Category Archives: Problematic sports injuries

08Jan/14
Skiing - aches and pains

A quick note on… skiing — pain and injury

Aches and pains, Problematic sports injuries, Rehabilitation, Skiing injuries, Sports Injuries, Sports medicine, , , ,
Skiing - aches and pains

Skiing – aches and pains

It is that time of year when many set off for the slopes for the joy of being on a mountain, the freedom of sliding, or bumping, down the piste and finishing the day with a favoured tipple, preferably in the sun. Sadly this is not always the case as there will be aches and pains, to be expected, and more serious injuries that require medical and surgical attention.

Firstly, the aches and pains. When we are active in a different way it usually hurts and that is normal. Waking up and trying to get out of bed with stiffness is never fun but it commonly eases off by the time a shower has been had and movement has been initiated. By and large, these aches and pains lessen as the week progresses and we are used to all the physical labours of carrying skis, poles and general clobber by the time we are heading home. I do not know how many people actively seek to improve their fitness before going skiing but many threaten to do so. If you are preparing, starting the week before will probably not do too much, but you may as well give it a go. Don’t go mad and pull a muscle. Ideally, several months before you should be undertaking exercises that in some way replicate skiing. Simple measures such as warming up and cooling down are often forgotten. Warming-up should involve easy mobilisation exercises of the whole body and cooling down in a similar way interlaced with a few stretches of the back and legs. Please note that you should always seek specific advice on exercises that are appropriate for you.

The more serious injuries involving ligaments, bones and tendons will need accurate diagnosis, good early management — that includes you knowing what has happened and everything that you should be doing physically and mentally to optimise healing; and there are many many things that you can do — pain control and a clear route forward of what needs to be done.

If you wish to prepare for your skiing trip and want to know more, or if you’ve suffered an injury that requires rehabilitation, please contact us now to find out how to go about getting back on the slopes and to normal living: 07932 689081

16Apr/13
Back pain clinics, London

‘Get betterers’ and ‘persisters’

Chronic pain, Pain, Problematic sports injuries, Sports Injuries, ,

Why is it that some people recover from an injury and others take longer than expected or continue to have problems beyond a normal healing time? It’s the latter group that I spend a great deal of time with, helping them to develop understanding of their pain and devising a plan of what they must do to move forward. 

The science of pain has moved on rapidly over the past 5 years with the neuroimmune system revealing some very interesting mechanisms that are fundamental to the pain experience. Groups of researchers around the World are gradually putting together the pieces of one of the most complex puzzles, that of pain, in tandem with modern thinkers who are blending science with philosophy to craft better ways of approaching the problem. This incorporates closing the gap between the individual’s narrative and the objective findings and termed first-person neuroscience.

The evolving understanding of pain as a multidimensional and multisensory experience sounds complex but in fact creates opportunity to tackle pain in different ways. Knowledge of how we prime the neuroimmune system with prior experiences, by the way we think and perceive the World, and how this blends with our genetic make-up is illuminating. There is no moment in isolation but rather a continuum. On sustaining an injury or feeling pain, this is a point in time when a certain threshold of excitability has been reached, triggering a range of protective responses including pain. The pain directs our attention to an area of the body and motivates behaviours that are congruent with healing and survival. Other responses include activation of the autonomic nervous system and changes in motor patterning. How we respond is down to what the psychoneuroimmune systems do to protect us. We feel the effects, sometimes subtly and sometimes like a tidal wave as they take hold. What happens next will depend on what has happened before, how we think and behave, our genetics, the context around the injury or when the pain starts and the state of the neuroimmune system at that point to name but a few. For simplicity I have named responders as the ’get betterers’ and the ’persisters’.

The ’get betterers’ are those who sustain injuries or develop pain (these are different constructs) and simply get better. Sometimes they seek advice and have treatment and sometimes they just modify their activities. The end result is a reduction in sensitivity and a return to normal life. Notably lacking in the early stages of the injury are any signs of catastrophising and excess vigilance to the injured area. Often these individuals have had prior injuries that have successfully resolved, have an optimistic outlook for the new injury and are not too bothered by the inconvenience. Clearly this is a simplified description of a necessarily complex interplay of physiology, behaviour, belief and character. 

The ‘persisters’ often tell a different story. The context of the injury maybe traumatic, the injury may have been poorly

Persisting Sports Injuries

managed and could have created a great deal of fear and anxiety (the latter could be pre-existing). The early focus is surrounded by catastrophic thinking in some cases, accompanied by a set of protective behaviours that although useful as an aid to healing in the acute phase, become problematic as time progresses. Often the early sensitivity and pain are intense and strong, the signals of danger bombarding the neuroimmune system and triggering changes in the properties of these neurons. Subsequent signals are amplified so that normal stimuli (touch, movement) hurt and those that would normally be painful are even more so.

A growing body of evidence suggests that at the point of injury, if the nervous system has been primed by epigenetic factors, the response could be overblown and persist due to the subsequent ‘rewiring’ in the central nervous system. Epigenetic factors are those that are as a result of the effects of the environment upon our genetic make-up. The good news regarding epigenetic effects is that they seem to be reversible if we create the right situation. This is why the thinking around the treatment of chronic or persisting pain must be different.

In a persisting pain state we are not dealing with the acute response to an injury that is unpleasant but normal and necessary. Instead we are tackling an emergent experience (the pain) from the ‘self’ (body) that is underpinned by a complex interplay between the body systems that include the neuroimmune, endocrine and autonomic. This takes a different and multidimensional approach.

How do we do this? We look at the individual and the physical-cognitive-emotional dimensions of the condition and pain. Tackling the problem requires strategies and therapies that target beliefs, behaviours, cognitions, stress, physical health (e.g. tissue mobility, strength etc), motor planning and control (i.e. normal movement), restoration of function, resilience and confidence to name a few.

Following an injury the tissues go through a healing process. Pain and other symptoms can certainly persist beyond the healing time and this is due to changes in the neuroimmune system. There can be little to see on a scan or x-ray in many cases (termed ‘medically unexplained symptoms’, i.e. no pathology or abnormality seen yet the symptoms are fully lived. However, the neuroimmune system is very plastic (neuroplasticity), a feature that allows for adaptation and learning. We can use this to our advantage and create the opportunity  to change the experience of pain and ease the symptoms concurrent with shifting our relationship with pain by changing the meaning. Reducing the threat value of pain (moving from fear/anxiety to ‘so what’) has an enormous impact upon the perception of pain, in a sense disarming the experience.

In summary, some people recover from an injury or painful condition and return to full activities at home, work and in their chosen sports whilst others have difficulty. The latter group require a very different model of care to tackle the problem of chronicity and recurrence, this model being comprehensive, addressing the physical-cognitive-emotional dimensions of pain. Naturally more complex as we must consider (in no particular order) neuroimmune development and priming, genetics, epigenetics, existing beliefs, culture, stressors, altered processing of nociceptive signals, sensory and motor cortical representation changes, altered body sense and the impact upon ‘self’ and lifestyle. Constructing a treatment programme around these factors  creates the opportunity for change, the development of wellness and the optimisation of performance.

 

29Aug/12

Back pain in football and sport

Back pain, Chronic low back pain, Chronic pain, Exercise, Football injuries, Low back pain, Pain Education, Problematic sports injuries, Sports Injuries, , , ,

Back pain is a common experience across society. Millions are spent each year on treatment yet we do not seem to be making any significant progress in tackling this vast problem. Undoubtedly footballers are also subject to spinal aches and pains, either from a direct injury or insidiously. Most people whom I see fall into the latter category, when the pain comes on gradually, the individual seeking help when the pain reaches a troubling level.

Frequently back pain is blamed upon a disc injury, a facet joint problem, arthritis or a ligament sprain. In the acute stages the muscles often tighten or spasm making it very difficult to move. The pain can be extremely intense and worrying, but in fact this is a normal body response to the problem, even if there is no significant damage to the tissues. It can sometimes take a few days for this to subside, with any movement triggering pain–when we move our arms and legs, because the trunk muscles are also being used it means that they can tighten and be painful.

Acute pain – seek help if you are unsure

The general advice with acute back pain is to remain active as possible. Usually your GP will suggest pain relief or anti-inflammatory medication to help ease the symptoms. Gentle and tolerable exercise maintains the tissue mobility meaning that movement becomes easier and easier. Typically the back will stiffen when we do not move, being painful and tight when we have to change position. Sometimes our posture is altered and we tilt forward or to one side, the muscles pulling the spine into a position of protection. Arguably pushing or pulling (manipulation) this into a straightened position is to force the body into a position and work against the natural protective mechanisms. It does seem that spinal manipulation can ease pain in the short term but does not necessarily offer a better long-term outcome. Consistent movement and positional change is a sensible option.

A study completed some years ago demonstrated that the best predictor of back pain was the ability to hold the back isometrically. With the individual lying face down on a table, his hips at the edge with the trunk being held straight out over the edge, they tested the endurance factor, i.e./ how long they could hold the position. Those with the ability to maintain the position were less likely to experience back pain over the next year.

Core stability encompasses a range of exercises that supposedly create a strong ‘middle’, thereby reducing the risk of back pain. This is based on research that was undertaken in Australia some years ago. Subsequent studies have found that to truly optimise the trunk muscles they need to be working as part of an overall movement strategy controlled by the brain. This requires subtle yet focused training with a strong cognitive element to ensure that the deeper muscles are working at the right level (very low) and with the right timing. This does not mean pulling the low abdomen in as tightly as possible. In fact, many whom I see who have practiced this end up with greater tension and pain as a result.

We simply cannot dissociate lifestyle factors from back pain. Our habits at home, work and during physical activity will have an effect upon the spinal tissues. At this point we have to consider the way in which we feel as stress plays a huge role in pain and how we use our body. The physiology of stress affects every system in the body including the musculoskeletal system where our movements and posturing are manifestations of our thinking. For example, many will tense their shoulders or clench their jaws on becoming stressed. Our thought processes therefore, have an enormous role to play in how we hold ourselves and move. In essence, movement is an expression of what we do and think about. When a pain has persisted for some time, dealing with stressors and emotions must be part of a comprehensive treatment programme. In the acute stage of back pain when fear and anxiety play a role in the protection, having a reassuring explanation is key to starting the process of recovery.

Many people with back pain demonstrate a fear of movement and avoid certain activities. The fear usually develops during the acute episode and is reinforced by further bouts of pain. This is one of the clearest demonstrations of how thinking affects our movement. Interestingly, the amygdala in the brain that deals with fear is connected with the motor centres thereby exerting an effect upon the planning and execution of movement. One of the primary roles of the healthcare professional is to thoroughly assess the patient and fully explain the symptoms and provide a meaning so as to reduce the fear factor and encourage positive engagement in tackling the problem proactively with physical and cognitive measures.

Spinal health in my view cannot be separated from our general health and lifestyle. Considering our physical activity levels, posturing, state of mind, life circumstances, past experiences, our beliefs about pain and injury, culture and the implications of injury are just some of the factors we must think about. No injury or pain happens in isolation. There is always a background to the initiation of pain whether it be acute or gradually building over a period of time. Our job is to look at the individual and their circumstances around the problem in order to find a route forward to recovery and health.

Many sports people will complain of back pain as it is such a common problem. With the right knowledge and strategies over a realistic timeline, the pain can change and we can adapt positively to lead fulfilling and active lives.

22Mar/12
London Marathon - Tower Bridge

Training for the marathon – developing pain & injury

London, Marathon, Pain, Problematic sports injuries, Running injuries, Sports Injuries, , , , , , ,

London Marathon - Tower Bridge

At this time of year, as the London Marathon nears, runners reaching new levels of training can start to develop aches and pains. Usually the pains are in the legs or feet and often begin as an annoyance but develop into a problem that means training has to stop.

The tissues are constantly breaking down and rebuilding. This is a carefully orchestrated process that is impacted upon by exercise. This is how we develop muscle bulk. However, we do need a period of adaptation that can be disrupted if there is inadequate rest. The balance tips towards tissue breakdown and inflammation triggers the development of sensitivity that if ignored can progress and become amplified. A good training programme should account for both rest periods and gradual progression of intensity.

A second issue is that of control of movement. On a day to day basis we can walk around, undertake normal activities, play sports and even run for certain distances with minor motor control issues. Motor control refers to the way in which our body is controlled by the brain with a feedback-feedforward system. The tissues send information to the brain so that there is a sense of position and awareness, allowing for the next movement to be made and corrected if necessary. The problem lies in the increasing distances, often never reached before, that can highlight these usually minor issues. Compensation and extra strain upon muscles and tendons that are trying to do the job of another can lead to tissue breakdown as explained previously. The sensitivity builds and training becomes difficult.

A full assessment of the affected area, body sense and the way in which movement is controlled will reveal factors that need addressing with treatment and specific exercises. This fits alongside a likely modification in the training programme that allows for the sensitivity to reduce before progressing once more. In some cases a scan or other investigations are recommend to determine the tissue nature of the problem.

If you are starting to develop consistent twinges that are worsening, pain that is affecting training or you are concerned, you should seek advice.

For appointments at one of the clinics please call 07518 445493

  • 9 Harley Street
  • The Chelsea Consulting Rooms
  • Temple
  • New Malden Diagnostic Centre
03Feb/12

Chronic pain in sport – Specialist Clinic in London

Chronic pain, Problematic sports injuries, Rehabilitation, Sports Injuries, Treatments, , , , , , , ,

Chronic pain is a real problem in the sporting world. The effects of not being able to participate are far reaching, especially when sport is your profession. There are a huge numbers of clinics offering treatments to deal with pain and injury and in many cases the problem improves. However, there are those who do not progress successfully, resulting in on-going pain, failed attempts to return to playing and varied responses to tissue-based treatment (manual therapy, injections, surgery etc). Understanding more about pain and how your body (brain) continues to protect itself is a really useful start point in moving forwards if you have become stuck. We know that gaining knowledge about the problem can actually improve a clinical test and the pain threshold.

When we injure ourselves playing sport the healing process begins immediately. Chemicals released by the tissues and the immune system are active locally, sealing off the area, dealing with the damaged tissue and setting the stage for rebuilding and repair. The pain asscociated with this phase is expected, normal and unpleasant. It is the unpleasantness that drives you to behave in a protective manner, for example limp, seek advice and treatment. Again, that is normal. Sometimes we can injure ourselves and not know that we have damaged the tissues. There are many stories of this happening when survival or something else is more important. This is because pain is a brain (not mind or ‘in the head’) experience 100% of the time. The brain perceives a threat and then protects the body. If no threat is perceived or it is more important to escape or finish the cup final, the brain is quite capable of releasing chemicals (perhaps 30 times more powerful than morphine) to provide natural pain relief. We know that pain is a brain experience because of phantom limb pain, a terrible situation when pain is felt in a limb that no longer exists. The reason is that we actually ‘feel’ or ‘sense’ our bodies via our virtual body that is mapped out in the brain. This has been mapped out by some clever scientists and in more recent years studies intensely using functional MRI scans of the brain.

Unfortunately, the brain can continue to protect the body with pain and altered movement beyond the time that is really useful. Changes in the properties of the neurons in the central nervous system (central sensitisation) mean that stimuli that are normally innocuous now trigger a painful response as can those outside of the affected area. One way to think about this functionality is that the gain or volume has been turned up, and we know that much of this amplification occurs in the spinal cord, involving both neurons and the immune system. Neurogenic inflammation can also be a feature, where the C-fibres release inflammatory chemicals into the tissues that they supply. On the basis that the brain is really interested in inflammation, even a small inflammatory response can evoke protective measures. Changes in the responsiveness of the ‘danger’ system as briefly described, underpin much of the persisting sensitivity. Altered perception is a further common description, either in the sense that the area is not controlled well or feels somewhat different – see here.

As the problem persists, so thinking and beliefs about the pain and injury can become increasingly negative. Unfortunately this can lead to behaviours that do not promote progression. Avoidance of activities, fear of movement, hypervigilance to signals from the body and catastrophising about the pain are all common features, all of which require addressing with both pain education and positive experiences to develop confidence and deeper understanding. An improvement in the pain level is a great way of starting this process, hence the importance of a tool box of therapies and strategies that target the pain mechanism(s) identified in the assessment.

Experience and plenty of scientific data describe the integration of body, brain and mind. This can no longer be ignored. It is fact. The contemporary biobehavioural approach to chronic and complex pain addresses the pain mechanisms, issues around the problem and the influencing factors in a biopsychosocial sense:

  • Biology: e.g./ physiology of pain, body systems involved in protection, tissue health
  • Psychology: e.g./ fears, anxiety, beliefs about the pain, thinking processes, outlook, coping, past experiences
  • Social: e.g./ work effects, effect upon the family, socialising, role of significant others (spouse, family), financial considerations

Specialist Clinic in London and Surrey for chronic pain and injury in sport – call 07518 445493

Chronic pain and injury requires an all-encompassing biobehavioural approach. Although the end aims can be different, the structure and themes within the treatment programme are similar to those that tackle any chronic pain issue. Bringing these principles into the sports arena, we can incorporate traditional models of care and advance beyond the tissue-based strategies to a way of working that addresses the source of the problem alongside the influencing factors that are slowing or even preventing recovery.

If you as a player are struggling to move forwards or have a player on your team who is not recovering or failing to respond as expected to treatment, we would be very pleased to help you. Call 07518 445 493 or email [email protected] for further infomartion about the clinics:

The Specialist Pain Physio Clinics work closely with the very best Consultants and can organise investigations such as MRI scans and x-rays with reports rapidly, an on-site at the New Malden Diagnostic Centre, 9 Harley Street and in Chelsea.

21Oct/11

Using neuroscience to understand and treat pain

Chronic low back pain, Chronic pain, Complex regional pain syndrome, Functional Pain Syndromes, Low back pain, Neck pain, Neuropathic pain, Neuroscience, Pain, Pain Education, Pain Psychology, Problematic sports injuries, Rehabilitation, Treatments, Understanding pain, , , , , , , , , , , , ,

Neuroscience to treat pain and injury

I love neuroscience. It makes my job much easier despite being a hugely complex subject. Neuroscience research has cast light over some of the vast workings of our brains and helped to explain how we experience ourselves and the richness of life. An enormous topic, in this blog I am briefly going to outline the way in which I use contemporary neuroscience to understand pain and how we can use this knowledge to treat pain more effectively. This is not about the management of pain, it is the treatment of pain. Management of pain is old news.

Understanding pain is the first step towards changing the painful experience. Knowing how the brain and nervous system operate allows us to create therapies that target the biological mechanisms that underpin pain. Appreciation of the plastic ability of the nervous system from top to bottom–brain to periphery–provides us with the opportunity to ‘re-wire’, and therefore to alter the function of the system and make things feel better. Knowing the role of the other body systems when the brain is defending us, is equally important. The synergy of inputs from the immune system, endocrine system and autonomic nervous system provides the brain with infomration about our internal physiology that it must scrutinse and act upon in the most appropriate way. We call this action the brain’s ‘output’ which is the responses that it co-ordinates to promote health and survival.

Treat the brain and to reduce pain

Excellent data from contemporary research tells us that understanding pain increases the pain threshold (harder to trigger pain), reduces anxiety in relation to pain and enhances our ability to cope and deal with the pain. We know that movement can also improve after an education session. This is because the perceived threat is reduced by learning and understanding what is going on inside, and knowing what can be done. The vast majority of patients who come to the clinic do not know why their pain has persisted, what pain really is, how it is influenced and what they can do about it themselves. For me this is the start point. Explaining the neuroscience of pain. Facts that we know people can absorb, understand and apply to themselves in such a way that the brain changes and provides a different experience.

It is the brain that gives us our experience of ourselves and the world around us. This includes the sensory and emotional experience of pain. The brain receives information from the body via the peripheral nervous system that suggests there is a threat to the tissues (input). In response, the brain must decide whether this threat is genuine based upon what is happening at the time, the emotional state, past experience, the belief system, gender, genetics, health status, culture and other factors. In the case that the brain perceives a threat, the output will be pain. The Mature Organism Model developed by Louis Gifford describes this beautifully (see below).

Pain is a motivator. It grabs our attention in the area of the body that the brain feels is threatened based upon the danger signals it is receiving from the tissues via the spinal cord. The brain actually ascribes the location of the pain via the map of the body that exist in the sensory cortex. On feeling the pain, we take action. This is the reason for pain. It motivates us to move, seek help or rest. Pain is an incredible device that we have for survival and learning, necessary to navigate life and completely normal. The brain constructs the pain experience and associated symptoms in such a way that we have to take note and do something about it immediately.

When we injure tissue there is a local release of inflammatory chemicals. These chemicals excite local nerves in the tissues called nociceptors. Normally, nociceptors are quiet but when they are stimulated by inflammation, these nerves send danger signals to the spinal cord where they meet secondary neurons. The early bombardment of signals into the spinal cord causes the secondary neurons to become excited. These cells then send danger signals up to the brain where the information is scrutinised. On the basis of this scrutiny, if the brain perceives a threat, pain will be allocated in the area of the body that is deemed to be in danger. The area of pain is allocated via the representation of the body in the brain (see previous blog here) in the sensory cortex, first mapped by Wilder Penfield and published in 1951. Therefore we know that actually there is no ‘muscle pain’ or ‘knee pain’ but rather pain as a brain experience, and not in the mind I hasten to add, that is detected in a body part or region according to the brain’s perception of threat. These are the body maps that the brain uses to know where information is coming from and to control movement.

This information is part of the neuroscience knowledge that can be used to help people understand their pain and to create therapies that treat pain. Future blogs will look at how we can change and nourish the nervous system to promote healthy tissues at one end of the spectrum with the brain end being targeted by deeper education and Graded Motor Imagery (GMI) for example–click here. The brain and the tissues are not separate, they affect each other in many ways, as do other body systems such as the immune and endocrine systems. Looking at healthy movement and functioning in a truly holistic and biopsychosocial manner with neuroscience underpinnings, provides us with an exciting route forwards in dealing with pain problems.
29Sep/11

Mastering your rehabilitation – Part 1: why exercise & train?

Pain Education, Problematic sports injuries, Psychology, Rehabilitation, Treatments, Understanding pain, , , , , , , , , , , , , , ,

When we sustain an injury or experience a painful condition, our movement changes. In the early stages this can be obvious, for example we would limp having sprained an ankle. Sometimes the limp, medically termed an ‘antalgic gait’, persists without the individual being aware. This is the same for other forms of guarding that is part of the body’s way of protecting itself. By tightening the affected area or posturing in a manner that withdraws, the body is changing the way that we work so that healing can proceed. Clearly this is very intelligent and useful. The problem lies with persisting guarding or protection that continues to operate.

Physiotherapy London

We know that when the brain is co-ordinating a response to a threat, a number of systems are active. This includes the nervous system, the motor system, the immune system and the endocrine system (hormones). This is all part of a defence in and around the location that is perceived to be under threat. It is important to be able to move away from danger and then to limit movement, firstly to escape from the threat (e.g. withdraw your hand from a hot plate) and then to facilitate the natural process of healing by keeping the area relatively immobilised. Interestingly, at this point our beliefs about the pain and injury will determine how we behave and what action we take. If we are concerned that there is a great deal of damage and that movement will cause further injury, we will tend to keep the area very still, looking out for anything or anyone who may harm us. Over-vigilance can lead to over-protection and potentially lengthen the recovery process. This is one reason why seeking early advice and understanding your pain and injury is important, so that you can optimise your potential for recovery.

We have established that we move differently when we are injured and in pain. In more chronic cases, the changes in movement and control of movement can be quite subtle. An experienced physiotherapist will be able to detect these and other protective measures that are being taken. These must be dealt with, because if we are not moving properly, this is a reason for the body to keep on protecting itself through feedback and feed-forward mechanisms. Re-training movement normalises the flow of information to and from the tissues to the brain. Often this process needs enhancement or enrichment as the sensory flow and position sense (proprioception) is not efficient. Movement is vital for tissue and brain health, nourishing the tissues with oxygen and chemicals that stimulate health and growth.

To train normal movement is to learn. The body is learning to move effectively and this process is the same as learning a golf shot, a tennis stroke, a language or a musical instrument. Mastery. You are asking yourself to master normal movement. What does this take? Consistency, discipline, practice (and then some more practice), time, dedication, awareness and more. The second part of this blog will look at mastery as a concept that can help you understand the way in which you can achieve success with your rehabilitation.

20Sep/11

Problematic Sports Injuries

Problematic sports injuries, Rehabilitation, Sports Injuries, , , , , , , ,

Sustaining an injury is a common problem for athletes. Unfortunately, a number of these injuries become enduring and the player struggles to regain fitness and cannot return to play. There are known reasons why this can happen, including the effectiveness of the early management, accurate diagnosis of the problem and how the player initially responds to the injury. All of these factors are important and often accounted for within the medical team’s preparation and planning. It is within the screening process that the medical team can gather such player information. This usually includes the usual fitness parameters, a history of previous problems and how they were managed and past medical history. Beyond these considerations I am interested in certain behavioural and physiological characteristics of the player that will give me an insight into how they will respond to pain and injury.

The problem has usually been persisting for some time when the player comes to the clinic. Beliefs, expectations and concerns will already be flying around his or her head. These emotions can be stoked by failed treatments and a lack of a diagnosis. Certain fundamental adaptations will have occurred as a result of the injury, such as changes in control of movement, altered perception of the affected area, pain felt with innocuous activities and other physiological goings-on that are not consciously observable. These vital functions involve the immune system, endocrine system and autonomic nervous system, all of which have a wide range of effects across body systems and play a significant role in healing, recovery and protection.

Protection is a key point. When you are in pain the body is protecting itself. You may also be aware of spasm or tightness and these are also part of a survival strategy that is orchestrated by the brain. When we are injured or have a problem we usually focus on the pain–and so we should. Pain is a motivator for us to take action to promote recovery. It grabs our attention to the area at risk so that we can attend to the injury. This is an amazing device that means we can learn and adapt. However, when this device adapts and creates sensitivity that is prolonged, it becomes difficult to progress and return to play.

The device is really a network of nerves that communicates information about the health of the tissues to the brain via the spinal cord. These nerves also play a role in maintaining tissue health by releasing certain factors into the tissues. On receiving information from the tissues via the spinal cord, the brain then scrutinises this data and responds appropriately. On perceiving there to be a threat to the tissues, the brain creates pain via a widespread network of neurons becoming active. It is this widespread network of neurons with a range of roles that is the reason for the many influences upon the pain including past experience, emotional state, fear, anxiety, vision, sound, genetics, gender and significance of the perceived danger to name but a few.

Returning to the enduring sports injury, these processes are underpinning the persisting sensitivity that is evoked with normal activities and amplified when pushed harder, altered motor control and perception, sensorimotor mismatch and continued tightness. These are common reasons for non-progression and require addressing with a modern rehabilitation programme that addresses the tissues, the aforementioned body systems and the brain with specific techniques and strategies that are based on the latest neurosciences.

If you would like any further information please do contact us here or call 07518 445493. Click here for our programme details.