Blog - The Back and Body Clinic | Specialist Physiotherapy Northampton

Running Blog Series - Patellofemoral Pain Syndrome


Patellofemoral pain syndrome is considered the most common running related injury, affecting 2.5 million runners a year! With such a vast number of people encountering this injury we thought it was the most appropriate place to start our running Read More

Running Blog Series - Introduction


Here at the Back & Body Clinic we love working with runners! We know that it doesn’t matter if you are an elite athlete, a mother of three or a carefree retiree; being side-lined by an injury can be Read More

Plantar fasciitis (PF)


Mirror mirror on the wall, who’s the most stubborn of them all?  If there was one condition that epitomises stubbornness… it has to be plantar fasciitis. If musculoskeletal conditions lived in the world of fantasy then plantar fasciitis would have to Read More

Torticollis, a head turning preference or plagiocephaly


My baby's head is flat and I am concerned they are only looking one way? When babies are born the bones in their skulls are not fully fused, which is why we’re always so careful of protecting a newborn Read More

The Importance of Tummy Time


With increased awareness being published on Sudden Infant Death Syndrome (SIDS) and the recommendation that babies should sleep on their backs, there seems to be an anxiety about getting your baby to spend time on their tummy. However, research Read More

Running Blog Series – Patellofemoral Pain Syndrome

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Patellofemoral pain syndrome is considered the most common running related injury, affecting 2.5 million runners a year! With such a vast number of people encountering this injury we thought it was the most appropriate place to start our running blog…so on your marks, get set, let’s go!

Patellofemoral pain syndrome (or PFPS for short) is a complex andPatella Femoral Pain sensitive condition which presents as pain in and around the knee cap (patella). It is usually aggravated by activities that load the patellofemoral joint including:

  • Lunging
  • Squatting
  • Kneeling
  • Running – particularly downhill as this exerts more stress on the joint as your quads work to control your acceleration.
  • Prolonged periods in sitting- otherwise known as ‘movie goers sign’. It is also a great excuse to avoid any drawn-out work meetings, but don’t say we told you!

Unlike many other knee injuries, locking, giving-way and swelling are not common in PFPS. You may have some clicking and it might feel stiff to move the joint, but you should be able to move it through a normal range.

The exact cause of PFPS (as with most things recently!) is debatable. But it is thought to be due to several factors including muscle tightness, weakness, malalignment and errors in training.

So, here’s the important part…what can we do to get you back out on the roads and maximising your running potential!?

Reduce Load- Initially it might be key to reduce load either by modifying or reducing aggravating movements. This is where the mantra ‘no pain no gain’ does not apply! For some of you this may mean stopping running for a period until your symptoms reduce, for others we suggest you adopt the more appropriate moto of ‘pain free running’. Don’t be alarmed! This isn’t a ‘no running life sentence’ Activity can be reintroduced, but this should be gradual, guidance from a specialist is essential and we’re on hand to help you out!

Optimising training- I know you’ve probably heard this song before…Too much, too soon, too little rest! But as with most running injuries, PFPS can be caused by increasing distance, frequency of sessions, speed and intensity of training without allowing adequate time for your body to adapt to these changes. It all starts with the right training program and regardless of your goals, our therapists are trained to give you expert advice on the right program for you.

Movement Control and Running Biomechanics- Muscle strength, timing of muscle contractions, single leg balance, foot mechanics and running gait are just a few from a vast list of factors that can contribute to the onset of PFPS. A full biomechanical screen will highlight any issues and inform your rehab.

Improve Flexibility – Tightness of the tissues around the knee can affect how the patella moves and potentially increase the load upon it. Stretches that target the quadriceps, hamstrings, glutes and calfs (to name a few) are important to maintain joint range of movement in the leg and keep the patella happy. In addition to this, foam rollers are a brilliant tool to increase tissue pliability and improve joint flexibility. We understand many of you will have a love-hate relationship with rollers but trust us- you have all to gain by using them- the mantra ‘no pain, no gain’ is completely relevant here!

Stay Tuned for Part 3 where we discuss iliotibial band syndrome….

 

Author: Rachel Jones I Physiotherapist BSc (Hons), MCSP
Rachel has a breath of experience working as a musculoskeletal Physiotherapist in both the NHS and private sector. She is passionate about offering only the highest quality care and believes an accurate diagnosis, confident hands on treatment and appropriate self-management advice is key to helping people lead happy, pain free lives.

She exudes positivity and prides herself on being an enthusiastic and empathetic Physiotherapist. Rachel is there to listen and strives to form strong partnerships with all her clients so they can work together to achieve their rehab goals

For more information on our Services call today
Moulton 01604 493066
Wootton 01604 875950
Great Denham 01234 980980

 


Running Blog Series – Introduction

Blogs, Physiotherapy, Running Leave a comment  

Here at the Back & Body Clinic we love working with runners! We know that it doesn’t matter if you are an elite athlete, a mother of three or a carefree retiree; being side-lined by an injury can be hard to deal with by yourself both physically and emotionally.

Unfortunately, getting injuring is very common and one group of people that this applies to is runners. Research estimates that up to 82% of runners will suffer an injury at some point in their running career…82%!!

Lucky for you, we’re here to help!!

We have compiled a running performance toolkit, designed to help maximise your running performance and stop injuries in their tracks!!

Over the next few weeks we are going to talk you through the most common running related injuries; how to avoid them and optimise performance, and how to deal with them and super charge your recovery if you are injured!!

  1. Patellofemoral Pain Syndrome

 What is it? Patellofemoral pain syndrome (PFPS) is a complex and sensitive condition which presents as pain in and around the knee cap (patella). It can often be caused by a number of factors including muscle tightness, weakness, malalignment or over training. Here at the clinic we use a comprehensive running biomechanical assessment to identify and address these route causes.

The facts

  • Considered the most common running related injury
  • 5 million runners a year are diagnosed with PFPS!!

  1. Iliotibial Band Syndrome

What is it? ITBs, ITBFS, IT band syndrome – call it what you want, iliotibial band syndrome is a commonly known running related injury that can stop a person right in their tracks…. literally!

The iliotibial band is a thick fibrous band that runs down the outside of the leg, attaching just below the knee joint. It is around this attachment point that most people will experience pain- hence it is commonly termed ‘runners’ knee’.

The facts

  • 2nd most common injury in runners
  • Most common cause of lateral knee pain in runners
  • Estimated 5-14% prevalence in runners.

  1. Plantar Fasciitis

 What is it? Other than being very difficult to spell, plantar fasciitis typically presents as pain in the sole and heel of the foot. The exact cause is understood to be like most running related injuries and is thought to be associated with ‘overloading’. Often the first few steps in the morning are painful, as well as walking barefoot and going up stairs.

The facts

  • 3rd most common injury in runners
  • 10% of the general population will experience plantar fasciitis at some point in their lifetime.

  1. Achilles Tendinopathy

 What is it? A sore spot for some runners, Achilles Tendinopathy’s usually begin as a gradual pain in a portion of the tendon either during or after a run. Usually the tendon is painful if you squeeze it and there may be some swelling or thickening.

The facts

  • Estimated to affect 9% of recreational runners

Stay tuned for our running injury series where we will run, jump and dive deeper in to each of these conditions! As they say, knowledge is power so let’s all strive to be healthier and happier runners!! 😊

Rachel Jones
Rachel has a breath of experience working as a musculoskeletal Physiotherapist in both the NHS and private sector. She is passionate about offering only the highest quality care and believes an accurate diagnosis, confident hands on treatment and appropriate self-management advice is key to helping people lead happy, pain free lives.

She exudes positivity and prides herself on being an enthusiastic and empathetic Physiotherapist. Rachel is there to listen and strives to form strong partnerships with all her clients so they can work together to achieve their rehab goals

For more information on our Services call today
Moulton 01604 493066
Wootton 01604 875950
Great Denham 01234 980980


Plantar fasciitis (PF)

Blogs, Physiotherapy, Podiatry, Shockwave Leave a comment  

Mirror mirror on the wall, who’s the most stubborn of them all? 

Plantar Fascilitis digramIf there was one condition that epitomises stubbornness… it has to be plantar fasciitis.

If musculoskeletal conditions lived in the world of fantasy then plantar fasciitis would have to be the villain.

We are lucky to live in a very exciting time of progressive research that leads to evolving opinions from various gurus across the globe. However in the case of plantar fasciitis there is a degree of uncertainty as to how it is best managed and how it is even caused in the first place.

There are several factors that can lead to the development of plantar fasciitis. If you are someone who has experienced it or is currently experiencing it you will know that it can hang around for a loooong time and in some cases even come back even after shaking it off the first time!

Luckily our therapists here at the clinic have a few tricks up their sleeves to give them an advantage when taking on this  villain. We approach plantar fasciitis on a case by case basis. After all there is no one-size fits all approach, as this condition can be caused by a variety of different factors.

Firstly we sit down with you and find out all the information about how your symptoms behave. We then carry out a thorough assessment to confirm plantar fasciitis is the cause of your issues. We then work together with you to devise a treatment plan that is achievable in everyone’s busy schedules. We also use manual therapy techniques, taping and often involve the specialist knowledge of our podiatrists in the fight against your plantar fasciitis.

On the rare occasion the initial treatment plan is unsuccessful our therapists have another trick up their sleeves.  If someone’s plantar fasciitis is really persistent, evidence shows that Shockwave Therapy can be a really effective treatment for this stubborn pathology. For more information on how Shockwave Therapy has been shown to improve plantar fasciitis and a range of other pathologies have a look at our Shockwave blogs! Our tricks don’t stop here, we can even consider cortisone injections for the most persistent of plantar fasciitis. Don’t just take our word for it…..this is what some fellow plantar fasciitis sufferers have said about their experience of treatment at the Back & body clinic:

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A single blast from the Shockwave machine was enough to rid me of a chronic episode of plantar fasciitis. It made a huge impact, so much so that within 10 days it was all but eradicated and with a few more exercises I was pain free within 14 days and have been since.

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I had Shockwave Therapy for plantar fasciitis…it was very effective and i am delighted with the results.  My pain levels have reduced considerably and I am now fully mobile and am back playing tennis and golf without any pain.  I would highly recommend this treatment for plantar fasciitis suffers.

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So if you feel that you have gone on long enough with that annoying pain in your foot, or maybe it is just starting to become a nuisance come and see one of our therapists today and they’ll help get you back on track!

Luke Girvan
Luke has worked with patients to help resolve various musculoskeletal conditions. In addition he has worked with patients recovering from surgery, acute traumatic brain injuries and those living with long-term neurological conditions. His collaborative approach, excellent assessment and treatment skills and consistent delivery of the highest standards of quality care ensure patients reach their goals.

With over 10 years’ experience as a Personal Trainer and Fitness Instructor Luke has worked with a diverse population of clients including adolescents, elderly and both semi-professional and professional sports men and women.

For more information on our Services call today
Contact the clinic –
Moulton 01604 493066
Wootton 01604 875950
Great Denham 01234 980980

 


Torticollis, a head turning preference or plagiocephaly

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My baby’s head is flat and I am concerned they are only looking one way?

When babies are born the bones in their skulls are not fully fused, which is why we’re always so careful of protecting a newborn babies head (that and because of their lack of head control!). It is also one of the reasons there are guidelines about how long your baby can be in a car seat for. The biological reason for their skulls not being fully fused at the time of birth is so that your baby’s head can mould itself to be a little bit smaller in order to fit through the birthing canal when the time comes!

Your baby has 2 soft spots on their head; one at the back (posterior) and one at the front (anterior) of their head. These are called their fontanelles. The posterior fontanelle does not fully fuse until around 6 weeks old, which is why, after this point you can start going on longer car journeys with your little one in their car seat. The anterior fontanelle on the other hand does not fuse until 10-24 months.

Because of these soft spots, sometimes you might notice that your baby’s head is a slightly different shape when they are first born, especially if they needed a bit of extra help coming out. This should settle down within the first week or so however you may want to come and see our specialist children’s physio if you have any concerns, if their head shape hasn’t changed or if you notice:

  • That your baby has a preference to look to one side more than the other?
  • That they hold their head on a slight tilt, especially when they’re tired.
  • A flattened spot on one side of their head.

 

If so, they might have something called torticollis, a head turning preference or plagiocephaly. These are all really common conditions children sometimes acquire and here at The Back and Body Clinic, our paediatric physiotherapist is trained in the assessment and treatment in order to get the muscles in your baby’s neck and back working correctly.

For more information on our Children’s Physiotherapy Service call today
Contact the clinic –
Moulton 01604 493066


The Importance of Tummy Time

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Importance of Tummy time | Paediatric Physiotherapy

With increased awareness being published on Sudden Infant Death Syndrome (SIDS) and the recommendation that babies should sleep on their backs, there seems to be an anxiety about getting your baby to spend time on their tummy. However, research also shows that a lack of tummy time can delay your baby from meeting their developmental milestones (lifting their head, rolling over, sitting…). Well this blog will tell you all you need to know about this vital activity that should be in your babies schedule.

Babies can sleep up to 15 hours a day if you add up all the time they nap throughout the day and night. That’s 15 hours spent on their back in one position. Therefore, when they are awake it is important for their development that they spend short periods of time playing in different positions to strengthen different muscles, particularly time spent on their tummy.

But why? What makes tummy time so vital for development?

Here are some reasons why Tummy Time is important:

  1. It helps strengthen the muscles in your baby’s neck so that they can hold their head up against gravity and look out at the world which surrounds them
  2. Aids cognitive development and awareness of the environment around them
  3. It encourages weight shift when playing, reaching, pivoting and all the precursors to crawling
  4. It increases strength in your child’s shoulders and arms so that later in life they can reach/ crawl/ climb/ write with ease
  5. It encourages hand-eye coordination when playing and the balance and coordination needed to roll over
  6. It prevents the development of a “flat spot” on the back of your baby’s head (plagiocephaly)
  7. Its helps with the formation of arches in their hand for fine motor development
  8. It helps with gas and constipation
  9. It stretches and develops muscles in and around the hips in preparation for crawling and walking
  10. It helps strengthen the muscles in your child’s back, helping with posture and skeletal alignment
  11. It helps visual-motor development and depth perception

Quite a few advantages of tummy time aren’t there?!?

I think all these points give you more than enough reason to try and get your little one to spend some time on their tummy.

When to start focussing on Tummy Time

Tummy times should, ideally start at around 2 weeks old. Initially it’ll only be for short periods of time (1 minute of play) but gradually; as your baby gets stronger neck muscles, gets more used to being in that position and as you get more confident with handling them being in this position you can gradually increase this time.

It’s perfectly normal for your baby to fuss when you initially begin tummy time, this is one of the reasons why we recommend starting it so young and gradually building up the time. It takes time to build up the strength in their necks and initially its hard work…if we asked you to run a marathon without training, you’d probably complain too!

Tips and exercise ideas:

Try incorporating tummy time into your daily routine, for example:

  • Lying on your chest
  • Tummy time after nappy change (not after feed or you’ll be feeding them again very quickly!)
  • Use a mirror to make your child engage in tummy time – they love making faces at themselves
  • Use a rolled-up towel under their chest initially if they are struggling to lift their chest and head up alone
  • Games such as flying aeroplane
  • Read a book in this position to keep them engaged

Tummy Time exercises | Paediatric Physiotherapy

By 2 months you should be aiming for your baby to tolerate 5 minutes of play on their tummy at a time. If it’s still tricky or they don’t like it, you can try rolling up a towel and putting it under their chest to give them a bit of support.

By 3-4 months all being well they should be able to lift their head and chest off the floor and be starting to weight bear through propped elbows to support them.

From 4 months they might start attempting to push up onto extended arms and this is when you don’t want to take your eyes off them as they will be rolling over from front to back before you know it!

By 6 months, if your baby is consistently rolling over and moving in between positions independently you don’t need to fit specific tummy time into your daily routine…you might want to start moving on to sitting!

However, if your baby is struggling to reach these milestones…don’t panic!!!

Get in touch and we can do a full assessment and advise you on what might help in each individual case. Even if it is just for a one off assessment to reassure you that everything is ok.

 

Author - Lucy Phillips | Paediatric Physiotherapist

For more information on our Children’s Physiotherapy Service call today
Contact the clinic –
Moulton 01604 493066


Growth and Associated Problems in Children

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Growth and Associated Problems

All you parents out there who get woken up early on a Sunday morning with a distressed child at the foot of your bed complaining of leg pains. This is a blog you’re going to want to read as it’s all about growing pains. Growth is one of the most common questions I get asked about in clinic and all the problems that come alongside growing:

  1. Growing pains
  2. Growth spurts
  3. Increased clumsiness
  4. Increased chances of issues such as:
    Severs Disease
    Osgood Schlatter’s Disease

    Sprains/ Strains

Growing pains – What are they? Its rotten luck isn’t it, everyone grows, you can’t help how quickly or slowly you do it, it’s fully out of our control and yet, we have to suffer the consequences of doing it. New research now suggests that you don’t only get growing pains from suddenly doubling in height you can get them even if your little one isn’t the tallest one in class.  Within the physio world they now use the term;“recurrent nocturnal limb pain in children” – a bit long winded don’t you think!.

So how will you know if your child has “recurrent nocturnal limb pain” … without stating the obvious, they will have repeated episodes of pain in the legs, shins, calves or ankles at night. Now that is a pretty vague explanation as there are lots of other reasons your child could get night pains but if they are severe enough for them to  still have pain into the day or walk with a limp it is unlikely to be true growing pains and therefore it is recommended you get in touch with us at the Back and Body Clinic – even if it’s just for some friendly advice!!

In the meantime, you can help ease the symptoms by rubbing/ massaging your child’s legs, use a hot water bottle/ wheat bag to relax the muscles and ease the pain, take pain relief as prescribed by your GP and finally try and do regular stretches throughout the day to help stretch out the muscles and stop them cramping up.

Growth Spurts – when to expect them? What to look out for? And what to do?

Growing can cause several issues in children that can be painful in the day time so:

How can I preempt my child is about to go through a growth spurt and what should I do?

The science (hopefully written in an easy to read way)

We’re pretty much constantly growing from birth until we reach full skeletal maturity between the ages of 18 and 20 (dependent on your gender, girls reach skeletal maturity first).

In the first year of life we have the most significant growth – growing an average of 25cm in length and tripling our birth weight – now that’s pretty impressive! Thereafter we continue to grow, often characterized by a last minute dash to the shoe shop the week before the start of the new term, followed by a mad rush to see if the school shop have the next size trousers in stock as the last pair are 2 inches off the floor.

With this in mind, it makes sense that when we grow it’s our extremities (hands and feet) that grow first followed by everything else. So, once our hands and feet have grown, we basically work up the body from our furthest extremities inwards. So next to grow is our arms and legs… starting with shins and forearms then followed by the thighs and arms before the last bit of growth we see in our spine and broadening of our chest in boys and our hips & pelvis in girls… But when does all this happen?

Well, as I’ve said in a previous blog post on walking “every child is different”. However, there are guidelines to help us pre-empt growth but also looking out for signs and symptoms such as the need to get new shoes, which is probably the easiest way to identify the first sign that your child is about to go through a growth spurt, and it’s at this time that its most pivotal to ensure your child protects their body to prevent injury.

How?

The best way to protect our bodies during periods of growth is by doing regular stretches and to take the pressure off your muscles by slightly altering your training program if you’re sporty. It is also probably a sensible time to visit your physio so that you can be advised on what exercises and stretches are most appropriate and avoid getting injured in the first place!

  • Increased clumsiness – why your child might suddenly experience a hattrick of falls or a call to the school office for suddenly being increasingly fidgety

Another associated factor to growing (frustratingly) is increased clumsiness. Why? Because basically our bones and muscles grow too quickly, and our brain cannot keep up. This means that until our brain ‘catches up’ our center of gravity is in a completely different place which can make us clumsier and also more fidgety. On average we grow at 6cm per year from 1 until puberty, but during our fastest periods of growth, boys can grow up to 9cm (usually between age 14-15) in a year and girls can grow up to 8cm in a year (usually between age 12-13) …it’s no wonder our brains can’t quite keep track!

  • Increased injury risk

Another associated issue with growing is an increased risk of injury. Muscles attach to bones, it’s what makes us so strong. However, when we grow, our bones grow rapidly, but our muscles take time to stretch in line with the speed at which our bones have grown, therefore this predisposes us to injury. Common injuries associated with growth are:

  • Sprains/ Strains

If you have any concerns about your child during a period of growth or pre-empt a growth spurt and want a pre-habilitative assessment and treatment, as well as some advice on what to do to prevent injury, please contact us directly and we will book you in 😊

For more information on our Children’s Physiotherapy Service call today
Contact the clinic –
Moulton 01604 493066


Running footwear Part 4…When should I change my shoes?

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When should I change my shoes?

Now there are no exacts or hard and fast rules with this, but as a rough guideline most manufacturers will say around 500 miles for a pair of shoes. Many things will affect this: weight, terrain, frequency of training etc. The best tell is either the shoes fall to pieces, or you start having aches, pains, blisters or recovery takes longer, for no apparent reason (no change in mileage, training type, terrain etc.)

When it comes to changing shoes before events, we usually recommend to allow around 1 month if you are training for a marathon or half marathon, or around 2 weeks if training for anything shorter. This is to allow you to gradually break the shoes in. Even if the shoes are exactly the same, a new pair will be stiffer, and won’t have “moulded” to your feet. This wearing in period mitigates any risk of blisters.

Here are a few handy tips on making shoes last longer and how/when to change them;

Have 2 pairs.  Whether this is 2 pairs of the same shoes that you cycle between, or different pairs for different activities (a trail shoe and a road shoe for example)

Only use your running shoes for running.

Keep a mileage diary from the day you buy your shoes. This way you can work out how many miles it is until you need a new pair, then it takes the guess work out of when to buy your next pair. You can also purchase a new pair a few weeks before and then break in the new pair whilst phasing out the old pair, therefore reducing any need to lower mileage to break in a new pair.

Don’t be fooled by the way the shoe looks. The shoe may look pristine, however this doesn’t mean that it is still offering the same level of cushioning and support as it did when new. Listen to your body and if in doubt go and try on a new pair, 9 times out of ten you will immediately feel the difference if the shoe is now past its best.

This concludes our 4-part piece on running footwear. If you have any questions or queries, please get in touch or make an appointment to come and see us.

Our podiatrists work across all 3 clinic locations
Contact the clinic –
Moulton 01604 493066
Wootton – 01604 875950
Great Denham (Bedford) – 01234 980980

 


Running footwear Part 3 – Does one shoe do it all?

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An overview of different types of running shoes, from marathon shoes to racing flats

Not all running is the same, as such, not all running shoes are the same. For example, there will be lots of differences in construction, design and feel of a marathon shoe vs a trail shoe.

Your goals, terrain, age, and weight should all be taken into account when deciding the best type of shoe for you. Having different shoes for different runs is also beneficial (a different pair for speed work and long running for example)

We will run (pun intended!) through some different categories of running shoes, their features and their uses.

Marathon/road shoes – These are designed to offer maximum support and cushioning. Usually chosen for slower, longer miles. Designed for a plusher, comfortable feel, to absorb shock and usually have a greater offset of between 8-12mm (thickness under heel vs that under forefoot). They are not exclusively for marathon miles however, the benefits of maximum support and cushioning are reaped by couch to 5k runners, just as much as marathon runners. Firstly, because a beginner on lower mileage may take longer to do shorter distances, secondly a lack of conditioning or adaptation to the loads running exerts on the body, can also be mitigated by extra cushioning and support. An elite marathoner could perhaps wear any shoe for 5km and have no problems, however needs the extra support and cushioning of a marathon shoe due to the cumulative effect of very high mileage training. It’s relative to level of conditioning.

Race shoes – These are performance orientated. Designed to be very lightweight, responsive, and looking to transmit as much power as possible as efficiently as possible. Because of this they tend to less forgiving, suited to shorter, faster activities and more conditioned runners. They usually have lower offsets (typically 4mm) and weigh around half of what a marathon road shoe typically would.

Lightweight road shoe – These are a halfway house between road shoes and race shoes. More responsive than a marathon road shoe and more cushioned than a race shoe. Designed to be worn as a training mileage shoe, or faster speed work shoe, or a more supportive option as a race shoe. Typically, the offset can be anywhere from 4mm to 10mm.

Trail shoes – These are, as the name suggests, designed for trails or off road running. There will be differing levels of grip, versatility, support and cushioning within the trail category. Depending on the terrain you are running on will inform your choice. As a general rule, the more grip and responsiveness, the less cushioning, support, versatility (some trail shoes will be suitable for 50% road and 50% trail, some will be almost exclusively grass and mud) and weight. For cross country running a much ‘grippier’ and responsive shoe may be more suitable, whereas a more supportive, cushioned, less grippy shoe may be more suitable for regular 10-mile mixed terrain runs. Trail shoes are almost always neutral as the terrain they are designed to be worn on is uneven therefore gait changes from stride to stride.

Another consideration, away from running is, different shoes for different activities. For example, a marathon road shoe essentially looks to mask the feeling between foot and ground – not ideal for power transmission or stability during heavy dead lifts or squats, a much firmer solid shoe would be more suitable. Look out for part 4, When should I change my shoes? In our next and final instalment of the running footwear series.

Our podiatrists work across all 3 clinic locations
Contact the clinic –
Moulton 01604 493066
Wootton – 01604 875950
Great Denham (Bedford) – 01234 980980


Running footwear Part 2

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Support levels and foot type/stability

Within running shoes today there are broadly speaking 4 different levels of support; (we will discuss different types of shoes like marathon or racer in part 3 of this series) Neutral, Guidance, Moderate Support and Stability/Motion Control.

Most specialist running shops will offer some kind of assessment to ascertain which shoe suits you best. Bear in mind that even with all the assessment in the world, it is still only an indicator, there will be exceptions to rules and it is always worth considering goals, terrain, comfort and other aspects of fit and performance of a shoe, as well as assessment of the foot and leg. Historically ‘foot type’ and rear foot position were/are still used, however more recently these have been incorporated into an assessment that involves ascertaining an idea of stability and alignment of the foot and leg.

For example, a ‘normal’ or ‘neutral’ foot structure/type (good congruent arch, no real collapse of flattening) would be recommended a neutral shoe based purely on foot type. However, the foot may be particularly unstable in single limb stance or the knees may fall inward when bending them, and the foot may roll inwards when walking/running. Therefore, a more supportive shoe might be more beneficial. Conversely a very flat foot may actually be very stable and the alignment of the leg good, so a neutral shoe would be recommended.

What is support in a shoe? Well with most shoes the ‘support’ is achieved by using a denser or firmer material in a specific place within the midsole (the bit between your foot and the ground).  The more support the denser the material, or longer the block. Support is also achieved by different lasting (usually wider and straighter), flared midsoles, trusstics (plastic inserts in the mid foot area of the midsole) or sometimes plastic reinforcements into the dual density block. The addition of support adds both weight and stiffness to a shoe.

So let’s run through some of the features of different support levels;

Neutral– Usually lighter weight than supports shoes, have a softer feel, no additional dual density block in the midsole. Suitable for a stable foot and leg, or someone looking for maximum cushioning.

Guidance– A small dual density block is placed in the midsole, offering a good mix of cushioning and a little extra support, without adding too much weight. Suitable for a mostly stable foot and leg, with perhaps a few signs of mild instability that may benefit from the added support later during a run once fatigue sets in.

Moderate support– As the name suggests a moderate dual density block is placed in the midsole, other factors affecting stability mentioned above may start to be introduced at this point too, a slightly firmer feel but stiffer midsole. Suitable for a more unstable foot and leg.

Stability/motion control– A larger, denser block is placed into the midsole, almost always a wider straighter last, much heavier and stiffer midsole. Suitable for a very unstable foot and leg.

This is a broad and brief overview, for any further advice please get in touch, make an appointment to come see us or visit your local specialist running shop. Be sure to look out for part 3, does one shoe do it all? An overview of different types of running shoes, from marathon shoes to racing flats.

Our podiatrists work across all 3 clinic locations
Contact the clinic – Moulton 01604 493066
Wootton – 01604 875950
Great Denham (Bedford) – 01234 980980

 


Upside of Down….How can physiotherapy help?

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Upside of Down. How can physiotherapy help?

As part of Down Syndrome awareness day, we have decided to discuss the role of Physiotherapy in Down Syndrome.

The first few years following the birth of your child who has been diagnosed with down syndrome can be tricky not just for your child but for you as well. One factor to consider is the realisation that your child might find it difficult to reach the same developmental milestones as quickly as children of similar age.

Developmental delay is commonly associated with children with Down Syndrome and can be a hurdle for both parents and their child.  Physiotherapists may be able to give you a helping hand through that journey and we at the Back & Body clinic would love to help out where we can to guide you through this adventure.

As you will know children with Down Syndrome are born with some specific characteristics some can be helped with physio and some can’t. Here are the characteristics which we can help with:

  1. Hypotonia (low muscle tone)
  2. Increased flexibility (due to increased laxity in their ligaments)
  3. Reduced balance (due to having shorter arms and legs)
  4. Decreased muscle strength (affecting fluidity of movement)

So…. what’s the physio’s role:

Physiotherapy aims to address any developmental issues that might arise. Delays vary on an individual basis however, research has shown that the earlier you can seek advice on positioning and activity ideas the better. This will help to promote developmental skills such as rolling, sitting, crawling and walking. The physiotherapist will assess your child and give recommendations on how to help support your child’s posture as well as give strategies and treatment to help facilitate movement and make movement easier. This will also prevent them from developing compensatory movement patterns that can be problematic later in life.

1. Hypotonia (low muscle tone)

For a child with hypotonia, you might notice when you pick your child up that sometimes they slip between your hands, or they may be described as “floppy”.

The difficulty is, that if you have slightly reduced muscle tone, it makes it much harder to initiate movement, which is commonly why children with Down Syndrome have associated developmental delays.  It’s harder for them to initiate the movements needed to roll over, crawl and walk therefore it takes them a little bit longer to learn.

2.Their increased flexibility (due to increased laxity in their ligaments)

Due to having increased laxity around their joints children with Down Syndrome are often extra flexible, this can make them feel unstable in sitting and standing. The ligaments that support the bones are slacker and therefore allow more movement which makes it difficult to balance. As a result, children will commonly adopt postures that take up a wide base of support to compensate.

This increased flexibility can make early developmental skills such as crawling and standing difficult. A physiotherapist will help facilitate your child into positions that at first will make them work harder but this will teach them how to use their muscles properly.

3. Reduced balance (due to having shorter arms and legs)

Having shorter arms and legs in comparison to their trunk can make developmental skills such as sitting difficult. This is because children are unable to rely on using their arms to prop them up in the same fashion than a child who is typically developing would,  therefore common compensatory techniques are learnt to overcome this which is great at the time of achieving the task, however can cause problems further down the line (such as knee and back pain). A physiotherapist can help your child develop gross motor skills such as sitting and walking, without them learning to rely on compensatory movements to achieve the task.

4.Decreased muscle strength (affecting fluidity of movement)

Reduced muscle strength will impact the fluidity and ease at which a movement is performed. Strength can be significantly improved through practice and repetition of movements in the right movement plane which is important to avoid the development of compensatory movement patterns. The physiotherapist will demonstrate and advise on play positions to help strengthen up weaker muscles (commonly around the hips and shoulders) to enhance their independence and function. They may recommend a block of treatment to work towards specific goals and will use facilitation to help assist your child in working muscles that are weaker.

TheraTogs:

TheraTogs is a useful tool that a physiotherapist may recommend using in conjunction with their therapy. TheraTogs is a therapeutic garment used to increase stability and help give proprioceptive feedback to the client. Specific strapping is used to help improve the alignment of the spine and pelvis to prevent the development of compensatory movement patterns and to encourage movement within a functional and well-aligned movement pattern.

Examples of compensatory movement patterns:

  • Walking with feet turned out
  • Standing in a lordotic (stomach out and back arched) posture
  • Sitting with their back rounded
  • Sitting with legs stretched out really wide/ Lying in “frog-legged posture”

Examples of common positions you might find your child rests in and what you can do to help…

  • Star fish posture
  • Frog legged posture

Due to a combination of increased laxity at joints and increased hypotonia, children with Down Syndrome also often adopt postures which allow them to take up as much of their base of support as possible.

So, when lying on their back children with low tone often adopt a “star fish” posture – they’re taking up as much of their base of support as possible because anything else takes a lot more effort. This lack of muscle tone makes it difficult for them to actively lift their arms up to play with their play-mobile, for example.

What to do? By rolling up a towel in a sausage shape and placing it under your child’s shoulders you are giving them a little bit of added support, which ultimately will help them to not only maintain a more functional position, but it will also support them in achieving the task of reaching up for their toys.

Additionally, if your child likes to adopt the famous “frog-legged” posture, by using the towel trick around their hips it’ll give them the added support they require to hold their hips in a neutral position whilst also helping to develop the strength needed later-on for crawling and walking.

The more they practice a task successfully, the more muscle strength they’re building up and will be able to reach their developmental goals successfully.

Lucy Pearson (Specialist Paediatric Physiotherapist)
Contact the clinic on 01604 493066