Heat is best applied once the injury is sub-acute (3-21 days after injury, depending on the severity).

COMPRESSION: is used to prevent and reduce any additional swelling by wearing an elastic compression bandage around the swollen area. The aim is to reduce swelling as much as possible as it can slow down the healing process. Some people may also experience pain relief from applying compression. If a throbbing sensation or feeling of tightness is experienced it means the compression is too tight and should be loosened off immediately.

ELEVATION: the final step in helping to reduce swelling and speed up your recovery. The injured area needs to be higher than your heart – this is because you want the excess fluids to drain towards your heart, and clearly gravity will help this immensely. For example, if your ankle is sprained you need to put your leg up higher than your heart; a good way is to lay on the floor with your leg on the sofa or bed – and ensure that the foot propped up on pillows higher than your knee.

Climbing Comp at Rockover Manchester

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Had a great, if tiring day out at Rockover Climbing wall yesterday. It was their First Birthday bash, and they were celebrating in style. The wall had been closed from Thursday, setting up problems and planning the final part of the competition - which was to go up at the end of the day while the competitors were in isolation.

We arrived early - at about 10 or so, and were astonished to learn that people had already tried to register for the comp - an hour before - it wasn't even going to be open until 11!

The wall looked great, DMM were there with the gear testing rig, Maverick Slacklines were going to be setting up later in the day, food was being prepared and the atmosphere was great. We lugged our stuff upstairs and began setting up - trying not to get in the way of where the slacklines were going to be, and after a short time had got our area prepped and ready to go.

Soon the climbers started arriving, and we had been briefed that it would be pretty quiet for the first hour or so while they all got on with the problems, and then more and more people would wander up.

However, at the beginning of the competition, as the competitiors wandered around looking at the problems, we did get a couple of guys wander up for a pre-climb massage, which was good. There was a box for donations to Oldham Mountain Rescue, so everyone that we treated was encouraged to give a small donation to them. Everyone was very generous and the box was quite heavy at the end of the day. Thanks Everyone!

Soon enough midday came and the air filled with chalk dust as 200 or so climbers launched themselves at the walls around the centre. It was not long until the first few people started trickling in.

Forearms, backs, shoulders, everything that we expected, but also some legs and calves which were hurting from lots of landing on them. The trickle turned into a flow and soon we were going all out, and time flew. I have no idea how long we went for, or how many people we treated, but all of a sudden it was 4pm and the top climbers were going into isolation - so that they could not see the final problems going up on the walls.

I left Lynne up with a small queue of people and made my way down to the "cave" where they were waiting to offer my services.

The isolation "cave"

Again, as expected, it was all forearms and shoulders, getting blood out of the pumped arms, and giving them a bit more life in the fingers. I was expecially careful not to get any lotion on the hands - friction being pretty important for climbers, and lotion really doesn't help all that much with that.

Once the finals had begun in earnest, I wandered back up to the top to help Lynne out, and spent the last few hours splitting my time between upstairs with Lynne and downstairs behind scenes, helping out with the competitors, forearms, cramping legs - and at the end, medial epicondilitis of the elbow. (yes, he was a trainee doctor and knew exactly what he had).

While I was doing that, Lynne was busy helping prepare the band for their evening of drumming and strumming - massaging sore arms and hands - with the drummer proclaiming that he felt like a new man and ready to play after treatment!

At the end of the day we were pretty tired - more tired - I would venture to say - than some of the climbers who we treated. We didn't stick around for the post comp party - having to drive back home in the state we were in was just about fine - but a couple of hours later and it might have been a much more tired version of us that would have to negotiate Manchesters bizarre set of roads around and out of the centre.

We packed all the stuff back down into the car, said our goodbyes, and headed out.
What a day- treated a goodly number of people, raised money for mountain rescue, had an excellent time, and made a load of new friends.

And today is a day of rest - and boy do we need it. I'd forgotten how much event work takes it out of you - doesn't feel like it at the time - I was full of energy and running around for hours on end, but today is the catch up day, chill out time.

Thanks muchly to Tom and Paul who invited us over to help out with the Party, hopefully we can fix something up in the near future where we come to the wall every week treating climbers and helping them get better.

Lower Back Pain Trigger points from the QL

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Now Lower Back Pain is quite a big subject, (minor understatement), and for the sake of not sitting here and writing an entire book, I'm going to limit this to a client I was treating last night.

Whilst driving, he was getting significant pain in the far lower back, right down where the back meets the bum- the lower lumbar area going into sacral area (L5-S1). He has had no history of spinal problems, no slipped discs, hernias or anything like that, and has to stretch the area out when driving because it hurts.

Now, originally you would assume that there is something wrong with the Glutes and surrounding muscles, for something to be hurting there, and you may well be correct. Weakness in the Glute area has been shown to be a major issue in terms of Lower Back Pain. As we walk around and sit at desks all day, the glutes barely get a look in and slowly waste away- getting overly tense when they are forced to be used.
In this case it is the case, however, it is not where the pain is originating from.

After palpation it was clear that there was pain in the glutes, and around the sacral area, but there was also referred pain into the glutes from the quadratus lumborum- and this was the main issue- I keep blabbing on about it, this is the fire and although there is pain in the glutes from lack of use and tension, this pain is the smoke.

So, in THIS particular case, it was a referring triggerpoint pain from the QL, (my model is unfortunately not available to draw on at the moment so you'll just have to google Quadratus Lumborum) which was antagonising the glutes, which was causing the pain. Had I treated JUST the pain in the butt (as it were), the client may have gone away happy that I had been treating the "right" area, but the pain would have come back quickly.
With a decent explanation of what I was doing and why, the client could understand- and indeed feel- why I was treating somewhere that wasn't initially painful- that is- didnt feel like the origination of the pain.

Lower Back Pain can be created from a variety of places- this time it happened to be in the QL, it could be coming from almost ANYWHERE in the body. Look at imbalances, look at other issues in the body, not just at the back.
Look for the FIRE not the SMOKE.

6-8 months on, what changed after the Gym Jones seminar?

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I thought it might be an interesting exercise to have a look back over my training diary and recent history since I did the Gym Jones FDI seminar and see how and if I had managed to keep up any of the training - or keep any of the concepts in my mind.

I worked out a training schedule for the first month, and decided to keep a food diary, to see what I was eating and see where I could cut out the bad things. This went well. It was November when I started the training, and I had a Fell race on the 22nd Jan which I was using as my target. I have a lot of information about the first 4 weeks and how it all went - I also had free access to a gym (ok, it was a globo gym, but at the times I was using it, there was no-one around, so that was good).

I wrote out a modified schedule for December, and kept to it pretty well, but what with it being crazy time in the shop, not all of the workouts got done, and some of the bad food crept in again as days got longer and more busy.

January came around and I tapered down rather well - basically by forgetting to to anything at all - except commute to work and back - to Boxhill fell race, and completely destroyed my previous time by about 10 mins and 50 or so places. Wow. That's not bad. And to be honest, at this point, although I had been pushing myself, I knew there was so much more that I could give.

Then came upheaval, and the planning for the move, I didn't plan a schedule, and my training log lapses, the food was still pretty much ok, and I went out for a couple of runs, but my general fitness - in GJ terms fell through the floor.

Unfortunately the general fitness is still somewhere down there, but there is a very real reason for that. We appear to have come up to the Peak District just at peak racing time, every week there is a race, I'm out on the hill at least 3 times a week, and climbing is beginning to make a bigger dint on my time. (or will as soon as I get that new bouldering guide from Vertabrate Publishing!), so I'm not going to the gym to push myself there. In fact, I don't even belong to a gym.

So was that seminar a waste of money, and simply a chance for me to meet a hero?
No, I don't believe so.
Everytime I get out on the hill, every time I head out on a race and find myself flagging - I know that the Mind is primary, I know that there is always more in the tank, no matter how bad I feel. As an athlete I know I can get to a certain point, but as a coach to myself, I believe that I can go at least half as far again.

Everytime I see a client, and work on their imbalances, I give them ideas based on GJ techniques - using the whole body, working the organism as a single unit. If you begin to isolate, it becomes disjointed and what body wants to be disjointed?

There are so many gems of information that I picked up on that course that I use for personal and professional improvement.
It's not about Spartans or 300 reps.
It's about training intelligently. With Spirit.

Osteopathy

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The introductory page on the General Osteopathic Council website defines osteopathy as:

"Osteopathy is a system of diagnosis and treatment for a wide range of medical conditions.  It works with the structure and function of the body, and is based on the principle that the well-being of an individual depends on the skeleton, muscles, ligaments and connective tissues functioning smoothly together.

To an osteopath, for your body to work well, its structure must also work well.  So osteopaths work to restore your body to a state of balance, where possible without the use of drugs or surgery.  Osteopaths use touch, physical manipulation, stretching and massage to increase the mobility of joints, to relieve muscle tension, to enhance the blood and nerve supply to tissues, and to help your body’s own healing mechanisms.  They may also provide advice on posture and exercise to aid recovery, promote health and prevent symptoms recurring."

I've included the full introduction, as it is important for a well rounded understanding of what this modality is about. I particularly like the quote that they "work to restore your body to a state of balance". 


My reason for posting about osteopathy is because I have just seen one. My reason for this was twofold. Firstly, from a professional viewpoint I need to know who in my local area is good, and who I can refer my own clients to. I found this particular practitioner on recommendation from a good friend - the best way to find a therapist in my view. But, I do not blindly send my own clients to someone unless that person has treated me personally.


The second reason I saw the osteopath is because I felt wonky! I have no serious or acute issue, I just felt like something wasn't quite right with my alignment, and no quantity or sports massage from my colleague was going to fix that as we don't manipulate hard structures, i.e. bones. I have had neck ache on and off for some time, putting it down to perhaps stress of relocation, entering the world of self-employment, or perhaps an underlying and long standing issue from some years back when my neck "froze"...I had a period of about three weeks six or seven years ago when I couldn't turn my neck at all. Perhaps that was a precursur to me becoming a sports massage therapist, but I digress. 


So, professional curiosity and personal need for perhaps a little realignment took me to the osteopath today.


He did quite a lot of work on me, partly because he knew I understood the anatomy and reasoning behind his treatment. This meant that he could reduce the amount of time explaining what he was working on and spend more time treating, but mostly because he know I was prepared and understood what was happening.


Realigned were:

• Left tibia/fibula (the two bones in your lower leg) - the head (top) of the tibia was too high - this caused me pain on the bone at the outside of my lower leg, just below my knee. Because of that my ITB was tight and caused me knee pain when running. Was this travelling up the body and giving me pains in my neck? Who knows...everything is linked afterall!
• Pelvis - slightly misaligned, with tenderness, especially at the iliosacral joint. Could this have been causing the neck pain? 
• T5 and T8 - two vertebrae around shoulder blade area . Were these responsible for my neck pain?
• C2 - a vertebrae in my neck - rotation of my neck wasn't quite so free looking round to the right, which is where the pain was manifesting, but not necessarily the key cause. (I think my fellow writer, Tim, refers to smoke and fire, and this analogy springs to mind here).
• C1 - the top vertebrae - this one wasn't going to play today. I was holding or protecting it too much and like all good practitioners, if something isn't allowing you to treat it, it is for a reason so leave it alone for now.

All the time he was realigning bones he kept checking and rechecking how my range of movement was, how joints felt - whether they were springy, hard, blocked - and asking me for feedback.


Muscle testing also took place, the result being that I have an overly tense (hypertonic) right psoas muscle. This muscle attaches from the vertabrae in your lower back to the inside of your thigh bone (lesser trochanter of the femur). It's deep inside your abdomen and you have one on each side. For me, my left psoas muscle has become weak so we did some work on strengthening it. I've also got an exercise I can do at home (with help from someone) to continue to strengthen that side. I may need a little work to ease the tension on the right side, but with the left becomes stronger it should ease the right side naturally - thereby creating balance - which is what this is all about! 


How do I feel now? At the end of the session the tension and blocked feeling on the right of my pelvis had gone, and my neck rotation improved, it certainly feels easier. A few hours later and I still feel good. It feels like I want, and more importantly can, stand upright on two feet. Now that might sound funny, but for ages now I've tended to put most of the weight through one leg - something that's bound to cause an imbalance, or be the cause of an imbalance.  I'll certainly be recommending more clients to see osteopaths after my experience today.

Midweek race- MDOC in Rowarth

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This is an interesting one to try to talk about as its not of the same ilk as a "normal" fell race such as I have been blogging about on this blog. It was an orienteering event, 90 mins, and somewhat akin to the adventure racing that I have done in the past, (except it obviously doesn't go on for 8 hours).

A whole load of Glossopdale were out as the race was a counter for the mid-week championships. You could tell the demarcation between the fellrunners and the orienteers who do this on a regular basis. The fellrunners were in shorts and vests, and were working out how to use their compasses, and the orienteers were in full body covering- lycra'd up to the eyeballs some with proper old school 80's headbands, and looked like they most probably knew what they were doing with a compass.

So we all got a map and a list of controls about a minute before the off, just enough time to look at the map for a short period and try to work out the route, and bang- or rather hoot, the hooter sounded and we were off- mass start and everyone setting off in radically different directions.
This is where it gets interesting to talk about, and partially why I enjoy events like this.

Any runner you see from this point on may have got more, or less points than you, you never really know who you are actually running against, and so its really you, against you and what your body thinks it can do. There is also the minor issue of having to navigate as well, but thats by the by.

This wasn't an event where you had to find orienteering kites and get the letters. Each point had a question on the paper that you had to answer at the point- like who is mentioned on a plaque, what number is carved on a telegraph pole, that kind of thing.
So I set off, looping around to the south, having a vague plan of where I wanted to go and what I wanted to do, getting the far away ones first and then swooping down to pick up the closer ones on the way back home. This worked relatively well, except for the fact that I got slightly lost about half way through. I climbed a hill faster than I thought possible and ended up about a kilometre further ahead of myself without realising it. This obviously cost me time.
On the way back I was fine, but if I hadn't got lost earlier, I probably would have had about 5-7 extra minutes in which I could have got 3 extra controls on the way back.
Ah well, never mind.

I think I also found pretty much the only boggy patch in the entire run- going up to my ankles as I careered through a field. Nearly everyone else at the end seemed to be bone dry.
In the end I got back with 30seconds to spare, and I think I got 20 controls, (though one of them was a bit ambiguous, so it may or may not be counted).
No idea where I came, no idea if I narrowly beat someone, but thats the nature of orienteering at this stage. Just got to wait for the results to come out.
Hopefully the link below should take you to the Garmin track of where I got to...

Rowath Orienteering event by ttbudd at Garmin Connect - Details

Pregnancy: postural changes

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It goes without saying that your body undergoes dramatic changes during pregnancy. One of those changes is your posture. But don't go thinking it will happen overnight because it doesn't, the changes are gradual and creep on you as you gain weight and your body adjusts to the various developments of pregnancy. Because of the weight you will gain your body experiences more aches and pains than it usually would. It's a given, but what you do about it could help provide relief, I'll return to that later.

As your abdomen and breasts enlarge your centre of gravity changes and your body does its best to hold you upright. The extra weight tends to pull you forwards and downwards (it's like that moment when you're starting to lean forward and pick something up), this affects the pelvis by tipping it forward and in turn leads to increased curve in your lower back (the lumbar region). Hey presto – you've got lower back ache!  You may also get sciatica as a result of the pelvis tilting forwards (anterior tilt) - causing compression of the sciatic nerve.

Try this now - stand up - tilt your pelvis so your bum sticks out, your abdomen pokes forwards - can you feel the subtle shift in your centre of gravity? Feel how the curve of your lower back has become exaggerated. You might notice your toes need to grip on the floor a little harder? Now imagine how all of these changes will increase and intensify as pregnancy progresses.  Men too should try this, so they can get a sense of what the woman goes through.

As a knock on effect of the pelvic shift and increased lumbar curve, muscles and joints higher up the spine and around your shoulder blades (thoracic area) and your neck (cervical area) will be put under increasing strain and before you know it you could end up with back ache higher up, maybe neck ache, stiffness, headaches and maybe sinus problems. A further effect of the increased lumbar curve (and breast enlargement) is that your shoulders tend to round forwards and your head and chin poke forwards. As we've said elsewhere, everything is linked and connected. Everything affects you elsewhere in your body. If one thing changes in your posture it will affect other areas of your body.

Lower down in your body your knees may have a tendency to lock backwards as they try to stabilise your body position, and your feet are constantly being challenged as the weight moves forwards and your toes take the strain.

Breathing changes in pregnancy too, firstly because of the internal organs, including lungs, being squashed and repositioned as your baby grows. But also the diaphragm (the major muscle involved in breathing and which separates the abdominal and thoraxic cavities) is also being repositioned. The diaphragm attaches in many places, including the upper two or three lower back (lumbar) vertebrae. As we've already mentioned, the lumbar curve becomes exagerated in pregnancy, and this will clearly affect how the diaphragm works and lead to a decrease in lung capacity. You would notice this as shortness of breath.

Returning to the spine, because of the change in the spinal curves the ligaments that hold your vertebrae and other joints together are subjected to additional strain – it's not just the muscles. If you've not already heard of relaxin then you need to know about it. This is a hormone which causes joint laxity because of how it acts on ligaments. In certain parts of the body during pregnancy this is very useful – such as the birth canal which needs to accommodate your baby during birth – the pelvis needs some flexibility to cope. However, relaxin doesn't just affect ligaments and joints which need some flexibility for birth – it affects all ligaments and therefore all joints. One effect can be the onset of symphysis pubis dysfunction (SPD), defined in the Illustrated Dictionary of Midwifery (Winson & McDonald, 2005) as “excessive softening of the cartilage with softening of the pubic bones and destabilisation of the joint”. Note the word excessive; not every woman who gets pregnant is affected by SPD. So it's good that your pelvis becomes more flexible, but you need to bear in mind that your pelvic bones may not be aligned, and that you may need to adjust the way you lift items or walk, particularly up/down stairs. Thinking about feet again, they're at risk of collapsing arches as the ligaments become lax and strain under the extra weight you're carrying.

When bones become misaligned the muscles will have to adjust in some way. That could be either by lengthening or shortening. Neither of these are great, but the good news is that tension in muscles caused by short muscles can be helped with focussed massage. In SPD the gluts (bum muscles) and lateral rotators (small and deep muscles in your bum) are often found to be short as the pelvis starts to open up and expand slightly. Shortness in these muscles can also be linked to sciatic pain.

As a consequence of the realigning of the pelvis, extra weight-bearing and postural adjustments, some muscles can also become weak through what could be termed overuse or by being strained. Fluid retention is also common during pregnancy, and this too can cause strain on joints. A common complaint in the wrists is carpal tunnel syndrome, where the nerve (medial nerve if you're interested) that goes to your thumb and some of your fingers is literally compressed in a tunnel of bone at the wrist. You might experience numbness or tingling, pain or loss of function. With this syndrome caused by fluid retention, lymphatic drainage massage can help disperse the accumulated fluids and ease the pain.

What can you do to help alleviate pain and discomfort caused by postural changes during pregnancy? Pilates or yoga are excellent for keeping your posture in the correct alignment. A specialist pregnancy class is invaluable because the instructor will have the knowledge about correct alignment of your posture, and know how to instruct you towards the optimal posture for your individual pregnancy. Swimming is also good because the water takes your weight – see my post on this in May here. Finally, it goes without saying, that massage is immensely beneficial for soothing the aches and pains that do crop up. The therapist can identify shortened tight muscles which need relaxing. If you have water retention then lymphatic drainage techniques can be employed with the aim of improving your circulation and reducing the swelling. By easing muscle tension and reducing swelling there should be a reduction in joint stress, particularly important for those weight-bearing joints like knees and pelvis which are subject to ever increasing pressure as pregnancy progresses.

I hope you are now more aware of the way your posture may change during pregnancy (and afterwards, as your body will need time to readjust back to its normal posture after giving birth), and that I've given you a few ideas how to have a more comfortable time. I always think it is better to know what may be coming and have the knowledge to deal with it. Let me know if you have any other suggestions or want to share your experiences.